A Day in the Life of a Neurosurgeon – SERIOUSLY?

6:00 am – Out of bed, to the shower

6:35 am – Wake up 11 yo son, remind him to take ADD medicine this morning

6:40 am – Feed 3 hungry cats, out the door to work

7:00 am – Sign and update day’s surgical H&P’s, type an overdue office note into EMR so procedure can be precert’d for Friday

7:10 am – Breakfast, grits and poppyseed muffin, with premed student who’s shadowing this month

7:30 am – See first surgical patient in preop, sign chart, dress in scrubs

7:45 am – Call medical records to assure them I did the overdue discharge summaries last night and I’m back on staff

8:00 am – Do first case, small outpatient procedure

8:40 am – Talk with first pt’s family, see next patient in preop holding, write postop orders, handwrite prescriptions since EMR printer not working AGAIN

9:00 am – Start next case, 2-hour outpatient procedure.  Get page about emergency cerebellar stroke pt en route to ICU from sister hospital, need to consult

9:30 am – Review films of stroke pt during short pause in surgery, obviously needs emergent craniectomy.  Book case, give anesthesia instructions while operating.

10:30 am – Still operating on pt #2; get paged about another consult, not emergent but needs to be seen today.

11:10 am – Finish case, stroke pt not here yet.  Speak with family, write postop orders, decide to proceed with next case (1 hour inpt surgery) while waiting for stroke pt

11:40 am – Start case #3 after difficult awake fiberoptic intubation.  Play Christmas music to improve mood.  Get paged about consult #3 – brain mass.  Start getting irritable, since this was supposed to be a short day (get home at 6:30, actually see family and get dinner made, start decorating tree we brought home on Saturday).  There goes any chance of getting home before 9:30 AGAIN, on a day I’m not on night call.

12:45 pm – Finish case #3, talk to pt family, write postop orders.  Run upstairs to see stroke pt.  Awake but with ominous “pressure” headache.  Discover the internist started him on blood thinners 2 days ago (including Plavix), and he had a dose this am.  Delay emergency OR so platelets can be transfused. 

1:15 pm - Cancel last 2 scheduled elective cases to accommodate emergency.  There goes Dec 18^th’s light schedule.  Soothe angry patients who have to be fixed before their deductible starts over Jan 1.

1:30 pm – Field call from our other hospital’s trauma committee chief, chewing me out for taking too long to see a trauma patient in their ER two weekends ago on call.  Explain that when I got their call, I was operating on the day’s second emergency case in the other town and couldn’t leave that patient on the table.  Called partner for help, who wouldn’t come in.  After finishing case, drove straight to ER 30 min away at 11:30 pm after operating since 8:00 am. Got stopped by police for speeding. Took pt straight to OR, operated until 4:00 am.  Pt survived and had great outcome.  “Oh, okay, I guess the circumstances were understandable.”

 

1:45 pm – Drop by doctor’s lounge for a cup of soup while platelets are being prepared.  Watch news about health care reform.  Wonder how many hospitals will have to close with Medicare cuts, and how many physicians will be able to stay out of hospital employment situations.  Realize there’s nothing I can do about it.

2:30 pm – Pt rolls into OR.

3:00 pm – Begin emergency surgery.  More Christmas music, reminding me I haven’t done any shopping or even thought about what to get for which people.

4:58 pm – Still operating.  Get paged about consult #4.  On call partner takes over at 5:00 pm.  Hospital called him first, but he told them to call me.

6:00 pm – Finish emergency.  Speak with family, write postop orders.  Review films on postop pt in rehab with new leg pain.  Can’t tell if his graft has migrated.  Order CT scan.

6:15 pm – Change out of scrubs, see patient with brain mass.  Order additional testing, type consult note.

7:00 pm – Answer text from husband to tell him I won’t be home for dinner AGAIN.  Attach sad emoticon.  Advise him to use olive oil to make couscous for the vegetarian exchange student who lives with us during the week.  Remind him to make sure son takes anxiety meds tonight.  Husband texts back that son only got sent out of one class today for disruptive behavior.  Progress.

7:05 pm – See consult #3, pt with back pain.  MRI films aren’t here, instruct pt’s family to bring tomorrow so we can make decisions.  Type consult note.

7:45 pm – Field question from floor nurses about a postop patient, preventing the need to disturb the on call partner.

7:50 pm – See consult #4, pt with back pain.  Explain to family why I didn’t get here earlier.  Discuss treatment plan, not surgical.  Enter orders and type consult note.

8:30 pm – Check on craniectomy pt in ICU.  BP is 210/130.  Start Cardene drip.  Otherwise doing well.  Hug family member.

8:50 pm – Stop by office to check messages.  Ignore inbox on my desk (known to my staff as “ Mount Surgeon .”)  Review To Do list, realize I can’t mark off a single item.  (There are 18.)

8:55 pm – Glance at call schedule accidentally, reminding myself that I’m on call Christmas (Thurs-Mon) and on backup for New Year’s.

9:00 pm – Rest for 5 minutes to read this blog, am inspired to write this guest post.

