Category — Medical / Medical school / career

Jack had a big week – he started school.  Travis was out of town until Monday night, so our nanny stayed over Thursday and Sunday nights (because I’m working nightfloat right now), and I rushed home from work Monday morning to take Jack to his first day.  He was SO excited and did really really well.  That was the 1st day.  Travis got home that night, so we were both able to take him to his 2nd day of school.  By day #3 he didn’t want to go anymore.

I guess the newness had worn off.  But also, Jack is such an emotionally in-tune kid and he’s SO aware of his own feelings and other kids’ that it had become very bothersome to him to watch all the meltdowns around him when parents left their kids at school.  He told Travis that school is a very sad place with lots of lonely babies who miss their mommies and daddies.  WOW.  Nail on the head?  It broke our hearts to hear that, but also made us realize again just how smart he is.  He is 4 years old in a 3 year old program, so he’s one of the oldest.  His teacher has been telling us how wonderful he is, and how much he helps the younger kids all day.  This was our hope – that he’d be a leader in his class, and that by waiting and starting him at an older age, his emotional maturity would allow him to make the most of his school experience.  But we have felt so bad about his internalization of all the emotions there.  I’m sure it DOES feel like a very lonely environment to a kid who is used to being home with his parents and his 2 almost-same-age siblings with whom he has always done EVERYTHING.  There is never a dull, or quiet, moment at our house and our kids are constantly chatting and playing together.  It’s a loving, stimulating environment in which he feels safe.  The transition from our home to his school, where kids learn to wait in lines and sit quietly at their tables during snack time is understandably challenging for him.  I know he’s lonely, and even though it’s only 3 hours a day, I know he misses Finley and Shane during that time too.  He is SO happy to come home and be with his buddies.

I’m trying to keep everything in mind – like why we’re doing this in the first place.  For one, it’s good for Fin and Shane to have the time together to cultivate a stronger relationship.  It also lets Shane and Fin drive their own play and allows them to be little.  Jack is their ring leader, so he dictates EVERYTHING around here from outings to imaginary play.  It’s great for Fin and Shane, especially since Jack is SO damn smart.  But it’s nice for them to just play normal, non-intellectual, little kid games that they come up with on their own from time to time.  And on outings, they can stay in the little kids’ area of the museums until they’re bored, not just until Jack says it’s boring.  Another big reason for Jack in school is because we have #4 coming along in the spring.  It complicates life just a tad and I think it’ll be good for Jack to have school as an outlet.  I had just hoped he would LOVE it from week 1 on.  But it’s an adjustment.  The good news is, we couldn’t be happier with the school or what Jack is learning there.  It’s an immersion program, and he’s already using his 2nd language, which is amazing to see.

I felt so bad leaving tonight; I told Jack I’d be home before he goes to school in the morning and the mere mention of school after a long weekend sent him into tears.  We’re all going through a rough transition time right now.  Shane has been very sensitive and has been crying at the drop of  hat, and Finley is still having some nighttime sleep issues.  Travis has been traveling a bit for his company, and I’m working really weird hours the next 2 weeks.  I come in at 4pm and take admission until 4am, last night I got home around 5:15am.  I slept until 10am and then played with the kids until I had to come back to the hospital, which is where I am currently.  I am really missing my kids and Travis right now.  It’s a weird homesick feeling that I can’t wait to be done with when this year is over.  I’ll leave you with the sweetest poem Jackie wrote for his daddy:

How Much I Love Daddy, by Jackson Good

More than a bird loves his wings

More than a dog loves his milk

More than a sun loves to set

More than a whale loves his spout

Apparently that inspired the poet within Finley as well, so here’s her meathead version;)

How Much I Love Daddy, by Finley Good

I love daddy so much, poo poo.

I thought Shane might want in on the action, but when asked if he wanted to write a poem for his dad, he answered in true Shane form as of late: “my don’t want to.”  We must hear that phrase 100 times a day;)

I started nightfloat on Monday, meaning I am on a month long rotation where I work nights instead of days (and night).  For the first 2 weeks, I work 7pm-7am (in theory, reality is more like 7pm-8am, but this morning I got a late admission and was stuck there until almost 9), then I’ll switch to 4pm-4am (4pm-5 or 6am).  It’s grueling but actually comes out to probably 15-20 fewer hours worked each week.   I come home, try to nap 2-3 hours, then have lunch and play with the kids until their naptimes, when I lay down with them for another 1.5hrs.  It’s REALLY hard on the body, but the bright side is I actually get to see my kids.  By this morning, I was SO exhausted from being on my feet all night and sleeping ~4 hours a day between shifts.  Nights at the hospital are CRAZY busy and I seriously don’t even sit down except in the ED when I’m admitting a new patient.  But the beauty of nightfloat, and the reason I paid one of my co-interns to swap me a wards month for a nightfloat month this spring, is that you get 2 days off per week (we get “weekends”).  Probably doesn’t sound too exciting to people with normal jobs, but it’s one of the only rotations we have during intern year where that happens. 

