To my patient

I had started a thankful list, a real one from the heart. And yes, I am thankful for those things. But then the precarious balance of my life got upset, so new post.

I got shingles - it’s the thing that has upset my life balance. Stupid, burning shingles. My pain isn’t too bad but the burning isn’t affected by pain medications. Occupational health cleared me to work as long as the rash was covered. So to my next shift I went.

It was the shittiest shift I have had in a long time. By the end, I was hating everyone and everything but especially myself and my job. It was a shift where I felt like I couldn’t or didn’t help anyone. Most of my patients didn’t need a doctor, they needed better coping skills and over-the-counter remedies and time. 

But my last patient, I need to thank him. He needed an Emergency Doctor for his problem. He changed my whole day for the better. His sense of humor about why he was there and interaction with his wife reset my outlook for the day. And I could and did fix his problem too. Spiritually and doctorly, I was better. 

That patient refilled my compassion cup. Usually that’s the job of a million little things: bad television and sports, beer and coffee, my Sleep Number bed, Mirena, goofy t-shirts under scrubs, nail polish of extraordinary colors, my Chuck Taylors, t-shirts and jeans on off-days, Twitter, my KitchenAid mixer, and the color orange. Or the job of some big things: Hubby and The Blurs.

So thank you, sir and your lovely wife, my next shift was much better because of you. My balance is restored (mostly, because stupid burning shingles are still here).

The Gauntlet

We have entered the time of year I call The Gauntlet because I feel like I am running through one. Historically, this refers to two rows of men with sticks and other weapons that who beat the person who runs in between rows. In my house, it refers to early October to late February. During that time, we celebrate Halloween, Thanksgiving, Hanukkah, Christmas, New Year’s Eve, both Blurs’ birthdays, the Super Bowl (yes, it is as important as these other holidays), Valentine’s Day, and my birthday. It seems most of the kids in Blur1’s kindergarten class were born in the fall. We have soccer for both Blurs in a fall and basketball for Blur1 in the winter. In addition, holiday schedules for me and the busy season for Hubby where he works many Saturdays. Between now and December 1st, with normal activities of school, work, and religious school, we have something every day except the seven days I took off for Thanksgiving to travel to my parents’ house; everyone knows this kind of vacation is no vacation.

By the time, we hit February, I am sick of cake, having made and eaten several because the Blurs’ birthdays are 10 days apart and want cake on their actual birthday as well as at school celebration and at their party. For Valentine’s Day, I ask for flowers only as we still likely have Christmas candy (and to be honest, Halloween candy too, if I didn’t go on a rampage one day and throw it all away) still around. For my birthday, I ask for dinner at my favorite local restaurant and I make my own cake (not sad, as I love to bake and am ready for cake again after 3 weeks of no cake) which we eat with the Blurs before going to dinner without them.

I cope mostly by overplanning. I have a Word Document that keeps me organized - presents bought, menus from prior years, locations for birthday parties, etc. I make great use of my freezer and pantry and have already started buying for special dinners and foods. My Halloween costumes (this past weekend), candy (the minute it was put out) and plans (annual party) are all set. I start looking for Hanukkah-Christmas presents in July, start buying August and currently, I’m mostly done with that shopping for the Blur1 (Blur2 being the 2nd kid is always harder to shop for). I know what I’m doing for Thanksgiving (traveling or not) in July and if I’m not traveling, my Thanksgiving dinner is bought the week they put those turkeys out in the grocery store. I have a gathering on trick-or-treat (kid friendly dinner with a couple families at my house and then the kids trick-or-treat in my awesome neighborhood) so that I can decline all other Halloween parties. I buy birthday presents at Christmas sales, usually the week after Christmas but sometimes before. The birthday parties are booked around Thanksgiving but actually take place late January. If we do something for New Year’s Eve (rare because I usually work), it has to be low-key and kid-friendly and in years past has involved the same families as the Halloween trick-or-treat party.

