The past, present and future

Howdy, blogland. Long time no see. Oh, and happy Mother’s Day.

It’s been a rough string of months. I had personal changes, a 40th birthday, a malignant rotation, a psoriatic arthritis flare, the stinking IRS is holding my refund for some sort of random review, a struggle with the black dog, and now I topped it off with a nasty viral infection that doesn’t want to leave my lungs.

But, things are looking up. Or, I have to start looking at the positive. I got my schedule for next year. Most rotations, I will be doing two days a week of clinic, which I am really looking forward to. I have zero nights, zero swing shift for the year. I’ll get to do some rotations I am looking forward to, like radiology (I hope I get to focus a lot on ultrasound) and hematology. I also will get to do a full four week block of clinic and one block in a community health center, so I’ll get my share of outpatient medicine. Hooray! I also have a block of NICU and a block of obstetrics, among other hospital based blocks.

I went to a social event with a lot of members of the local natural birth community, and everyone seems to be eager to work with me in the future. I see a lot of possibilities. I have always kept myself motivated by imagining what my future would look like. I am imagining a future with a practice in a freestanding birth center, doing women’s health, prenatals, family planning, lactation medicine, pediatrics, and possibly even some births. One of the local obstetricians said she would welcome me into her solo practice to see her clinic patients. This may be a more compatible future than doing hysterectomies and cesareans.

So, the future is bright. I just have to free myself from the gloom of the recent past.

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Overheard at work

1. Two elevator repairmen in the lobby this morning: “I don’t know how those Seaman systems work.” I snickered, because I am really mature.

2. A medical student: “What’s water boarding?” I overreacted. “Are you SERIOUS? You have never heard of waterboarding?!” I gave her a two minute synopsis on so-called advanced interrogation techniques vs. torture, the Geneva convention.

3. A patient: “Someone is taking medications out of my purse!” I rocked this one. No ableism intended, but I am known as the “crazy whisperer” at my site. I didn’t come up with that name. A lot of practitioners / caregivers take an adversarial communication style with patients that are combative, delusional, or simply question or want to refuse treatments. I try as hard as I can to meet them where they are. The patient is intermittently in florid psychosis, is paranoid, and is refusing treatments, tests, meds and food. She is sick, in many ways, and some of her meds can literally be a matter of life and death. I had a good, long conversation with her. I am going to let her use her home inhaler if she informs us, instead of confiscating it and making respiratory document every administration. I am ordering sealed cans of dietary supplements to her bedside to accommodate her fear of “dirty hands” contaminating her food. I told her that her 1:1 sitter will help keep track of her belongings, trying to establish trust with her sitter and to help her feel more secure. I let her know some of her meds are refuseable, even though she has been involuntary committed and deemed confused and inappropriate. I find that when patients feel like the have some respect and control, they are more secure and cooperative. She immediately agreed to her most critical meds, and is much more calm.

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I know what I’m going to be when I grow up

I am going to be a family practice physician.

 

I have mixed feelings about this. I think I will make the best of it, and I can have a rewarding (and hopefully successful) career in family medicine. I can still do a lot of women’s health, and even possibly some obstetric care of sorts.

 

Anyway, here’s to the future.

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Should I go to medical school? An advice column.

Check out my post over at Mothers in Medicine:

Should I go to medical school?

It is an answer to a series of emails I have received over time asking me advice about the whole single parent medical school doctor used to be in the natural birth community thing.

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Working during the holidays

Happy holidays!

I have had the dubious honor of being on what our residency calls the “swing shift” during most of December and early January. That’s 4 pm to midnight, Monday through Friday, and one of those nights I stay until 7 am to relieve a member of the night float team.

In other words, I worked Christmas Eve and Christmas Day, and I will be working New Year’s Eve and New Year’s Day.

In some ways it’s been rough. It was hard during the kids’ last week of school. I didn’t see them much. I was up until 3 am making treats for their teachers after getting off at midnight, but then I did have the freedom to drop off the treats at their schools before going into work. I also got to spend Christmas morning with them.

