Not glamorous

This week I deeply felt whatever it is that fundamentally altruistic people who go into medicine but end up not practicing altruistically feel that makes them not do so. I’m tired, physically, existentially. I’m sick of delaying gratification and waiting for the time I can do the things I want to do. I want to travel, read books, do crafts, travel, fix up a house (just a little, not like Money Pit style), walk my dog, oh and travel. I can see why private practice life has such a siren song to those folks who started med school thinking they’d end up on a reservation or in the inner city or rural hospital or at an FQHC. I don’t think it is going to fundamentally change my plans, but I can see why we have a crisis of distribution in medicine.

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Today I was reminded that days of constant pain are exhausting and emotionally stressful. And that pain relief brings with it the sleep of the innocent. I mean, I knew those things before, but today I experienced them again. I got a steroid shot in my L knee. Long standing issues, my L knee has. Missing a part, kind of unstable, makes trouble for the neighbor joints. In the 30 years I have struggled with this knee, I have developed solid strategies for dealing with the pain & injury when it comes up (off the top of my head, I thought of 7 times but there are probably more that weren’t as emotionally charged and therefore memorable). Unfortunately those strategies involve rest, proper exercise, regular pain meds (hold on, forgot my nightly ibuprofen…), icing & probably physical therapy. I cannot rest, I don’t have time or access to a pool for swimming, time or extra cash for PT, regular pain meds & icing are the best I can accomplish. Unfortunately dosing q6h is a bit challenging to my memory, even if I carry ibuprofen everywhere with me.

So, steroid shot. With lidocaine. Which has worn off by now but still it feels so much better. But more full of fluid than I’ve ever had it. Residency is a very deconditioning event, especially in middle age. If residency were designed for 40 year olds, it would take longer but be less time consuming from moment to moment. People in their 40s are not is the same hurry that people in their 20s are in. There is a sort of existential urgency that slows over time. Like the escape velocity from childhood is still driving them forward. Telling a person in their 20s that it is okay to take a year off, go a little slower, don’t worry about getting there just yet, is like speaking to them in a way they literally cannot understand. “Why the old lady suddenly talkin’ in word salad?” they think to themselves.

I don’t begrudge them the urgency at all. I had it when I was their age. I remember feeling absolutely justified in the decisions that my urgency inspired: marriage, graduate school, home purchase, childbearing, job changes, religious pursuits. I **needed** to do those things RIGHT NOW. I don’t regret those decisions, I just realize that I’m making my plans with a different background velocity these days and it is hard for me to muster the same sense of urgency that many of my peers show about life.

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Parenting teens subjects One to a regular whiplash. I have gone from feeling horribly desperate on Tuesday to feeling a bit more put together and calm on Thursday. Feeling like my children were suffering, I was not fixing it, I had no idea how to fix it and dear sweet ever loving Honey God, how was I ever going to find the time to deal with All. These. Things.

Turns out that my kids were having a hard time, but it was mostly transient (I need to reflect on how they spend their vacations and how it impacts their overall well being going forward). The things I was doing WERE helping, and I thought of some new stuff and got that on board as well. But I still don’t know either who this Honey God is I’ve suddenly discovered or how I’m going to find time to deal with everything. One bite at a time, I suppose. And I was instructed to pursue treatment for my stupid knee by someone I trust and respect. And she was right. Because being in pain makes everything harder. Now I will just try to do the next right thing, and the next right thing and the next.

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I’m now 1 week post-steroid shot in my knee and 3 days into some simple PT rehab exercises. I’m a highly adherent PT patient. They hurt so bad the first day, I could only do 4 of the 10+ exercises in the regimen. And the second day I honestly considered skipping bc I was worried the pain would be too bad. But it was better, and today was even better. Ainsley & I have joined a kickboxing gym (called 9 Rounds, it’s like Curves but with punching & kicking. I’m very excited). She’s gone twice now and I haven’t been able to work out yet (the registration was a really good deal so I just went for it, even though I know it will be a couple more weeks until I can workout).

Happy New Year

I’m really grateful for my dog. And my friends. Who help with my dog. But mostly my dog. He’s sweet and loves me and makes me laugh. I mean he’s the kids’ dog but I’m really grateful that he stays here with me when they go away. He’s very snuggly.

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Do you ever have those days where you’re just in a foul mood? I’m having a stretch of them right now. I know that it is temporary, but it still sucks. Some of it is because of the time of year. Some of it is burnout. Some of it is because of the day I had. Some of it is because of adulting life stuff. None of it is world-ending, but taken together they are pretty crushing at the moment. I’m fantasizing about holing up in bed for days on end, my appetite is shot. I really wish I could sleep in or nap. Probably both. Let’s break it down one by one.

