Clowns to the left of me, jokers to the right, where the heck am I?!?

My life is so topsy turvy, I don’t think I should try to make sense of it. I think I need to just grow sea legs. Some good things happened today for my daughter, some things made me realize that my son was having a harder time than he lets on with his teflon smile. I had a pretty chill day at work, which is a nice change and helps me get some administrative stuff done and be rested so I can have some active recovery time this weekend. I’m lonely for friends but don’t have much time to arrange social events and I rarely know when I’m going to feel up for the adventure of hanging out. I love my job but it is so...consuming. I am consumed.

The bullshit that is happening in the Senate judiciary committee this week is not helping me. Like many (most?) women in America, I’m a sexual assault and trauma survivor. I don’t think about it a lot but it’s there and it has come roaring back to my front burner this week. I’m dreadfully proud of Dr. Ford, not just that she came forward, but how she did it and how she comported herself during the process. And the whole damn thing is triggering, a word I don’t particularly like, but it’s appropriate in this context. I feel like I’m listening to a loud drippy faucet ring out in a quiet night while I’m trying to sleep. Just as I’m drifting off *PING* there it goes again and my adrenaline surges. I want to do something incredibly restorative and self-soothing tomorrow but I’m not sure what it would be. A hike someplace beautiful, maybe. Where I can get my feet wet if I were so inclined. Western NC is known for its beautiful waterfalls. Hmm. That sounds very grounding. Bonus if I can take the cute pup with me. 

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I am now one-quarter of the way through what is arguably the most inhumane of my 4 years of residency. This year I will have 12 weeks of night call, much more frequent weekend coverage, the god damned 24 hour shifts (those don’t go away). This job is back breaking, it is destructive to one’s psyche and it is murder on any notion of balance. Despite how upsetting it might sound, I state this without emotional distress. The material is difficult to master and it should require superhuman effort to do so. We hold life in our hands. We have to know our shit. And despite all those practical and logistic realities, it is not an abusive environment. The superiors are supportive and there are many structures in place to help diffuse the hardship. I don’t feel like I’m on the receiving end of a psychological beating. I’m just really fucking tired.

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I have been delayed gratification girl for so many years. I have recently been prompted to make more declarative statements to someone about “what I want.” This person is not necessarily in a position where such requests/demands are going to be met but it has gotten me thinking. What holds me back from really living, and not just surviving. I’ve been in survival mode for so long, I need to deliberately break out of the mindset, it isn’t just going away. Conversations with people who ARE on the inside, who get to hear my process and know my heart, have helped me realize that I have a great big psychological boogey man standing between me and my goals. I have a Dweller on the threshold and I’m calling it the “BUT HOW.” Because when I think about things that I want - friendships, romance, socializing, etc. I get a huge BUT HOW thrown in my face by this archetype in my mind that I cannot yet get around. I don’t know how I could fit one. More. Fucking. Thing. into my life, but I still want things! Like many problems at this point in my life, this is not a new issue, this is just a variation on a theme. I must know the whole path before I take the first step. Obviously I’ve gotten over that compulsion or I never would have gotten married, had children, gone to medical school, gotten divorced, moved across the country so many times, etc. But here I am, thinking about what is missing from my life, wanting to make a plan to add it, and the BUT HOW is standing in my way.

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My co-parent is planning a visit. As a result we are thrust into conversation more frequently. I’m not enjoying how these talks are going. I value having him more present in the kids lives, but it is hard for us to navigate this stuff. We cohabitated (so awkwardly) then I left, the kids followed suit shortly after. We haven’t had to manage family sharing much beyond managing vacation times. I want him to come see his kids. I want them to have time together. I’m pretty sure it is going to be painful and hard for me. I still want it.

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If all goes well, I am going to have 3 days during this rotation at a local FQHC that has services for trans patients - I’ll be shadowing and learning from an MD and a PA, and they have a support group that I’ll be attending as well. I’m trying really hard to get some experience that is going to be helpful for my eventual post-residency career. Plus I get to queer up the residency program. Win-win.

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I miss being in the OR. That is an unusual sentiment for me, I was kind of surprised by how much I like surgery. I always thought of it as a means to an end (the end being patient care) but the fact is I actually like OR days. The work is gratifying.

That being said, I’m still chipping away at my emails and just finished 2 writing projects that were anticipated several weeks ago. I am enjoying having my brain back and being able to see my kids more. So all OR all the time, not really what I’m looking for either.

