Thursday, December 28, 2017

Chocolate Sprinkle Sandwhiches

I cannot believe it has been so many months since a post. A quick update...

1) Biking to work is so unbelievable. When we moved across the country, one promise I made myself was that if I had to fly 3000 miles to train in my dream specialty, there was no way I was going to sit in traffic every day. So we found a house that is a good bike-able distance from the hospital. I have composed so many posts in the many early morning and late (and odd, 2 AM post shift) rides home, but none have translated into an actual post. I'll catch up.

2) Time is a great healer. A great equalizer. A great decompressor. When we first moved, everything was so raw, so scary. It stayed that way for a while. That fear, uncertainty, difficulty, and stress was only compounded by having our moving truck arrive a month late, evacuating for a hurricane, and realizing that being a resident is really intimidatingly scary stuff. Also, my son HATED school. And my husband realized finding a job was not as easy as it seemed in a new city with no contacts or networks. But all that is over now.

Which brings me to now...

Some days I feel like super mom. I have prepped meal plan organized food in the fridge, menus written on the kitchen chalkboard, cut up fruits and vegetables to snack on. My kids have their backpacks and lunches packed by the door, clothing laid out on their beds. I'm rocking this mom/resident thing. But then there are days like tonight. I was coming off a really hard stretch of super intense 5 nights in a row. Working over Xmas in a vacation spot is like Target on Black Friday in the ED. So. Many. Patients. So. Many. Drunk. People. So. Many. Lacerations/Holiday Hearts/I left my meds in another state. Just. So. Many. So when I had a "switch day" from nights to days, I slept. Then I made a cake. Then I went out for a manicure. I had no energy for the market, meal prep, lunch making, and homework organizing, so we took a night off. But today, I had an early morning shift, that stretched from "I'll be home by dinner" to "I'll be home after a central line/LP/all my notes." Our wonderfully flexible nanny texted me at 5 pm asking dinner plans. At 5:30, I got a picture of my kids eating their favorite go to snack-for-dinner: Chocolate hazelnut butter sandwiches with rainbow sprinkles, on whole wheat bread. At least it's whole wheat? And the "healthy" brand chocolate butter instead of Nutella?

One thing I am learning as a resident/mom without my family around is that I can't do it all, and I can't pretend to do it all. I have learned to be okay not looking put together all the time (ie: show up to the holiday show post overnight in scrubs), be okay that my kids eat the provided lunch plan instead of a cute bento box, and be okay that I have yet to attend a single PTA function and don't really feel guilty at all.

Hope to post more often,
Boxes

Thursday, December 21, 2017

'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy

I've always been slightly more than casually OCD.  Not the flip-the-light-switch-seven-times-then-tap-dance-thru-three-choruses-of-I-Could've-Danced-All-Night-before-leaving-the-house kind, but more like the picks-stray-hairs-from-my-pillow-before-laying-down-and-always-on-the-lookout-for-dead-bodies kind.  I can't explain away the hair thing, but you try working for the body pickup service contracted to the medical examiner's office of a major metropolitan city for a year and *not* look for corpses on the side of every road and behind every hydrangea.  They're there, people.

Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery.  "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top".  But let me tell you, shit got real when Punky arrived four weeks early.  I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind.  I had no idea that this was even a thing.  You learn some (but not near enough) about post-partum depression in med school.  But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period.  It was absolutely heinous.  I've never been so terrified in my whole life.  I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze.  And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene.  I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four).  I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in.  I visualized her tiny electrocuted body lying next to a wall outlet, no joke.  My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find.  Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time.  And a little bit of me mourned her faux death, so many times a day.

But that actually wasn't the worst of it.  The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it.  It was me hurting her in all of those ways every time.  In the bath tub.  In the kitchen.  In her nursery.  It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind.  The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having.  I was beyond terrified.  I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her.  A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior.  It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple.  They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen.  And he was the one doing it.  On one hand, he just *knew* that he had no desire to harm his wife in the least.  But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?

Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self.  These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)

So, I went back and listened to the episode again, and I felt an immediate sense of relief.  I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard.  However, at least I had some hope that perhaps I could fix this somehow.  So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment.  And, I did.  And doing so was the first step in my journey toward recovery from my post-partum Harm OCD.  And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.

And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues.  Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening.  Gives me the sense of control that I need to feel comfortable and safe.  And then I can go about my quirky day.

Watching a toddler eat peanut butter off the floor of an airport.  Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim.  Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy.  It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light.  And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience.  It was a super gross experience, but she thoroughly enjoyed it nonetheless.  And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house.  There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good.  And the older I get, the better of a handle that I have on my weird brain.  It's actually pretty interesting in here most of the time.........  :0)

Friday, December 15, 2017

My DIY Kitchen Makeover: The Affair Is Over, But It Was Worth It!