 

9:20 pm – Start wiping away tears as I think about what I’ve just written.  I used to love my career, but I am realizing how sick and tired I am of this workload - of not seeing my family, not being ready for holidays, using weekends to catch up on charts… of being dumped on by partners and pushed around by insurance companies.  I can’t remember what I used to do for fun, and I can’t figure out why I’m still getting out of bed for this, day after day.  Why would anybody want to have a day like this, or worse, 5+ days a week?   I know, it’s supposed to be hard, and the culture of neurosurgery is to suck it up and avoid asking for help, because that’s a sign of weakness.  Maybe my fellow residents were right after all, and I’m just lazy.  Maybe I just need to finally reconsider my options and decide whether this has devoured enough of my life.

 

GCS15

 

Day in the life of a physiatrist

Note: I am a PM&R clinical and research fellow.

5AM: Melly crawls into our bed and the kicking commences. If her head is on our pillow, how is she still able to kick me in the ear?

7AM: Alarm goes off.
Me: "I have to shower."
Husband: "No, I have to shower."
Me: "Goddammit."

7:20AM:
Me: "Melly, would you like to sit on the potty?"
Melly: "No."
Me: "If you make on the potty, you'll get a treat."
Melly: "No, I'm doing something."
(She's a very busy girl.)

7:50AM:
Me: "Melly, it's time to get off the potty."
Melly: "No."

8:10AM: Day care drop-off.
Melly: "Mommy, I don't like day care. I want to go home."
Me: "You can come home later."
Melly: "No, NOW." [tries to slip out the door]

8:20AM: I arrive at my bus stop. Bus is just pulling away from stop. I am waving my arms and yelling, but it doesn't stop. I am certain everyone on the bus sees me and is laughing to themselves. If I am feeling particularly limber, I chase the bus down at the next stop.

8:45AM: Arrive at work, pretending I've already been there for the last fifteen minutes.

9AM:
Patient: "My back hurts."
Me: "I think you might benefit from a course of physical therapy and/or injections."
Patient: "Can I have Percocet?"
Repeat x infinity

11AM: EMG time
Me: "Please relax your arm while I stick this giant needle into it and move it around."
Patient: "Gaaahhhhhhh!!!!!!"
Me: "OK, you're not relaxing."

1PM: Work on IRB application during lunch, while fantasizing about a long ago, simpler time, before I knew what the hell an IRB application was.

2PM: Research meeting
Colleague #1: "Research is frustrating."
Colleague #2: "There are many barriers to doing research. Let's discuss these."

4:30PM: Head home.

5PM: Arrive at daycare. When I get there, all the remaining kids crowd around the door, crying out, "Mama!"
Me: "Time to go home!"
Melly: "I don't want to go home. I want to stay here."

5:10PM:
Day care worker: "You know, Melly really loves babies. You should have a little baby brother or sister for her to play with."
Me: "If she agrees to take care of the nighttime feedings, then no problem."

6:30PM: Dinner. For years, we used to eat in front of the TV, but now my husband wants to eat at our dining table and have "family time." Loser.

7PM:
"Melly, would you like to use the potty?" vs. "Don't worry, we'll clean up the pee on the floor."

8:30PM: Melly's bedtime. I lie next to her in bed and generally fall asleep myself, waking up 1-2 hours later, completely disoriented.

11PM: Watch one of a selection of TIVO'd programs, including The Office, 30 Rock, Parks and Recreation, Top Chef, South Park, or Glee. In the meantime, I prepare lunch for the next day for me and Melly.

11:30PM: Bed time for real. I drift off to the sound of my husband's CPAP machine.

A Day in the Life of a Part-Time Pediatrician

I am a pediatrician working part-time and mother to a 4 month-old and a 6 year-old.  I work 3 days a week.  My husband is a physician working full time.  Below is a typical work day.

 

5:15 AM Wake up, try to sneak out of bed without waking co-sleeping baby, shower, get dressed

5:45 AM Eat breakfast, take a pill of lecithin to prevent plugged ducts (I must hold some sort of record for having the most number of plugged ducts by 4 months post-partum)

6:00AM Call hospital to find out how many newborns to round on then call other docs to come in if reinforcement is needed

6:30 AM Get to hospital and round

7:50 AM Pump in NICU pump room while reading Us Magazine

8:20 AM Drive to clinic and start seeing clinic patients

12:30 PM Done with AM clinic, answer Mommy calls, Pump, drive home to kiss baby a million times and have lunch

1:30 PM  Start seeing clinic patients

4:00 PM Pump

5:30 PM Done with seeing patients, answer Mommy calls

5:45 PM Pick up 5 year-old at After-School program

6:00 PM Make dinner (I have help with making dinner on work days), play with baby, help 6 year-old with homework, wonder why first-grade homework is so demanding, try to keep baby awake until hubby comes home

7:30 PM Baby is now irritable and wants to sleep NOW, hubby comes home and spends a bit of time with baby, I put baby to bed

7:45 PM Eat dinner

8:45 PM Hubby and I help 6 year-old floss, brush, pick out clothes for next day

9:00 PM Pump then time to relax!!!  TV, internet, read for fun

11:00 PM    Bedtime

1 or 2 AM     Baby up to nurse, change diaper

3 and maybe even 4 AM     Baby up, sometimes I nurse, sometimes I don't and just let him settle down on his own, depending on how tired I am

 

Yes, I am exhausted but feel so privileged to be able to work part-time.  On my non-work days, I get to play with my kids all day long.  It is truly having the best of both worlds.     

