Dig deep

This batch of vignettes are more personal, less about residency. I started a new rotation this week, I"m on the benign GYN service for 3 weeks (I have a vacation week thrown in there as well). I will have more time to write in the coming weeks so expect more reflections on medicine soon...

I sorta want to start dating but not enough to write a witty description of myself or to go on the requisite adventures one needs in order to demonstrate through photos their enthusiasm for life and show off their body. My life is too busy to swipe left or right, let alone download and manage a dating app.

One of the things that strikes me when I talk to other women who are physicians (particularly Ob/Gyns, cuz like, those are the ones I am talking with these days), is that whenever I talk about missing something in my kids’ lives they don't do that instinctive “awww” or “tsk-tsk” thing that I’ve experienced from so many other kinds of moms. It isn’t just super judgy SAHM vs WOHM dynamic. I’ve had other working mothers (though with arguably less insane schedules) do the pity voice when I talk about how busy I am. It doesn’t really serve me to have people react like that. On balance, I’m really happy with my choices. I am struggling with many things, including having borne and raised these amazing humans who I don’t get to spend as much time with as I’d like. But that isn’t a lamentable fact, it is a fact that comes with doing important and meaningful work and knowing myself well enough to know that I operate better with many irons in the fire. I’m frankly a less good mother when I have more free time. In my experience, doctor moms understand that balance, we understand what we're giving up, we know that we've made our choices and we are not apologetic about them.

After spending time with several married female resident & attending physicians and their spouses, I’m realizing that my relationship, relative to my career and the realities and demands of its pursuit, was even less supportive than I realized. Almost every interaction I have these days reinforces for me that whatever my struggles, I’m better off with the choices I made to single-parent during residency instead of keeping the tepid and sometimes outright antagonistic dynamic that I dealt with in med school.

“Next year, in Jerusalem” is an expression that I have stolen from the Passover seder and use for my own purposes. I love the sentiment of hope & optimism and of having a home place that this phrase engenders for me. I struggle with patience, with the incomplete mission, with the life in progress. Next year in Jerusalem is another permutation of This Too Shall Pass, which is a life and sanity saving mantra.

I'm more into Tend & Befriend

“Misery loves company” has always sounded like an unkind expression. Unfortunately, “When struggling with difficult life circumstances, it is comforting to know that others in similar circumstances are also struggling” doesn’t quite roll off the tongue the same way. I know that there are people who do not seek companionship when they are stressed but I don’t understand how any of them ever survive their first life crisis with their sanity intact. I would absolutely be incapable of accomplishing the difficult things in my life - residency, moving, divorce, parenting teens, etc - if it weren’t for the people with whom I commiserate, vent, empathize, and seek distraction, connection and support. I’m so grateful for technology that allows me to stay connected to people who are far away.

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Tying knots is a lot more complicated than it looks when you are doing a “knot tying” lesson as a medical student. And different sutures feel different when you sew and tie with them. Figuring out which hand holds and which hand throws and remembering when you used your thumb and when you used your forefinger is a lot harder than you think it might be. Then there’s elevating the sutures and securing the knot with your finger. Every attending has their own tricks that they want to teach you and watch you master before their eyes. And the kinds of needles and the different suture materials. Sewing people up is a pretty complicated endeavor. Which, I suppose, it should be.

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Things that are going well:

