Work smarter, work happier

It is 6am, I am just getting to bed. I was last here 23 hours ago. Yesterday I had lecture at 8am then an afternoon in clinic and an overnight helping out on L&D. I had work, but I also had down time. It was a long night, but I didn’t have to round and I didn’t have to stay through sign out. I was lucky also that I am on a rotation that starts with lecture at 8 and not with rounding on patients 2 or more hours before that. I was just awake for 24 hours. It was hard. I’m tired. And yet it was 5 hours less than a usual Friday overnight shift when you are working on L&D. Appreciate the small gifts

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Today I had a postpartum visit with a patient I saw in the hospital, managed for a day and a half while she was sick, delivered her baby and saw for some postpartum follow up needs as well. By today, I only needed a quick perusal of her chart to remind myself of the details, I got to see her baby and we chatted casually about life. We were both disappointed that there won’t be any real reason for her to follow up with me anymore. It was so great to walk the path with someone so consistently!

I had 7 patients (in 8 slots, one was a double visit) today in my afternoon clinic. 5 of these patients were people I had either seen previously in clinic or seen in the hospital during their latest stay. 3 of them were Spanish speaking and I did their visits without an interpreter. None of my patients today were there for prenatal care though there was some pregnancy management involved along with the multiple gynecologic indications that brought people to see me.

Having continuity with patients is amazing. It is hard for most residency programs to accomplish. I am very proactive about encouraging patients to return to MY clinic. I make plans that I work hard to be able to follow up on myself and patients are usually game to come back when I’m available if it means getting some stability in their care. I look forward to having my own panel of patients someday!

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I’ve worked hard and long to achieve a place of knowledge and social capital to be able to live the way I want. I’m really close to the time when I get to make the decisions about where I go and how I live next. I’m excited by the prospect of being able to take care of myself, my children and to pick a frame for the next phase of my life based solely on my own criteria. Yeah, I gotta get a job offer, of course, but no more Matches, no more considering other people’s needs, no more compromise. Where do I want to go? Who do I want to work with? What do I want to do? It’s all up to me!

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I just worked 19 days in a row, had 2 days off and am about to work another 12 days in a row. On Sunday evening, after a full and exciting weekend, I snuck off for a quick dip in the pool. I LOVE living in a home with a pool, particularly b/c since I don’t have to take care of it at all. I was floating and swimming laps and looking at the sky and realized that I had an enormous sense of satisfaction and peace. I am happy. I’m happy. Wow, how great is that!

I had a rough childhood. Worse than many, not as bad as some. A pivotal time for me was when I was about 14 or 15, the age of going to the mall with friends. I started tossing coins in the fountain at the mall and making what has become my Go-To wish ever since, “ I wish to be happy.” I guess now that it has come true, it’s okay to tell the story! This wish was the start of my internal locus of control, my journey to becoming whole. It has taken a lot of years and after my kids were born I started to realize that I may not ever actually be finished. I’m amused now to think about when I had the audacity to think that I was “fixed” in the year or two before my kids arrived. Becoming a parent teaches you what charming mirrors your children can be, and how very much work you still have to do on yourself!

I'm back, Baby!

I haven’t been here in a long time! But I’ve been drafting posts in my head throughout my day for the last week so I figured I’d start putting some of them down in print. I amy not finish a thought as completely as I’d like but at least I will have some of it down.

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One of the things that bothers me about my job is how gendered conversations are. When we are talking about the babies, gendered pronouns are hard to stay away from. Lately I’ve been trying to use “baby” as if it is a pronoun.

One of the ways I am showing my age and probably my radical-ish feminist roots, is my disdain for the “gender reveal” parties. It isn’t a gender reveal, it’s a genitalia reveal, which sounds as creepy to everyone else as the popular term sounds to me.

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It’s July again, and that means a new year of medicine, a new crop of interns. My relationship to new interns is different this year, I have more opportunities to teach because I feel more comfortable with my job and I’m starting to transition to the end of 2nd year role, training for and looking toward the role a 3rd year has on L&D. This last week, I delivered babies with a med student and with a family medicine intern. Being the “knowledgeable one” in the scenario (with my chief or attending watching most of it from the corner of the room) was a new place to be. It was fun, especially because said student & intern are very competent & enthusiastic about learning OB stuff.

