Guest post: Ready

In high school, I decided that I wanted to be an ob-gyn.  I felt it was my calling, and I bought books to learn as much as I could about the field.  I knew quite a bit, so much so that in medical school, I didn't have to study for my reproductive exams--I already knew everything!  (And have now forgotten it all, sadly.)  In college, I used to drive home tired from the library late at night and imagine that one day this is what it might one day be like when I would be an ob-gyn and get a call from the hospital about a laboring patient.  I loved thinking about it, imagining it, and I would never have believed anyone if they told me that it's not the specialty I would end up choosing.  But I didn't become an ob-gyn--you might ask, what happened?

Towards the end of college, long after I had already gotten into medical school, I started to get nervous about the hours that becoming a doctor, particularly an ob-gyn, would require.  When I started medical school, I regretted what I had done (going to medical school)-- I was angry that I would never be able to be a stay at home mom, which was largely because of the loans I was taking.  I complained for years about how unfair the hours that it would take to become a doctor were.  I chose psychiatry residency because it was the next subject after reproduction that interested me.  Luckily psychiatry is one of those residencies with typically less hours than most other residencies.  For almost a year, I was happy with my decision to go into psychiatry.  I felt it was a good job with good career prospects and not crazy hours.

But when I got pregnant and still had to take 24 hour calls, those feelings of bitterness re-emerged.  "What 9 month pregnant people stay up for 24 hours working??" I thought.  When I finally had my baby, I was so glad to finally get a break and finally get a chance to live that "stay at home mom" dream I'd had for years, even if it was just for 6 weeks.

About three weeks into my leave, I was done.  Done.  Done.  Done.

I hated sitting home all day and watching TV.  I hated waking up late and not having a reason to get dressed up, to put make-up on.  I hated only having my husband to talk to at night, and occasionally my mother when she came to visit.  Some days when my husband was on call, I had nobody to speak to all. day.  So is this the life I yearned for all those years?

I am now three days away from going back to work, and I'm ready.  Ready to exercise my brain.  Ready to communicate with colleagues, with patients.  Ready for it all, except for one thing:  those darn 24-hour calls!

What eats at me just a little... is that maybe I had the wrong idea of myself the last 4 years.  Maybe I've always had it in me to become an ob-gyn, and maybe I sold myself short.  Maybe I was never meant to be the mommy dearest that I thought.  If I didn't hate those 24s so much, I might even consider switching.  But I'll stick with my decision.  With my GOOD job.  And maybe in a few months, I'll be back to crying about how unfair the world of medicine is for mommies like me.

MiM Mail: How do you do it?

Hello Supermomdocs,

I stumbled across your blog when I was trying to decide if I made the wrong choice in choosing an internal medicine position over a dermatology one.  I think it's a fantastic site, by the way.

I'm Jenny, I'm a physician assistant, and currently mom to a furry 4-year-old, 70 lb. boy.  :)  At the time I chose my current internal medicine position, I was leaving a place where I was not treated very well, or respected at all.  So I went with the offer that I felt more at ease with as far as the people I'd be working with.  And so far, I must say, I love every aspect of my job except the work I didn't know I signed up for. 

My patient load here is a lot heavier than my old place, and I see more chronic illnesses than I did at the last place (I saw some follow-ups, mostly acute visits).  I find myself working late, bringing work home, and working on the weekends.  I am preparing to bring this up with my supervising doc, the owner of the practice, but I wanted some feedback from some women in the field, and I thought you all might be able to provide some insight.

The dermatologist doctor has also told me he was looking to hire a second mid-level provider come Spring.  I am tempted, for I feel that derm would not have as much "homework."  Am I wrong in thinking this?  I'd be taking a paycut and possibly vacation cut too, but at this point, I can't be leaving the office at 8 or 9 every day.  HOW DID YOU BUSY DOCTORS MAKE TIME TO MAKE BABIES?!  That is another thing on the horizon.  My husband and I would like to start a family, but we've refrained from "trying," for fear of stressing ourselves out.  So perhaps this is TMI, but we've opted to just try to increase frequency of intimacy instead of plotting calendars and such.  The problem with this-there is never any time!  I'm always working, we're always tired by the time the day is done. 