It’s fun, in a weird way, being in the hospital on Christmas. Everyone is in a good mood. People bring in treats, including me. The whole hospital is decorated. Usually, there are less BS admissions because people tend to want to be home with their family.

Anyway, hope you all get to spend time with your loved ones. I need to do another admission!

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I spoke too soon

So, right when I convinced myself that I would be better off in family medicine, I got an invitation to interview at my local ob/gyn residency. I think the delighted yelp I let out when I opened the email made it pretty clear that all of that self-convincing and denial didn’t work 100%.

Here we go again. Wish me luck!

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Breaking the silence

I am happily coming down off the high of presenting at the Medical Students for Choice annual conference – I was part of a fantastic panel on Protecting Choice in Birth. I felt honored to be sharing the table with some brilliant people – two wonderful ob/gyns, two reproductive justice lawyers, and little old me. We talked about the legal and ethical underpinnings of patients’ rights and choice in birth: site of birth (e.g. out of hospital birth), VBAC, even use of a doula or refusal of certain interventions.

It was a wonderful experience. The director of MS4C told us the response was so overwhelming that the conference was buzzing about our panel, and we are definitely invited to return. I learned a lot from my co-panelists, and loved the enthusiastic response from the audience. One sweet medical student literally had his jaw agape when Farah Diaz-Tello, from the National Association for Pregnant Women, described a woman who had her baby taken away and put in foster care for simply wanting to postpone signing a blanket consent for any intervention or procedure during her labor and delivery. She had a healthy, spontaneous vaginal delivery with no complications during her SECOND psych consult (after the first psychiatrist deemed she was clearly mentally competent and allowed to refuse consenting to an unnecessary hypothetical cesarean), and apparently her six year old is still not in her care due to the red tape surrounding her case. Jaw dropping, indeed.

I talked about my journey, including being a patient, mother, midwifery student, doula and research fellow before becoming a doctor. I discussed the hostile-to-patient-autonomy atmosphere in South Florida, my fellowship research on labor interventions, and how to present risk to patients.

I almost burst into tears when my co-panelist, the lovely and dynamic Dr. Hanson, showed pictures of twins and breech births she has delivered all over the world. I did end up tearing up during lunch, not just because birth is moving and emotional, but because I am slowly accepting that I will most likely never be doing these difficult deliveries, and my wonderful copanelists innocently asked me about my residency plans. I may not be doing deliveries at all.

I got a decent amount of invitations to obstetrics residency programs. I am slowly canceling them, one by one. I simply cannot justify moving my two boys to a city where I don’t know anybody, then disappearing to work my ass off 80 hours a week at all times of day or night. I also don’t want to put them in public schools in the Deep South. When I got divorced during my third year of medical school I knew that would mean facing residency as a single mom. The divorce was worth it, but now that I have experienced the reality of how hard internship is, even with significant family support in my home town, I had to reconsider my options.

I will most likely be pursuing a family practice residency at a local residency program, probably at the hospital where I am doing my internship. Yes, obstetrics can fall under the family practice umbrella, but I would be the first family practitioner to get hospital privileges in the greater Miami area in recent or remote history. In other words, the chances of that happening falls between not likely and impossible. Yes, not even if I do an obstetrics fellowship, which would involve leaving town for a year. It’s just not the standard of care here, even if it’s normal in other parts of the country. And my custody arrangement stipulates that I practice here after training. So, even if I move for residency, I would have to uproot again and come back.

I can still do women’s health. I can still do prenatals. I can do lactation medicine, including the pediatrics portion. I can even be the medical director of a local freestanding birth center, just not their backup surgeon. Which, honestly, was never a huge draw for me. I want to be at the normal pregnancies, not a back up for the ones that go wrong. I can do family planning. I can still do academics, including medical ethics, which is an interest of mine.

So, most of the time I am ok with this. Most of the time. I have a lot to be happy about. I have great kids, good family support, a supportive director of my residency program, relatively good health, friends, a cute little house, a fuzzy loyal dog, and a blossoming (very tentative!) new relationship with a nice guy. And I’m a doctor, for Chrissakes. With a job in a shitty economy.

So, anyway, another permutation on the journey. Let’s see how it plays out.

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