The juxtaposition of learner and teacher requires a nimble sense of self. One night I did an extensive perineal repair under the direct guidance of my chief - it was an excellent opportunity to discuss & learn and improve. The next night I directed the intern in completing another repair, albeit a simpler one.

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My kids are having an important summer in their growing up - they are both engaging with their feelings and navigating the world in response to those feelings in a new, stronger, more resilient way. It makes me so proud to see them growing up into self-possessed, well attached people. Some things have been hard about the summer for them, but I’ve come to peace with the fact that growing up is a messy process and my job in their lives is not to shield them from the splashback but to help them learn to manage it. There’s a lot less pressure on me if I accept how little control I have over the whole thing!

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Daily, I am grateful for the leave of absence I took from residency. I cannot express how much of a difference the time off has made. “Time off” is a really poor choice of idiom in this case. It was not time off. I was working very hard the whole time I was not in residency. I was working on my physical health, my mental health, my children’s health, my family system. I was processing the end of a long marriage that was mostly good but for a few years was in fact pretty toxic and had turned me into something that I didn’t want to be. I started the long, slow process of actually dealing with an eating disorder that, for over 30 years, I have been controlled by or desperately tried to ignore.

The investment in all these parts of myself has resulted (this will probably not surprise anyone) in making me a better resident, a better team member and a better doctor. Frankly, as capable and responsible as I like to consider myself, I was not as capable and responsible as I could or should have been. Now that I do not have a back burner filled with stress and pain, I have more bandwidth to perform at work.

(Bandwidth is one of my favorite phrases. I often describe my choices in terms of my bandwidth - I would love to date more often, to volunteer, to putter around the house, to be crafty. But I don’t have the bandwidth to do everything. It isn’t a question of “want” or “willing” so much as an issue of how much will fit into any given day.)

And I am absolutely LOVING my job. The hours and responsibilities are absolutely insane but the work, the Work, is an absolute joy. Even when I’m taking care of very sick people, even when tragedy is striking or trauma is making a patient’s course frustrating, I love my job.

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Two more sleeps until my son comes home! He’s had something of an unexpected and disappointing summer but also he has done an excellent job of tuning into his feelings, tapping into resources and making lemonade. Amongst other things, he realized he has some roots in Asheville that he missed - his dog, his girlfriend, even me (I was way flattered when he said that he missed hanging out with me!). He’s coming home 2 weeks before his sister. It’s a nice easing back into parenting for me as well. I’m going to work to keep my level of focus at work and not be distracted by unfounded worries or preoccupations with my kids, who are actually doing quite well and don’t need me as much as they did before. It’s okay for me to focus on my own priorities now.

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One rotation that we don’t have as a 2nd year is Gyn Oncology. We are very focused on L&D in 2nd year, spending half our time there. In the other years, we spend 2 6 week blocks on Gyn Onc. The patients are very different from L&D, generally sicker and older. And it’s a complicated dynamic to navigate - there is a Gyn Onc group we work for, we assist with their surgeries and round on their patients daily, we are in-house on nights and weekends to manage most needs. It is a busy service with complicated patients, very involved attendings (rightly so, just to be clear, I’m not complaining about that - but there are 4 of them and every week there is a different style, it takes some nimbleness). I’m a little nervous going back into the Gyn Onc world - it is a different kind of stress than I’m used to on L&D.

One of the differences between our program and the private docs in the community is that we are always in the hospital. There is one group that has a nocturnist, another that has a midwife that works with them but usually they are not here all night every night. Sometimes they have a patient who is sick enough that they really need someone actively looking out for her all the time. We have sometimes taken over care of these patients - their doctor explains to them the level of care they now need, we introduce ourselves and we become their primary doctors.

Something I’ve heard from recent graduates of residency is that the volume of private practice is much lower/slower than residency. One may only do a few hysterectomies a year, not see a patient with preeclampsia for months, or rarely see an ectopic pregnancy. In this community, we help out the private docs however we can. Sometimes they review standards of care with us (our chiefs & attendings) or they ask us to assume care of someone who is really sick or we help them with surgery to save them from having to call in a colleague from their practice to operate with them in the middle of the night. If they have a patient in Triage and she needs a quick set of eyes on her before going home, we will often meet the patient and make sure everything is on the up and up for them, saving them a trip into the hospital in the wee hours. In addition to the patients we serve, we are serving the broader community. It makes me think about how I will manage these sorts of cases in my own eventual practice. Knowing what referrals are available in a community will be an important data point.