1. Time of year: In this instance I don’t mean December or “the holidays” I mean time of year in the resident calendar. With the “new year” being July 1st, I’m in my 2nd year hump time right now. It’s been a hard year, I know that I am getting better at my job but I haven’t had a chance to really demonstrate mastery yet. I have done a LOT of nights and weekend call and it is exhausting and I still have 6 months left. BUT. It will get better. The second half of the year is reallyreallyreally nice. I remember thinking the second half of last year was lots better and people generally agreed that for all years of residency, the second half of the year is a great time. 
2. Burnout: One of the hard things about this schedule with lots of days in a row and lots of weeks of nights is the quantity of time I have to ON. I am craving a few days to just lay around in my pajamas and watch crap TV. I want to not have to decide things. I want to have some fun and relaxation. But my kids will be back in 2 days and in 4 we are going to NYC for vacation and I’m so very much looking forward to that. 
3. Ugh my day: I wrote before about delivering a preterm baby that had died and I remarked that in my anxiety and focus about taking good medical care of my patient, I somehow forgot to FEEL any kind of way about the experience. I postulated that when I was more comfortable with the role, perhaps I would feel more. Well, today, unfortunately, I can report that to be in fact what happens. Few things are more tragic than a fetal demise except maybe a fetal demise at Christmastime. I felt all kinds of ways about this today. It was harder than last time, for lots of reasons. 
4. Adulting: You know, this is a really unrelenting part of life that I look forward to being able to outsource in the future. I’m going to have people, minions, assistants, something. People to clean things, wash and fold and walk dogs and pick up poop for me. I’m going to be less stressed about paying bills and I’m going to feel safe and secure enough in my financial status to be able to use autopay more than I do now (too many years of living hand to mouth with a very unstable income have left me scarred). Being an adult is so tiresome. 

I’m not prone to ennui, depression or self-defeating attitudes. I know this will pass. I’m sure there are more reasons than these for me to feel existentially tired. But it will pass. I largely define my self-image as a Woman Who Takes Care of Things. Every once in a while I need to let myself feel this fatigue. I’ll get bored of it very soon. But right now, it is making me feel heavy.

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I just finished my last shift of the Stretch of DOOM. I will now be off of work until next weekend. I have very many observations and lessons from this stretch of time that I need and want to put down on the page but tomorrow the kids & I are going to NYC to see friends and visit the city for their first time. The alarm goes off in too few hours for me to get settled into writing. More later…

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The kids & I are in NYC, Brooklyn specifically. We are staying with friends and having a fantastic time. We’ve explored Brooklyn, gone to the Met, seen the High Line, shopped at some amazing place called Century 21. Tomorrow we’ll see Book of Mormon and explore a little bit more (D was promised an arcade and A was promised the NYC public library). I’m not taking pictures because I don’t want to look like a dork and it makes my kids roll their eyes. Also it is cold. My friend got some nice pictures of D climbing scaffolding with the Empire State Building in the background. I’ve got one kid who is loving NYC and another who isn’t really, aside from the shopping. I mean it is hard to not be impressed by the Metropolitan Museum of Art but if anyone could do it, it would be a teenager, right?

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Part of what has made this vacation nice is the lack of plan. I didn’t have time to set an agenda and we’ve decided to be pretty organic about what we are doing. Which means some sleeping in, some laying around in the evenings, and long lazy rides on the subway home. After just 2 days of reduced responsibility and increased sleep, I felt ready to study again. It only took a teeny tiny break for me to be interested in work again. I love my job. I can totally listen to CREOG topic podcasts and compose op notes in my head while I’m on the subway. Decision fatigue has hit me hard with the latest string of work. I’m glad to have a break.

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I am a supporter of out of hospital birth. I am a supporter of midwifery care. I am a supporter of delayed cord clamping, water birth, low intervention, unmedicated labors and even of lotus birth. I’m pretty grossed out by placenta encapsulation from a food handling and meat preservation perspective but I’m not opposed to it out of hand.

In addition to all these things, I’m also a supporter of trustworthy prenatal care, appropriate scope of practice, timely referral to higher levels of care as needed and respectful transfers between home and hospital (with respect going both ways).

As safety net providers, we often see patients who are home birth transfers, at varying stages in their care - prenatally, intrapartum and postpartum. When we care for these patients, I am full of empathy and respect for their choices, things haven’t gone how they’d hoped if they are with me, but that doesn’t mean it has to be a bad day. I sometimes have less respect for the providers who set us up as slice-happy demons, hospitals as dens of horror and worst-case scenarios, who’s propaganda indoctrinates patients to make choices that can harm their and their child’s health. I have little patience for out of hospital providers, doulas, childbirth educators or anyone who sees their role as protector, with a chip on their shoulder, who prefers to foment conflict. It doesn’t help anyone - not your patient/client, not you, not your reputation, not your profession.

