Around we go

The Wiccan calender is all about new beginnings. Yeah, Samhain is the "new year" for most of us, but really the whole frickin' thing is about renewal and fresh starts. Now I have another New Year celebration - July 1st. Thus begins my second year of residency. Happy New Year. 

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I’m now 3 weeks into second year and I can report a couple of things: I like not being new at my job, surgery is fun, complicated pregnancies are complicated.

I’m on the benign gyn rotation during the week but second year involves lots of weekend call so I’m also spending time on L&D. I had an absolutely insane shift the first time I worked a solid 24 hours (we don’t do 24 hour shifts as interns, a hold over from some old duty hour restrictions that got lifted but our program kept them. I’m eternally grateful). The second 24 I worked was THIS weekend and it was a bit different, I worked my regular day shift job and then showed up on L&D to take report from the day team and work a second shift on L&D until morning. I managed to sneak in about a 40 minute power nap prior to my shift and the night was a steady stream of busy but not the insanity of over a dozen deliveries, half done by me, that last weekend brought us.

I have admitted a couple of people with some interesting problems to our Maternal Fetal Medicine unit on my weekends on L&D. It is interesting how much of a Black Box Warning pregnancy is for every other kind of medicine. If someone happens to have something else going on - Lung infection? Cellulitis? Broken bone? Odds are good that we will either be called to consult or be asked to admit a person to our service even though we have no idea how to manage the medical issue that brings her in! We had someone who was miscarrying recently and still the medicine docs would not recommend surgery for an unrelated and REALLY IMPORTANT problem she was having. Instead they opted for “conservative management” which involved NOT fixing the problem that they wanted to fix surgically before they realized she was pregnant. The consult note from my gyn-team colleague had very explicit ALL CAPS instructions about recommending “DO WHATEVER THE HELL YOU WOULD DO IF YOU DIDN’T KNOW SHE WAS PREGNANT!!)”

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Two small raccoons, one lying, still, on the side of the road. The other approaching carefully, tentatively forward from the tall grass. Nose to nose. Heartbreak in a flash of my headlights at 5am

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Laparoscopic surgery is a different kind of frustration. There are issues of dexterity and muscle memory with all surgery but this year I’m getting more exposure to laparoscopic surgery. It’s making me wish I’d played a LOT more video games in my youth! It is so frustrating to be looking at my tools on a screen, trying to grasp and maneuver, find the right angle.Trying to make the tools do what I need them to do, while remembering they are on a fulcrum, that levers move backwards (If I want the grasper to go up, I move my hand down). And on a 2 dimensional screen. And that is real tissue you are grasping, so don’t pull too hard, watch where the instruments are going, and please for the love of everything holy, do not require us to open because you perforated the bowel or tore open a blood vessel. Also, I’m trying to remember crucial details like the names of the different types of graspers and when you use them, a Maryland is different from a Prestige which is different from a Hunter Bowel (really, you have to know what to ask for. Often the scrub knows what I need before I ask for it, but sometimes s/he is wrong and I need to adjust my field of view. AND I need to remember the steps of the surgery - DON’T FORGET TO INJECT THE DILUTE VASOPRESSIN!!!!! WHY DO I ALWAYS FORGET THAT STEP?!?!?! Sigh, anyway, it’s July again and I love my job but I am going to be a LOT better at it in six months!

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I just had an amazing half day in clinic. As I think I mentioned, as a 2nd year a lot of your responsibilities increase. We have a lot more people on our clinic schedule and they can be more complex than return OB prenatal visits. This time, I had 8 patients on my schedule - and they all came!! That in and of itself is a little unusual for me. I usually have at least 1 no show to give me a little breathing room. Today I had 3 Spanish speaking patients, 3 return patients, a consult for PCOS, a woman needing a new contraception plan (one of the Spanish speakers), a woman with gestational diabetes who wanted a trial of labor after cesarean and didn’t have her sugars with her and didn’t know how she was supposed to be testing her sugars (also a Spanish speaker) and what turned out to be a VERY complicated IUD removal. I didn’t get a single note done before the end of seeing patients, but I got all the prescriptions done as I went, I had all the salient details either in the notes or in my head or written down someplace so I could write my notes afterward. My last patient had a 4pm appointment and I walked into her room at 4:22. That is running spectacularly on time in a resident clinic! Then I stayed after work and finished my charts before heading home. I’m getting good at this!

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I’m on vacation as of this afternoon.. I haven’t started packing yet. I need to be at work in 40 minutes and I’m still in bed. I will be driving to DC at some point today. I should probably get up!