Internist(s), I feel like part of the issue with my current situation is that it's just the field of primary care.  There's always going to be a slew of labs to go through, and it's never ending.  The previous doctor I worked for never followed up on his labs for months, and then would just ambush them when he took a vacation, or was about to leave for vacation. 

I currently do not take a half day, but I'm thinking about asking for one, to work on labs (so technically I wouldn't be workingless).  I currently work over 60 hours a week. 

Any advice or input would be appreciated.  This is a struggle for me to find a balance between work and home life.  Is it something you still juggle?  Am I just complaining too much?

Thanks for hearing me out.  Again, I'm so glad to have found your site.  Great job!

Sincerely,
Jenny

BEST WEEK EVER!

I've been on vacation this past week.  Since I had nothing pre-planned I decided to make it a stay-cation.  It was much needed, as all vacations are.  This time, I didn't have my typical residency feeling of wanting to emotionally implode prior to the vacation starting.  I was just happy and ready to have some time off as I transition to another rotation.

My husband has demanded all week that I have "me time" and salon time and manicure time, etc.  But, for this vacation all I wanted to do was hang out with my precious girl.  I was literally giddy with excitement planning activities for us to do.  Now that she is almost 3, she is so curious and at a perfect age to do things.  I had prepped her for our week of "adventures" and she was just as excited as I was.  She kept telling people that she wasn't going to school because she was going to hang out with mommy.  Well, we hung out, and with one day to go I can say hands down that this has been the BEST WEEK EVER!!

We went to museums, the library (about 1 million times, its our "spot!"), different parks, we had picnics and did crafts at home - it was AWESOME!  But the even better part about our awesome week of adventures, is that, the thought of going back to work on Monday doesn't make me want to vomit.  The call night before my vacation started we had a few emergent-ish, difficult-ish cases that I felt comfortable with.  The morning after my call, one of my former med students from an earlier rotation, called me aside to help him think through a patient situation.  This call marked the end of my chiefdom at the knife and gun club hospital that we rotate through and I truly feel like I have surgically and clinically matured since I was here a year ago.  It was a great call to mark the start of my vacation.  

Today, at the science museum I ran into a former chief at our program.  He finished the year before I started but was technically in the building on my first day of intern year.  He ran into the group of new interns as he was saying his final goodbyes. He was all smiles as he left the building on his final day of a long surgical residency.  I was right at the door as he was walking out.  He gave me a hug and said "Welcome!" Then he chuckled and left.  I had never seen him again until today.  I re-introduced myself and we did some shop talk as our kids played in the aerospace exhibit.  He was still all smiles and at the end he said, "its long but its so worth it!"

So to summarize, I just had the best week ever, just being a mom.  I am really happy with my career.  And, to top it off, I've witnessed proof of the light at the end of the tunnel.

Happy Saturday!

Beauty in Crisis: the dance of the Pediatric Pharmacist

G is a beloved Pediatric Pharmacist in our hospital. She is thorough yet collegial, encyclopedic yet approachable.

Tonight during a crisis I realized yet again why she is invaluable. I am in the last weeks of my first Pediatric Intensive Care Unit (PICU) rotation. Tonight, like other nights, a very sick patient became critically ill. She needed infusions and doses of medications out of the normal ranges and she needed them fast.

I power-walked to the pharmacy to pick up some meds and I got to watch G in action. Together we researched doses and administration. And then I got to sit back and watch the master at her work. She floated. She glided. All the while silently mouthing things to herself like a dancer reviewing her choreography. She taught me her choreography, explaining why she was drawing up the medication in this way, why she was adding it to a carrier fluid in that way. The entire time I was enraptured. It made the physically and emotionally draining night more manageable and allowed me to step back and see the beauty in this crisis. I saw how the members of the team, including me, worked together to bring a patient on the brink of death back to life.

Guest post: The Leap List

A while ago, back before we decided to be honest with ourselves and cancel even our bare-minimum cable package, I saw a Honda commercial extolling the virtues of the Leap List.  The Leap List, it seems, is a sort of Bucket List of things you’ve always dreamed of doing, except the deadline isn’t death but some other major life event - namely, according to the commercial, having a baby. 