So I got home ~9am today and don’t have to be back to the hospital until 7pm on Sunday.  The hard part is that my body is so damn confused about what time of day it is, and I can’t quite convince it to sleep right now.  Instead, I’ve decided to post pictures of the last 2 hikes we did – Burning Bear Creek Trail, which was AMAZING, and a little hike we’ve done before in Roxborough State Park, which I love.  Both were incredible, but Burning Bear is my new favorite to do with kids, especially if it’s warm enough to “swim” in the beautiful mountain creek the trail follows.

These are from Burning Bear Creek hike:

And in case you’re not sick of pictures, here are a couple from Roxy State Park:

Jack starts school this week, which is huge.  He’s VERY excited, but every time the topic comes up, Fin becomes hysterical.  She doesn’t want him to go, and if he does, she wants to go with him.  It’s kind of sad that their little pod of 3 is breaking up.  Jack will only go to school a few hours a day (~3), but since it’s in the am, it’ll mean he doesn’t go on morning outtings with Fin and Shane.  They’ll probably struggle without him for a bit, but I’m guessing Fin and Shane will become closer because of it (not that they aren’t close already, but you get the point).  Sad. 

Travis and I are back to daydreaming about getting to a point after I finish derm training (<4yrs) where we can pay off loans and just whisk our family overseas to travel for a few years while doing different types of international work.  We’d homeschool and hire an international school teacher to join us and help teach the curriculum we design for our kids, with tons of hands-on learning Travis and I can provide along the way while we take our kids to see the world and do humanitarian work along the way.  Then we’ll settle in London for 2 years, where I’ll do the Tropical Medicine fellowship before returning to the developing world to practice medicine / tropical derm / and teach at a med school.  Travis is now doing health IT development work in Africa, but hopefully it’ll expand into Asia as well, so lots of possibilities for his non-clinical role overseas too.  We just need his start-up company to do what people are projecting it will, and I just need to survive internship for now.  In the meantime, it’s nice to dream, ya know?

Anyway, I think I might take a Tylenol PM and attempt sleep – I haven’t taken a single pill during pregnancy, and that’s a safe one anyway so don’t worry (Yiayia;).  I think the baby would appreciate some rest.  I can’t even imagine what kind of little monster is lurking within me, but if it’s anything like the last one, I should be resting every second I can!  Speaking of, check out this tantrum, I call it a Fintrum:

Travis wasn’t in town when this happened and Fin gets very out of sorts without her daddy.  It’s kind of an amusing video at first, and then it’s just sad when her little body just gives up and you realize the meltdown was a combo of exhaustion and missing her dad.  I stopped filming and she just collapsed into my arms:(  Poor little monster.  But it does give you a glimpse into how her head can spin around!!  I posted this so I can look back on this blog someday and see the good, the bad, and the ugly.  And of course the beautiful, wonderful, fun, hilarious stuff that happens in our house everyday too.

Thank you to all of you who reached out with supportive words for me.  Right now I need that kind of support.  It doesn’t help me to hear “suck it up, that’s just the way it is.  Lots of us do it, you can to.”  That’s the ass backwards logic that has made medicine the cold environment that it is, and I’m sick of hearing it. 

I was so lucky to have had an upper level resident for the past month that would have never said that to me.  Instead she’d just sit with me after we signed out and hug me while I cried, she’d ask about my kids when she could sense I needed to talk about them, and she’d avoid it when she knew I couldn’t handle talking about them.  She taught me at every opportunity, shared my workload when I was overwhelmed (which she did NOT have to do, being as she was my upper level), impressed me with her humanism, and made me laugh when I just really needed it.  She’s probably the reason I got through last month.  So intern year isn’t all bad I guess; I have come across a few amazing people, like many of you, who have lovingly nudged me on while also letting me know you’d still support me if I decided to go a different way.  That’s the kind of encouragement I have needed in my life lately, so thank you.  To our parents and my grandparents, I really am doing ok, I promise.

Today was awesome.  We made it feel like a full weekend, even if it was just a day.  First, I have to introduce you to a new member of the Good household…I got a cryptic text while I was on-call Saturday and had hoped the snake Travis mentioned would be dead or something before I got home.  Instead, I found it in a little reptile aquarium ON MY KITCHEN TABLE. 

It’s only a matter of time before a mischievous someone “accidentally” lets him out of the cage and he slithers under a couch or appliance. 

So yeah, we have a snake.  His name is Slinky, and he’s a gross little thing Travis and the kids caught on a hike last weekend.  That’s just what happens when I’m gone for 30 straight hours and daddy’s left in charge;)  There’s also a praying mantis, 2 frogs, and a tube full of crickets – all caught by my kids on their hike.  Saturday was a rough day for the animal kingdom.