Nighty night

I just finished my first of 3 weeks of night for this rotation. I’ll do this 3 more times before next July. I’m so ridiculously tired right now but it’s 11pm and my body clock is all messed up so I’m just going to journal for a while while the melatonin kicks in.

I was a bit anxious about how much awake & home time I’m missing as a parent. And this is only the 2nd week of school. I’m already gone by dinner & bedtime, I’m not home yet most mornings when they leave for school. I tried to prep the kids as much as I could, but as they are 15 and 17 now (D’s birthday is in 2 days, A’s was on Labor Day), they know much more than I do and have assured me that I am, in fact, overreacting and quite foolish. (insert eyeroll emoji here)

Halfway through the week we had a demonstration that adolescent brains are not the same as adult brains. Independent of each other on the 3rd or 4th day of my week, during the after school period we have together, they both made incredulous comments about my schedule. And the amount of sleep I’m (not) getting. I chose to find it heartwarming that they noticed and not irritating that they didn’t believe me the dozen times I tried to warn them about it before the rotation started. But we’re all on the same page now, it seems.

The work itself has been amazing. It is rare that I have time to sleep any amount that really matters. Maybe a 5-10 minute power snooze with my head on the table. Sometimes I do so much, I can’t keep patients straight (obviously I take good notes and rely on my team to help me, I don’t actually get anyone’s care confused!). I did 3 c-sections one night. Another night I was in the main OR doing urgent gyn surgery for 5 or 6 hours (ectopic pregnancies and septic abortions and torsed ovaries). Some nights I just managed sick people and didn’t do any deliveries or surgeries. And then there was a night that we had (on either side of midnight) 2 women roll in and deliver babies very quickly. As the 2nd year, I usually get the sicker patients, but when the intern on the team is a relatively new family med intern and we have to deliver a preemie baby for someone who’s been in the hospital 15 minutes, that counts as complicated enough to be in my wheelhouse. At night we sometimes take care of some things the day team didn’t have time to get to - consenting postpartum patients for tubal ligations, reading the daily fetal monitoring for patients who are in hospital for many days or weeks, following up on hypertension/pre-eclampsia management changes.

This week I decided that I’m going to try managing my pre-eclamptic patients with treatable BPs with nifedipine instead of labetalol. The science is basically the same but the meds are dosed a bit differently (1-2 times a day vs 2-3 times a day, 2 dose options vs a large range of doses) and I’m wondering if starting with nifedipine will enable us to shorten length of stay and titrate an effective treatment faster than starting with labetalol. This is one of those things we call “practice variation” which means there’s not a good reason to do one over the other, but individual doctors still have preferences.

I have the weekend off, a little bonus to working nights. I’m very happy to have 48+ hours off in a row after a week of 5:45pm to 8am work (bonus on Fridays - didactics until noon). 2 more weeks of this then I have an Outpatient rotation which is a luxurious 8-5 job!

One of the ways I’m coping with the arduous role of a 2nd year resident (really the workhorse year of our program) is by breaking the year up into fractions. Recently I “celebrated” the completion of ⅙ of the year. This week marks the 4th of 6 weeks of this rotation so I’m two thirds of the way through. Breaking things into smaller manageable chunks makes the whole year stretched out before me a bit less daunting.

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And I just finished my last week of nights for this rotation. I’ll do another 3 weeks of nights in 7 weeks. After that I have a longer break and then there will be 2 more 3 week stints in the spring & summer. I am consoled by the fact that though I have 12 weeks of nights this year, I only have 7 next year and 5 the year after that. It all comes out in the wash. “It’s a 4 year program” is one of the truisms we use to remind ourselves of patience with our own learning and to get through the times when our schedules are harder. I’m very tired and I miss my kids. They’ve done a great job but taking care of themselves - a lot of frozen lunches, yogurt and bowls of cereal. The dog has been walked, the homework has been done (or so I’m told) and life has gone on. With the night shift schedule, there’s not really enough time to do anything other than come sleep and have about 20-30 minutes to do something else - shower, eat, see the kids. Pick one.

