Sips and Chips: Notes from a nascent pediatrician

Art Projects For The Creatively Disinclined

2012-01-24T14:30:00.006-06:00

I've been feeling a bit overwhelmed lately. Whether it was the holidays, our cross country road trip, my seasonal upper respiratory infection or my 2 weeks of service on either end of those things, I can't be sure. Perhaps I've taken on too much. At least that's my husband's theory. Regardless of the reason, I can't continue to wallow in my office or at home lamenting the dust mites and watching another episode of 30 Rock. I just can't. So what did I do? I bought a giant dry erase board and the most colorful set of dry erase markers I could find. Organization should be pretty to look at. I'm dividing my to-do list into 4 quadrants based on those outlined in another book that changed my life, The 7 Habits of Highly Effective People by Stephen Covey. This is otherwise known as the Time Management Matrix and I'm in love with it.

Basically, we spend our time in one of four ways. Two factors that define a task are its urgency and its importance. Now picture a box divided into 4 smaller boxes. Across the top two boxes are the words "urgent" and "not urgent". Down the left side of the boxes are the words "important" and "not important" such that if you slide your finger down from the words "not urgent" and across from the word "not important" they would meet in the bottom right box. Quadrant I is where "urgent" and "important" meet. These are tasks that are crises and deadline driven projects. Quadrant II is where "not urgent" and "important" meet. These are relationship building or career building activities, recognizing new opportunities, planning and preventing future problems. Recreation goes in this box too. In Quadrant III, where "urgent" and "not important" meet, we have some email, some phone calls, some meetings, popular activities (committees, gossiping) and the ever present interruptions. Quadrant IV is where "not urgent" and "not important" meet. This is trivial busy work, some email, some phone calls, time wasters, and mind numbing time surfing the internet. Where do you spend the most of your time? I'll tell you right now that for the past 3 months at least I've been living in Quadrants I and III. Hence, the overwhelming urge to crawl into bed and watch a Law and Order marathon when I really need to be working on my research project that needs to be finished by May. Ugh. When you spend too much time producing and not enough time replenishing you reach the state I'm in right now. I can't even seem to muster the energy to whip up a batch of soul soothing chocolate chip cookies or go for a 4 mile run through the woods. That's a problem. Where would I like to be spending my time? Or rather where do I need to be spending my time? You got it, Quadrant II. That's where the magic happens people.

So for the next 2 weeks, I am focusing on my white board color-coordinated quadrant-ized to-do list. I'm going to focus my energy in Quadrant II and spend less time in Quadrants I and III. And yes, cookie making and running are going into Quadrant II. I challenge you to do the same...find your Quadrant II.

Aliens Abduct Snow Plow Drivers (or how I spent Christmas Eve)

2012-01-11T08:31:00.005-06:00

On December 22nd, Jeff and I loaded up the car with Christmas gifts, suitcases, my laptop, beer, a 1lb bag of Twizzlers and a plate of freshly made peanut butter kiss cookies and set off on what was supposed to be a 26 hour road trip to Arizona. Why on earth would you do something so stupid you ask? You're not alone, don't worry. I surmise that the holidays induce some sort of salt o' the earth adventurous spirit that invoke flashbacks of weary travelers arriving at the threshold of a home warmed from the inside by firelight and smelling like cinnamon and pine. Much like the three wisemen. Or something like that. Anyway, the first night consisted of delirious (on my part) conversation while driving late into the night to Kansas City after leaving straight from work after a solid 2 week stretch on a busy service all the while propping my throbbing foot on the dashboard. Oh did I mention that I broke my toe by accidentally kicking my suitcase while packing? So, there was that. The next day we got on the road early, excited for our journey to Roswell, New Mexico and some potential alien sightings. Keep in mind that the weather in the midwest was awesome (you will never again hear me utter that statement) and we had sunny skies and clear roads all the way through that part of our journey. At this point, we were feeling pretty smug about our enlightened decision to drive to Arizona. It's so easy! And so fun! The fast food, the conversation, the sights (once out of Kansas) and the audio books! Our dream came to a halt somewhere between Amarillo and Portales, New Mexico. We heard on the forecast that there was "light snow" in New Mexico. Ok, we're from Wisconsin. Light snow means turn on your windshield wipers. What they didn't tell us was that New Mexico doesn't feel the need to clear the roads of said "light snow". Or salt. Or do much of anything except encourage every resident with a large Chevy truck to get out on the roads and speed. After spending an hour traveling 25 miles, with Jeff white knuckling the steering wheel and me gripping the door handle while trying to identify the edge of the road so that we don't in fact, drive off of it, we stopped at the first gas station we saw. Our plan was to stop short of our goal of getting to Roswell and just spend the night wherever we could find a bed. A bed, however, was not to be had in the town of Elida. "No motels here!" we were cheerily told by two older ladies manning the register. "You can go back the way you came 25 miles or keep going another 65 miles!". Ok, awesome. Thanks New Mexico, for your continuing inhospitality. We ended up driving the same route back the way we came and paid way too much for a room at the Holiday Inn.