We did all kinds of stuff today, including getting a preview of the Botanical Gardens’ new kid’s section, which is going to be amazing when it fully opens next week.  We had a really fun scavenger hunt there. 

[Note: in the picture below, you can see Fin’s new sense of fashion – she insists on mix and matching her shoes]

We also walked to a pocket of nearby restaurants to enjoy my fav food – sushi.  Also, my best friend delivered a baby today in a VERY high risk delivery.  Dominique and her baby girl are both doing great, after a very stressful pregnancy.  Thank God.  So today was a wonderful day for many reasons.  Speaking of pregnancy and babies, little Good #4 is doing well.  I started feeling movement early this time, but the first real kick you could feel from the outside of my belly happened 2 weeks ago.  We had an ultrasound last week and we brought all the kids (and Jen, our incredible nanny who has become a crucial member of the family).  The kids LOVED being involved and seeing the baby on the big screen during the ultrasound. 

The ultrasound ended up showing a marginal cord insertion, meaning we’ll have to have another ultrasound and see a perinatologist next month to monitor the baby’s growth (since the cord doesn’t insert in the center of the placenta, there’s a concern that the baby might not get as much blood flow / nutrients, which could cause growth restriction).  I’m not too worried about it at this point, but my experience with perinatologists makes me roll my eyes at the thought of having to see one.  Always ironic when the fields that could really use people with good bedside manner tend to draw the ice cubes, but whatever.

Anyway, here are some pictures from dinner tonight.  We walked a few miles, ate a great dinner, let the kids play in some water, and headed home watching the sunset over the Rocky Mountains.  In the interest of transparency and honesty, this is the secret to getting our kids to sit still at a restaurant so Travis and I can pretend like we’re on a date, even if there are 3 very nosey chaperones present;) 

Every now and then, Shane would pick his head up and say something funny like “cuse me, I farted.”  Cracks me up.

Here’s a beautiful thing: 3 toddlers all finally wearing underwear!  No more diapers (for a few months!).

So it’s 1am, I can’t connect to the internet, but I did bring my computer in case I had a chance to write from my call room.  Looks like there’s no point in even trying to sleep, since my cross-cover pager is possessed.  Might as well write for 5 minutes at a time while I wait for the next train to wreck on the oncology floor (that’s where all my cross-cover action has been so far tonight).

I miss feeling like a mom.  Some days (most, if I’m being honest), I really wonder why the hell I’m doing this.  I don’t like it; there’s very little that I enjoy about my days, other than the moment I step out of the hospital and run for my car before my pager goes off again.  I’m in survival mode, just trying to stay afloat.  My kids, thankfully, are doing much better, but I can still sense their anxiety.  Shane’s is disguised, but it’s there.  He’s more sensitive and he’s actually been saying “my sad mama” every time he sees me.  Fin’s is obvious – she’s become terrified of everything and is constantly on the lookout for the “big bad wolf.”  Seriously, she won’t even go to the bathroom by herself right now because of the damn wolf.  At night is when she really melts.  Jack’s is subtle, but it’s there too.  He’s always asking me about when I have to go to work next.  It’s the first thing he thinks about when he sees me – how long will I be there.

And then there’s the compassion burnout.  I almost ate a patient the other night – I got a late admit, which meant I wasn’t going to make it home in time to see my kids before their bedtime.  When I went in to see the patient, she was on a call and told me to come back later.  My blood pressure seriously shot higher than that patient’s who stroked in front of me last Friday.  I don’t even cry when nice people die anymore, I hardly even feel…anything.  It’s survival mode.  But I miss feeling like a person and I don’t like what this process is doing to me.  The only thing that grounds me every once in awhile (especially after a diet coke;) is feeling this baby inside me kick.  I always pause what I’m doing to put my hand on my belly and just enjoy that little glimpse of a life.  And that brings me back to thinking about my family.  Those are about the only enjoyable moments I can think of in my otherwise very hard, very stressful days.

As I wrote on twitter a few days ago, you know you’re unhappy at work when the drive there seems to fly by in the mornings, yet it seems to take FOREVER to get home at night.  We are supposed to fill out these work hour forms to document the hours we were in the hospital each week.  I decided to fill mine out honestly.  Guess how that went?  Not so well.  It’s no wonder everyone lies about duty hours; it’s just not worth the hassle to tell the truth and deal with the phone calls and the getting your resident in trouble with the administration because you broke work week hours (worked more than you’re legally allowed as a resident).  The best is how the administration then calls and asks questions like “well, what can we do to keep this from happening again?”  And after you tell them a reasonable solution (ie: allow us to stop taking admissions an hour earlier), you come to understand what they are really asking is “how can we get you to stop logging the hours you really work?”  Gotta love medicine.

