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.

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.

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.

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.

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!

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.

“Life” as a single mom in internship

It’s life, Jim, but not as we know it…

I am blowing the cobwebs off of the blog once again. I have a rare moment to write. Well, it’s not like I don’t have a lot of other things I could or should be doing, but I can’t pass up this quiet pause.

I am just over two weeks into my intern year. I am doing a traditional rotating internship at a local hospital. I volunteered to be on nights first. For the night float, I am working 6 nights a week, and an average of about 10 hours a night. Our team does admissions into the hospital from the ER, handles house calls, and helps run rapid response codes and code blues. As busy and frustrating as the job can be, it is not horrible. I love the people I work with. We have a great team, and I really like the people in the graduate medical program in general.

I am happy because I have gotten to handle a few emergency night gynecology admissions for my favorite attending physician in the hospital, a gynecologic oncologist. I also have gotten to handle a few psych admissions. Psych is my second love. The other members of the team gladly let me handle these cases. I know what to do on a lot of basic house calls now. I got to help save a woman’s life, a patient who coded and ended up having a massive heart attack.

I am naturally nocturnal, so the nights thing isn’t killing me so much. It is really difficult to have a life outside of the night float, however. One of my sons is mostly traveling with his father, and my other son is in camp and is spending nights at his grandmother’s house. That is why I volunteered to do my 4 weeks of nights now. I try to see them every day that I can. Sometimes it is only for a brief visit, after I wake up and before I head in for my next shift. I have one day off a week. The last one I spent dozing off on the couch. I had to spend the day today at an excruciating orientation. I had to flip my schedule to days for two days in order to attend it. As my friend and fellow expert in scatolgical therapy told me, this kind of sleep deprivation would turn her into a “drooling turd sandwich”. I am officially there.

I am gearing up for the match again. I am not looking forward to going through the whole process again, except with less spare time and optimism. I am also facing the harsh reality of residency as a single mom, without the benefit of doing what I love – ob/gyn. So, the application process is especially horrible.

Today, after orientation, I stopped by to see an old friend whose brain cancer is, unfortunately, messing with him again. He is now suddenly mostly blind, and will find out soon if he will be having his fourth brain surgery, and will most likely be starting chemo again for the umpteenth time. I picked up the kids, and made it all the way to the grocery store parking lot. I looked around in my wallet and purse for a Visa gift card I had been saving for such rainy days. It is pouring, my friends. I am waiting for a check to clear, and a deposit to show up in my account. My cushion between the two is $10. I couldn’t find the Visa card, so I took the kids home.

When I got there, I was so emotionally, mentally and physically exhausted, I couldn’t even bear the thought of looking through my cluttered, dirty house for the gift card. I, luckily, am quite a food person. Even though I have not done a decent food shopping trip in more than a month, I have a kick ass pantry and reserves. I had defrosted catfish nuggets (yeah, mama is buying cheap) already, and had hoped to buy the ingredients for the beer batter today. I also haven’t had any bread for over a week, and I have to make breakfast tomorrow for the kids, and Seb needs a lunch for camp.

I put together a breading for the catfish out of flour, cornmeal and plain yogurt. I had vegetable oil for frying. I had half a bag of onions, so I made onion rings with the rest of the breading and oil. I also had half a packet of yeast, and just enough flour and milk to make dough for bread. After the kids and I ate the interesting, slightly tart but definitely edible dinner, I passed out on the couch at about 8 pm. I am officially a drooling turd sandwich, and am on the exact opposite schedule I need to be on to resume a stretch of seven night shits in a row as of tomorrow night.

I didn’t clean the kitchen, which was wrecked. I didn’t bake the bread. I didn’t dry the laundry, which included stuff that S needs for camp tomorrow. I did manage to wake up intermittently to tell the kids to shower and brush teeth. I got Z into bed, and eventually got myself from the couch into bed.