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Today was my first grumpy moments back to work. It was 100% because of a misunderstanding on my part that led to some other crap that is no big deal but pushes all my buttons. Also our team has been tumultuous this week, one of the downsides of days is that there is some fluidity in the schedule. This is the time of year that our new 4th years are doing things like job searches and fellowship interviews, so there are days that one or two of them might be gone and we have to patch holes in the schedule. Now I am not in ANY position to complain about that, and I’m genuinely not complaining. BUT having to do that shuffle of people is stressful for many of us - the new person covering for a colleague doesn’t know the patients, has their own communication style and way they like to run a team. We all work together and we can all work well together, but when you have four chiefs in 3 days, it makes for a little bit of nuttiness.

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Here’s another important thing I realize now that I have internalized about doctoring: taking care of patients is in no way like substitute teaching.

Lemme ‘splain…

When you have a doctor, they investigate, examine, diagnose and treat you for a given condition. In many cases, there are multiple ways to manage said condition. There may be a difference in the order of treatment options, different medications, counseling, weighing of certain factors in making decisions. Any individual clinician will have their own concerns, plans and ideas.

When one doctor takes over for another, there is next to no sense of loyalty to a plan just because it was implemented by a previous clinician. I may take over the treatment of a patient with a complication that *could* be treated with meds but wasn’t. I will look at that decision making process, try to get sign out from the other clinician and realize that in this case, I would have done something different.

Often the doctor taking over will try to find a way to bend the plan more to their comfort level. In this specific circumstance, I may document a change in management by prescribing medications that had previously been held. This makes things confusion for patients - they think the left hand doesn’t know what the right is doing. As someone with high health literacy and experience with health care, I didn’t understand this aspect of medicine before I was in the decision-making position myself.

"Divorced with children" is like joining the mob, you can't ever get out

You know that expression, “Poor planning on your part does not constitute an emergency on my part,”? That doesn’t really apply with co-parenting.

I’m working hard not to be angry and stressed out and scared during my last week before I go back to residency. It is taking all my strength and coping to manage. If I may say, I think I’m doing a pretty good job. And I'm trying not to be resentful that this clusterf*ck is damping my joy at going back to a job I love. I'm being less successful at that.

It is a week into June and I have not yet received all the month’s child support. I have had to drag communication out of my co-parent about when any money might be coming and how much. And today I was presented with a duality - either he can pay me what he owes me (what I depend on to keep house for my children) or he can buy a plane ticket for my daughter to come visit. The timing for her visit is based on theatre tickets for a show that is NEXT WEDNESDAY (6 days from today) and he doesn’t have tickets for her yet. So I looked over my finances and figured out how little I could manage with for the next week.

Both kids are in need of plane tickets for their summer plans and they have not been acquired yet either. I have a FB friend who might let me use some points or miles or something to try to help with things if he fails to provide, and I spent some time with my credit union seeing if I could increase my credit limit on my currently maxed credit card.

I am grateful that this is a temporary reality, that I know in 2 and a half years I will have a salary that will make his contributions irrelevant to my survival. Unfortunately this makes the current reality no less dire or stressful.

In the past, I’ve relied on the generosity of friends for these hard moments. In that spirit, I offer an exchange: any sort of support (financial, material, emotional) and I am at your disposal by phone, text or FB messenger to help you with medical questions - interpreting lab results, talking through a problem, helping understand & navigate a hospitalization or guiding you through am interaction with your doctor. Not diagnosing or prescribing, but more of a medical tour guide, helping your health care be more approachable and understandable. I think people who have taken me up on this in the past have gotten some good out of it.

If anyone wants to help us out of the tight spot that we are in for the next couple of weeks, I would greatly appreciate it, whether it is with a donation or a comment on a post - anything that helps me feel your love & support is greatly appreciated. I struggle with isolation during these moments, because I'm very stressed out about the situation and my children are completely oblivious. I try very hard not to expose them to the stress between their father and I, and I don't want my relationship with him to color theirs. Commenting on FB really does help - it increases the visibility of the post and makes me feel good, I swear. If you are able to help financially, I have PayPal and Venmo at my email address, larissa (at) northstarbirth (dot) com. You can contact me there with any questions or comments as well.

Thanks to everyone who has supported us, emotionally & materially, through this arduous process. All of it has been appreciated. 