The next morning we were full of new hope, bolstered by beer the night before and free waffles for breakfast. We headed out, sure that they would've cleared the roads by then. We reached the same damn small town and realized that we were going to be sorely disappointed. The roads were now even more icy and the "light snow" had begun to fall again. We reached Roswell a couple hours later and stopped at yet another gas station hoping for good news. "Do the roads get better going west towards Arizona?" I asked. I was greeted by another cheery response. "Nope. All roads going west are closed. All roads going south are closed too." I asked "How am I supposed to get to Arizona?" my voice trembling as I'm exhausted and frustrated and on the verge of tears. I was told to try in a couple days. Refusing to miss spending the holiday with my family, I was determined to get to Tucson by Christmas morning. We ended up taking the only road open heading north to Albuquerque. Miraculously, 10 miles north of Roswell the skies opened up and the sun was shining, the roads were cleared and it felt like we were in another world. Or on another planet. Twelve hours later, we pulled into my sister's driveway. There was no fire in the fireplace and her house smells more like organic all natural air freshener than cinnamon and pine, but we were home for Christmas. I was able to wake up with my niece on Christmas and discover what Santa had brought for her. Seeing her play with her new princess house made the entire snow bound-car sick-foot throbbing-post apocalyptic New Mexico landscape-fast food free for all road trip worthwhile. And Roswell, I'm not fooled by your aliens cleverly disguised as monster truck drivers. Where were they going??

Why I Love My Job: Reason #35

2011-12-19T20:58:00.004-06:00

I called my first code today since I've been in Madison. When I worked in the NICU codes were a monthly event. But here, I've been relatively unscathed by the heart-thumping "oh crap this kid's going to die unless I do something" scenario. Until this morning. My patient is 2 months old and I have spent the last week stretching the limits of my brain trying to figure out what is wrong with her. Her parents, young and oh-so-trusting, have put their faith in me day after day. And day after day I go into that room and explain that we don't know what is wrong and that the tests we ran did not help explain what is happening with her. This morning I was at her crib listening to the resident explain to the parents yet again the plan for the day, the plan to continue our testing and investigation. Then, she decided to quit breathing and turn blue in a matter of seconds. And in a matter of seconds I was back in the NICU, calmly asking for the bag and mask, asking the nurse to please call a code, asking the resident to listen for a heartbeat, all the while reassuring the parents that we had this all under control. And they looked at me with complete trust. She recovered and I transferred her to the ICU. I went to check on her this afternoon and to see how those parents were holding up. And you know what? Despite being hooked up to a ventilator and under the care of excellent critical care physicians and nurses, those parents wanted to know what I thought was going on and what I thought should be done. They told me all the things the ICU doctors had suggested and they wanted to know my opinion. In spite of everything that had happened, they still thought of me as their doctor and they still trusted me. Even though I had spent the day doubting myself and my abilities, they never stopped. I can't express in words how much that meant to me. For some, a day like today might make them question their choice of medicine or pediatrics as a career. For me, I question how I ever thought I could do anything else.

No Pain No Gain

2011-12-12T20:30:00.003-06:00

We're living on borrowed time here. My internet has decided to cut out after about 8 minutes of web-time and it won't come back unless I restart my computer. Calling AT&T is on my list of things to do along with experimenting with shortening (I've always been a real butter girl)...and only one of these things is getting done tonight. Bear with me if this is short and disjointed.

I threw my first holiday dinner party over the weekend. It was a relatively safe foray into the holiday entertaining world but a challenge nonetheless. My husband criticizes me for being a food snob but honestly I just think things are better when homemade. Don't you agree? I did second guess this sentiment after spending 9 hours running around my kitchen, burning out my KitchenAid stand mixer and frightening my dog Swayze. But in the end, it was so worth it. Here's the menu:

Spice rubbed pork tenderloin

Mashed sweet potatoes

Roasted brussels sprouts and pancetta

Glazed carrots and thyme

Cornmeal buttermilk biscuits

Maple brown butter semifreddo

Guests were sent home with double chocolate biscotti, apricot cranberry granola and honey vanilla marshmallows. This is why I haven't had time to blog. Or call AT&T. Happy Holidays.

A Sunday Night PSA

2011-11-27T18:50:00.004-06:00

This picture is the new ad campaign for Milwaukee's fight against infant co-sleeping. The campaign's purpose is to make people aware of the dangers of co-sleeping and in effect, reduce Milwaukee's infant mortality rate by 10%. As I looked into the reason behind the campaign, I was shocked to learn that certain zip codes in Milwaukee have an infant mortality rate higher than many 3rd world countries. In fact, they are neck and neck with Albania for rates of infant deaths. The rate is even higher for African-American babies.

As unsettling as this ad is, once you get past the shock and confusion (I wondered how sleeping with a baby could be more dangerous for me than sleeping with a meat cleaver....then I got it) you might just understand how something as innocent as sharing a bed with your baby can have a tragic ending. Because the facts speak so much louder than I ever could, please visit this website for more information. A little dose of perspective seems fitting to wrap up this Thanksgiving weekend.

Life Lessons From Swayze

2011-11-17T14:43:00.003-06:00

My dog Swayze loves walks. Let me rephrase that, lives for walks. The only thing she loves more is my husband. I come in a distant third. I try to take her on long walks around the neighborhood at least a few times a week. Swayze likes to play dumb but she is actually pretty perceptive. Case in point...No matter how long we walk, whether 5 minutes or 50, she slows down considerably on the way home. It's embarrassing really. She'll lag so far behind me that I'm practically dragging her down the street towards home. I'm sure people drive by and think "Look at that poor exhausted dog being dragged down the street by that awful woman." At first I was concerned that she was out of shape and was truly exhausted. Then I took her to the dog park and proceeded to spend a good 20 minutes laughing at her greyhound-chasing-a-rabbit impression. No, the dog does not get tired. Ever. So why does she do this?