With no conscious decision to do so, my mind began spouting all of the things that have for years floated around in a nebulous wouldn’t-it-be-nice-to miscellany but had never before spooled forth as an actual set of goals with names and deadlines to anchor them into existence.  Yet suddenly here they were, insistently making themselves known.  The list went something like this: run a marathon, learn Turkish (my husband’s native language), write a book.  Go back to Paris, this time with my husband; but first, brush up on my French and put to use some of the books collected on previous visits that have for years sat untouched on my shelf.  Re-establish a yoga practice; this time make it stick.  Ride in a hot air balloon.  Travel, always more travel.

 Less than a year later, with none of these things checked off my list, my husband and I are expecting our first baby.  Fleeting thoughts of unrealized dreams floated through my head as the reality of this new development registered.  But they floated right back out as a new set of goals – a healthy pregnancy, becoming the type of parents we hope to be – set up firm residence. 

Pregnancy thus far has been nothing like I expected, nor has my own casual shrugging off of the list of things that remain undone.  Perhaps it has only served to help me highlight which things I value most and which others will not leave me feeling unfulfilled in their absence.  Or perhaps – and seasoned parents and even I myself one day may laugh at this – I will see that while there is a distinct Before and After to life surrounding the birth of a child, the pursuance of my own life goals needn’t be completely tossed aside.  Perhaps there will actually be time in between and around the diapers and the feedings and the potty-training to dedicate to undertaking the things that nurture me and feed my soul.  I hope it’s not just wishful thinking.

But the realization of one goal has already sprung from the decision to start a family.  When my husband and I decided that it was time, a voice inside me said, Well then you’d better start that blog.  It’s now or never.  I  later learned that at the time of my first post, I was already pregnant.  So maybe, just maybe, there will be a way to find room for both.  And maybe someday I will enjoy that hot air balloon ride with my child at my side.

PICU and the Biting Beast

I don’t know when it began, but somewhere in between finishing first year of residency and starting in the Pediatric Intensive Care Unit (uggghhh, acckkkk, poooo), my cute talking toddler became a biting, hitting, aggressive little beast. Sometimes he’s soo sweet and soo cute and I forget that at any moment, when we run out grapes or he can’t find his motorcycle, things could get very ugly, very fast.

When it’s ugly, he hits, he bites, he smacks. Who? Me, my husband, his favorite friends, his not-so-favorite classmates, his bath toys, his Froggy. Oh yes and when we recently tried to redirect him by holding his hand when he swats at us, he even tried a head butt. My husband and I sat stunned, where does he learn these things?

And did I mention I’m in the PICU?!? It makes everything worse. The guilt I feel about his aggressive behavior is exacerbated by my sheer emotional and physical exhaustion. I arrive home sometime during twilight outdoor playtime only to take him away from his beloved friends and the sandbox. I then clean him up and prepare him for bed while he wails and hits. Daddy pours the wine, puts his headphones on, and begins his nighttime graduate-student-writing routine. The only respite I get is story time, where Zo picks out his favorite books and says, “Sit down Mommy” and pats the couch beside him. Then I rock him to sleep as he cuddles and rubs my ears. After that I sit mindlessly perusing the internet for the countless hours while my husband repeatedly says, “Don’t you need to go to bed, don’t you have to get up at 4:30am?”

I have begun polling friends and have gotten: smack him, give him time outs, redirect him, it’s a developmental milestone, this too shall pass. Knowing that this phase is developmentally “normal” means nothing when I pick him up from daycare for the first time in weeks and his teacher says, “Sorry Miss, but Zo bit a friend, again” as she points to the cherubic chunky boy Zo has taken to like an apocalyptic zombie.

I can now proudly say that PICU is over and I learned a lot. I can also proudly say that Zo has made it 3 days in a row without biting anyone besides his toys, we celebrated at school today with dancing and he seemed very proud of himself. He starts everyday with a new family mantra “No biting people!” It’s the little-big victories; we have at least temporarily slewed the PICU and the Biting Beast.