Mishmash

I just finished day 14 of 26 in a row. Because I just got off night shift (no weekends while on night shift) and because I chose to work Xmas instead of NY, I’m working many days in a row.

Today I broached the subject of the divorce with my kids. It is not something that they’ve really wanted to hear about before but since their dad is coming out here again in a few days and since it was a HUGE elephant in the room that caused all manner of psychic distress for my kid, I thought we should at least start a discussion. I think it took nearly this long for me to be able to have this conversation and be as fair as I needed to be to my co-parent in explaining the whole thing to them.

I studied today for CREOGs. This is an annual exam we take in January to evaluate our knowledge of the content you need to know to be an Ob/Gyn. It was a day that was busy in pieces, but gave me time to answer questions and review my notes. Not as many deliveries in the last couple of weeks, but I’m in for the long haul, I can wait.

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Been feeling pretty crappy lately but it turns out I wasn’t burnt or depressed, I was just in need of a damn day off. Mercifully, once I figured out that I was working 26 days in a row, we were gifted with the world’s slowest Monday on L&D and my chiefs let me go home for the day. I walked my dog, cleaned my room, did some fun errands, made dinner, did stockings with the kids and baked peanut blossoms. I didn’t swing a nap but the day was great anyway. Only 2 weeks (well 12 days) until my next day off. Can’t wait to do it again.

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Every service has its upsides and downsides. When I’m on an L&D rotation I’m reminded what a creature comfort predictability is for me. On L&D from day to day, hour to hour, you never know what you’re going to get. I guess that you can remember that Tuesday is high risk clinic day and to expect a bunch of you-know-what to hit the fan in the afternoon - patients coming for extended monitoring, to rule out pre-eclampsia, ultrasounds, EKGs, etc. The sucky part is when that semi-reliable day happens in addition to a bunch of walk-ons with all manner of complications. Life on L&D is like a box of chocolates, you never know what you’re going to get. And sometimes it just kicks your ass.

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We got an admission recently that is making everyone varying degrees of sad and angry and frustrated. A patient with a terribly sad, avoidable outcome has been handed into our care by an out of hospital birth attendant who works in the area. This is my own personal first horror story of tragic, avoidable outcomes due to this person’s poor standard of care but I understand that it isn’t likely to be my last. There have been reports to the medical board, by patients and doctors, yet somehow this person is still peddling their toxic product. I have known that there were people like this out there - allowing women to get sick or permanently injured and babies to die (I’m not exaggerating) and still offering substandard prenatal care that doesn’t provide recommended evidence-based surveillance or have necessary back ups in place. 

I can only imagine safe out of hospital birth when it is coupled with seamless integration into higher levels of care - knowing when you are performing at the edge of your scope and where to get the next level of care and accessing it quickly. I think the thing that bothers me the most about this is that even in the setting of harming women and babies, this person sets themself up on a pedestal, revels in the title of “infamous” and considers themself the one true champion for women & babies in Western North Carolina.

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I get a lot of feedback. My actions are under a lot of scrutiny and that is right and good. I need to be careful, precise and as correct as possible in my actions and decisions. I accept this as necessary. At this point, I’m not (usually) a danger to patients, so the feedback is mostly fine tuning. It seems to be having unexpected consequences on my psyche.

I get correction from 3rd & 4th year residents frequently. Sometimes we have responsibilities that overlap. So I might see a note or orders placed by someone who is also responsible for making sure I do my job correctly. Because they are also still being trained and learning, they do things incorrectly as well. Also because they are human. None of these things are dire or consequential. Like much of the feedback I get.

There is this little “first thought” that I get that is a petty “A HA!” when I see a mistake made by an upper level. As in, “Not so perfect, are you?!?” I’m immediately layering a second thought that gently reminds myself that they never claimed to be perfect and to stop being petty. But the first thought is there and I need to recognize it so I don’t let it sneak into my attitude and relationships with my co-workers.

Halfway

I feel like I haven’t published in a million years but I see that it has been less than 3 weeks. (It's been longer than that by now but it was about 3 weeks when I wrote this)

I noticed recently that my posts that talk more about work seem to get more views and I was trying to think of things to say about work but having a little bit of writer’s block for lots of reasons.