I woke up at 4 am. Initially I was annoyed, since, as I said, this is the exact opposite schedule I need to be on. But, now I am grateful. Even with only half a packet of yeast, the bread dough rose beautifully. I kneaded it and put it in the oven. I put the wet clothes in the dryer and started a new load of laundry. I tackled the oily, breading-y mess of a kitchen. I started a load of dishes, cleaned all the pots and pans, I swept the floor, wiped down the counters and some surfaces, and I am now on the couch, enjoying a cup of delicious coffee and the aroma of freshly baked bread.

S made me a pot of French press before he went to bed last night, and it was waiting, full and gorgeous, on the kitchen counter amid the oily mess this morning. It was quite a love letter from a thirteen year old. He and I share a love of French press. He offered to try to help me out, since my fancy coffee maker decided to finally die about a week into my internship, by making me pots of French press when he was home. But, we got in a big argument about it the other day. I was exhausted, he was feeling very thirteen and had been juggled from his grandma’s to his dad’s and then back to my house. We got in one of our worst arguments in a while over him making me a pot of coffee. It was the first hour I had seen him in three days (his dad had him for the whole weekend), it was the first time he had spent with his brother in a few weeks. We spent it fighting about him plunging the coffee, and he was reduced to tears. So, it meant a lot to me to wake up to a fresh, full pot waiting for me, unbidden.

So, the kids are still sleeping. The washer, dryer and dish washer are humming. The sun is coming up. My coffee cup is empty, and I am going to pour myself another love offering and I’m going to walk the dog to the lake and drink it and the sunrise in. The bread is cooling and will be ready to enjoy for breakfast. I may even get to my presentation for the VBAC Summit.

Could be worse.

Countdown one week

Interviewing time is quickly approaching. I have my first interview in one week.

Eek.

I have four interviews scheduled so far. I would like more. I am thinking of applying to more programs. I haven’t gotten an invite to my local program yet, which will most likely be my top choice. But, I am doing a full month there next month, and they invite and interview late.

I am preparing for the interviews, clothing wise and mentally wise. I have no idea what to wear to a mixer with the residents.

I just wish I could fast forward to match day.

In the meantime, it seems like I may be taking a leave of absence this month. I am entitled to a vacation month, which I wanted to take this month, but I was assigned to emergency medicine this month, and I have February and April still open. While my site was willing to have me switch my ER month to February, but my school has a policy that you can’t change your months without actually switching with another student. But, no other student will have a vacation month they set up and then want to switch. So, I am finagling it as a one month leave of absence. I will work out the details tomorrow. And then, I’ll get to interview twice this month, and even spend Thanksgiving with my kids!

First day at an “audition rotation” observations

I’m waiting on line to get an I.D. card for my new rotation site. It’s a family planning rotation at a program that has an obstetrics and gynecology residency to which I applied.

I’m really excited and nervous. So, to distract myself, here are some observations:

1. One of the streets bordering the hospital is named “Papanicolauo Way.” Yes, I will be taking a picture at some point.

2. They sell “The Club”, the old school car security device here in the security office. Geez, maybe I should have put my purse in my trunk.

3. When we were cruising through the school corridors among research labs with cool looking beakers, goggled research assistants, and radioactive materials and biohazard warning signs, there was a water fountain with an old, worn sign stating “This water is SAFE for drinking and cooking.” If there was no sign, I wouldn’t have been suspicious. Now, I’m not so sure.

I’ll be back with more clinically relevant observations.

*blink blink*

I have been swamped in all areas of my life lately. Between a rotation in gynecologic oncology that had me waking up at four most mornings and had OR days that easily stretched into fifteen hours long, to my seven year old’s birthday, to applications for residencies, to working on research, there are many days I don’t even touch my computer. If I do it’s to look up a medical topic to study or to do research.

I actually slept 10 hours a few nights ago. It was incredible. I still feel sleep deprived, and I am not a sleeper. I usually say “Sleep is for the weak,” which proves I am meant to do obstetrics. But, even I have my limits.

It is really exciting to be at a point in my educational path at which I can focus on obstetrics and gynecology. I still have core rotations in family practice and emergency medicine and an elective in cardiology ahead, but my boards are done. Pretty much, it’s ob/gyn, full speed ahead otherwise.

I am going to be spending two weeks at a Family Planning rotation site. This will be my first rotation at my local ob/gyn residency program. Eek.