Swayze understands what so many of us choose not to remember. Time is fleeting. Especially when that time is spent doing something you truly love. When was the last time you stopped and looked around you? Looked at things the way they were at that very moment and saw them? I recently spent an awesome weekend in Chicago with my husband, just because. I lived there for 4 years before moving to Madison and I thought I had my fill of the big city life. I spent a good portion of my time there waiting to be able to leave. I wanted so badly to get on with the next phase of my life, to find a job I loved. I am so lucky to have that now.

Over the weekend, I went for a run around downtown Chicago. Everywhere I looked, I was inundated with memories. The restaurant I went to by myself and was asked out by a waiter, the first time I ran from my apartment all the way to the Hancock building, my all time favorite cupcake place, the building where I met my husband, the boutique where I bought my wedding dress, the hotel where we had our wedding reception. As much as I love my life now, I yearned to go back in time if only to stop and look and smell and taste and be in those moments again. Because unlike Swayze, I didn't slow down to enjoy where I was. Instead, I focused on where I was going and tried to get there as fast as I could. I wish I knew then what Swayze has always known: Take time to enjoy the journey because home will wait for your return, but time will not.

Garbage In, Garbage Out

2011-11-06T11:23:00.004-06:00

This week, as I was sitting down to teach my team on the wards, one of my residents decided to spill her emotional garbage out on the table. She was tired and stressed and not in the mood to stop working and learn. I sat and listened with a polite smile on my face but on the inside I was burning. How dare she question the value of an attending wanting to teach their team! When I was a resident (there I said it, I'm officially old) I would never think about expressing a lack of interest in learning to an attending. At least not out loud. In front of the entire team. After this incident I found another one of my hospitalist colleagues to vent. She was appropriately incensed at that resident's behavior. "I'm not taking it personally" I said. And she said "of course you are." Yes, she was right. I took it as a personal attack. I took it to mean that I wasn't interesting enough. That what I had to say had a diminished value in the grand scheme of getting the work done and getting home in time for dinner. How fragile my ego is that a stressed resident can make me question my worth as a teacher!

I've thought about this a lot this week. About how I let her get under my skin. How I let her dampen my enthusiasm for teaching. How I let someone else's baggage become my own. There's a word for that you know. It's codependency. Codependency is defined in broad terms as: a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition; dependence on the needs of or control by another. I know this sounds dramatic, but in the most basic sense I let her dysfunction (pathological condition) manipulate me into thinking that I had my own dysfunction. How many times in the past week have you been codependent? Probably more than you think. It takes an enlightened person to stay focused on abiding by their own values in the face of dissent. But it can be done with awareness and discipline. Eleanor Roosevelt said "Nobody can make you feel inferior without your consent." You always have control of your own feelings, no one else's.

That resident has since taken me aside and apologized for her actions. I empathize with her, I really do. I remember how hard residency was. But I stressed to her the need for professionalism at all times in our line of work and to remember that we are mentoring impressionable learners. What I didn't tell her was that she made my day with her apology. And that she forced me to come to terms with my own path towards interdependence and away from codependence.

Home Is Where The Start Is

2011-10-25T20:46:00.005-05:00

Let's talk about this whole life coach thing. Now I'm into it about a month and I can honestly say it is worth every penny. Here's how it works: For a monthly fee, I get "coached" for 45 mins twice a month over the phone. I met my coach in person for our initial session which was 2 hours of intensive talking about myself. Totally draining! You might think that 45 mins on the phone is not enough time to delve into what you need to delve into, but let me tell you, my coach is uber-efficient at getting out of me what she needs to know in order to direct me to the next goal. On the real. In order to facilitate this efficiency, I fill out a "call focus form" and email it the night before our session. In it I answer questions about what progress I've made on my previous goals, what obstacles I've faced, what things I'm procrastinating about (because we all have something), and what I'm happy about. This is a worthwhile exercise in itself because it allows me to really reflect on my life and be completely honest with myself. This is also accompanied by a glass of wine. My coach uses the call focus form to do just that: focus the call on the pressing issues. I have to admit when I call her and she says "There's a lot of good stuff here!" I feel a mix of pride and embarrassment. Pride because I'm a perfectionist and want to do well at everything including analyzing myself. Embarrassment because I didn't realize I had so much "stuff". There's a lot of work to be done people. Most use coaching for 3 to 6 months and then feel comfortable taking their show on the road. I have no idea how long this process will take for me.

This experiment started out as a way for me to develop the skills necessary to be successful and happy at work. However, in quality improvement lingo, I've found it necessary to perform a root cause analysis and drill down to the very source of my habits and patterns of reaction. What I've uncovered so far is the need for a fundamental shift in my way of thinking. We don't leave our patterns at the door when we come home. Who you are at work is who you are at home and vice versa. In order to change how you think and behave you have to start where you are most real. And that place, for most of us, is home.

Check Yourself Before You Wreck Yourself

2011-10-12T20:09:00.003-05:00

Let's talk about integrity for a minute. What is your definition of integrity? I dug myself into a small hole yesterday when I said that someone (who shall remain nameless) did not have integrity. The person I said it to immediately zeroed in and said "That's a pretty strong statement. Do you really feel that way?". I stammered and rambled but hopefully didn't look like a complete idiot trying to defend myself. When I replayed the conversation to my husband he also made the face that says "Ohhh, did you really say that?!". You know the face I'm talking about...eyes wide, eyebrows raised, air being sucked through teeth. Yes, that face. A coworker and I were talking about it today and she said "You said he didn't have integrity. That's a pretty strong thing to say!". Yikes. Am I the only person on the planet who didn't know that was the most awful accusation I could possibly make?? I was only speaking what I really felt was the truth. So what did I do? I researched the definition of integrity just to make sure I had it right. I was fully prepared to apologize if I indeed misspoke.