Today I managed a 16 week loss. The patient was admitted and stable when I came on this morning but she was going through something called an “inevitable spontaneous abortion.” The pregnancy wasn’t over yet, but we knew it was just a matter of time.

This wasn’t a situation where the pregnancy was no longer viable, when there’s no heartbeat and we’re just waiting for the body to notice that it was no longer gestating. This wasn’t a “passenger” problem, it was a “passage” problem. These sorts of problems can be infections, very early rupture of membranes, labor, painless cervical dilation to name a few. In these cases, there’s still a heartbeat and if we were cruel enough to put an ultrasound on the uterus, we’d see it. And the fetus moving, oblivious to the looming danger.

In these situations, there are a few ways we can manage things but before I do I want to state very clearly that this is a pregnancy that Is. Going. To. End. 100% chance of miscarriage. No chance of survival. No chance of waiting until the fetus is big enough to be viable and benefit from a neonatal intensive care unit. This is a hard, hard day, for everyone involved. It is heartbreaking and tragic and absolutely no one’s fault. It didn’t happen because someone was fat, used drugs, had bad teeth, didn’t pray enough. ANYTHING. I really don’t want some anti-abortion troll to find this post randomly and call me a baby killer.

Patients need some time to come to grips with this reality. It doesn’t fit in a brain - the baby is alive, but it won’t be for long, and there’s nothing I can do about it except choose the manner of its passing. Sometimes while they are coming to grips, the situation changes and our path is limited by the circumstances - bleeding, infection, retained placenta. This is exactly what happened today. Our stable, very sad patient was taking some time with family to mourn when her body decided it was time.

Had we not had our hand forced by our patient’s uterus, we would have offered her 3 different options: (continued) watchful waiting, induction of labor or dilation and evacuation or a D&E. I think a D&E is what is known as a “partial birth abortion” in political spheres but I couldn’t honestly tell you because there is NO SUCH THING as a partial birth abortion. It is a made up term used by non-medical people to misrepresent a heart breaking and sometimes life saving medical procedure.

We know some things about placentas in the middle of pregnancy - they are now big enough to do work and pool blood, despite what else is happening. And they are often still very adherent to the uterus, if they don’t come out all the way, we need to go in and get them or they cause deadly trouble. If a patient is already sick or just doesn’t want the risk, a D&E is, hands down, unquestionably the safest way to get to manage a second trimester loss. The downside from patient perspective is that they don’t have a baby to hold, For some people that is very important and they are willing to risk needing manual extraction of a placenta, a D&C, a blood transfusion. It isn’t a guarantee but it is common.

You may have noticed that this is a fairly clinical description of these events. It was an oddly clinical day for me - I kind of forgot to be sad about the baby dying. I was thinking about managing a sick patient who was not conveniently (or as it turned out, safely) located relative to the supplies, staffing and OR. I was deciding about when to give her medications, how much to give and what signs would mean I needed to do something different. I actually had to make an emergency call at one point. People were moving slowly toward a goal and I said “We need to go NOW” and what do you know, people reassessed their needs and moved a lot faster after that. This was MY patient. I managed her (with help, guidance, supervision, of course), I counseled her, I met with her family afterward. I was very busy and it was a huge growth experience for me. But I forgot to feel sad. And now its been a few days (I’m finishing this post up a few days later) and I don’t think I can unpack that sadness at this point. Maybe later, when managing the medicine is not as new and intense, I’ll be able to hold sadness while getting shit done. Life goals.

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Today in clinic I helped a experienced nurse practitioner diagnose an unusual problem she encountered in a postpartum patient visiting for an IUD. Bodies are weird, this one was doing unusual things and she couldn’t make heads or tails of it. I did an exam and identified and evaluated the problem. Then I put in the IUD. Proud little “I’m becoming the next level provider” moment.

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Had something of a personal curveball last week. I’m on a leave from work for the last 7 days, will probably be heading back in about 4 days. It wasn’t my curveball, it was a parenting curveball. No, I’m not going to say more about it than that at this point. When your kids get older, the stories aren’t really yours to tell anymore. This is going to be one of those things that comes out over a series of small posts, peppered throughout my blog. Stand by for more.

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I've not been feeling great recently, realized that I haven't been reaching out, not trying to talk to friends, just keeping my head down and moving forward. Feeling a bit out of sorts. I'm publishing this stuff that I've already written so that I can clear the plate and maybe do some blogging again. I need to get back to the quick vignettes so it can feel more accessible to blog. My life is hard but my life is also amazing. I need to remember the second part a little more readily. 

We're about halfway through 2nd year and it has indeed been a tough year. Last year I liked the second half a lot better, I sure hope that's the case this year too. 

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!