 

 

An Average FD Weekend

December 5 and 6, 2009


I am an assistant professor in the family medicine/osteopathic manipulative medicine department at a medical school. My job includes teaching on campus and two days of clinic per week. I do not work with residents or do hospital work at this time.

0530: Hit the snooze.

0600: Get up, shower, dress, meet Husband in the great room where he is feeding Daughter breakfast. Have fifteen minutes "share time," a luxury in our marriage.

0730: Pull into parking garage of local hotel which is hosting the winter cme program sponsored by the medical school for whom I work. This is the final day of the program. I am both presenting and moderating today and must stay through the last lecture.

0745: Have a frightening conversation with an elderly family practice doc, retired, who "never believed in mammograms. " Wow.

0755: Cardiologist thought he was to speak at 0800, my speaking time, and he has to get his son to a soccer thing. I trade spots with him because I'll be here all day anyway.

0845: I give my lecture on EMR (history, political stuff, choosing and implementation). To my surprise, it went very well and was well-received. Spend rest of the day basking in the glow of good feedback.

1200: Had to cut the financial planner's discussion short as it was clear he was overtime and wouldn't be stopping anytime soon. I don't feel too bad as it was basically a sales pitch. I apologized profusely to him and the audience and he kindly left the room. I'm pretty sure I see his tail tucked between his legs.

1300: Final lecturer finishes and I realize his area of interest is mine, too. We briefly collaborate and agree to start a project together, trade contact info. I realize my self-imposed deadline to identify an area for my academic research by the New Year has been met. I give myself an internal high-five, which may or may not feel like a Kegel exercise.

1340: Fill up gas tank, decide to go to WalMart, closer to my house, rather than Target, closer to the gas station, for my quick errand of getting pantyhose.

1400: Leave WalMart SEETHING that they no longer carry Just My Size. Queen size is the biggest they carry now and for my height that means no heavier than 185. Am I the only obese WalMart shopper? Hmmmph! Go through Taco Bell drive-thru as I'm sure a taco will ease the psychic pain.

1415: Back at Target, telling Sister via iPhone about the WalMart incident. She asks me to pick up panty hose for her, too, while I'm there. She too has her work party tonight.

1500: Now at Catherines all the way across town because Target also doesn't carry Just My Size. Picked out a festive party blouse for my work holiday party tonight. Threw in some cheap costume jewelry for safe measure. Retail therapy. I feel calm and somewhat refreshed.

1530: Deliver Sister's pantyhose to her house. She leans in to take them from me and notes my nasty chin hairs reflecting the sunlight. I produce a pair of tweezers from my purse and she plucks them as I sit in my car in her driveway.

1600: Home. Son is playing Noggin games on the computer. Daughter is grumpy, so I give her a bottle and put her down for a nap. Husband jumps in the shower. We need to leave for the party at 1745 and his mom should be here to watch kids by 1730. My mom, apparently, also will be here at 1730 to pick up library books she checked out for Son. After an all out search, we find only two of the three books.

1630: Update my Facebook status and start this post.

1700: Gettin' purty - makeup, sparkly top, jewelry and perfume. Mom-in-law arrives to watch the kids.

1830: Husband and I arrive at the most expensive and exuberant employee party EVER. The Las Vegas theme was complete with showgirls, elvis impersonators, a great band, aerial artists a la Cirque du Soleil, food, booze and gambling (fake money). Many of my colleagues are in costume. We'd planned to stay 30 minutes then ditch out but stayed for the duration. On the way home, Husband notes that the atmosphere was different than he had ever experienced because it was clear everyone, from the president of the university to the maintenance people and cafeteria workers, was part of the same group. "You all seem to really like each other," he said. I agreed. Best Job Ever.

0000-0530 Sleep!

0530: Wake up and straighten house for cleaning lady. Mom-in-law spent the night and agrees to watch the children, for whom a long church day is exhausting because nap time is missed. Husband makes our turkey sandwiches for breakfast so we can eat in the car on the hour trip to church.

0730-1300: Travel, choir practice, School, worship then travel home.

1300-1600: Skip lunch in favor of a nap. I wake when Daughter is crying on the monitor placed by her crib and note that at some point, Husband has taken Son for their weekly parent-child bowling league.

1600-1730: While Daughter plays, I finish up just a few outstanding EMR reports so I can start with a clean slate in clinic tomorrow. I then check the upcoming week's schedule...clinic, practical exams for the students, serial committee meetings and Husband will be out of town Tuesday through Thursday.


1730-1830: Dinner with the fam. Turkey casserole that Husband made yesterday while I was at the conference. I note that Daughter shares my love for all foods and I feel a pang in my heart. It will important for me to try to model some healthy habits for her, but first I must adopt them.

1830-1900: Bathtime and bedtime for kidlets.