I am somewhat envious of those of you who can just go with the flow and buy Christmas presents on Christmas Eve and “let traditions happen”. I get anxious. I had all these wonderful traditions and my mother made it look so easy. Like my father, it never crosses Hubby’s mind what presents the Blurs should get or what to serve for Hanukkah dinner or even to buy groceries for said dinner. Hubby, for his part, does a lot of the day-to-day home stuff - laundry, dishes, bathtime, bedtime - so it’s not like he doing nothing. The Blurs do get time with us, which I know you’re thinking they want more than a fancy dinner, but they do have to eat.

So if you see me in the store this week, buying Hanukkah supplies (or lamenting my uber-Christian area has Christmas stuff out but not Hanukkah stuff), buy me a Starbucks, because you know I need one.

Going to the Doctor

Recently, I took Blur2 to the doctor. He’d been having a diaper rash for weeks. Initially, it started out like any other rash and my usual treatment (40% zinc oxide) worked. But weeks later, it was worsening and my treatment wasn’t working like it should if it was a typical diaper rash. So we went to our doctor.

I love my/our doctor (and the whole office) but I hate going for these minor ailments. As an ED doc, I knew what the next step was likely an antifungal cream; as a Mom, I didn’t want to be treating my own kid. Some of my colleagues and doctor friends would have just called in their own prescription. I feel dumb sitting there, telling the story, just really wanting reassurance. I do have a small supply of medications and laceration repair supplies at home for minor things; we don’t go for every URI/fever/etc but when things aren’t going how I expect, we go to the doctor. When Blur2 went through ear infection after ear infection, I kept hauling him into the doctor, to get them all documented because I was afraid he was going to need tubes - he ultimately did.

We have a separate Pediatric Emergency Department that is staffed by Peds EM and plain EM doctors. I do about 20% of my shifts there and most of them on the overnight shifts. I remind myself of my feelings that I have sitting in my own pediatrician’s office and teach my residents that the parents are often just looking for reassurance - that this fever is a virus, that this GI bug will pass, that this rash is not a serious rash, that the simple closed head injury does not need a CT scan - and guidance as to what to look out for next that would mean something serious.

I got my reassurance and prescription for an antifungal cream. And I feel better and so does Blur2.

When do you take your kid to the doctor? What’s your threshold? What do you take from your personal healthcare experience and add to your practice?

Change in Schedule

As an Emergency Medicine physician, I work weird hours, 8-10 hours at a time. I prefer the evening and overnight shifts for lots of reasons. This complicates my “outside life,” as I call my home life and I need a small army of babysitters and the daycare to accomplish this. This summer, Blur1 is out of school for the first time (he just “graduated” pre-k) and we’ve added camp to the mix of my arsenal of childcare. With camps and school and daycare, why do I need the babysitters too? Hubby’s job starts at 5a and he has to leave by 4a. Babysitters come to my house at 4a on nights I work overnights and he has to work; I pay ridiculously for this.

Having done this for 10 years now, I have figured out what I need to do the overnight, schedule-wise. 7a wake up the morning of the first one (The Blurs’ fault), do a heavier than normal workout, a pre-shift nap (1 hour or less on the couch), overnight shift (11p-7a), get The Blurs to school/camp/daycare, get to sleep by 9a, wake up by 3p, maybe preshift nap, and repeat until the overnights are done. I abstain from alcohol this entire time and don’t worry about my diet or working out. I also try not to schedule anything important for the morning-early afternoon hours because I know I won’t make it. Sometimes, before the 3rd or 4th overnight, I’ll go into work early and get some administrative or academic things done, especially if I’ve flipped good or have a pressing deadline. After the last overnight, I have a beer or two with dinner and only one cup of coffee when I first get up to help reset me to going back to days. With this regimen, I flip back and forth from days and nights as easy as one can.