Back in the saddle again

It is almost the end of the school year, my kids are tired of school, it is hard to get out of bed, hard to remember to pack a lunch, annoying to do homework. This is a tough time of year and this has been a tough year besides. Starting over is nice, starting over is a gift of childhood. They will have summer adventures, have a re-set and start the school year over again in the fall. But first we have to get through this. Just a couple more weeks!

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Local theatre company is doing Shakespeare in Love and I’m going to see it this weekend. I’m very excited. I hope it’s good. Result: it was passable local theatre, free and at a neat outside amphitheatre. We took the dog. He had fun!

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I’m almost done with a burst of steroids to help treat my hearing. It has been 2 weeks of high doses and now I’m doing about a week of a taper. The meds have been a mixed bag - some of the usual side effects were not present but I slept like crap and now that I’m tapering down the dose, I’m getting symptoms again - headaches, fatigue, appetite changes. I ate like a starving animal today and I have no idea why. And as the anti-inflammatory benefits wean, there are changes to my hearing & my tinnitus that are annoying and tiring.

Tinnitus is a tough condition to deal with. I was used to the frequency & sensation of my tinnitus but it has changed this week, maybe due to the new hearing aid but probably due to the steroids. I’m spending a lot of mental effort getting re-acclimated to my tinnitus. There are mindfulness and distraction activities that you can practice that help train your brain to either ignore or not be distressed by the constant whine coming from one side of your head. And as you are getting there, it is cause for headaches (different from the steroid headaches) and fatigue. For me, it is hard to concentrate on writing and creative tasks (some of which I have with my current role) when I’m struggling with tinnitus management.

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I got a hearing aid! I’m still getting used to it and I had to get it turned WAY down after a couple of days. I took today off from it to give myself some time to adjust to the tinnitus changes and to recover from the higher volume setting. Apparently getting a hearing aid is more like learning to drive than getting a pair of glasses. It takes your brain some time to be able to make sense of the sounds again. I don’t know that I will ever be able to tolerate a fully compensated volume but the fact that I can hear more now is amazing. Listening to my own voice is one of the interesting changes, I am singing with the radio more now. I was overwhelmed by the return of the hearing, I didn’t realize how much I had lost. Now I’m just trying to get to a new normal.

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I’m getting ready to go back to residency. It is an interesting if somewhat nerve-wracking experience. My program continues to be amazing and innovative and we are talking about how to structure my return to maximize success. Since I’m going to have to take extra time anyway now, we are working on building in some cushion so I can single-parent effectively and still reliably meet obligations to my co-workers and my training. I’ve also been thinking a lot about how to come back mindfully so that my co-workers can be honest about the time I’ve been gone and what it’s meant for them. It is going to be a several weeks process.

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The relevant people have been consulted and notified, specifically my children and the other residents, and it has been officially announced - I’m going back to work on June 10th. I continue to be so grateful for the space and time to take care of my family and myself. I’m a little apprehensive about going back - it’s a bit like choosing to go for a walk in gale force winds. But as soon as I made the decision to go back, I started feeling better about things. This is still what I want to do, still what I am most excited about.

I don't know. It's a Mystery

My favorite scene from Shakespeare in Love:

A: The natural condition is one of insurmountable obstacles on the road to imminent disaster.

B: So what do we do?

A: Nothing. Strangely enough, it all turns out well.”

B: How?

A: I don’t know. It’s a mystery.

This always makes me think of my dear friend Keith. He often sent me this clip as a reminder to have faith, that living is a Mystery and even when things are hard, strangely enough, it all turns out well.

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I’m struggling with letting go of the high touch, interventionist parenting that I’ve been doing for the last couple of months. Action comforts me, distracts me. Now we’re all in a place where my action is not the action that is needed to get anyone where they need to be. The action needs to be theirs. Which means they do things their way. Which is not my way. And sitting back and allowing my kids to do things their way is hard when I don’t have my own things to do to fill the space. I’m waking them up in the morning but then backing off and letting them get ready for school without my intervention. Which means they scramble at the last minute and rush out the door. Which is a very teenagerly way of doing things. And probably what they did for a year and a half while I wasn’t looking. It works for them, the unease is all my problem. So I’m working on sitting with it. 