Labor & Delivery has been an amazing place to work the last 6 weeks. The team I was working with gelled really well and I cannot express how much I have learned, what a better doctor and surgeon I am now. I’ve taken care of some really sick women and participated in some amazing births. I’m a lot faster at doing c-sections now and I was the person who did things for the intern when they couldn’t manage - breaking water, checking a difficult cervix, helping to make a plan for a patient with an unusual presentation. More often than not, I’m able to deliver the fetal head in a c-section (this is harder than you’d think) and I rocked c-section breech birth maneuvers several times. I still need a lot of help and there were some times I had to turn to my chief to do things for me - breaking water, making treatment plans, some hard surgical stuff. I was present with women when they delivered babies born still and took care of some sick women who ended up losing their uteruses or being told that pregnancy was now a life-risking endeavor that they should not undertake again.

Next week we have a short week of filler stuff - all our rotations don’t divide evenly into 52 weeks so we have several “freak weeks” - at the end of the year when the graduating chiefs aren’t around, during orientation for the new interns, this week when more trainings happen and 2 weeks over the winter holidays. After that I have 6 weeks of outpatient clinic - heaven is a job from 8 to 5!

Each one, multitudes

Things you may not know about surgery/medicine/humans: 1. Blood congeals really quickly. This knowledge has started to inhibit my ability to enjoy a good police procedural. 2. It is pretty much universal for people’s guts to stop working when they have abdominal surgery. And there’s not much that we can do to get them going again. Patients think it is really weird for their doctors to ask them about farting every day. 3. Different tissues have different smells when treated by electrocautery. Blood & fat together is my least favorite. Muscle is the most confusing, it smells like you are grilling.

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The way we can take care of all our patients, but especially patients who are really sick, who need real doctors, while we are learning: layers. There is a team taking care of every patient “I” see. There’s a chief resident above me, there’s an attending above her. I talk to my chief and my attending about my patients. Sometimes I ask if I should do what I think I should do, sometimes I tell them what I’m doing. Often I am confirming what I know and they are refining my understanding.

This is all information the front of my brain knows.

The inside of my brain, however, is pretty heartbroken today. It thinks that learning medicine is pretty shitty when you have to almost kill someone to learn things. My basic instinct brain thinks I’m essentially an attempted murderer. Today has been a hard day.

The truth is, I didn’t miss something. I really don’t think so at least. I think one of my patients had early symptoms that resolved while I was caring for her and then acutely had some really bad shit go down. Women really do die after having babies. It’s a thing.

She didn’t die but she was and is very unwell. There are implications for the rest of her life. I didn’t miss it when I saw her yesterday afternoon, because it wasn’t there yet. But this morning she was whisked away from our care and sent to the intensivists, to the ICU, where they will hopefully stabilize her.

I will never ever forget this constellation of symptoms and circumstances and I will work hard to catch it sooner next time. If it could even be caught any sooner. It is quite possible that the complications were caught as soon as there was something to catch, that her body was hiding the problem even from trained eyes, that there was no telling that she was going to go into that level of distress based on any information we had at our disposal before she actually crashed.

I can’t save everyone. Today I am confronted with that reality and it hurts. 

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Today I delivered a baby that weighed a pound and a half.

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After work today I was too keyed up to go straight to the Mom Duties that await me. It was also warm enough to consider a swim so I invited the kids to join me and my daughter and I went for a quick dip. When you have a pool at your immediate disposal, you use it differently than how I used to think about going to the pool. It can be a quick 15 minute dip, floating in the water, staring at the sky, or maybe swimming a few laps to get some pent up energy out or practicing cannonballs and somersaults. Then you just head home, take a shower and make breakfast burritos for dinner. Onward and upward!

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Today I delivered a baby that was alive yesterday.

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My son made dinner tonight. Wouldn’t let me into the house when I got home (our main door is through the kitchen) so I sat outside on the porch with my feet up and listened to music. And had a delicious dinner delivered to me! Don’t let anyone tell you that raising boys is easy or that young men have simple emotional lives. This kid contains multitudes and he’s amazing.

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One of my children or the other has lost their temper three times now and and damaged a piece of my home. All the pieces are repairable, but it is still a huge pain in the ass. They need to reign in their tempers a little bit. At least the latest one is an easy replacement part (door shelf on the fridge) and I can charge Little Hothead for it. Good thing they made all that money this summer!

Personal life? What personal life?!?

I’m having something of a parenting challenge right now. Teenager’s brains are difficult to live in and difficult to live with. My son is man-sized. I have to regularly remind myself that he is NOT a man. And I have to check my own issues with male anger and avoid getting worked up when he’s worked up. He’s working through some very appropriate and very complicated emotions but, like most men-type people, he’s lacking some of the emotional intelligence and self-regulation to really experience and process his emotions. Walking him through this process is sticky. It’s really REALLY hard to see the 10,000 foot view.