Guest post: When doctors become patients

I recently gave birth to a beautiful baby girl.  My entire pregnancy was so incredible -- I loved every minute of it!  I never thought for one minute that my baby could have anything wrong with her.  But alas, she was born with a hand deformity that was not diagnosed in utero.  I cried non-stop for days.  My husband would come home from work and cry with me, hold me while I sobbed, "Why our baby?" While I know that this hand deformity will not stop her from becoming an amazing person, amazing daughter, I know she will struggle because of it.  I wish it was my hand, not hers that was deformed.  I wish I could take back whatever I did wrong during my pregnancy.  I wish so many things.

So it started, the doctor visits. Today was our first visit to the orthopedist.  He didn't have any good news for us.  He just said, "We'll have to try to give it function. When we walked out of his office, I was stunned.  "Why didn't he tell us more?  Why didn't he know what else to say? Why didn't he give us a clear answer about what the future holds?"  My husband pointed out that he probably did not know what the future held.  That he probably didn't know what else to say.  That only time would tell what the outcome would be.

I made an appointment with another orthopedist, in hopes of a better and clearer picture of what to anticipate. But I know that probably nobody will be able to ease my mind the way I'd like.

I know it could be worse.  There are children out there with cancer!  With immunodeficiencies. With cerebral palsy.  With all kinds of terrible things.  How lucky I should consider myself that my baby only has a hand deformity.  But I can't consider myself lucky. I just cry and cry, and ask myself, "Why my baby?"

did you take his name?

I think I had already decided to keep my name even before my boyfriend-at-the-time told me his (rather long) surname was old German for "caveman", "neanderthal" or "man who lives in a hole in the ground". I would be lying, however, if that bit of information didn't help solidify the decision.

I got married at age 25, while I was still in medical school. No one in either my personal or professional life gave me a hard time about keeping my maiden name. I thought at the time that most people would assume I had changed my name and we would, at least socially, be known as "The Caveman Family", when children eventually came around.

But that hasn't been the case. People are, for the most part, careful to acknowledge that I do not share the same last name as my husband and children. I should also note that my last name is nothing beautiful itself - my sister describes it as a grunt and has vowed that, should she ever get married, changing it would be the first order of business. Perhaps now it is clear why I never really considered hyphenation. One borderline unattractive name is not improved upon by the addition of a multi-syllabic and even less attractive name.

Wedding invitations and baby announcements are addressed to Me Grunt, Husband Caveman, and Children (1) and (2) Caveman. When told I wont be home for dinner, my daughter will reply "We'll have Caveman family night!", the obvious implication being that my last name would exclude me from "Caveman family night", which is too bad because it usually involves movies, ice cream, and late bedtime. 

I have mixed feelings about this. I guess I just care less about my name now as compared to when I was 25. I think my self-identity would just as intact if I were Dr. Grunt or Dr. Caveman. The work I did in undergrad or medical school would not be wasted if I then practiced under a different name. 

I am not sure that I would make a different decision if I were getting married now (at age 33) and I certainly don't care enough to change it at this point. I am, however, surprised by how wistful I feel when seeing my name separated out from those of my family or when my daughter talks about "Caveman family night". Honey, I might not have given you my name, but that chin dimple of yours? That's from me. 

MiM Mail: Bringing family on the residency interview trail

Hi,
I've been reading MIM since my M1 year, and I'm finally an M4 applying for residency!  Come interview time, I'll have an almost four year old and a six month old.  My husband has a lot of time off between Nov and Jan, plus my mom offered to go with me on any trips my husband can't come on, so we're going to make the interview trail a family thing.  I know I'll be busy with dinners and interviews, but being able to tuck in my three year old and nurse my baby at night will mean so much to me.  Did anyone bring kids along on their interview trips?  Any tips?

Sarah

Reaching (or not reaching) breastfeeding goals

Apparently, most moms who want to exclusively breastfeed their babies for three months fail.

There are all sorts of hypotheses for why women don't reach their breastfeeding goals. But I think we have a perfect sample here of educated women who can accurately assess the positives and negatives of breastfeeding.

If you didn't meet your breastfeeding goal, please share with us why not....