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I read an article that said that 50 year olds who did 15 minutes of meditation a day had the grey matter in their brains equivalent to that of a 25 year old. Given the cognitive demands of my training and my profession, I’m happy that I already have a robust meditation habit. At some point I realized that sitting with discomfort was something that I could interpret as an “action” for the sake of my own coping mechanisms. Sitting and noticing how a situation makes me feel or what it makes me think is an action I can take. It didn’t used to feel like DOING something, but it does now.

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I’m going to bring my kids to the Mahec OB residency graduation this June before they go off for the summer. I want them to see the people who have worked harder this spring so I could be here to take care of them. It is strange to spend more time with my colleagues than I do my kids and have my kids not really know them at all. They need to see what a big deal residency graduation is, they need to know that there have been people affected by this windfall they’ve had.

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As someone who Gets Things Done, I’ve developed a surgical ability to jump right over the “emotional reaction” to a crisis and move right into action mode. This is very good for my job, for parenting through crises and for being able to take care of myself and the people I love.


My problem has been that once the crisis winds down, I find myself still having feelings (UGH so annoying!) even though the problems are in the past. It is hard to gain access to feelings of fear, sadness, loss, worry without triggering second guessing, self-blame, spinning my mind’s wheels trying to think of some ACTION I can take to mitigate the feelings I don’t even realize I have. It is usually only while talking to a friend or a therapist that the emotions come out. I’m working on identifying my cover behaviors so I can slow down and find those emotions on my own.


This week I had a bought of “they’re both better now, it’s safe to be sad & scared” in response to my kids’ challenges since about October. That’s 7 months of TCB, of pushing the fear away and just keeping moving. It turns out, I was also terrified about and so very sad for their pain. I’m profoundly grateful for the healing place at which my children have arrived but given what I know about both their family tree and the world, this destination was not the easiest or even the most likely for them.

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I’m having a scary exacerbation of my hearing loss this week. I woke up 2 days ago thinking there was something off with my head but didn’t realize what it was until being at my desk for a while. Around 9:30 I realized that it felt like I was talking to the right of where I was sitting, the dial tone on the phone was hardly audible and I couldn’t hear my fingers rub together at my left ear at all. I went to get an urgent audiogram (mad props to my new audiologist for having an appointment for me 15 minutes after I called!) and was found to have about a 15% reduction in my hearing from the audiogram I had done about 4 weeks ago.


My hearing condition is both cyclic and progressive hearing loss, meaning this big dip will likely be temporary but the general trajectory of my hearing is to decline. I’m getting into profound enough hearing loss that these 10-15dB changes in my hearing are very notable to me. Not being able to localize my own voice really freaked me out.


After some back and forth with my neurotologist in Charlotte, I got a prescription for high dose steroids for 2 weeks and then a 2 week taper. It sucks. I feel lousy and my hearing and tinnitus continue to fluctuate. The tinnitus was so bad this AM I actually called in sick to work. I can’t strain to hear and try to ignore this constant whine in my ear and think at the same time. I put drops in my ear. I took a nap. I gave myself a day with no obligations beyond keeping the dog from making messes on the floor and taking my kid where they needed to be (was a therapy day unfortunately). I feel better now than I did this AM but I’m a little worried what 2 weeks on this dose of prednisone is going to do to me!

I'm tired of being vague about things

This weekend we cleaned the house, which shouldn’t have been as big a deal as it was, but it was and so I’m feeling very accomplished and proud of my kids. We swept, swiffered, vacuumed, dusted, de-cluttered and cleaned bathrooms. We also rearranged the living room, at the request of my son, into an arrangement that solves the problem of flow into the sitting area and has the happy coincidence of being easier for us to play fetch with the dog!

My physical therapy is making progress, which is good but it is also not complete which is making me impatient. Being well enough to actually do the cleaning that was necessary was progress, but I did have to watch the amount of stair-climbing I did and was sore for a couple of days afterward anyway. I’m still swimming a couple of times a week and am more limited by my availability & boredom than by my pain now. I’m getting another steroid injection in my worse knee and that will help a lot. Soon I might even be able to do weight bearing exercises!

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I’ve now passed the 2 year mark since I left my marriage, though the divorce was finalized months later. As happens with the passage of time, the edges of the pain are softening and life is looking, in many ways, better than it ever has. I’m exploring my own sense of self, wants and needs with patience in the safe space of independence. I’m enjoying dating and connecting with people on all sorts of levels, though I still miss many of my far flung friends. One of my co-workers told me months ago about her dating adventures and how she went on many dates after a big break up. I remember the story making me sad and overwhelmed, now I believe that it was actually as fun as she said it was.