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I’m coming out of a place in my life where I performed hypervigilance in response to someone else’s emotional state and needs. As such, I’m having something of a backlash against expectations that I read people’s minds. I don’t mind hard work, I don’t mind staying late or staying up late to help you with your problem. But don’t expect me to intuit your problem. I’m more than a little bit psychic but I’m still a terrible mind reader. 

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Back on the dating horse - we’ll see how it goes this time around! 

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Had a good conversation with my son to work toward helping him with some of the things that are holding him down right now. It was a successful conversation and forward steps have been made in the process. It is hard to blog about these huge aspects of my life because I want to respect my kids' privacy and right to own their own digital identity. I want him to get help. He’s got a lot of emotions tucked inside but anger seems to be the door we need to go through to get to them. I think we've found  the start of a solution.  I love it when I’m able to navigate the psyche of a teenager and it goes well. 

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I absolutely cannot stand gossip. It is right up there with mind reading. Once my ex remarked to someone that something he liked about me was that I wasn’t catty or gossipy. I was surprised, I guess it was a little like someone complimenting me for not being an aggressive picker of lint off of the clothes of strangers on the bus. Of course I don’t do that! Why the fuck would I want to do that? I don’t get any joy from talking about people behind their backs. It is malicious and poisonous.

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I have shrines that want constructing and it is making me sad that I can’t get that done. I need a few little bits for one of them - some nice paper & an hour of internet research and printing of things, plus someplace to put the things I print (I’m thinking tiny picture frames). The other I think is just a matter of cleaning off a shelf and rearranging things that are in other places in my room. I also want a full moon calendar. At this point, I should probably just wait and get a 2019 one, but dammit money is always tight around the holidays and I forget to get it in the new year. These are things that will make me feel more centered and authentic in my home. Lots of little shrines and a full/new moon calendar as art. Life goals.

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There are many areas of my life where I am full of curiosity. Curiosity helps me understand people who are different from me. It helps me parent. It helps me do my job and it helps me learn and grow as a human.

I get texts from people I’m dating, asking about my day or sharing some tidbit and it occurs to me, I may be crucially lacking the curiosity about that person’s life for casual dating to evolve into actual relationships. I’m not sure I have space in my life right now to care about another person. I care about so many already!

Summertime, and the livin is easy

I just had the best vacation! It involved a lot of driving that mercifully went very smoothly. Every single day I was gone I was able to visit with wonderful friends. Some friendships were formed in the crucible of parenthood. Somehow it is more incredible to me that these children are young men and women than the fact that my own children are. My friends are doing our part to bury the Mommy Wars - we have all made different decisions about how to raise our kids and we respect each other’s paths as right and good. And we can be honest about our doubts about raising teens and the troubles that entails as we were when we were uncertain about toddler temper tantrums and daycare and nap time. It is important to have friends you can be honest with. I did some very Maryland/DC activities while I was there - a visit to Great Falls (wow the Potomac was raging!) and played tourist at the Supreme Court and the LIbrary of Congress. I know that you can’t go back to places and times you’ve lived but I think I might find myself moving forward to a new life in Maryland. It has ocean, mountains, cities. Ample communities in the shadow of our capitol that need doctors. I’m familiar with the politics, the terrain, the culture. There is a good bit of time between now and when I need to make my What’s Next plans, but Maryland is definitely an option.

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Three years ago today I was making a mad dash across the country in what turned out to be a futile effort to be at a dear friend’s deathbed. He sickened and died very quickly but was held close and sung home by the very same people I would have at my side when my time comes. Wicca is a relatively new religion and we are learning and creating rituals for ourselves. With Keith’s passing, we hit on something old and familiar. Many have taken up the commitment to build our end of life traditions and customs as a result. Though I missed the end of his life, I was able to be part of the next steps of preparation of his remains. Death is a Mystery but dying is a human act that should be discussed, anticipated and witnessed. Know what you want at the end of your life. Talk to your loved ones about it. Don’t leave them with the burden of uncertainty during that painful time. I still feel waves of grief from the loss of Keith. But I don’t ever wonder if we did the right thing, in the decisions of his last days, in how we sang him Away or in how we dealt with his possessions afterward.

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Sometimes the surreality of my life hits me at the must mundane moments. Today it was while I was gloving up for surgery. I’m almost 45, I have teens about to turn 15 and 17. I’m a 2nd year resident. I do surgery. I’m an effing doctor.