1900: Finish the medical records catch-up and this post.

2100 (anticipated): Fill my weekly medication dispenser then Go. To. Bed.

A day at the refugee clinic

I get up at 6:40, always reluctantly. I shuffle downstairs to eat a bowl of granola with yogurt while checking email. Ten minutes later Ariana shouts from her bed, "I want to wake up now! Time to wake up!" and forty-five minutes of prodding three kids through the morning routine begins. If they are dressed and seated at the table by 7:30, I make them tea in a white elephant teapot.

We wind our way out of Deep Cove, dark waters to our left and hulking mountains to our right, with CBC Radio 2 playing. I adore Tom Allen's voice and think how my patients would benefit if I could speak in such kind, good-humoured tones. Forty-five minutes later and I've dropped two kids off at school, the youngest at preschool, and parked the van in a neighbourhood five blocks from the clinic.

As I walk to work, I often dread a day of seeing patients. I wish desperately that I were a pathologist working at VGH, looking up from my microscope periodically to gaze out over a view of False Creek. I feel immense pressure to be fully present for each of my patients and in the moments leading up to the start of my day it sometimes feels unbearable.

I am one of five part-time family physicians at the refugee clinic. I typically have five 30-minute appointments booked for the morning.

9:00 My first patient is a 27-year-old Ethiopian woman with a new diagnosis of HIV. I break the news through the interpreter, who is clearly shaken. The patient is distraught. I explain that HIV care and prognosis is different in Canada than it was in her village. Grim though this task is, the face-to-face, front line provision of care to this crying woman seated before me strikes me as an incredible privilege on my part, and any longing for the detachment of a pathology lab slips away.

9:30 The next patient is an elderly Afghani widow with hypertension and depression, well-known to me. At the end of the visit she tells me that when her son was severely wounded in Afghanistan years ago he became a pastry chef. She produces two Ziploc bags of cardamom-flavoured pastries, one for me, the other for the interpreter.

10:00 A 42-year-old Burmese woman comes in for her first well-woman check. I do a pap smear, bimanual exam and breast exam. She had never heard of these exams before I introduced the concept at her last visit. The idea of screening for disease, rather than treating it as it presents, is a novelty to her.

10:30 An elderly Bhutanese man, illiterate in his own language, presents with symptoms of prostatic enlargement. I pull up a diagram of the prostate on Google images and he stares at it. I am not sure how effective my teaching is.

11:00 A Congolese woman comes in for follow-up of her PTSD. She also needs documentation of her torture scars for a medicolegal report. She weeps as she describes how each wound was inflicted. I make detailed notes and feel ashamed of the human race.

The morning is not quite that orderly. One patient brings her two children, and because they've spent ninety minutes getting here on public transit, I feel compelled to fit them in. Two patients are late. The other physician and the psychologist tussle with me over the Farsi interpreter. An infectious disease physician calls to discuss my patient with echinococcosis. The nurse taps on the door to ask for a signature on a parasite medication prescription.

I leave for a quick lunch with my colleague at the Indian place a block away. We head out the back way, bypassing the waiting room that's already filling with the afternoon patients. The clinic is so busy that taking time to eat or pee induces feelings of guilt.

I see prenatal patients on Tuesday afternoons. I have a medical student today. I let her palpate fetal parts and find the heartbeat with the doptone. She is thrilled; I can tell she's going to tell her classmates all about it tomorrow and I feel nostalgic for those fresh and glowing medical student days.

I'm ravenous with hunger by the end of the afternoon, and briefly consider the Fibre One cereal samples, Tums smoothies and chocolate Caltrate Soft Chews in the cupboards. I resist and head out into the December cold to pick up Ariana.

Forty minutes later we pull into our driveway. The cedars are stirring from the wind blowing up Indian Arm and the docks across the water are decorated with Christmas lights. Deep Cove is serene and worth the commute.

I open the front door and the entrance way is strewn with backpacks and toques. We head up to the kitchen where Pete - who cooks every night - has prepared a meal of grilled salmon, asparagus and French bread. Everyone tells anecdotes from their days, including me, but the story I attempt to tell Pete is interrupted so many times that it fizzles out and doesn't seem worth finishing.

I put the kids to bed at 7:00. I crawl under the covers with my five-year-old for a few moments and he suggests, "Hey! How about you move out of Daddy's room and move in here with me?"

I answer any urgent emails and then watch a movie, too often something like Blood Diamond or The Killing Fields or Lost Boys of Sudan, one that turns out to be overwhelming after a day at the clinic. If we've thought to chlorinate the hot tub, Pete and I will spend ten minutes before bed with piping hot water up to our necks, gazing out at the towering spruce trees across the way and the moon on the water.

And then bed, the sweet, delicious coolness of sheets and pillow, and I am asleep in minutes.

Day in the Life of a Middle Aged Full Time Student/Mom/Wife/Friend etc .etc. etc.