Integrity: noun Adherence to moral and ethical principles; soundness of moral character; honesty; the state of being whole, entire, or undiminished.

When I read that, I take it to mean that one with integrity is one who lives their values in a recognizable fashion. You will be able to see what a person stands for because they live it everyday. They walk the talk. They show their go. They vote with their feet. And every other cliche that you can think of that means that someone backs up their words with their actions. At its most basic connotation, integrity is to be whole. There is a seamless transition from values (inside) to actions (outside). There is no separation.

Did I mean it when I said this person had no integrity based on the definition and my experience with this person? Absolutely. Do I wish I could turn back time and not have said it out loud? You bet. I can't help but wonder what impression I made on the people listening. Although I value honesty, I also value discretion and respect, especially in the professional arena. I did not necessarily act with integrity, because I was not fully acting in congruence with my values. Learn from my mistake: take the time to think before you make a bold statement, even if it's the absolute truth.

Double Negatives=A Positive Attitude

2011-09-20T21:54:00.006-05:00

What have I not been up to this month?! The correct answer is not much. Now I've confused myself with multiple negatives. Let's just say I've been busy. Here's what went down the past 2 weeks...

1. I was fired by a patient for the first time. Well, not really fired. More like not rehired. A patient of mine was readmitted 2 days after I had discharged her (no small feat!) and her mom was requesting "a different experience" aka a different attending. It stung but I tried to not take it personally. Since I believe that the universe sends me signs if I only pay attention (listening on the 3rd level as my life coach put it), I wasn't entirely surprised when the topic of my first year medical student small group session was "Bias In Healthcare". We discussed all the different types of bias healthcare providers carry into their patient interactions and how that affects the doctor-patient relationship. I used this to reflect on my "firing" experience and realized that yes, I did harbor a bias towards a difficult and dramatic patient and this undoubtedly affected my interactions with this patient and her mother, however subtle that effect might be. Touche, universe.

2. I was touched by the death of a patient. Hearing about the death of a patient you have cared for stirs up so many emotions...shock, sadness, disbelief, fear, and an incredible compassion for the family. I felt all of these feelings in a span of about 2 minutes. And I continued to cycle through them all day and the rest of that week. I will carry her face and her story in my heart for a very long time. Such is being a pediatrician.

3. I spent the first of five weekends as a participant in a Primary Care Faculty Development Fellowship. A small group of us attend a series of sessions covering everything from teaching methods, using technology in medical education, evidence based medicine, and a potpourri of similar topics. At the end of the fellowship in May, we will be expected to have completed a research project with the intention of presenting at a national meeting. My inner geek rejoices at the opportunity to pretend I'm back in school.

4. Speaking of research projects, I've started my first clinical research project and just today realized that it might actually go somewhere. We are still in the preliminary analysis, but if it pans out, this will be the first project that I personally have conceptualized and followed through to completion and hopefully to publication. I'm trying not to get too excited but this feels big. Really big.

5. I had my first session with my life coach today. Fascinating is all I can say at the moment as I'm still processing. It's like therapy (without all the crying and dwelling on the past) meets mentorship (without the person having anything to do with my career) meets tough-love friend (everyone needs one of those but hardly anyone has one) meets personal cheerleader (but not super annoyingly cheery) meets guru (without the spiritual heaviness). More on this later.

6. My mom is coming to visit tomorrow for the first time since I've lived here. This entails frantic house cleaning and laundry and telling the dogs over and over again that "grandma is coming and bringing you presents!" They're very excited. So am I!

7. Last but not least, I spent an entire morning waiting for my new dishwasher to be delivered, watching it being installed, and then standing there in barely concealed disgust as the delivery person could not get it to work. I look forward to spending tomorrow morning waiting for the dishwasher repairman to fix my brand new dishwasher. But enough about that.

Day Ten: Renew, Restart, and Revitalize to Continue the Journey

2011-09-03T13:14:00.004-05:00

Here we are, day ten of our journey to a happier, more successful career and life. How do you feel? Happier? More successful? The good news is that if you've been doing the emotional work over the last ten days you should feel like you're at least on your way to feeling more fulfilled. The less good news is that your work is not done. Life is a continually changing organism and so are you. When you wake up tomorrow you might have a different perspective than you do today. In fact, I hope you do. I hope that you see each day as fundamentally different from the last and in turn, you are a different person because of your experiences of the day before. If you strive to learn and grow everyday, you will never be the same person you were yesterday. It is an amazing gift to reinvent yourself and see the world as an endless sea of opportunities again and again and again. We begin to die the moment we are born. It is up to you what you want to see when you look back on your life and your accomplishments. Each day ask yourself "What is worth doing? What is within my reach?".

When we talk again (I need a few days off!) I will tell you about a conscious decision I've made to better my life. Until then, enjoy your journey. Maybe over a glass of wine and a sunset.

Day Nine: Network Your Way To Professional Success

2011-09-02T21:28:00.005-05:00

First let me say that this is my 100th blog post. Second, I had the best frozen custard of my life today in St Louis. And now on to networking.

When I think of networking I think of handing out business cards and going to lame networking events where one is forced to "work the room" speed dating style. Neither of these appeals to me and my introvert personality. However, in reading more about networking, I realized there is a much broader definition of the term and that I could network and still be true to myself. Networking is defined as "meeting an extended group of people to form mutually beneficial relationships that provide assistance and support over time." If you expand the term meeting to include social networking sites and interpret a group of people to mean many people but one at a time, it doesn't sound quite so intimidating. We network every single day without even realizing it. Now is your time to use those opportunities to your benefit.