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So I wrote that on my overnight call last night.  Saturday call is the worst – makes for a REALLY long week.  That was a long 30 hours.  My day off is Tuesday and it couldn’t come soon enough.  I am ok though, probably better than that made me sound!

Amy Mann- I canNOT find your email address but I need to thank you.  Your letter was so touching and totally made my week; I am so grateful for the clothes you sent me.

It sure feels like we lived it a few months ago; as crazy and chaotic as life was then, it didn’t compare to this new life with 3 wild toddlers, a pregnant intern for a mom, and a dad who sporadically travels to a far away coast to wine and dine potential investors.  This week was hard, really hard.  I pretty much didn’t see my kids for 3 days, didn’t sleep more than 5 hours any night this week, and probably cried 6 of 7 days.  <sigh>  I am really sad to say I don’t like medicine very much right now, and I hate what I’m having to sacrifice to be in it.  I’m tired of missing out on my kids lives to be at the hospital watching people die.  It’s depressing on both fronts.  Internal medicine is not really my thing.  About 75% of internal medicine patients are over 75, and that is not really an exaggeration.  And I’d say 75 would be on the young side for the hospital service I’m on right now.

On top of other stress, I had an exposure yesterday that really freaked me out…a possible infectious disease that, as a pregnant intern, I have been afraid of encountering.  After researching shingles in pregnancy, I think my risk of badness is extremely low, especially since I’ve had chicken pox and even if I hadn’t, it’s still not likely my pregnancy would be affected.  But it was enough to make me worry for a few hours yesterday and have to spend a little time looking it.  I didn’t need that. 

Today was my day off.  It was an AWESOME day off, all the way until this evening when Fin fell off a chair at Chipotle and cracked the back of her head open.  I didn’t realize she’d hit her head until I scooped her up and felt something wet spilling onto my arm.  I was pretty sure we were going to have to take her to the ED for stitches, but Travis and I got the bleeding to stop without that.  Fin is the toughest little thing on the planet, thankfully.  She just wanted to eat her burrito and drink a “beered” (beer) to make her feel better;)  So we went home and did just that.  Before you call CPS, Finley thinks Izzy with lime in a frozen mug is a beer, so it’s all good.  [what you can’t see in the picture, nor could she, thankfully, is the blood matted hair on the back of her head]

As for the good parts, we went to the Dragon Boat Festival today in celebration of Asian Pacific heritage.  We’ve gone every year we’ve been here and we always love it. 

Travis’ mom is out here with us, which is a great thing for the kids and has been very helpful to us too.  Travis left for Boston at 3:30am on Friday morning and came back at 2am that night, so she was here to help our nanny, Jen, with the kids that very long day until I came home. 

Anyway, the festival was fantastic.  Afterwards, my MIL and I had a chance to run to the mall while the kids napped today and I finally got myself some pants.  It’s weird how fast this pregnancy is going, but I swear, it’s been ALL OF THE SUDDEN that this huge belly has popped out of nowhere.  I’m 21+ weeks now and the belly band over my regular dress pants is becoming uncomfortable.  And because I have such incredibly kind people who read this blog and offer support, I have had people send me maternity clothes too!!  Can you believe that?  I am SO grateful, I can’t even begin to tell you. 

So, after the Chipotle drama, we did a fun little dessert craft with the kids.  Worms in mud.  If you don’t know what I’m talking about, just get some gummy worms, chocolate pudding, and oreos.  Let the kids mash the oreos with mallets (they love that part), put them at the bottom of a clear plastic cup.  Then put a chocolate pudding layer on top.  Last, have them drop the worms in the mix and stir it all up.  It was disgusting to watch, but Jack, Shane, and Fin had such a blast searching for and eating their worms and the mud / dirt.  Especially since they’re still obsessed with pretending to be baby birds!

Here are a few other pictures from the past few weeks that I’m just now getting off my computer.  The first couple are from my day off last week – took my MIL and the kids up to Boulder Creek on the most beautiful day and had a wonderful time.

My kids have been playing “doctor” a LOT lately.  The role playing is adorable, and Finley goes around saying to everyone she meets, “I’m a dot-tor.”  Sadly, I kind of hope my kids are only role playing and I never hear any of them say that for real.  Maybe that’s just intern year talking and I’ll change my mind down the road, but for now that’s how I feel and I’m just being honest about it. 

I love this picture of my Yiayia and my Finley:

That’s all for my stream-of-consciousness ramblings tonight.  Sorry if it was a downer…again.  Hopefully I’ll snap out of it soon?  Like next year when I’m no longer an internal medicine intern?!!  Ahhh, just got keep banging my head against this brick wall for now.  I’ll eventually crack it.  The wall I mean. 