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I’m trying to stay engaged in Ob/Gyn medicine while I’m on this hiatus from residency so I’m not completely rusty when I go back. I’m finding as many excuses as I can to read practice bulletins and even reading the main academic journal we have (the one we get paper copies of as residents). I have issues and issues stacked up, unexplored. I decided to start with 2019 and read some of them. I’m also continuing to think about surgery, imagining the steps and the sensations of the common procedures I do - cesareans, hysterectomies, etc. I want to spend some time with the laparoscopic trainer in the sim lab but it is going to have to wait until my duties at home are a little less time consuming. I’m hoping that after spring break I’ll be able to work a regular in-office schedule instead of having to work from home sometimes. Everyone needs to get used to me having obligations outside of parenting so we can ease back into residency.

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I have this chronic health condition that I have alluded to here but not spelled out. I have something called endolymph hydrops in my left ear. The medical eponym is Meniere’s disease, which is a term I hate. In part because it is more of a syndrome than a disease and in part because I hate eponyms.

I started having symptoms in the 2nd year of med school, whether it was just onset of the hydrops or if I had an infection in the ear after which the consequence was hydrops, we’ll never know. I believe it was the latter. The most limiting symptom of this condition is episodes of debilitating vertigo. Fortunately I have had very few of these and not for nearly three years. However, it does also have symptoms of progressive but waxing & waning hearing loss and tinnitus. Also the process of losing hearing is not painless, at least for me. It is accompanied by pain and fullness in my inner ear that causes headaches and fatigue.

I’ve got some triggers that I avoid or manage to reduce symptoms and I’ve recently learned that I clench my jaw a lot and have TMJ pain as well that is causing some of my symptoms and is not related to the hydrops. A bite guard helps so I’m splurging for a custom one so I can sleep a little easier. The cheap one I have now is already helping. I take a low dose diuretic that has absolutely no data to support it (Never seen such an empty review from the Cochrane database!). Some doctors tell me it will help the fullness, others say it is really only for the vertigo. So I may not need to take it but I think it helps so I am going to keep taking it. I’m limited in dose by my very low blood pressure so this is as much effect as I’m going to get.

There are also times that the tinnitus & hearing just get worse and I don’t know why. Right now is one of those times. It may get better again, but it is pretty bad right now. I have profound hearing loss in low frequencies and mild hearing loss in higher (conversational) frequencies. I have a REALLY hard time localizing sound right now (recently thought my kids were in the bathroom together, which they would never do!) My new ear doctor says that I definitely qualify for a hearing aid at this point. Whether or not I can tolerate one will be another question. Hearing loss sometimes causes paradoxical noise sensitivity and I’ve got that. Also insurance doesn’t cover hearing aids or accompanying visits at all.

Right now I have this low steady tinnitus that is constant, but better than it has been the last few days (bite guard!). There have been moments this week where the tinnitus is so distracting, I have trouble thinking, I talk loudly, or I just have to go to my room and put glycerine drops in my ear and lay down (the drops put pressure against my eardrum and into my cochlea, they are soothing). Interestingly, I have another tone of tinnitus that comes when certain muscles in my back & neck are tensed. In a quiet room, I can tell when that tone is present and if I relax the muscles, it goes right away. I’m regularly wowed by this little experiment on my 8th cranial nerve.

The changes to my reality with this syndrome now include that I don’t drink alcohol (I already didn’t drink caffeine but that would have been another change to make), I endeavor to eat a low sodium diet (I fail miserably often), I have an earplug that I can use if I want to be social someplace loud (any bar, restaurant or public gathering place, even movies sometimes), and sometimes I can’t bear to be in any of those places at all. I can’t go see live music without days of repercussions so it has to be good to make it worth it. Even during this leave of absence when I’m able to think about my food more and get enough sleep (obviously fatigue is also a trigger), I’m still very tense and stressed (I want to go back to work, but the timing of that is very much out of my control, not something I cope well with). Couple all that with a rising pollen count (nothing like living in Oregon at least), and I’ve been pretty symptomatic recently.

This too shall pass.