Looking back, I realize that I found my last two jobs through networking. When I was finishing fellowship and still without a job, I got a page one afternoon from the pediatric residency program director. She asked me if I was still looking for a job and of course I told her yes. She mentioned that the head of the neonatology division had called her because a position opened up and he asked her if she knew of any good candidates. She immediately thought of me. Prior to this, I had only spoken to her one other time about something unrelated so was flattered that she even remembered me. She gave me his phone number, I called and told him she sent me, I interviewed, and he offered me the job on the spot. You never know when a brief interaction with someone of status will lead to an opportunity. Even if you never think you will interact with that person again, put your best foot forward. Always. When looking for my next job, I remembered that a resident I had worked with in Chicago was currently living in Madison and working as a hospitalist. I had run into her a few months before at the Pediatric Hospital Medicine conference and mentioned that I would be looking for a job soon. She raved about her position and her coworkers but I didn't really think much of it because I had my heart set on leaving the Midwest. Six months later I thought about her and decided to inquire about a position in Madison just in case I didn't find a job I wanted in a warmer climate. Much to my husband's dismay, the job turned out to be exactly what I was looking for. She put in a good word for me and here I am, one year and a snowblower later.

My take on the concept of networking is this: grab every opportunity, accept every invitation you can, sit on panels and committees, volunteer for tasks nobody else has the time for, explore possibilities even briefly, teach classes, write blogs, and sell yourself. That is the essence of networking and that is how you are ultimately going to own your success.

Day Eight: Practice Personal Courage to Participate In and Resolve Conflicts

2011-09-01T21:09:00.004-05:00

Oooohhhh, this one's a biggie. And one I would have to admit I'm not very good at. Conflict is one of those things that is so easy to create yet so hard to destroy. When I'm faced with conflict of any kind, I get hot and flushed and my heart starts racing. I also tend to cry. I know, not a good situation. There's no crying in academia.

However, how do you get anything done without ruffling a few feathers? At least that's what I tell myself. Here's my recent experience with conflict. I was put in the position of doing a child abuse evaluation for which I felt woefully unprepared and completely overwhelmed. I've had no specific training in forensic pediatrics and although I can handle straightforward suspicions of abuse, I didn't feel equipped to deal with a complex trauma patient. Yet, there I was on a Saturday night, listed as the person on call for child abuse. After handling the consult, I wrote an honest, professional email detailing the issues I found and ways to improve them. Little did I know that the email would activate a chain of events leading to the removal of our hospitalist division from the child abuse call pool. This was a victory for our group, many of whom felt uncomfortable with our presence in the call pool without any training. However, when one group pulls out of call, another group has to pick up the calls. The woman who is now handling all the calls that we previously handled stopped by my office to "chat" after the fact. Even though I felt justified in speaking out the way I did and satisfied that my actions actually resulted in positive results, when she left my office I still felt a sense of fear and shame that I might have made someone else "mad" at me. It was a disquieting feeling and stayed with me for days.

I wish I could let go of that sense of needing everyone to like me and not making anyone else even remotely unhappy. Because not everyone is going to like me. One of my favorite quotes is "What people think of you is none of your business." I remind myself of that when I'm feeling paranoid that I'm ruffling too many feathers. Engaging in productive conflict is the only way you can be successful in reaching your goals both in your career and personal life. The goal is not to eliminate conflict, but to learn to manage it constructively (and without crying!) while maintaining your integrity and your relationships with others.

Day Seven: Identify and Live Your Personal Values

2011-08-31T20:44:00.005-05:00

"Yes, if you want to say that I was a drum major, say that I was a drum major for justice. Say that I was a drum major for peace. I was a drum major for righteousness. And all of the other shallow things will not matter." Martin Luther King Jr delivered this quote in 1968 about a eulogy that could be given when he died. It is now at the center of a controversy involving his memorial in Washington. Maya Angelou has criticized the shortened version inscribed on the memorial which reads "I was a drum major for justice, peace and righteousness." Her criticism comes from a firm belief that the values for which King stood are exemplified in the humility of the real quote and not reflected in the shortened version. You can decide for yourself.

Today's task is to identify the values from which you were formed and those with which you conduct yourself today. Values come from a lifetime of experiences and relationships and form the foundation upon which you make decisions and choices. In order to change the way you think and act, necessities for moving forward and reaching your goals, you must know the values guiding those thoughts and actions. Once defined, values impact every aspect of your life.

Here are some of my values: efficiency, loyalty, honesty, accountability, integrity, independence, activity. Despite sounding like a German car commercial, I live these values in my day to day personal and professional life. And for the most part, I am at peace with who I am and where I am in life. There's something to be said for living your values and true happiness. Living your values is a powerful tool to helping you reach your goals and attain success.

Day Six: Promote Your Personal Development Every Day

2011-08-30T20:19:00.005-05:00

When was the last time you sat and thought about all the things that make you happy? Does anyone really ever do that? And why the heck don't we do it more often? How about the last time you felt bored, unfulfilled or generally unhappy with the way your life is going? Dollars to doughnuts that question was easier for you to answer. Sad isn't it? Day six is all about promoting your growth and motivation. Also known as indulging in a bit of daydreaming and emotional pampering. It's ok, really. More than ok, it's necessary if we are going to get past this day and move on with our quest for happiness.