When my son (the almost 15yo) was in 2nd grade we decided that what he needed was to be in 3rd grade. It took some doing but it worked and he went from being old for his grade to being young for his grade and has been just fine with that ever since. But one of the things I remember thinking, calculating, considering, when he was in SECOND GRADE (he was 8) was that if everything went my way, he’d graduate from high school the same year I finished my residency if he moved up a grade. I have been doing this for a long long time.

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Did you ever listen to the NPR show Car Talk? Two of the funniest, smartest guys on a radio show. They used to have all sorts of people call with problems with their cars they KNEW were caused by a certain event that correlated with the onset of the problems. They were pretty unabashed about telling people when they thought, in their expert opinion, the 2 events were actually not related at all. They could be pretty funny about it.

Humans are trend makers. We look for patterns, in the stars, in chicken entrails, in our lives. People in medicine are no exception. There are all sorts of superstitions about saying that things have been “quiet” on the floor and people often label each other as Black or White clouds, leading to doom or peace. Our patients do the same thing. Very often someone will associate getting their tubes tied or some other event with other problems in their lives. And no one else knows your body like YOU know your body. But as someone who knows BODIES in general better than the average person, I often don’t agree with their assessments of cause and effect. I have learned not wish co-workers a “quiet shift”, instead I say “smooth” and mean quiet in my head. And if you insist that while we are taking out your uterus, we need to get your tubes too because of an association between your tubal and your skin rash, I’m not going to try to dissuade you of that notion. Respect the patterns, people. Otherwise it’s all just chaos.

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My kids are home! They are jet lagged and a bit feral but they are coming back into house manners quite well. I hope they will re-learn the skill of putting themselves to bed. They are loving the dog, fixing meals and today they helped me assemble a futon frame. Actually, I would say that I helped them. I read the instructions and they did the work. The worked well together after their summer of construction/handyman work with their dad. I wish I had an ongoing need for home improvement tasks so they could continue to work together. And tonight they are celebrating their accomplishment by playing GTA, sitting on the futon together.

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I was going to comment on a friend's FaceBook post but didn't want to get off topic of her own adventures with a ketogenic diet. Ketogenic diets sound frighteningly complicated. Likely complicated enough to trigger my eating disorder but *maybe* going gangbusters on it would just re-direct all that dysfunctional eating into something that was less unhealthy (and a good bit more creative) than just eating fewer and fewer calories each day.

I spent 4 months not eating sugar (well no desserts or sweets, but not monitoring hidden sugars in foods, which are myriad). I think that most of that time I struggled against the urges of my eating disorder. I had this overpowering drive to add more rules, change my exercise habits, set goals and critique my body in such self-hateful ways. I fell off the wagon for a vacation, and I don’t regret it. And though I am making some subtle efforts to reduce my bad food choices again, I am wary of making declarative statements about my eating. I’m pretty annoyed with the weight I’ve gained in the last 18-24 months, but I am leaning more toward buying clothes that fit instead of trying to lose the weight.

I hate that I’m so limited in my food management options. I really walk a narrow, potentially dangerous space between disregarding all limits (and therefore gaining even more weight, which would put me closer to a health-debilitating BMI) and imposing disordered eating upon myself. I wish I didn’t have this particular mental hiccup. And I want a pony.

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Yesterday I worked 11 hours then came home and made dinner - pork chops, couscous & peas. I cook, you clean up - house rules. I don’t care if it gets done right after dinner but it has to get done. This morning when I walked into the kitchen at 0530 to go to work the dinner pans & dishes were still there. I woke up both kids and put them to work. To their credit, they got right up and did it. To my credit, I did not harp on them or lecture about it. I have a penchant for lecturing.

I also put tracking and blocking apps on my kids' phones this week. They are pretty pissed but I don't really care. I know that their shiny new iphone 8+s are going to be a major distraction when school starts and I'm not going to be around to tell them to get off the games and videos. They are going to have to learn to manage their tech, yes, but expecting 2 teens with ADHD and very little parental oversight/micromanaging to just figure it out is not reasonable. I hope that these tools will ultimately be useful. Their dad has concerns about taking the learning away from them and I appreciate and respect that opinion. I may be hindering them. But I also don't want them to have to learn from mistakes that involve failing classes and harming the trajectory of the next 5-10 years of their life because they have the whole of the internet at their fingertips without limits.  My goal is to make it a conversation and learning experience. 

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)