Medical middle man syndrome

My mom and I were talking about dinner table conversation and I mentioned that I had the idea to get some conversation starters for us to use because frankly I run out of energy & inspiration trying to engage my teenagers. So she found a list of nearly 100 questions (we took out the Jesus ones), we printed them out and she cut them into strips and we put them in a vase to use as conversation starters at dinner tonight. They were a big hit! Each kid picked several, prompted me and Grandma to pick and we talked and joked about our answers. And we got to tell some family stories and talk about relatives and that was very heartwarming.

When the kids were little there was a parenting strategy to get them to complete tasks quickly that involved setting a timer and letting the timer be the “bad guy” instead of the parent. It sounded ridiculous to me, that a kid would not be able to connect the person to the timer. But it mostly worked! I think this new dinner table conversation approach is very similar. There’s something empowering in them picking out their own question instead of me asking/interrogating them. All in all it made for a very pleasant meal.

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I started my new job about 2 weeks ago. Shortly after which, the woman who is training me announced that she is leaving. So the person who was filling in on the QI duties is going to be gone at the end of March and the job has been vacant for some time. In steps this now well-rested resident, experienced in program management and interested in quality improvement, to help out. Serendipity. I honestly do not believe that the Universe navigates itself to provide these sorts of opportunities for people. The Universe is chaotic and random, and sometimes things just work out. Whether this opportunity is provided by the cold randomness of existence or because of The Secret & the “law of attraction” (insert eyeroll emoji here), I am grateful and engaged in doing the very best for the organization that I can while I’m here.

One of my recent tasks was looking over phone triage protocols for a new service we are starting that adds a layer of evaluation & support over the phone before patients get sent to the resident pager. In order for the nurses at the triage service to take the calls, we need to approve, add and amend protocols that they will use to address some simple concerns. I was able to review this with the clinical manager so that instead of asking a very busy attending to create it, she was able to take a proposal to them and ask for revisions/approval.

I’m also going to be running an every other week 90 minute meeting about quality improvement initiatives at our practice. I’ll write more later about why these QI measures are important to clinical care anc clinic operations. I just wanted to get started blogging about the new job and now it is time to get some sleep.

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Children are like a gas - they will fill up any space you allow them to occupy. This is not a good or bad thing, it just is. My children have very quickly gotten used to having me around more. They are taking up more space; there are requests for things that they can very easily accomplish on their own (Can I have some milk? Will you go get my __?). Sometimes I oblige them, sometimes I make them do it themselves. Usually the former is met with appreciation, the latter with resignation. Also, they have lost the ability to get themselves up and out the door in the mornings. There is oversleeping, forgetting to set alarms (okay, I’m guilty of that one too), some unfortunate cases where the bus comes much earlier than expected. After a whole school year of up and at ‘em, they are now decidedly slacking. I’ve decided that is okay for now. I will wean them back to the harsh reality of getting their acts together when we are all ready for me to go back to work.

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Some of the scariest moments of my life have been filled with worry about my children. Fortunately these days, mostly I’m feeling moments of joy, peace and an unclenching of my heart as my kids demonstrate resiliency and emotional fluency they are mastering in the process of recovering from the first real moments where their lives went sideways. Not that there haven’t been hardships in their lives, but the divorce and relocation were the first big “oh shit” moments they’ve experienced, where their lives unfolded in drastically unexpected ways. They’re both learning to deal with disappointment and not to let a bad moment ruin their entire day. They are better able to communicate their needs and are more open and loving people than the angry (albeit justifiably) and resentful people they were at the beginning of this big change. Bittersweet indeed that just as they develop these nuanced personalities, they are nearly done being my full-time responsibility. I swear, they were toddlers & preschoolers like 20 minutes ago, where has the time gone?!?

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One of the dizzying things about this temporary job I’ve got is that it is squarely in the “other half” of the health care system from where I have been situated as a resident. Instead of seeing patients and learning clinical decision making, I’m dealing with a lot of administration, billing, health information management, insurance (private & public) and practice management issues. These are real and important issues and it is amazing how divorced they are from the day to day work of taking care of patients. We have a whole office of billing & HIM people who retrieve & send out records and submit and manage reimbursements. This is a very necessary part of the current structure of our delivery of health care. Granted, I think Medicare for all is the way to go, but DAMN there is going to be some serious unemployment that we will have to deal with if that ever were to become the way things work. There are so many middle men in medicine, I can’t even accurately convey the scope of it.