My husband and I were driving on campus today and noticed the students moving in to the residence halls. He commented that he felt sad that the great adventures in life, going away to college, studying abroad, going away for grad school, were already past. I've been thinking about what he said and just can't get myself to feel the same way. I've loved my past...but I love the anticipation of my future even more. I can't wait to have kids, advance in my career, make new friends, travel, rescue more dogs from the shelter, watch my friends fall in love and get married, be the favorite aunt, run more races and grow old with my husband. I admit, maybe I'm naive. But I'll choose naive and happy any day. If you feel bored with your life, or even if you feel content but want to feel joyful, try the following exercises.

List everything you'd like to do in your lifetime. Does your current lifestyle support the accomplishment of these dreams? If not, what changes will you need to make in order to make this true?

Write down your ten favorite activities. Do you get to do these things weekly? Daily? Is it possible to fit at least one of them in each day? How about making that the goal for the week?

Think of a time when you felt more positively about your life. What has changed between then and now? List everything that is different. This may help give you insight into what is making you less happy now. Can you find something to improve? This might be a toughie.

Schedule quiet, thinking time for yourself every single day. Allow your thoughts to wander, they will often lead you to unexpected places and if you quiet the loud (negative) noise in your head, you might hear a revealing answer to the questions above. This sounds easy but takes practice. Self reflection does not come automatically for many and it might be a weak muscle that you need to strengthen before you can really make the most of this quiet time. For me, that time is when I run. I notice that if I don't exercise for a couple days in a row, I get irritable and agitated. It's like my thoughts are piling up on my mental desk, covering all available space and generally creating clutter in my mind. My exercise time is for me and me alone, and it's when I do my mental filing. When I finish, I feel mentally and emotionally "cleaner". Spend time in your own head. And if you need a mantra, repeat after me "Self care is a worthwhile endeavor". You're on your way.

Day Five: Stay the Course or Change the Course

2011-08-29T20:19:00.004-05:00

How many times have you started something only to drift away, leaving it only partially finished? I'm ashamed to admit I've done this numerous times. A couple years ago I wanted to take up knitting. It was winter in Chicago and I felt if I was going to be cooped up inside I might as well have something to show for it other than an encyclopedic knowledge of Law & Order. So my husband, as thoughtful as he is, surprised me with a knitting book, some yarn and needles to start with. I got as far as reading the book. Then I drifted. Then spring came and I was on to something else. I have many unfinished scrapbooks, half-written journals, boxes of photos yearning to be placed in chronologic order, expired gift certificates and good intentions tucked away in the closet in our guest room. Am I alone in this?

The only way to achieve your goals is persistence in the undertaking of the challenge. This might be a weekly or even daily renewal of your commitment to accomplish whatever it is you set out to do. I've heard that it takes 30 days for something to become a habit. This means that you need to make a concerted effort to check in with yourself and evaluate your course everyday for a month. Then progress will become your habit.

I don't know if I will ever sit down and knit. Frankly, it's hard for me to sit and watch a movie. Sitting is just not my thing. It's ok to change your course, change your goals. But you have to intentionally do so. Drifting is not the same as consciously evaluating whether a goal still makes sense for you. Give your goals 30 days to weave their way into the fabric of who you are and see if they still feel right. You'll know.

Day Four: Chart Your Course

2011-08-28T18:24:00.005-05:00

Now that we've figured out who we are and where we want to go, how are we going to get there? That brings us to our next step: Chart Your Course. I'm going to go through these steps with you using one of my achieved goals as an example. I'm certainly not a pro at this (obviously, or I'd be writing about the yummy baked oatmeal I made for dinner tonight instead) but I did just go through the process. So here goes. Remember I mentioned that race last weekend where I reached my time goal? Here's how I did it.

1. You need to deeply desire the goal or resolution.

I've been working at this goal for about 9 years now. I shouldn't say I've been working at it...because I really never had a definite plan like what I'm about to show you. But I have been consistently running, entering races, and wanting to reach the goal. To be honest I was almost content to just let it go and give in to "slowing down with age". Then I decided to give it one really systematic hard effort. I wanted to give it my best shot.

2. Visualize yourself achieving the goal.

One thing I always do before a race is to make an iPod playlist specific to that race. I choose songs and order them in the list based on where in the race I will hear them. For example, I usually start with a slower, catchy beat to get me into a rhythm. In the middle of the race are longer songs with a steady beat. Towards the end of the race I put songs that are fast or inspirational. Then I listen to this playlist on some of my training runs and visualize how I will feel and where in the race I'll be during that particular song. I found this to be very effective at boosting my confidence and in turn, my performance. It helped that "Eye of the Tiger" played as I was nearing the finish line!

3. Make a plan for the path you need to follow to accomplish the goal.

In order to push myself, I joined a running group through a local running store. They had a specific training plan for the race I wanted to run. I knew that if I followed the plan and attended all the group training runs, that I would be giving myself the best shot at achieving my goal. I had a map of the path I needed to follow. It was up to me to put in the work.

4. Commit to achieving the goal by writing down the goal.

Rather than writing down my goal, I committed to it in two different ways. I hung up a copy of my training plan both at my office and at home, so it was visible to me no matter where I was spending my time. And of course, it was visible to anyone who came into my office. Second, for certain long runs the training group was divided into "pace groups" based on how fast they wanted to finish the race so that we could practice running our goal pace. By joining a certain pace group, I made it known exactly how fast I wanted to run this race. The people with whom I ran all knew my goal.

5. Establish times for checking your progress in your calendar system.

Luckily, this was built in for me in the form of the training schedule and running group. I knew that halfway through my training I needed to be able to run 10 miles without feeling completely exhausted at the end in order to be able to run 13.1 miles as fast as I needed to on race day. I also made it a point to run a segment of the race route at various points in my training to get a feel for the terrain. By race day, I had run every segment of the route at least once so that it was all familiar to me. I knew every hill and curve ahead of time only because I used them to check my progress during my training.