Genmedmom here.

Last month, I posted about my crazy DIY kitchen makeover project. Well, we finished weeks ago, and we're thrilled. It just took me forever to figure out how to make before/ after photos. (FYI, the Scrapcollage app is fantastic, very easy to use.)

Our kitchen was perfectly nice. Nice and yellow. Honey oak cabinets and floors, yellow-beige walls. The overall effect was that anyone standing in our kitchen immediately developed jaundice.

Plus, we've lived here for almost ten years, and we've never painted the kitchen. It was time. Farmhouse is in, and so farmhouse we got.

So here we go, Benjamin Moore "Slate Gray" Cabinets and "Hardwood Putty" Walls. My uncle is a contractor who helped immensely with the priming and painting of the cabinets. Kudos to my mom as well, who did a whole lot of Ikea shopping and wall painting with me:

























Our main entryway is the back door leading into the kitchen, and we have no closet there. The freestanding coatrack would get so heavy it fell down numerous times, so we were throwing overflow crap on the floor and a chair. That whole situation had to change. So I bought a cheap standing coat and hat rack at Ikea, which my uncle attached to the wall:


















I also bought cheap Ikea bookcases which we made into storage benches, and my mom sewed removeable pillow covers out of the water-resistant fabric I'd bought on sale at Fabric.com. (Thanks again, mom!) These benches are game-changers: so super-sturdy, and useful:


















We were sick of looking at the kitty litterbox, so I ordered a hideaway one on Amazon that's disguised as a little table, and stuck it under our new location for the message board (which is still a mess, but hey, it's the message board):



I repurposed a particleboard pantry I'd bought at Home Depot for sixty dollars like five years ago and was using to store all sorts of mishmosh. Painted it Benjamin Moore "Apollo Blue", changed the location, and now it holds cookware:












The best part about this makeover is it was mainly done for organization purposes, to help us to de-clutter. It certainly did that, and more. Overall, we are very happy!

We also did the dining room and bathroom, but those are posts for another day.

Got a project you want to tackle? Go for it!

Wednesday, December 13, 2017

When You're Happy Being a Mother, But Not In Medicine

Lately, seeing patients has really taken a toll on me.  The need of parents to "quick-fix" their child that very likely has spent many years getting to the situation that they are currently in (perhaps aggression, depression, etc) has really been weighing on me.  I sympathize with parents of difficult children, I really do.  This past weekend, every time I had an enjoyable moment with my own children (or a moment of peace away from my own children), I thought of the families I see that do not get such luxuries.  It was quite difficult; I was not able to enjoy even the littlest of moments with my family.

In the past, I had spent much time looking into non-clinical careers and I'm at it again.  However, nothing ever seems to be "attainable", even for me, a board-certified physician.  Everything seems that it is outside of my area of expertise, everything except clinical care.  But today, and actually for several weeks, I've just been feeling more and more that I will not last in this career.  I won't make it at the rate it's going.  I need an out, but what? And most importantly, what's an out that will still allow me to pay off my student loans?

This may sound like burn-out to some of you wiser ladies.  And it very well may be, and maybe if I just took a step back and re-assessed the situation I would feel differently.  But the reality is that I disliked medical school, residency, fellowship, and now attending life.  All the while, I told myself it would be better; that I picked a good career; that I had a good job; that I was able to live comfortably with decent hours of work; that at least I didn't hate what I did (I do not hate child psychiatry, when parents are reasonable); and most importantly, I always told myself, "It will get better one day" and one day hasn't come. Is all of my life going to be tolerating what my job is, or will I ever be excited to go to work? What kind of career would that even be for me to be excited to go to work?

So I wanted to ask you ladies.  Have you ever considered a career away from medicine? What did you consider? Why didn't you do it (or if you did, how's it going??)  I know I'm not alone in this.  How can we help each other?

Wednesday, December 6, 2017

Doctors Make the Worst Patients

     I have always been blessed with great health. When I got my life insurance a few years ago, I got the best rates because my blood work was so good. I have always taken pride in that, kind of like getting straight A's or being number one on a test in medical school (ok, that only happened once, and in pathology, my future profession, but it happened! Out of a class of 150!). So you can imagine my despair last Fall in the midst of wedding preparation when my OB incidentally discovered I had hypertension. I'm not talking minor hypertension: my systolic would swing up in the 2 teens and diastolic would go over 100 easily. I know, because I bought a sphygmomanometer (I love that word) for home and work, and became obsessive.

     My OB recommended a family doctor and he prescribed me with metoprolol. I have been long acquainted with beta blockers - learning from a friend in med school that they are good for anxiety inducing situations such as giving talks in front of large groups of people. I applied this knowledge to many situations - that time I was interviewed about the swine flu on TV, going out on excruciating first dates on match after I was divorced. They are great for calming your physiologic response to stress without messing with your thought process. But the same bottle lasted me almost ten years and learning I had to take it daily really upset me. I have always run low, why the sudden change? I learned that I accidentally gained 26 pounds after I got engaged, and was determined to lose half before the wedding.