I'm Peggikaye 

I'm a 45 year old wife and mother who, after 20 years of being home decided to go back to school. Majoring in psychology with the goal of becoming a clinical psychologist to work with families of children with disabilities (and provide a service that was lacking when I was going through the diagnostic and adjustment period as a mother of a kiddo with disabilities). When I went to school 22 years ago, I'd gained all of 24 credits before I became too ill with Myasthenia Gravis and Lupus to continue. I'm not in remission, but I don't feel any worse at home than I do going to school so ... WHY NOT?

As a wife, mother, full time student (during finals time no less) I sometimes get a bit shocked when normal problems crop up. (like pharmacy misplacing my medication)

My favorite statement when someone is causing me difficulty is "Stop messing with my midlife crisis!"

I've been a reader and occassional commenter on this blog since it's inception. I comment under Dreaming Again.

6:00 AM … wake up even though alarm isn’t set until 9 am. 

Know that if I get up, son #2 (17 years, 11 months and 2 weeks old) will ask for a ride to the bus stop a whole 3 blocks away.  After all, it’s colder than the arctic out there!! It’s all the way down to 27º (he’s really going to not like me when it’s in the single digits, which it will get to)

So, lay in bed, reminding myself that I didn’t go to sleep till 3 AM so it’s just as well. REST PK REST!!

7:10 AM

Hear front door shut and get up to work on speech that did not get quite finished at 3 AM when my body gave up.

7:12 AM Start the coffee (most important job of the day!)

7:15 AM Find all the information that I left on the computer desk at 3 AM that has been moved. Evidently someone got on the computer before school this morning. (it’s ok, he’s allowed. Just wish he’d leave my stuff be!)

7:20 AM Sit down with coffee (yum!) and start to figure out where I left off with the speech.  (and randomly go to Facebook for a distraction)

9:00 AM FINISH speech!! Realize morning is getting away from me and jump into shower.

9:18 AM Grab second cup of coffee

9:22 AM Finally get around to taking my turns on my word games (Lexulous and Wordscrapper, my life would be so tense without you!)

9:27 AM Start to get ready for school : Breakfast, make up, hair, dress. (While doing hair realize that I miss my long hair …wash and go!)

9:55 AM  Realize I’ve got an errand to run (Pharmacy) before school and I need to be at school early to print off report for Personality Theories (10 page paper, developing my own personality theory …while using the text book theories to support my theory. I am still unsure how this isn’t just a review of material as well as still protesting the assignment in general. This is graduate level assignment ...not undergrad and certainly not freshman/sophomore level!)

10:00 AM Leave for school/pharmacy.  Argue with pharmacist about the medication they say they have no record of ever having.

10:10 AM run back home, grab Mestinon Rx bottle and go back to Pharmacy to *SHOW* them that I get Mestinon there every single solitary month, without fail … They tell me it needs a refill authorization.(the bottle clearly states 3 refills) They tell me they can’t help it and it could be Monday before they get it back. I ask to speak to the main pharmacist. I ask him if he knows what Mestinon is and what it’s for. He says yes, I tell him that I have 2 days of medication left and there is no way to wait 5 days. He agrees and finds my refill in the computer. (Amazing!)

10:20 AM Finally get onto school, now running later than planned. Stop at Quiktrip to grab an extra caffeinated Mighty Mocha Cappuccino that I wasn’t going to get but after Pharmacy rigmarole, need it!

10:30 AM Arrive at school and calculate if I have enough time to print off all I need to print off. Decide to try it walk as fast as possible to get to library and pray there is a computer!

11:00 AM get to Speech class, unsure if I have to present my speech on talking about critical care medical choices before the time comes to need them. 

Sit through speech class impressed with my young classmates at the seriousness of their choices as well as the quality of their research. Listen to final speech and about get knocked out of my seat with the offensive nature of her conclusion.

12:20 PM Head over to Personality Theories, more nervous about turning in this 10 page paper than any speech I’ve ever had to give.

1:50 PM Review over, paper handed in, it’s all over but the crying.  (Something is wrong when a science phobic, stage frightened Psychology Major enjoys biology for non majors and speech class above and beyond their psych class!)

2:00 PM Walk into 17 year olds school to check him out early to go to a doctor appt to get toenail removed.

2:45 PM Arrive at doctor’s office and check in. Check in sheet says we’re there to get results of flu test. Um, no, we’re really not. We got those the day we got the test. We’re here to get is very infected toe fixed. (again, this will be the 3^rd time to remove his toenail!)

3:10 PM get called back, they weigh and measure my son who was 6’ tall just 6 weeks ago …he’s now 6’1.5’’

3:30 PM Here a male voice outside the room sounding like he’s in a panic. “I can’t do that! I’ve never done it!!”  While I try to keep my OCD teenager in the exam room till we find out what is going on.

4:00 PM Office manager comes in to explain that we, #1 needed an appt with a doctor, not a medical student (yes, I asked for one …) and #2 it’s a procedure and we had to have and we have to have an appt for the procedure room. (Which had it been booked, the computer would not have allowed her to assign a medical student nor resident to his case) (yes, I know, I specifically asked for a procedure appt, we’ve been through this before) They leave, come back and apologize, give him antibiotic to help infection and reschedule for Tuesday. In the middle of my class … where I must give my speech. Husband gets the honor!