For the most part, this regimen has worked with The Blurs and Hubby. They are at school or work while I sleep and vice versa and we spend our evenings together. However, this summer has put a cramp in our schedules. School is out and camp doesn’t cover the entire summer. I have had to adjust my routine and it sucks. This week I had an isolated overnight but no childcare for Blur1 during my prime sleeping time. I tried taking a much bigger nap preshift and it worked by giving me 2 additional hours of feeling awake after my shift. Too bad I needed 5-6; Hubby can’t get home until 11a at the earliest for special things and this wasn’t one of those days. The shift happened two nights ago and I’m still hurting. I know what I need is more sleep but I also know that is not going to happen.

I am curious how others cope when their normal schedule, abnormal as it may be at baseline, is disrupted. Do you have things in place to help you adjust? I thought 10 years would have been enough to figure this out but The Blurs keep adding new wrinkles I never previously considered.

Ps. Those of you with older kids than mine (5 & 2 yo), what wrinkles should I be on the lookout for?

MiM Intro: EMMomma

I am an Emergency Physician and Medical Toxicologist practicing in a large academic center in the only tertiary care and level one trauma center in my region. My path here was not typical: undergraduate degree in bioengineering, did not get into medical school the first time around because GPA was "too low" (thanks, bioengineering!), worked for a year using my bioengineering degree clinically, got into medical school, did not match in EM and spent a year as a surgical preliminary resident, got into my first choice the second match go-around, and then did a med tox fellowship. I am at my first real, non-moonlighting job. I prefer evening and overnights shifts and take call for toxicology about 10 days a month. I have academic duties and I love teaching, especially in the classroom or small group setting. My research is focused in toxicology but not a very large part of what I do. I will likely never be tenured and I'm okay with that.

I never wanted to be a mother the way most women seem to want to; I wanted a career in Medicine since always. I decided to become one when I realized Hubby was The One and for him, it was an unspoken deal-breaker. Now I have two adorable boys, Blur1 who is 5 and Blur2 who is 2. Blur1 was born during the first year of my fellowship and was a relatively easy pregnancy. Blur2 was within 18 months of my first real (and current) job and while I was never at actual death's door, I had a hard second pregnancy. I had to tell two relatively new bosses that I was pregnant and I've never taken a written board exam not pregnant.

I would not be where I am without Hubby. He is very much not medical and blanches as some of my stories from work. He has an unusual job that requires early morning hours but unlike EM, they are generally Monday-Friday. We split the household stuff and kid stuff along our strengths and who's available but truth be told, he does more because my shifts are often when the kids are awake and not in school. Currently, we are focusing on my career so we are here, in The South, as transplanted Northerners. We are hundreds of miles away from family so we use a combination of daycare, school, camps, and a small army of babysitters who have to come to our house some days at 4 am (yes, 4 am). We have four Google calendars to coordinate Hubby's, my work, my personal, and our family's schedule; I imagine the kids will each get their own calendar in the future. We do most things as a family, including grocery shop, and we're a bit sports obsessed.

I recently realized I do not do anything for me, as a person, on a regular basis. I enjoy Social Media but primarily use my accounts for education (FOAMed supporter) or keeping in touch with friends and family. I love to read but with The Blurs, that is hard. I bake and cook but there is only so much food we can eat. I started working out more but I view exercise as a necessary form of torture. I was looking for a hobby or something to call my own that is not work, Hubby, or Blur related when this offer from MiM came along, which means the thing I call my own will be my thoughts on work, Hubby, and the Blurs (thanks universe). I have been reading MiM since the near beginning. During my first maternity leave, I had a hard time alone with Blur1. I found momblogs and medical blogs. I found MiM through one of Fizzy's cross-posts. I don't follow many of those blogs from those early days anymore but they got me through maternity leave(s) and early motherhood and career and made me realize many of the things I felt and thought were normal. Now I hope I impart this feeling of normalness to my residents, colleagues, and MiM readers.

And in response to Cutter, I would do it all again. Definitely the medicine. And Hubby. And the Blurs.