     That was two months of mania. It didn't seem to me that the beta blockers were doing much - I checked five or six times a day and my blood pressure was all over the map. I was religiously weighing myself every morning - something I normally stay away from doing. I managed to carve my weight gain in half before I got married. I was texting my cardiologist friend and hospitalist friend weekly with my numbers and quizzing them on how to get them down. "My systolic is way over 200! My diastolic is over 100! Should I take another beta blocker? Go to the ED? AHHH."

   About a week before the October wedding when I finally fit in my dress I had bought in June I was like ENOUGH. I made myself stop getting on the scale. I stopped checking my pressures. I was determined to enjoy my wedding and honeymoon. On a follow up appointment with my family doc in January, my pressure was fine. Not low, but systolic was 130, diastolic mid 80's. "I wouldn't treat those numbers," he said, and I breathed a sigh of relief. It was the weight gain, the wedding, the holidays, I told myself. This is over now. I'm back to perfect health.

     So you can imagine my surprise three weeks ago at my yearly OB check-up when the nurse asked to take my pressure again, "These numbers cannot be right. Are you symptomatic? Do you have a headache or anything?" No, never. My OB recommended another appointment with family doc. His nurse measured it twice too. 164/100. "Stop talking take a deep breath let me do it again." 152/90. I looked at her expectantly, "That's not very good, is it?" The doctor in me knowing it wasn't but the perfectionist in me wanting reassurance. No such luck. "No, it's not. Are you stressed?" I told her no, I was on vacation, I spent the entire weekend watching Homeland on the couch.

     Family doc decided to re-start the metoprolol daily. I told him I cannot go back to the manic numbers oriented person I was last Fall. I made him laugh describing crazy texts to mutual colleagues. I said, "This is your territory, not mine. Can we keep it that way, is that ok?" He laughed and told me to come back in six weeks for a physical and we would check it then. I asked him to review my blood work from last fall. He said it all looked great. Cholesterol was fine. Then he said something with utter surprise that filled my bruised ego with pride. "I think that is the best LDL I've ever seen. Yup, I've never seen one lower than that."

     I could think of worse things than having to take a daily beta blocker. It sure made me chill in the face of a large cooking project yesterday - not my area of expertise. I had to call my pulmonologist friend in Philly in a panic when my Instapot wasn't working, but I managed to figure it out without blowing up the kitchen or burning myself. I guess I keep going on as usual - working out a few times a week, eating as normal (my low salt diet attempt last Fall was dismal but I'll keep it in mind) and healthy as possible. Aging is tough, but I guess we all have to do it.

Sunday, December 3, 2017

this little wiggly squirming miracle in my belly

I just stopped on the MiM website when it dawned on me, I haven’t posted in 3 months?!? What in THE world?

I realized it’s because I’ve been holding my breath for the last few months. Putting all of my energy into cooking up a healthy baby. Doing my dag-on best to not stress and submit to this process of life after loss.

I posted in August that we are welcoming our second child. This little baby is now about the size of a butternut squash, just shy of 29 weeks and the third trimester. It wiggles and flips, squirms and dips all of the time. I’m in love.

I’ve been holding my breath. The first 12 weeks I fretted every time I used the bathroom with a prayer of “please no blood, please no blood, please no blood”. And there wasn’t any blood! 4 early ultrasounds later I knew this one was a strong one with a heartbeat like it’s big brother Zo (many thanks to the sweet Ultrasound Tech at my hospital and at my obstetrics office who let me see the baby’s heart beat so many times and hugged me as I cried each time). It’s been strong since it made its first appearance with my linea nigra at 3 weeks.

Balancing part-time work with a first grader and tenure track husband is no small feat. I am so thankful that pursuing medicine has afforded me with the ability to work part-time and still live quite comfortably. I am able to eat delicious, healthy food, attend prenatal pilates class weekly., see a chiropractor for my aching back and hips twice a week as prescribed, volunteer at Zo’s school, be the Parent Teacher Association Co-Secretary, and have days every week to myself with my favorite Netflix series (Supernatural season 4 of 28 and She’s Gotta Have It!). Though I am exhausted at the end of my office days seeing pediatric patients, I am so thankful for those days. I get to see my patient grow. They get to see me grow. And I am now getting advice from everyone about welcoming another baby into our world. I love my staff. I love my patients.

I love this little wiggly squirming miracle in my belly. Here’s to 10 more weeks of us being conjoined. Please stay healthy. Please stay healthy. Please stay healthy. You are so strong. You are so strong. We love you so much. We love you so much. We love you so much.