Highs and lows, but mostly highs

I just had the best day ever!!!

It started with an interesting surgery, that I did not actually do but rather watched 2 community docs work together to do. It was interesting because of the problems of approach and there were some techniques that were used to accomplish the surgery that were the very definition of mastery. The problem was not one either had exactly seen before, the situation required flexible problem-solving, innovative application of familiar surgical techniques and a good bit of communication and collaboration. It was an interesting bit of medicine. And an interesting bit of people watching, to see a relatively recently graduated physician (it was his patient) work with one of his more experienced partners.

After the surgery, I found out that I PASSED my Step 3 exam! Last hurdle before I abandon general medicine and start focusing on Ob/Gyn stuff exclusively!! The stupid exam administrators send you an email, make you log into a rarely used account, download a score report and THEN open the report to find out whether or not you passed. Believe me, doing all that shit then seeing the word FAIL on your score report is heartbreaking. But no more!!!

Then I did a cool ED consultation for a patient who needed to be admitted. I got a lot of the workup right and learned a lot about managing this diagnosis. She’ll be my patient for the next few days.

In the afternoon, I got to do a cool in office procedure that we have done exclusively in the OR until very recently. It was a boatload of fun. Then I put in an IUD, and THEN I put in a Nexplanon. Birth control!!!!

Then I met the boy who is dog sitting for me and found out that he and his mother are lovely and are going to watch Bear for me while I’m on a 24 this weekend. I had dinner with my dear friend Christy from Portland who is here with her extended family on a vacation. She dragged them from Nashville for the week so that we could hang too! Efficiency!

Finally, my swipey app has born some interesting fruit and I’m enjoying some texts and planning some dates. This has been an all around amazing and fun day. Yay!!!!

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I think it is safe to say that I’m having a good week. I’m so fucking relieved not to be an intern anymore I can’t even tell you. I underestimated what a difference it would make to my coping, my mood and my performance. Being just a resident (well and a dog mom) is so much easier than being a singlemotherresident. I had aspirations of getting some home updates done but I find I’m not focusing on that as much after all. The time I’m not parenting, I’ve filled with other things. I’ve done some administrative and educational tasks, I’ve done a few things around the house, I’ve spent some time with friends & on dates. But honestly, I had a lot bigger to do list than what I’m accomplishing. Part of the issue is that I’m saving money for my vacation, part of it is that if I have time, I’m choosing to use it to relax or have fun. Errands and buying house fixer upper things is not as entertaining.

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I worked a 24 hour shift this weekend, something doesn’t happen in intern year in our program, but will happen a LOT this year, and continue but to a lesser extent for 3rd and 4the year. It is actually more than 24, I started at 6am on Saturday and left around 8:15am on Sunday. It was an absolutely insane night after a series of what were apparently record breaking days on L&D. I personally attended 6 deliveries, was primary surgeon on 2 cesareans, assisted another, and did 3 vaginal deliveries. I could have done a cesarean delivery of twins too if I hadn’t felt like I was losing my mind by that point. Plus the 2nd year answers the answering service pages and there was a fair amount of helping the intern figure out how to do her job. July is a nutty time. I am a bit intimidated by the 24 hour shift. I am worried it is going to kill me. That is only a little bit of hyperbole.

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Power napping seems to be a crucial element to managing my new weekend work schedule. I took a 20-30 minute nap the 2 days following my weekend and I was able to go to ballet class and take the dog to the vet and make dinner (well dinner happened on the not-ballet class night at least). I set my timer for 30 minutes and just let myself drift off. I don’t think I slept hard but it was very restorative!

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I’m only going to parent full time living with me children for another 3 years. One of my kids only has 2 years left on her lease. I can’t believe it is almost over! Thank goodness for the dog.

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Until recently I was struggling with temptation to suggest reconciliation to my ex-husband. To be clear, the idea is a product of a tiny minority portion of my mind. The rest of my mind is working on bringing her around, but she’s pretty stubborn in the notion that the only happiness in my future lies in the past. and is gone now. When I realized how such an action would be repeating self-defeating behaviors of the past, a lot of the wind was taken out of her sails and she’s been pretty quiet since for a few weeks.