6. Review your overall progress regularly.

I've blogged about my beloved running partner before and I couldn't have reached my goal without it. My Garmin allowed me to save all of my running times and routes and download them onto my computer. Visualizing my progress was incredibly powerful. Reviewing your progress will allow you to make adjustments if necessary and will hopefully give you a little boost 'o motivation when you see that you actually are making progress.

This achievement of mine is certainly nothing to brag about and many people have achieved my race time with minimal effort and training. But that's not the point. The point is that this was my goal and I was, in a sense, competing with myself. Or at least the part of myself who thought getting older meant getting slower. That's just not true.

Day Three: Define Your Purpose, Your Mission and Your Goals

2011-08-27T20:13:00.004-05:00

If you know me at all, you know that goal setting is one of my favorite activities ever. Annoyingly so. I love to have the "5 year plan" conversation on a regular basis, much to my husband's dismay. So step three on the road to success being all about goal setting makes me feel like I can take a breather 'cause I have this one down. But I can't, because I'm not so familiar with defining my purpose and my mission. How many times have you been to a work function where you are forced to collaborate with your colleagues to come up with a "vision statement"? This goes down as one of my least favorite activities. I know, maybe I'm a cynic but I hate forcing corporate jargon into a wandering run-on sentence over which everyone will feign excitement but will forget within 2 days. So the thought of creating my personal vision statement makes my eyes glaze over like my ancient pug Lucy's. But if I'm honest with myself, I realize that without knowing who I am, I can't define where it is I want to be. So I'll do it. And maybe you can too so I won't be the only one feigning excitement. Here's some ideas to get you started:

1. What are the ten things you most enjoy doing?

2. What three things must you do everyday to feel fulfilled in your work? Mine would be laugh, learn something, and teach something. Hmmm, this isn't so hard.

3. What are your 5 most important values? Think of things like empathy, ambition, diversity, security, etc.

4. Write one important goal for each of the following areas of your life: physical, spiritual, career, family, social relationships, financial security, mental improvement and attention, and fun.

5. If you never had to work again, how would you spend your time?

6. When your life is ending, what will you regret not seeing, doing or achieving?

7. What strengths have other people noticed about you? What strengths have you noticed in yourself?

8. What do you believe are your weaknesses? What do others say are your weaknesses?

Now craft your vision statement and write about the future you hope to achieve. Good luck!

Day Two: Your Thoughts Matter

2011-08-26T16:45:00.003-05:00

Let's talk about the concept of pre-suffering. I had never heard this term until one of my coworkers identified it as the way I was feeling. If pre-suffering was an Olympic sport, let's just say I would be successful beyond my wildest dreams. The way I understand it, pre-suffering is when you feel all the negative emotion and worry associated with an event well before the event has even happened. And there's no guarantee the event will ever happen. An example (I have many): Before starting a weekend of call at our community hospital I have trouble sleeping. All day Friday I am filled with a vague sense of melancholy. I find myself glancing at the clock, mentally counting down the hours until the admissions flood in and my pager calls out it's disgustingly cheerful jingle. I brood over how tired I'll be on Monday and wonder if I'll get any sleep at all at night. Want to know what makes matters even worse? I not only do this right before a call weekend but also whenever I look ahead at the schedule and visualize how many weekends of call I have coming up. I know, get over it right? Right.

I tend to look ahead and try to prepare myself for the worst possible outcome of everything just so I'm not caught off guard. The effect of this is that I spend an enormous amount of time and emotional energy worrying about things that might never happen. And even if they did happen, what did I change by worrying about them? So I might not get any sleep tonight on call and I will feel like crap. But, I don't feel like crap right now. In fact, it's a beautiful warm afternoon and I just took my dog on a long walk through the park. I have a comfortable house and am planning a delicious dinner of spaghetti with Italian sausage and whole wheat bread. I'm looking forward to going on a road trip with my dear husband next weekend and seeing old friends at a wedding. Aaaaannnnnd I have an appointment with a "life coach" next week. So we have that little bit of randomness to anticipate.

Do you see what I did? I redirected my thoughts away from my useless pre-suffering and focused on the here and now. I focused on the good parts of my life. The things that are actually happening. So simple yet so difficult to achieve on an hourly basis. Earl Nightingale, known as the "Dean of Personal Development", said "the mind moves in the direction of our currently dominant thoughts". Practice channeling your thoughts and see if this makes a difference in your attitude. Or in your life. Then you'll be on your way to a happier and more successful career and life on day two of the journey: Your Thoughts Matter.

Day One: Taking Responsibility

2011-08-25T14:33:00.003-05:00

Isn't it awful to feel out of control? I felt that way for a time when I lived in Chicago and felt that I had no choice but to stay and wait for my husband to finish grad school. No choice but to take the job that I was offered, despite it being not what I really wanted to be doing. No choice but to take the bus or the train day after day because I didn't have a car. But what I didn't understand was that I did have a choice and those are the decisions that I made. I chose to stay in Chicago because I couldn't imagine living without my husband for even one day. I chose to take the job I did because it allowed me to have flexibility and time to explore other interests. I chose to use public transportation because it allowed me freedom from the responsibility of having a car in the city. It was all in how I framed it. Here's another example of someone taking responsibility for her life. She did not choose to lose her husband suddenly and be left with two young children to raise. But she is choosing to express herself in an honest and healthy manner and to be a role model for her kids. Totally inspiring and heart wrenching at the same time.