• My job: I cannot overstate how much I love my job. I LOVE my job. The only bad thing about my job is that I often feel very inept at it. I am NOT inept at it, but I am a beginner at the bottom of a very long and steep learning curve. And I’m impatient and hold myself to high standards. But it is going well. I am progressing up the learning curve. I’m better at surgery than I was 4 weeks ago. I’m WAY better at writing notes. I am good with patients (if I may say) and I am enjoying speaking Spanish when the opportunity presents itself.
• My kids: They are spectacular! They don’t know anyone in town except me (actually my daughter is texting friends with an attending’s daughter, which is amazing) and I know they are sick of the limited social sphere. How sad that teenagers are looking forward to a new school & academic year. Poor kids. But they’ve kept up with their chores and are doing a great job settling into a new normal. They take care of their dog, they are learning to cook, they are doing a lot of household chores and supporting themselves. They are getting really good at asking me for things when they need them, since our face time is limited. I’m very proud of the composed and conscientious people they are showing themselves to be.
• My dog: He’s cute, he loves me, he gets so excited when we go for walks. I like to take him to the park and let him run off leash (don’t tell!) and there is a cute little creek that he loves to go lay down in and then explore and dig and drink in. He needs another haircut, which he is going to get this weekend. But even brushing him out and getting rid of the matts on his fur is a relaxing pasttime for me in the evenings.
• Sometimes I need to remind myself that vast aspects of my life are amazing and wonderful, when I find myself frustrated by the lingering rotator cuff injury or worried about tight finances or when I have to talk my kid through things I would rather be in the room for instead of across town. Fortunately it is easy to remember!  

I can't think of a witty title for this post. I'm going to stop trying and just publish.

Regarding my earlier post about forgetting the thrill. I want to just dial that back a little. Different, more skilled tasks are now giving me that thrill. I can prescribe and it even is becoming routine for me to reconcile meds and send prescriptions when I transfer or discharge a patient. But this week I’m thrilled that I am starting to really get knot tying and elevating my sutures is not the dismal event it was 2 weeks ago. Integral to the practice of medicine is lifelong learning. I think the goal line for the “thrill” is going to just keep moving for the rest of my life.

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Earlier this week I made a mistake. It was a process error - the decision I came to would have been different if I had followed a different process. Fortunately the decision I made didn’t harm anyone but it left me feeling like a dumbass. I’m deeply grateful the patients involved were not affected and I’m grateful that my learning moment didn’t come at anyone’s expense. I wish I could guarantee that all my learning will unfold in that manner.

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One of the hard things about the current state of my life is a lack of intimacy. I don’t (just) mean sex, I mean the whole kit and kaboodle. I move through the world from one important task to another yet I often feel like I am not *seen*. I miss having a sweetie. I miss having someone play with my hair. Look me in the eye for what might otherwise be an uncomfortably long time. Sit close to me on the couch and hang out. Hearing about their day and telling them about mine. Talking about these terrible and important things happening in the world from a place of common values. These things that I miss are not a new loss, there is a reason I sought a divorce afterall. Yet they remain a source of a dull, itching ache in my soul. The ache does come with a sense of loss when I let myself feel it, I was in a relationship for over 20 years afterall. I have known many wonderful forms of love and friendship. I *have* many forms of love and friendship. I am loved beyond measure, I know that. But every once in awhile I dwell on this missing piece.

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Today I introduced myself to someone on rounds and said “I’m your doctor.” And I meant it.

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It is hard to have someone with mental illness in your life. That feels bad to say because however hard it is for you, it is exponentially harder for the person themself. An important part of having someone with mental illness in your life is recognizing that you are not responsible for the mental illness, you did not cause the angry outburst or depression relapse, it is not appropriate for you to try to fix the circumstances and you are not responsible for the outcome of their actions or their mental illness. It is very hard to remember this. You live your life as best you can, with loving kindness and compassion for them, but there are parts of their experience with which you just cannot engage. And you hope that they find a path out. This is the perfect place for a “you can lead a horse to water” metaphor because you cannot compel a person with mental illness to seek the treatment you want them to have or you think they need. They will engage with their wellness how they see fit. And if you disagree, you lose. End of story. No matter the role you play in their life, you do not get to tell them how to manage their disease. It is hard to have someone with mental illness in your life. And that feels bad to say. However hard it is for me, I know that it is exponentially harder for you.