5:00 PM Finally make it home. Work on homework and play on Facebook until time to figure out dinner. Realize we don’t have anything and a grocery store run is in order.

6:45 PM come home with readymade chicken from the grocery store.

8:00 PM Sit back down to computer to work with philosophy portfolio. Wonder if I’m really ever going to finish this. I’m 12 chapters worth of reviews behind and it’s due next week.

8:30 PM Decide to email speech professor about the offensive speech. There is nothing she can do now, it’s already done, but maybe she can keep it from happening in future semesters.

3:00 AM stand up from computer to stretch and look at the clock. Realize it’s 4 hours after I’d planned on going to bed. Shut down computer and get ready to start the whole thing over again around 7 am.

The Family:

Don 54 (hubby and sometimes child)
Samuel 20 (going on 21 going on 12 going on 40)
Benjamin 17 years, 11 months and 2 weeks (I refuse to put 18 and the fact that both my children are leagal adults one moment before I have to!)
Myself ... Peggikaye ...45 years old

One day in my clinician-educator internist's life, last week

2:15 am Daughter appears in bedroom doorway. Blanket has fallen off bed. Why she is unable to replace is a mystery, otherwise very capable 4 1/2 year-old.
2:15:30 am Back to my room, door slightly ajar. I fear the worst. The cat has infiltrated the sacred sleeping space. Allergic to cat.
2:15:35 am Back into bed.
2:17 am Cat jumps on bed. Turn on the light and spend next 5 minutes looking for him. (Husband away on business - am alone dealing with cat highjinx.)
2:45 am Never found cat. Can't sleep. Thinking about 1,000 things. Eventually fall asleep.
6:19:30 am Wake preemptively to 6:20 am alarm, then set it for 6:40 am. So tired.
6:40 am Awaken to alarm.  Let cat out of room - he is peeved to have been trapped inside all night. The nerve!
6:55 am Daughter enters my bathroom as I'm getting ready - she hangs out a bit then watches some Super Why while I finish getting dressed.
7:10 am Son awake and summoning me with a pressing "MAMA! MAMA!"
7:20 am All are dressed for school, head downstairs for breakfast.
8:00 am I'm out the door after goodbye kisses. Nanny will take kids to preschool.
8:50 am Walk into office, answer emails etc
9:10 am Arrive at Team room - first day back as ward attending. Start rounds, we are on-call. Take advantage of teachable moments. Only gentle, encouraging pimping.
10:30 am Done with rounding, resident and I meet with interdiscplinary team for discharge planning. I love my social worker and case manager.They are the greatest.
10:45 am Back in office. Starving -skipped breakfast - eat grapes, saltines. Wonder how early I can eat my lunch. More emails. Do some writing for a manuscript. Multiple, multiple emails with various collaborators on different research projects.
11:45 am Start calling ward teams to find good patients with physical exam findings for physical examination round teaching session for third-year students at 2pm.
11:55 am Eat lunch (leftovers) in between calls to teams to find patients, writing, email, and 28,471 other things.
2:00 pm Meet students, show them picture of Osler and have them guess who it is. Need hints. Introduce him as the Father of Modern Medicine and read an inspiring quote about the art of observation as segue to physical exam rounds.
Divvy up students into 3 groups to go with 3 faculty mentors - I have one group.
2:15 pm See first patient together. Student notices his great example of clubbing. Discuss causes, pathophysiology, correlate to current patient.
2:35 pm See second patient with interesting heart exam. No one else can hear his murmur. Have them all listen multiple times in same spot but 2/6 systolic ejection murmur continues to elude. Patient is wonderful with us, wants to help, has fun.
3:02 pm Call in two minutes late to conference call with collaborators (who are also friends) for a research study.
4:45 pm Finally done with very productive call - head to team room to see how call is going.
4:55 pm Leave- with husband out of town, have to pick-up daughter at school.
5:45 pm Pick up daughter
6:10 pm Dinner altogether, made by godsend nanny
6:45 pm Up for daughter's shower, read story to both, changed into pajamas. The two roughhouse a bit until someone ends up crying.
7:10 pm Resident calls with run-down of admissions so far. Son and daughter chant her name over and over, much to her delight.
7:15 pm Son tucked in with bear and lullaby - he is starting to sing along - I've sung this to him since he was a wee bug.
7:20 pm Do daughter's Stars for the day - I'm generous and she gets all 5 today (say please and thank you; try not to whine; share; clear your plates; make bed). Daughter tucked in. Same lullaby by demand.
7:35 pm Curled up on couch under throw blanket, writing for leisure and work. Miss husband.
10:00 pm Call husband. Then stay up working on side project (essay on health policy) --my usual routine when he's away (otherwise asleep by 10:30).
11:20 Done. Sleep. Hope blankets don't fall off beds tonight.

Which Day?

I have no adequate way of selecting one typical day to post about, as part of the joy is the variation inherent in a career of education, research, and clinical care, and two ever changing kids and a supportive husband. If I was a better writer, could be a memoir instead of a post!

Morning:
Awoken by happy child, other child wakes, was happy but she wants more snuggle time, downstairs for breakfast, play some music, make some music, move lunches from refrigerator to car, socks on, brush teeth, pee, finish getting dressed myself, get in car. I take one to school, husband takes other to daycare. Off to fight traffic.