Hope you all are doing well, and I hope you understand why I’m so out of touch if you’ve emailed me in the last few weeks and I haven’t responded.  Almost forgot – PLEASE check out our SkinnyKidz sale!!!  LOTS of our belts are on sale as we get ready to bring in our fall prints, which are adorable, btw.  Don’t forget to check it out. 

Nothing in medicine is more painful, more torturous, more heart-wrenching than providing futile medical care to a patient who is suffering.  I am not talking about a person who carries a terminal diagnosis but is still coherent and choosing to pursue experimental treatments, even if they are hail mary options.  I’m talking about the patient who is no longer mentating, who needs modern medicine to breath for him and a tube to feed him, who is developing decubitus ulcers all over his body from laying in a practically vegetative state, who moans if the ativan and morphine wear off, who has to have the suction jammed down his throat to remove the sloughing mucosa from the back of his dry, blood-crusted oropharynx, who is barely recognizable because fluid has left the intravascular space and pooled in every dependent area of tissue, leaving him swollen and water-logged.  I’m referring to the patient whose family members STOP visiting his bedside because even they can’t stand to look at him like that anymore.  Yet they still want everything done to keep him from dying. 

Talking and pleading with families in the most compassionate way I know how becomes a frustrating effort when they continue to believe a miracle might occur.  In one breath, they realize that if God wanted a miracle to occur, he would make one occur.  But in the next breath, they aren’t confident enough in their God to allow us, the medical team, to stop prolonging the patient’s suffering and just leave it up to God. 

I know it often takes people a long time to come to terms with a family member’s death.  I don’t ever want to be in those shoes because I can’t imagine how painful it must be.  I never know the people I take care of before they became ill, but for me to show up and see them in a state of suffering day in and day out while their families debate pursuing aggressive, futile medical treatments, is really hard.  Our 1st obligation as physicians is to “do no harm,” but I can’t think of anything more inhumane than prolonging death under those circumstances.  Yet, in this country, we are virtually powerless and our hands are practically tied.  We aren’t able to say “I’m sorry, I cannot / will not put a feeding tube down your father’s throat because it will only cause him more discomfort and there is truly no benefit to him.”  In an ideal medical world, I would be able to say “I’m sorry, but it would be against the medical oath I have taken as a doctor.”  But we don’t live in Europe, we live in a highly litigious country where doctors are puppets out of the fear of a lawsuit.  So we go on torturing patients when they’re families demand us to.  And we bring in palliative care, case managers, hospice, the ethics committee, and so many other people to try and help us make our case.  But in the end, we bend to the families’ wishes and allow the antibiotics, the feeding tubes, the blood draws, the suctions, beeping alarms, the rib-cracking CPR, the defibrillator, the breathing machines to continue to prolong suffering.  It’s truly disturbing.  And in the end, the patient dies a painful death, and all that is gained goes to insurance companies – the  hundreds of thousands of dollars our futile care costs. 

If you don’t have a living will, even if you are 30 years old and healthy as can be (believe me, I’ve had this patient who was hit with something out of the blue too), sit down with your family and talk about these things.  Everyone who sees these patients always says “please don’t ever let me go like that,” but it’s so hard for the family members left behind to make such huge decisions when they haven’t explicitly had these conversations with their loved ones before tragedy befalls.  No one wants to be responsible for saying “ok, withdraw treatment and let him/her die in peace.”  So everyone defers making a decision, and the patient just lingers and suffers.  Something to think about.  Here’s a site to help you think through these things if you haven’t before: http://www.yourcommunityhospital.com/LivWill5wishes.cfm

Because my kids are so damn funny, of course…ahem.

Yesterday, I came home from the hospital in time to play with the kids, eat dinner as a family, and tuck everyone into bed.  It was fantastic.  While eating dinner, Jack asked, as he does everyday / night when I get home: “how was your day at the hops-ital mom?  Were there lots of sick people?  What happened to them?  Did you help them get better?”  Then he said “dad, are you a doctor?”  Travis then said “wellllll, yes, kind of.  But daddy helps people get healthy using technology…with his computer.”  Jack let out this hysterical laugh and said condescendingly, “daaaad! Computers don’t help people; they have buttons, and are used for things like games and PBSkids.org!”  We laughed so hard. 

Later, we put the kids to bed.  About 10 minutes after tucking them in, we heard Finley yell and start crying, so Travis and I ran upstairs to find her with barf everywhere.  We scooped her up, cleaned her off, and Travis rocked her in the chair.  She begged him to sleep in the rocking chair next to her bed, so he shot me the look.  I said “fine, bring her in our bed.”  A strange, Grinch-like smile curled across her little face.  When we got her into our bed, I laid down in bed with her, patted her hair and stroked her face until she started drifting off.  Then she said, in this scratchy little voice, “hey mom?  I stuck my hand down my mouf so the barf would come out.”  Sneaky little shit.