Guest post: In one's element

In his NYT bestseller 'The Element', Ken Robinson argues that we are in our element - doing what we should be doing - when we do the thing we love, and in doing it feel like our most authentic self.

This got my attention. I've often felt that the place I am most me is in the clinic, and I find that somewhat disturbing: how can that be, if my children and closest friends never experience me in that context? I feel I'm less the real me at home - or maybe that's wishful thinking. At any rate, I like myself best at work, and the following description by Robinson of people in their element holds true:

". . . time passes differently and they are more alive, more centered, and more vibrant than at any other times." p21

He suggests that we find ourselves in our element when four things align: aptitude, passion, attitude and opportunity. Because his description of the attitude necessary to find one's element (perseverence, ambition,  wanting something strongly and being willing to exert oneself for it) is, I think, almost universal among physicians, I've 've taken the liberty of replacing "attitude" with "need" for the purposes of applying this to medicine.

And so, the four pieces that fit together when in one's element

1. aptitude (what you're good at)
2. passion (what you love)
3. a̶t̶t̶i̶t̶u̶d̶e̶ need (in the world, that your work fills)
4. opportunity (a position where you can do the work)

I'm a good physician, I love medicine, I provide primary care to refugees, and I work in the only such clinic in the province. Perfect score.

Thinking over other positions from which I've moved on, or avoided, or wished for, I can identify which of the above was missing. I lost my passion for work in Vancouver's downtown east side when I came to view the work as palliative. In private practice in an affluent neighbourhood of Vancouver's worried well, the preponderance of women complaining that their hair had lost its lustre left me feeling my work wasn't filling a genuine need. I've avoided high acuity settings (emergency room, deliveries) because I haven't kept up those skills. And I don't work in a medical practice where I'm given paid time to write because I haven't found the opportunity.

I do think that health care workers have an advantage in finding our element in that the need is so obvious in our work. We care for sick people; what's more basic than that? It's less tangible for people like my husband, who works in business software. And I think it's more difficult still for artists to define and defend the need for their work.

The concept of opportunity trips me up a little.  My current job, and the one before that (HIV clinic) were both positions that I did not seek out. They were offered to me. Sometimes I second-guess myself: isn't accepting an opportunity a passive choice? Picking the low-hanging fruit? Shouldn't I be actively pursuing the perfect, hard-to-get position, chasing it down? (But what would that even be?)

Maybe we can increase our work satisfaction by changing what fills those four criteria. If I were to increase my skills (say, learning some basic surgical skills like appendectomies) and set up shop where there is greater need (rural Zambia) would I be even more satisfied? Perhaps that's why so many 50+ physicians do exactly that.

I like the idea of applying this framework to job considerations in the future. I've been dipping my toes into adminstrative work. There's a need for (young) medical administrators, and plenty of opportunities. But I haven't had enough experience yet to determine whether I have a passion for it, and whether I have (or can develop) the necessary skills. Whether I would find myself in my element there remains to be seen. At least I know what to look for:

"One of the strongest signs of being in the zone is a sense of freedom and of authenticity. When we are doing something that we love and are naturally good at, we are much more likely to feel centered in our true sense of self - to be who we feel we truly are." p90

And you? Are you currently in your element? If not, which is missing: skill, passion, need or opportunity?

[cross-posted at www.freshmd.com]

Guest post: Men in Surgery (A Satire)

As a woman in surgery, gender issues come up frequently.  It’s something that really weighs on my mind, and I want to take this opportunity to set the record straight.  Gender equality matters, and we all need to do our part to even the playing field in surgical specialties.

The fields of sewing and knot tying have historically been dominated by women.  For thousands of years, everything that was sewn by a human was sewn by a woman.  In the modern era, women are taught from a very young age to handle needles and thread, and go through rigorous afternoon craft sessions where our work is critiqued and judged until it reaches a level of precision suitable for a surgeon, or at least enough to hold our handmade pillow case together.   When we wanted to cement our social standing with our best friend, we were forced to undertake a tedious and tiresome knot tying ritual known as “making friendship bracelets.”   The intricacy and precision of the bracelet was believed to be reflective of the commitment to the friendship, forcing BFF’s to engage in a never ending competition to out-tie and out-braid their brightly colored mess of threads into a work of art. Our hands would ache, our eyes would water, and all we could think was  “one more knot,  just one more knot….”  Looking back at my Girl Scout experience, it really could be renamed “Surgical Technique 101.” Except there would be less cookies.