Or, should I describe a typical day where I take the whole morning to go on a class trip with one of my children? Or take them to the dentist? Or pick them up early for a special concert performance?

There’s the occasional day where I have to leave so early to lead a morning meeting that the kids are just waking up as I kiss them goodbye.

And the day that where I use my “administrative” time to be academically productive, surfing PubMed, online journals, checking personal and professional emails, catching up and making plans scholarly and otherwise? Attending noon conference, meeting with trainees.


And when I spend the afternoon at our pediatric health center with (in 5 to 30+ minute intervals):
· a teen who doesn't think she’s pregnant and is;
· a teen who thinks she’s pregnant and isn't;
· a newborn, it’s his first visit but we know the family as the 8 other siblings come to our practice as well;
· a mother who wants H1N1 vaccine for her child, but we’re out of the supply;
· a mother who doesn't want H1N1 vaccine for her child (once we have a good stock in)
· a former resident’s baby for a well check
· quick: what’s that rash
· not so quick: a teen who is about to be kicked out of school, needs residential treatment for his addiction, in my office with his mom, both wanting help
· pre-op physical and can you see the sibling too for her cold
· phone calls and school forms intermixed with above
· and a few others

Rush home. Finish my electronic medical records securely, but from home, after the kids go to sleep. Will this be a good commute day or a bad one? Often depends on the weather.

There’s the periodic 5pm meeting that I phone in to so I can commute home in time to make dinner.

And twice monthly when I am on call, which means I answer my pages by phone in the presence of the kids from 5pm-8pm, so they know as well as I how to respond to a parent of a child with a gastro or the appropriate Tylenol dose for fever.

Evening:
Some arrangement of the village picks up the kids, quick dinner prep, not real cooking but is healthy enough, kindergarten homework, all eat together (wow!), competition for who gets to hold a conversation with whom, try to make tomorrow’s lunches while doing dishes after dinner, reading books, playing music, 30 minutes of video time, get in the bathtub, brush teeth, books books books, pee again, one more book, one child to bed, more books with older child, pee again, finally both are sleeping.

Rest of evening:
Catch up with spouse, more online time, maybe a little bit of TV, crossword, finish something for work, finish electronic medical record notes, read residency program applicant’s interview for the next day, maybe take shower, more spouse fun time, sleep…

The ebb and flow of an academic neurologist

I am an academic neurologist with twin four year old girls. Academic life has teaching, research, and administrative responsibilities that you basically try to squeeze in between seeing patients, so I didn't write about one particular day, just what the daily ebb and flow is like.

6:30am: wake up, get ready for work, make kids’ lunch
7 to 7:30: commute, listen to NPR, try to plan day
7:30 to 9:30: answer emails, try to do some uninterrupted writing, prepare something to teach the residents that day
9:30 to 12 inpatient rounding, teaching
12 to 1pm: grab lunch, or attend noon conference
1 to 6pm: afternoon clinic, if not a clinic day, meet with clinical trial coordinator, interview applicants, go to committee meeting (quality assurance for the department), do paperwork for clinical trial—data safety reports, case report forms, adverse events, etc., prepare grand rounds or other talks, submit abstracts, apply for grants, call patients that need follow-up, write prescriptions, go back to the hospital to see new consults or follow-up on EEG or MRI results that have been done during the day, meet with resident advisee
6 to 6:45pm: commute, try to clear mind of work, sing in the car
6:45 to 7:30pm: see kids for the first time in the day, play with them while husband makes dinner (or vice versa), eat dinner
7:30 to 8:30pm: play with kids—board games, 10min of piano practicing each, games on nickjr.com, or watch Dora
8:30: husband does bath with kids, while I start the clean up from dinner
8:45 to 9:30: help kids get dressed, floss, brush teeth, read several stories, sing several songs, then lights out
9:30 to 11pm: I do one or more of the following in order of frequency:

Chores: clear dishes, sweep under table, plan future meals and shopping list, consolidate trash, separate recycling, laundry, clean toilet, general pick-up of clutter
Relax: fold laundry while watching TV, read in bed
Spend time with husband
Work out for 30 minutes on the Wii Fit
Go to bed early
Do work: edit paper, prepare talk
Socialize on phone with mom, sister, friends
Try to avoid eating anything
Try to avoid facebook

Note: When I am on service, which is six months of the year, I am also on 24 hour pager call, usually getting 2 to 3 after-hours pages per night. I rarely have to go in.