First of all, please go enter the SkinnyKidz giveaway hosted by Mrs Broccoli Guy.  We introduced a “big kid” sized belt (6-10), as many of you requested, and her kids were the perfect little demo models!  She wrote an amazing review for us too.  Thanks Christina!  Also, our new charity partner this month is a UK-based organization, Just a Drop, which works to bring clean water to Haiti.  It’s staggering to consider that diarrhea is still a leading cause of death worldwide…mostly due to lack of clean water.  That is so sad, and so preventable.  Please consider donating to this organization, and/or doing so through the purchase of this adorable belt (I think the print Jena chose for the Just a Drop belt is my favorite yet):

If I sounded overwhelmed in my last post, well, that was nothing.  Since then, the virus hit all of us except my little boys, thank God for them being spared at least.  It hit Yiayia on Tuesday night, so I was up most of the night with her / worrying about her.  She took a bad fall during one of her bouts that scared the living crap out of me.  Travis was able to stay home the next day to make sure she was ok, which thank God she was.  The next day, the same bug hit me just minutes after I signed my patients out and was trying to leave the hospital.  I was heading for the door…had to turn around and run for a bathroom, which I proceeded to barf ALL OVER.  I felt SO freakin bad for the poor janitor who was unfortunate enough to be pushing the mop bucket down the hall when I came out.  I apologized profusely and RAN to the car to race home before the next bout hit me.  I made it, thankfully, but was up all night again and totally dehydrated by 4:45am the next morning (when my alarm went off).  It sucked.  I wasn’t about to call in sick, as 1) that’s frowned upon as a resident or doctor, and 2) it would’ve taken a day away from my maternity leave. 

I made it through the day at work, although I felt like hell, but had to suffer through a 30 hour call shift the very next night.  It was rough; I was in my call room LITERALLY for 40 minutes, and I got paged about 4 times while I was in there, so I didn’t sleep a wink.  I’m still dragging ass.  I napped for 2hrs while the kids did when I got home Saturday afternoon, but that was it.  I worked later than I should have yesterday because all my patients were totally unstable and I could not get out of the hospital with them all like that.

Today is my “day off.”  It’s also Travis’ and my 7th wedding anniversary.  We laid low and got to see our friends Kaakpema and Sara briefly this afternoon when the kids swam in Sara’s parent’s pool.  The other day when Yiayia fell, she landed pretty hard on her chest, so although today was my 1 day off, I was in the hospital anyway.  I’ve been so worried about her and her pain has gotten pretty bad, so I took her to get some xrays, which thankfully were all (-).  She’s an ass-kicker and that makes her a pain in the ass patient – too tough for pain meds, too busy-bodied to rest herself, etc.  So thank God nothing is broken.  Yiayia is going back home on Wednesday, which is going to be especially hard for Fin and Shane who get so much snuggle time from her.  Finley has been an emotional WRECK, to put it lightly, so not having Yiayia here anymore to give her extra love and comfort is probably going to send her for another loop.  When I say “wreck,” I really can’t put it into words.  The poor child is so smart and so articulate, so she’ll tell me that she’s angry and sad that I work and leave her all day, but expressing her emotions verbally doesn’t stop her from expressing them physically in addition.  She’s been melting CONSTANTLY.  I almost peed last night from laughing so hard when I heard Yiayia thinking out loud through her geneology and saying “now, let me think, who in our family was a little on the kookie side?” 

It doesn’t make things easier that I happen to be on the grim reaper service right now - 1 of my patients died last night, 2 went to the ICU, and a bunch of others to hospice (plus another for whom we’re providing futile medical care because his family hasn’t come to terms with the terminal nature of his state…so he’s just suffering).  Depressing.  Also on a depressing note, when I came home from work yesterday, Jackie asked “hey mom, how was the hops-ital?” (he can’t get that word right – so cute).  I said “it was good, but there are lots of sick people there I have to take care of.”  And his response?  “My belly hurts, maybe I could come to your hopsital and you could take care of me!”  It’s so sad that my kids realize I no longer take care of them, just the sickies in the hops-ital.  I can’t wait until this year is over. 