Despite our natural and obvious dominance of the skills required for surgery, women must actively work to welcome men into the field of surgery.  This revolutionary and controversial viewpoint is not embraced yet by the mainstream surgical audience, so allow me to make my case.  I truly believe that there is a role for Men in Surgery, and that, over time, we will come to find them a truly valuable part of the surgical community.

Despite their obvious deficit in sewing and knot tying based on childhood experiences, men can in fact develop these skills if given proper time and training.  A patient teacher and an abundance of motivation must be present in order for these men to make up lost time, but it is possible.  There’s a growing body of evidence that video gaming at a young age improves laparoscopic skills.  So we should remind them that their wasted youth, devoid of knot-tying, may still have some usefulness.

Another obstacle that men must overcome is their natural urges and biologic shortcomings which often distract them from surgery.  Their frequent requests for time off to attend major sporting events, improve their golf game, or simply to fart and scratch themselves at home, must be met with tolerance and understanding.  The biologic differences between women and men cannot be changed, but we must work to adjust our expectations and work schedules to account for these inconvenient and unexpected interruptions to the work flow.

The operating room can be a hostile place for men in surgery, and as women we must actively work to reform this.  Both circulating and scrub nurses are almost uniformly female, and careers in anesthesia (including CRNA’s) is rapidly trending toward a female predominance.  Many scholars have postulated that men are simply no longer a relevant part of the operating room culture.  The sisterhood that has developed often alienates men. They are kept out of the social circle by their lack of understanding of our reality TV show and Glee references.  Metaphors related to the contestants on the Bachelor often go over their head  and they find themselves lacking a common language as their female peers.  As women in surgery, we must actively reach out to these men.  Take time away from the operating room to review common metaphors which they may overhear.  Answer their questions about Grey’s Anatomy in a honest and respectful way.  It’s not their fault that they cannot participate in the female-dominated operating room culture- they were simply raised differently.

Change must come from the leadership in our field.  There is no room for gender bias in the hiring process. Science has proven repeatedly that women tend to be more detail oriented, more patient, and better at resolving complex emotional and relationship issues- all of which are highly valued in choosing which surgeon to hire for an open position.  But I urge my colleagues to consider some of the lesser known traits of men which may in fact be just as valuable.  For example, I bet you didn’t know that men can lift very heavy things.  Additionally, men tend to have larger hands.  While this makes them struggle in many of the fine and delicate aspects of surgery, it could be seen as a positive when considering stool disimpaction.  Lastly, remember that men have feelings too.  They just might surprise you with their compassion and grace.  Oh yeah! And they are tall.  Think of all those dead light bulbs they could change.

Allowing men to become surgeons enhances the diversity of our work force, which I’ve been told is a good thing.  If we hope to remain a vital and relevant field amongst medical specialties, we must embrace all gender equally- even the ones with external genitalia.


-A happily married PGY-3 general surgery resident
.

My Brain Doesn't Work Like This: chronicles of an aspiring primary care provider in the PICU

I am in the throes of my first Pediatric Intensive Care Unit rotation. I was shocked that by Day 2 I wanted to run away and hide under my covers. Shocked that soo early into the rotation, I was hitting  the snooze button soo many times that my husband who sleeps through anything (except my occasional snoring and Zo crying) ordered me out of bed.

I am NOT that Resident. I’m not the one who hates residency. On most days I am so excited to serve patients and work with amazing colleagues. But I fear I have become THAT Resident. The grumpy one. The one who doesn’t want to be here. The PICU and its acuity has brought it out. Stealing the “oomf” from my life. Encouraging family members and friends have given me pep talks as I weep into the phone about how draining dealing with such critically ill children and their families has been; children with devastating neurologic damage or those with genetic syndromes with abysmal prognosis.