Typically go to bed at 11pm


Husband and kids’ schedule
7:30am—wake up, play with each other in bedroom
7:50am—Dad wakes up, tells kids to get dressed while he shaves and gets dressed
8:10am—Dad goes into kids’ room to find them in various states of undress and helps them finish getting dressed
8:20am—Go downstairs, get cup of milk to drink from the refrigerator (already prepared by mom), get socks and shoes on, get jacket, lunch bags, make toast and bring toast to car
8:35am—leave for preschool, eat in the car
8:45am to 5:30pm: spend day at preschool while Dad works from home as a software engineer
5:30pm—Dad picks up kids from school, they put away jackets, shoes, get a small snack and play until mom comes home


AC

Call Day: Internal Medicine Intern

5am: wake up
5:30: head in (baby is still sleeping)
5:45 arrive and see my first patient
round - round - round - we can admit 5 patients and often the private attendings give us procedures to do
12 lunch lecture
then we start taking all the code blues, and keep admitting patients until 7am the next day
usually our last admit is around 1am, and it still takes me forever...
maybe get a wink of sleep
up at 5:30... start rounding on my patients... start in the ICU and then head for the floors
follow up on labs, CTs, find consults, etc.
around 1 or 2 or 3 start thinking of heading home
make check out list
call husband to have him pick me up... maybe 2 hours of sleep in a 32 hour shift... I've got too much to live for to be in an accident on my way home
sleep 3 hours
pick up child from daycare, he's within walking distance
lay on couch while husband takes care of kid, makes dinner... too tired to move much
play with baby
feed baby
put him to bed
spend 30 minutes with husband watching TV on the couch
go to bed around 8pm or 9pm
spend basically no quality time with husband or child
return to hospital at 5:45 the next day

(so... 2/5 days I spend virtually no time with my young family.. the other 3 days I am exhausted.. and attendings are constantly complaining on how lazy interns are these days)

Oh, and I should include my schedule when not on call... it is so much better, but I guess my schedule is a vent. Often a 65- hour work week which is awesome for an internal medicine program.

How I Spent My Maternity Leave

I am winding down from an extended maternity leave. I decided after having my third kid in April of this year that it was time to take some time off from being doctor, and focus on just being Mom. I am now in my 7th month and I have had a wonderful time. It's amazing how fast time has flown. I found a list yesterday that I made before I had my baby, of all the things I wanted to do in my time off. Fortunately, I have done most things on the list - the last thing on the list is to make a scrap-book for the kids, which I'm not sure will get done.

I spent most of my time being Mom - doing activities with the kids, thinking about their diets, their sleeping habits, organizing their toys and arranging play dates (most of which I could barely find time for in my juggling act prior to leave).

Over and above being Mom, I seemed to have gone through various phases during my leave:

The first couple months I spent in a post-partum state. Sleepy, emotionally labile, sensitive about my weight and just trying to establish new coping mechanisms with three kids. Fortunately, that phase seemed to go by quickly.

The next two months, while my baby was temporarily sleeping through the night, I spent most of my time on me - I worked out every morning, read a book, started a global health blog, established a presence on twitter, got involved in some volunteer work...yes, a busy couple of months.

The next phase was in the fall, flu season started and the baby stopped sleeping through the night. I spent at least one month again sleepy and this time driving to doctor's appointments or vaccine appointments all of which seemed to be inefficiently staggered.

Last month, I focused on doing research on schools (since my eldest will start kindergarten next academic year). I'm trying to determine my answer to public vs, private school and get to know the options in my area. I had been meaning to do this for the last year and I finally made this a priority.

Finally, in the home stretch, I am now interviewing for a full-time nanny. I've met at least a dozen ladies from all walks of life and have yet to find the right match. This process has taken much more time that I anticipated and after spending the last 7 months with my little one, I'm much more attached than I expected.

After deliberately neglecting my medical journals for the last few months, it's now time to dust them off and get reaquainted with the medical world. I'm nervous about all that I must have forgotten and all the patient follow-up that always follows me home. Yet, I'm excited to start being a doctor again - having spent so much time on myself, it will be nice to focus on my patients.

Time Flies

It's the end of 2009 and this is just my fourth post of the year. Thanks to KC for allowing some flexibility this year. New baby, then a layoff and subsequent job search...I got too busy to post here regularly. But now I'm back.

Last year at this time, we were in the midst of adopting our daughter. One year later, it seems she's always been here. Time flies. I note some of my mothers-in-medicine colleagues have new babies in their homes. I would encourage them to take plenty photos to document how time flies.

Here, for example, is a demonstration of what a change just one year can make...

Just to update you in all areas of the Fat Doctor Life, I thought I should just list some general subjects.

• My weight: Highest ever. One foot in the grave. Not yet hopeless, but not sure what I need, want or can do right now. Praying for guidance.
• My career: Happiest job ever. Teaching, clinic work, may get back to some hospital work soon.
• My family: Son growing into a funny, smart kid. Daughter just had her first birthday and is starting to toddle. Husband is busy with work, the church and taking care of me. He remains my favorite person ever.

So the holidays are back now and the FD family has a full schedule of work parties, church programs and family get togethers. I'm busy but not complaining. This is the kind of busy that makes the world go round, the kind of busy that makes time...well...fly.

It's good to be back.

Adoption Journey Part 2

Since I posted "A Random Day in My Life" a couple weeks ago, my days have changed in the most wonderfully exhausting way. After waiting almost 3 years for a baby, we got 'the call' a couple of weeks ago, and 48 hours later we brought home our beautiful new son from the hospital. Our adoption journey has not been easy, but the final result worth every minute.

Also see:
Adoption Journey Part 1