Sorry for being a downer.  And this coming weekend is my “black weekend,” so termed because I have the overnight call on Saturday, meaning no shorter days or off days.  All this for less than the wage a garbage man makes.  Since I’ve held barf bags for my patients, held up the pannus of my 415lb patient so I could examine the skin fold (and was almost knocked over by the smell of bacteria & yeast living under there), and done some other pretty gruesome things lately, I think I have earned *at least* a garbage man’s salary.  <sigh> 

On a HUGELY positive note, big big things happened for Travis’ career last week.  He was offered COO of a really exciting health IT start-up.  Buh-bye residency.  Thank God too because I really don’t think I could live through him going through residency too.  He’s really excited about the speed with which his career is taking off, and as usual, Travis finds himself in the right place at the right time.  Part of his agreement with this company is that he finish his medical degree, so he’ll be COO / MD/MBA student all at once.  Part of his agreement is also that he will work remotely, with sporadic travel to Boston when necessary for meetings and workshops.  If you remember, my favorite derm program was actually Brown (45min from Boston), but Travis vetoed me ranking it highly since he had this “thing” about East Coast medicine.  I seriously almost strangled him the other day when he said “too bad you didn’t match at Brown, that would’ve made things easy!”  My heart went into asystole for a brief moment. 

That’s our story.  It’s a crazy one and feels like it’s getting crazier every day.  My belly popped this week; I’m now 18+ weeks.  By “popped,” I mean you can now tell I’m pregnant.  It’s still sort of truck-driverish, but it’s definitely round and now noticeably spilling out of my pants and shirts.  Since we’re still in financial trouble, I’m making do with the belly band for as long as possible, but it really is almost time I move to maternity clothes.  If anyone has any cute maternity clothes you’d like to sell, hit me.  I don’t have time, desire, or money to shop for new maternity clothes but I do need work attire that’ll fit over this belly. 

I hate feeling like a minion, which is why being a medicine intern sucks.  Or one of the reasons anyway.  No one likes to feel incompetent on a regular basis, but in medicine, I guess it’s just the norm until YOU’RE the one who’s been in practice long enough to think everyone else is just dumb for not knowing the answers all the time. 

So my first few days were rough, the 1st day especially.  I came onto a service full of very sick patients, picked up 7 my first day, then had new admissions that day on top (each team admits everyday in my program, and then we admit for ALL teams on our call nights – every 4th night).  It was beyond overwhelming and I got home ~7pm, missing my kids, missing Trav, and absolutely sobbing.  I could not pull it together that night.  I literally didn’t think I was going to be able to open my eyes the next morning I cried so damn hard.

Let me back up.  Travis left on a red eye flight Tuesday night to Boston – sort of a last minute business trip.  There was no way to pass it up; it was the opportunity of a lifetime for him and one of those now or never offers.  Of course he went, but that left me alone the night before starting my first day of intern year.  I was terrified and an emotional wreck – not pretty. 

Thank GOD I wasn’t really all alone.  My Yiayia to the rescue.  I am blessed with an amazing family.  I was joking with Yiayia the other day about how ironic it is that of all our family members, the one who has been there for us, doing all the “heavy lifting” in our greatest time of need is her - my 80 year old grandmother.  She is one hell of an Yiayia.  She cooks for us, cleans for us, takes care of our kids when we can’t, etc.  While Travis was gone, she’d get up when I’d leave for the hospital to assume care for the kids until Jen, our nanny, arrived.  The new nanny has been here too, obviously, but Yiayia has filled in on numerous occasions.  She has been wonderful and I don’t know what we would have done without her.  I’ve always known and been made to feel that we, as her grandkids, are her world, and I am so lucky to have that kind of love.  I know my parents would do it for me in a heartbeat too if Yiayia couldn’t, but they have a LOT on their plates as is with their own young kids whose needs are still very high. 

I get 1 day off a week, and that was yesterday for me.  I had that feeling of “Sunday night dread” all day and did my best to let go of it, but it was tough.  Unfortunately, Fin was up all night last night barfing too.  Thankfully Travis is home now and slept on the rocking chair by her bed, hauling her to and from the bathroom.  It killed me that I had to leave so early when she was still sick.  That didn’t feel very motherly to me; I really hate leaving my kids.  I’m on-call tomorrow, which means I said goodnight to my kids tonight and won’t see them now until I get home from work on Tuesday evening.  Sorry to be so negative, but medicine is a tough life.  Thank God for derm.  Still, getting through this year is going to be really freakin hard for me.  Here’s what my upcoming week looks like and what they’ll all look like, for those crazy enough to be contemplating a career in medicine or are just interested in what it takes to be a doctor (mind you, this is after 4 years of college which included required years in biology, chemistry, organic chemistry, physics, calculus - yes, I passed calc Jena;) – plus 4 years of painful hours as a medical student and a whole ton of abuse during that time). 

A day in the Life of a Minion

5:45am start pre-rounding; figuring out what happened to my patients since I last saw them, cehcking labs, etc.