And top off the emotional heaviness with the fact that my brain just doesn’t work like this! The Attendings and Fellows are amazing. Without a single written note, they can recall doses of infusions from the prior week, what the Neurologist or Infectious Disease Consultant said 8 days ago, what I and other Residents said at every moment of the day, and various other details that I cannot ever imagine myself being able to recall without very detailed notes. Ventilators and infusions and cardiac physiology after a specific surgery, my brain screams out, “give me 5 minutes, 5 more minutes with the Peds In Review or Up-to-date and I promise I’ll have a detailed explanation!” but no, I have 2.5 seconds before I get the “you are dumb, hush up now” look. And of course I am now tachycardic and sweating and feeling hypoglycemic in the third hour of rounding.

I have tried to somewhat let myself off of the hook. I will never be a great PICU Resident, but I’m getting better and might even be pretty darn good by the end, nor do I endeavor to become a great PICU Attending. As an aspiring primary care provider and maybe even a Nursery or part-time ER Attending I will know how to keep critically ill patients alive until the Intensivists arrive. And even now, I am keeping my patients alive. I am learning how to more efficiently and effectively manage their acute issues and prioritize. I have come up with some good ideas and my brain works really well sometimes. But feeling adequate most of the time, just doesn’t feel good. And then my brain screams that it just can’t work fast enough to be excellent in this setting. And I acquiesce because it’s right and this is something I’ll just have to come to terms with as I snuggle even more under my covers while pressing snooze one more time. Because now more than ever, my brain needs its rest.

Night Float - The Bad Beginning

A few years ago my family medicine residency program, realizing that duty hour changes(*1) were coming soon, decided to start a night float system (*2).  The new duty hour limits were not in place, so residents worked 14 hour shifts for 14 nights in a row (*3).  (Then we got one day and one evening off in preparation to return to work - on day shift.)

In case you were wondering, this was a horrible idea.

Just a few generalizations about night shift - when you work nights, you never, ever feel good.  You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing.  You feel disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday.

I know that six nights in a row can be difficult and taxing but 14 were just monstrous (*4).  By the second week, I started to lose perspective.  I was crying every night on the way to work.  I left home with my child in tears as well and my husband frustrated at being thrust into single parenthood with a very angry roommate.

I was angry – initially at the program directors, but gradually at the nurses, the other residents, and ultimately the patients.  I wondered why I was getting so many stupid pages, and why none of the other residents could do their own work without dragging me into it, and mostly why all these stupid people had to choose tonight for their shortness of breath/chest pain/drug overdose.   Not a good attitude.  Add to that the directors’ insistence that no one ever, EVER nap on nights even if all the work was done (“Because you have all DAY to sleep”) and their refusal to consider putting a day off in the middle (“Because it would disrupt the sleep schedule” (*5)).  By the end of that two weeks, I honestly hated my program and was wishing heartily that I’d gone with my second choice.

Then I reverted back to days and life improved tremendously.  I still had a chip on my shoulder for a while, though.

*1) No longer allowing interns to work 30 hour shifts.
*2) “Night Float” means that a handful of residents take care of the hospitalized patients all night so that no one has to work a 30 hour-shift.
*3) Yes, this means a 98-hour work week.  As long as they averaged the first week of night float with the week before it and the second week of night float with the week after it (and each of those weeks were electives), we still satisfied the ACGME requirement of <80 hours per week average.
*4) I don’t want to sound like I think I had the most difficult job in the world –  I just want to make a few points about how badly it went for me personally.
*5) By this logic, no one should ever take weekends off, because most people sleep in on those days thus disrupting the sleep schedule.  However, the program directors did not forego their own weekends off.

MiM Mail: Regret going into medicine?

Dear MIM,

Hi there,

I am a 2nd year medical student, and I have a question for all the MIM's out there: Do you regret going into medicine?

The statistic has been steady around 50% for several years. This seems like a large percentage to me! I know that as humans, we tend to minimize challenges that we have overcome. For example, I remember there were so many times in first year when I felt like my world was collapsing, and that I would just never get through it. But when I did, I oftentimes found myself unjustly minimizing the past, saying "It wasn't all that bad."

So, I'd like to hear your authentic thoughts and reflections:  Do you regret going into medicine, why/why not?

Sincerely,

Andrea C.