But right now my co-parent is with the kids, staying with my parents at a property that we have in Northern California. A place my children will someday own. He’s helping clean up from a tragedy there and doing traditional fun things - swimming hole & soft serve - with the kids. So last night that tiny short sighted part of my brain did something only your brain can do. It delivered unto me a dream, full of visceral, physical sensations. Reminding me what good parts of a long marriage include. It wasn’t a sex dream. That I could handle. It was a dream of walking next to someone, hands gently intertwined, feeling their breath on your neck. The comfort, familiarity, intimacy were overwhelming. But it was a dream, the reality was starker. My body aches for something it hasn’t had from my ex in years. My stupid brain doesn’t care how long it’s been, it’s so sure we could have it again if only I would…

Even in the dream I managed to stop myself. I left the room, I tried to walk up stairs but they were covered with obstacles (tiny stupid part didn’t want me to leave I guess). I’m left this morning with the aching feeling of a missing touch. Grief is a circle.

(Has anyone noticed I have 2 terms for the same person? He is my ex-husband when we are talking about the relationship between us that is gone. He is my co-parent when we are talking about the relationship I still have with him. That’s deliberate)

Summer snippets

I wondered how I was going to manage with meals while the kids were away, cooking for one and for my own tastes & preferences is very different from cooking for myself & 2 teens. It’s been going pretty well. I think I may have mastered the pork chop! I made 2 the other night and it gave me 2 meals worth of main protein source. I’ve been eating a LOT of broccoli & cauliflower. I’m struggling with reducing my portion sizes (to reasonable sizes, not diminutive ones, fear not) so I’m trying to fill up on veggies and water if I find myself wanting bigger portions, carbs, seconds or dessert. I bought a Brita water pitcher, I think I have FINALLY tired of drinking only seltzer water. I need to get a new water bottle too, the handle of my current fave is broken. Also the charger for my computer finally kicked the bucket (it’s been frayed and precarious looking for a while) so I’ll need to get one of those soon. And I need a shop broom so I can sweep water out from under my carport where my fancy new outdoor seats are. It’s been rainy in the afternoons the last few days and it is pooling and cramping my style. This evening Bear and I sat outside together for a bit next to the big puddle, I didn’t make him go out in the rain again!

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I wrote about my chronic occasional health thing recently. I just realized that the likely source of my recent remission was my abstention from alcohol. I didn’t drink from January through April. In the last 2 months I have had more symptoms despite being okay during spring allergy season and while sleep deprived. I am going to start a new experiment. It’s not super complicated: I’m going to stop drinking again and see how I do. I’m pretty irritated but on balance I would much rather not drink than have the annoying and often debilitating symptoms I have to deal with. I’d be curious if the aforementioned provoking factors would still provoke symptoms if I’m not drinking at all. I look forward to this new era of discovery. 

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Today I started my second year of residency. It was mostly a fun day. Figuring out how much time I had to teach and how much time I had to do my own work was something of a task. And watching the new interns work gave me a little PTSD flashback and I had to remind myself that I never had to be at the bottom of that learning curve again. It was a little like the feeling I had during my second pregnancy when I viscerally remembered the experience of labor and was like “Oh SHIT” about having to do it again. Except this time it came with the happy reality that I DON’T have to do it again. Second year will be hard in a different way but it won’t be hard in the myriad of ways first year was hard. Learning to be a doctor, manage orders, notes, pages, locating places in the hospital, meeting my superiors (literally everyone on the care team) and managing expectations...breathe, breathe, breathe. Anyway, suffice it to say that it’s a new year and I’m pretty happy about that! 

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Today I went for a swim after work. It was perfection, floating on the cool water during a hot evening, staring up at the puffy clouds in the sky. I almost went to ballet but I decided against it. The class tonight is a 90 minute class. Not sure I’m up for 90 minutes of ballet just yet. Maybe next week! 

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I have gone to 3 ballet classes during my “summer vacation”. Last night I inspired 3 of my co-workers to go with me to that 90 minute beginner ballet class. It was a good class! Not too many jumps (which I have to sit out due to old injuries I’m not quite ready to poke) It is also closer to my house. I liked it a lot! And it was fun to go with friends. Ballet is hard but also something I feel competent at. It challenges me but is also meditative. 

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That person I was falling out of interest with ran out of patience for my schedule so they have been “archived” per their request. But now I’m back on one of those swipey dating apps and I’m surprised by how much choice I have in dating options. I’m quite limited by my own availability but otherwise I feel really good about my options. And I continue to be completely unapologetic about my availability or lack thereof.

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Until recently I have been overwhelmed by an urge to act in a way that is contrary to my best interests regarding my ex-husband. I know that these urges are part of the grief process and that I shouldn’t act on them. Last time I was bowled over by these desires, I also realized that if I were to cave into them, I’d be investing emotional labor into a relationship that already showed me that my emotional labor did not bear fruit. Something about that realization has helped free me from the fantasy of reconciliation. Also I’ve had a few opportunities to cry about the whole thing that have been very cathartic.