7am get signout from the overnight team to find out what patients were admitted to my service overnight;

7:15-9:30 scrambling to see new & old patients, write orders, & follow up on labs before attending rounds;

9:30-10:30 rounds with the attending and team; answer questions about the patients’ disease processes and management (in medicine, we call this getting “pimped” – you’re in the hot seat getting grilled and trying not to look dumb)

10:30-11:30 morning report (mandatory; we present cases to other residents and attendings); “pimping” is also very much a part of this

11:30-12 finish writing notes and touching base with attendings;

12-1pm noon conference (mandatory education time);

1-4pm check in with specialists and consultants, discharge patients, follow-up on studies, and continue admitting new patients that come in.  One day a week we have rounds in the late afternoon with the chair of our program for 1hr (another session in which we get “pimped”).  This means less time to get work done for patients, which means I leave even later those days.

4pm – in theory, could signout to the on-call team…in reality, this doesn’t happen until ~6:30pm for me each day;

—-every 4th night——

4pm-7pm – on-call, admitting new patients for all the ward teams; since we take admissions until until 7, if one comes in at 6:55, it means I’m stuck there until the patient is stable and the admission process is done (which still takes me HOURS). 

—–when the 4th night falls on a Friday or Saturday, it’s an overnight call—–

4pm – get signout from all the other teams.  This means ALL their patients become my responsibility overnight.  So I all of the sudden have all my patients, my new admissions, and the other interns’ patients (~20-40 patients) who I get  a few sentences about from my fellow interns as they signout to me – that’s called “cross cover".  My first overnight call is this Friday, and I’m terrified of cross cover.  Bad stuff always happens overnight, and when you only know a 1 liner about a patient and you get called by a nurse saying they’re crashing and wanting to know right then what to do about it, it’s freakin scary. 

We had a talk last week by a girl who just finished her intern year and told us about the tragic death of a cross cover patient who fell through the cracks.  The intern on-call didn’t realize how sick that person was, didn’t know that patient (we never really know the cross cover patients), and it ended up resulting in her dying.  It was a mistake anyone could have made, which makes it even scarier.  Intern year is just stressful all around so far. 

This poor baby in my belly is going to come out with no fingernails, gnawing on its own arm or something. 

It’s finally here.  All the dread in the world couldn’t keep it away I guess.  My clinical responsibilities as an intern start on Wednesday of this week, and just to kick it off with a bang, my first call as an intern is on Thursday.  I’m really not excited.

This was my last weekend off for the next several months, so we tried to make it count.  We packed in a party with my program on Friday afternoon (our kids crashed it;), the Greek festival Friday evening, then Yiayia and I took the kids berry picking Saturday morning while Travis gave a big presentation to the ophthalmology department.  We picked 10lbs of strawberries for ~$20, and we had a great time doing it.  If you’re local, and you don’t know about Berry Patch Farms, you HAVE to check it out.  Where else can you take a hayride out to pick berries, eat all you want in the fields, then come back and listen to a live bluegrass band while sitting in a rocking chair or eating lunch at a picnic table nearby?!  Love that place.  Later on Saturday, we took the kids to see Toy Story 3 in 3D, which was AWESOME.  Then, today, Emilie and Chris came over with the girls and we set up their GIANT waterslide on our sidewalk just to provoke the HOA…it’s been awhile and we kinda miss the drama;) 

It was a blast and Jack was especially wild about it!

Then we all headed up to Evergreen for the rodeo.  My kids are big rodeo fans, and we turned Yiayia into a rodeo junkie too!  Ya gotta love Colorado in the summer; I think there’s a rodeo in one town or another just about every weekend.  How cute is little cowgirl Juneau:

Shane-Bug and Emilie:

Fin’s twin, but the sweet version, Nova:

Finley, of course, loves the music in between events the most.  She was doing the most hysterical, funky little dance and then when everyone would cheer the next cowboy on, she’d assume the applause was for her!  Ahh, my little girl. 

So, it was a great weekend.  We ended it with Yiayia taking Travis, the kids, and me to dinner for Father’s Day.  I have 2 more days to savor before the real chaos begins.  Our nanny situation is working out well so far.  The kids are adjusting, but the stress on them has been coming out in other ways.  For Fin, it means we’re back to FREQUENT wake-ups, on the order of 4-6/night.  For Shane, it means when I’m home he perseverates and sounds like a broken record saying “mama, mama, mama, mama” until I feel like my head is going to pop off.  Jack has sort of been a rockstar through the transition so far, but he’s always harder to read and a bit more subtle with his reactions to things like this.  For example, his acropustulosis has been flaring…that’s also heat-related, but stress plays a part for sure. 

I, on the other hand, am not so subtle with my emotions.  I know I’ll be a wreck again by mid-week.  I’m trying to take it all in very small pieces.  This week, my goal is to make it to Friday without melting.  I’m intentionally NOT thinking about how I’m going to survive the spring, leaving a newborn (in addition to my 3 other babies) to return to q3 overnight call in the ICU.  I’m just not going there yet.  First I have to get to Friday.  I don’t get all of next weekend off, but I will get 1 day since my first call falls on Thursday (& next call is Monday).  Wish me luck.