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My residency program is really humane - there is daily emphasis on maintaining schedules for our shifts and leaving the hospital ON TIME. There is regular “admin time” (occasional afternoons off to finish notes or do outstanding paperwork, run errands, see your family) and there are, relatively speaking, a lot of weekends off in the first year schedule. I just happen to be coming to the end of a string of weekends with work - beginnings or ends of night float, weekend coverage, etc. I’ve had time off, but for the last three weekends (which means 4 weeks) I have had some sort of work on either or on both Saturday or Sunday. I have this weekend and the next off. I’m very much looking forward to catching up on sleep. I’ve been sacrificing sleep to do things during this time - go for a float on the river with my kids, grocery shopping, talking to friends, chatting in the living room with my mom, take my son to soccer practice, etc. Without diminishing any of the joy or enthusiasm I have for my work, I’m getting tired and I really need a break. 3 more days until I get to sleep in 2 days in a row!

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Already I’m starting to forget the thrill of being the ultimate responsible party in patient care (though one could quite validly argue that the patient herself is the ultimate responsible party). I remember my first prescription I wrote in the outpatient setting all by myself. Most of the sense of mastery at that point was that I had figured out how to work the electronic health record. I mean, when I say “by myself” I’m really exaggerating. Interns don’t really do anything by themselves, not for the first 6 months or so anyway. I did meet the patient by myself and I did create the plan by myself and I did put the prescription in the EHR by myself (eventually) and I did talk to the patient about the plan by myself. But tucked into that process was the crucial step of Discussing the Plan with the Attending Physician. Discussing the Plan is part presentation, part mini-individualized Socratic seminar and part instructional process. I tell the things I know, I get asked questions until I don’t know the answer to identify my knowledge base, then I get instructed on the gaps in my process or knowledge. Patients who come to see residents often don’t have a choice in the matter (they are often publicly or un-insured and have little say in where their care takes place) but they are still the most patient patients you can imagine. And I SO appreciate them!

These are the sorts of things I want to write more about - I want to have time and energy to craft an essay or a thoughtful post about the responsibility that I’m being given and how it feels to take up a mantle that literally has people putting their lives in my hands. I’m writing these bits on a Google doc entitled “Vignettes”, adding new passages as often as I can. But a vignette doesn’t get to the heart of why I wanted to start blogging again. I’ll have to work on that.

2 (TWO!) Lentils

Yesterday the kids & I went for a float on the French Broad river, which winds through Asheville. It is kind of a muddy river but other than that, it is perfect for floating - slow, smooth, lined with parks. Best part - you can’t have phones on the river! I got to have my kids’ undivided time for nearly 2 hours. We splashed, played, joked and all fell in the river at some point in the journey. It was great fun!

Tonight after dinner, we were all cleaning up together (it was just canned soup, bread & fresh veggies, so there wasn’t that much to do!) and Duncan noticed that there were lentils on the stovetop. He remarked, outraged, that he had just wiped down the stove a couple of days before. And then he made me pick up both lentils (TWO!) that I accidentally spilled while stirring the soup. I was pretty proud of him, having that perspective on things getting dirty that you just cleaned. I’m optimistic that some day he will remember regularly that everything has been cleaned by someone and leaving things neat after using them is just a good way to be a human.

The last 2 days I haven’t delivered a baby and I’ve only assisted on one cesarean. Granted, I was in my continuity clinic for half a day and didactic lectures another half day. Still, I’m not sure I delivered a baby the day before that either. Things have been insanely busy on the OB service - sick people coming in for sudden and often tragic care, worried people being evaluated and then sent home and So. Many. Labors. We’ve had a change in the weather this week - it is stormy & cloudy. I’m convinced that the changes in barometric pressure impact labor onset. I need a very multidisciplinary team to study this. I like the fact that Ob/Gyn is a mix of medicine & surgery, and the opportunity to take care of people I admitted as they progress to discharge is very satisfying. But my fingertips start itching if I don’t get to tend to births for a few days!

Scenes from a life, not still

I’m a really good manager of many things. I can adult the hell out of life. But really the hardest thing about my job right now is figuring out what to do first. It feels like everything is the most important. Okay, maybe that page from the postpartum unit about writing a work excuse note for a patient’s mother can clearly wait until after I admit this patient walking in off the street in active labor. That one I figured out.

I’ve been wearing a cheap old sports bra under my scrubs and I find I don’t think about my boobs at all for the whole day - from 5am to 7pm. Readers with breasts will appreciate what a feat this is. Clearly I need more Fred Meyer brand sports bras. Alas…AND I have given up on knee socks, they just fall down too much and it disappoints me. Sock It To Me, maybe I had unreasonable expectations all those years. But now I don’t have enough fun socks to satisfy me. I started replacing the knee socks with trouser socks with my recent SITM purchases, but having built up an impressive store of socks with ninjas, Van Gogh scenes, firebirds, koi fish and peacocks, my paltry few pairs with cats in rockets, bears on bicycles & hummingbirds has stopped stimulating my creativity. I’ve stooped to wearing my holiday socks just to change it up a little. Clearly I am having a clothes crisis.

I like sleeping next to the night table. It feels...stuck…not to take up the middle of my new queen sized only for me bed but really it isn’t about being stuck in a past where I shared a bed with someone nightly. It’s about the night stand. I wish my arms were longer.

There’s always 2 surgeons in a c-section, a lead and an assistant. Our program provides assists to several community physicians. I love working with them, they are good, they are fast, they like teaching and the vibe seems more relaxed to me. One of the best tips I’ve received on my OB rotation was from a private doc - advice on how to hold the suture scissors as a lefty and still be able to provide a cutting edge (screw up, palm up - never fails me!) Today I assisted one of the private physicians on a c-section. Another great experience where I got to operate instead of just straight up retracting & blotting. Walking back to the workroom, I asked her when residents were ready to close the hysterotomy (the incision in the uterus), not a step I’d done yet.. Rapid and effective closure of the hysterotomy is required for hemostasis and hemostasis is really important. She assured me that I was “just a step away” from being ready to take on that part of the surgery. I remained skeptical. About an hour later, I did a c-section where I ACTUALLY DID the c-section. Including sewing up the hysterotomy. I have a lot more to say about that but it will have to wait.

A moment in time...

I want to keep blogging but I find myself getting mired in the weeds of my life. Instead of writing about the amazing existential experiences I’m having, what comes out are a lot of mundane details about moving and getting settled in a new town. Instead of sounding like an synthesis, it sounds like a journal. Not that there’s anything wrong with a journal, but it isn’t the voice I’m trying to express.

Instead of trying to craft the perfect piece, I'm going to just put a few tidbits here tonight. Every time I can, I'll put a few more. It will be more like a mosaic than a landscape but eventually the bigger picture will become clear.

This morning I was talking to one of my preceptors about how things have been going and in addition to saying that I was having SO much fun, I acknowledged the constant slog that the pace of residency brings to one's life. I said it was sort of like a hamster wheel but sensing that was not quite what I meant she quipped, "It's like Groundhog Day, except everyone else is on repeat too." That was a great comparison.

At some point during the last few weeks it occurred to me, “You will learn as much between now and the end of your residency as you learned between your first and last days of medical school.” Considering how much I’ve already learned, that is a pretty shocking statement about how much more there is to know when settling into a specialty.

Some of my favorite truisms involve allowing for imperfection. Probably because I need to be reminded that human-ness is allowed. One that I have been latched onto recently came from my residency orientation about wellness - Something is better than nothing.

So in the spirit of giving myself something, I have found a new name for this blog. I don’t know if I will officially change it or start over with a new blog or just use it as a subtitle. Now that I’ve gotten the MD, I find this journey is about getting to ME. So welcome to the new blog - it’s going to be messy, sporadic, evolving, unpredictable and imperfect. I’m going to love it!