Today's step towards success and happiness is called "how to take responsibility for your life". Do you truly take responsibility for your thoughts and actions? I know I have fallen into a pattern of blaming others for any dissatisfaction I may feel at work. I blame the schedule, the culture, the politics, the leadership, etc. It's an easy trap to fall into and not the first time I've fallen. I'm trying to see my life as a series of choices I've made rather than things that have "happened". You really do have control over your life. Or at least how you react to the things that occur. If you know where it is you ultimately want to be, you can begin to take steps, make choices, to help yourself get there.

The Ten Day Challenge

2011-08-24T14:48:00.003-05:00

Over the weekend, I had the awesome experience of reaching a long sought after goal. It was nothing earth shattering, merely reaching a certain time goal in a race I was running, but let's just say my late thirties best beat out my late twenties best and it was immensely satisfying. Still riding on that high, I've been thinking a lot about goals and the importance of setting and reaching them, one at a time. I've also been thinking about my career direction. I moved to Madison to explore this career opportunity because I saw it as a way to reach my goals. Unlike many I've encountered here, I don't have those other 'intangibles' in Madison that make a person choose to settle down in one place. I didn't realize it when I made the decision, but I'm learning that not many people move to a place solely for the career opportunities offered. This puts me in a unique position of constantly reevaluating my career and personal goals and in effect, reevaluating why I am where I am. And more importantly, where am I going from here?

I came across an article called "Ten Days to a Happier, More Successful Career and Life". Ok, I'll bite. Anything I can achieve in ten days is worth a shot. So, I plan to read a step each day for the next ten days and see if I come out happier and more successful in the end. The good news? I'm taking you with me. Day one: How to Take Responsibility for Your Life. More to come tomorrow...

A GPS For Your Life

2011-08-14T16:01:00.006-05:00

Can I tell you about my new running partner? Let me preface this by saying that I have spent the summer training for a half marathon that will take place on Saturday here in Madison. You're probably questioning the wisdom of training for a long race during the season where one continues to sweat even after a cold shower and one's makeup slides off one's face as fast as one can put it on. Yes, I get that. I'm with you.

About six weeks ago, I started running with my new partner and I can honestly say that I have never been so focused and efficient in my training. I have improved immensely over the summer and I hope to "PR" (by this I mean set a personal record for myself) at the race next weekend. I owe a lot to my partner. Let me introduce you: Garmin Forerunner 210, meet everyone. Everyone, meet my cherished running partner, a birthday gift from my husband. The Garmin is a GPS watch that "accurately records how far, how fast and how hard you worked". Absolute bliss for my detail loving, goal oriented, personal challenge needing self. Oh yes. When I reflect on my relationship with my Garmin, I realize how much we would all benefit from a life GPS. Wouldn't it be awesome to know exactly where you stand in the grand scheme of things? Let's adapt the information on the Garmin website to our lives and see what happens....

Easy to use: Press start and take off. Really does it have to be more complex than that? Can we leave the house in the morning with the attitude of taking on the world rather than letting the world take us?

Take it further: For runners who want more training capabilities. One of my favorite questions is "what's the worst that can happen?". Ask for a raise. Take a chance on a different job. Make a new friend. If you push yourself and go for what you deserve, what will happen? Be your own biggest cheerleader.

Follow your heart: Heart rate alerts to notify you when you are above or below your targets. In other words, trust your gut. Your heart knows you better than anyone and only wants you to stay true. Practice listening to what your heart is saying underneath the cacophany of all the noise competing for your attention. Listen.

Outdoors or in: For those who like options. Be flexible and understand that everyone has their own idea of what's good and right and you may certainly feel strongly that your way is the best way....but rest assured there will be plenty who disagree. Try to see things from others' perspectives and you will gain invaluable insight into what makes them tick. A little compassion goes a long way.

Store, analyze and share: See the route you traveled on a map, view a summary of your workout data, create goals and more. We do this subconsciously all the time. We store up experiences and emotions and use them to guide us (right or wrong) the next time we make decisions. When we aren't aware of this, we are in danger of repeating unhealthy patterns. When you are stuck in a place (once again!) of unhappiness, consciously analyze what brought you there. And then choose a different route to travel.

Monitor your health: Track weight, body fat, body water, etc...I firmly believe that physical health is directly affected by mental and emotional health and vice versa. Try improving one and see what happens to the other.

Fast and accurate: A high sensitivity GPS receiver to stay locked onto satellites, even near tall buildings and under tree cover. Ahhh, beware of the proverbial obstacles that will inevitably be thrown in your path. Take a step back, breathe and ask yourself "Where was I going again?". Then your trusty GPS will guide you back to the right path, wherever that may be.

Happy travels.

I Have Trouble With Math

2011-08-04T14:50:00.005-05:00

Five things I learned about myself last week:

1. If I drive for more than 7 hours straight in a crappy rental car without cruise control, power windows or locks and stained upholstery, I will curse myself for not choosing instead to drive our brand new SUV.

2. I live in a very small world. I know this because at the Pediatric Hospital Medicine conference I ran into my med school roommate whom I haven't seen in 9 years and found out that she just took a job in Tucson that my friend from residency recently left in order to take a job in Austin that I had applied for and didn't get but told her how great it was so she applied for it a year later. Make sense?

3. I have a friend who I only see once a year but we can still pick up where we left off and spend hours talking about our lives. Everyone needs that kind of friend and sometimes I forget to give thanks for that friendship.

4. If given a set of evaluations from medical students and residents, and they are positive in nature, I will carry them around in my bag and pull them out at lunch and read them over and over again (to myself, not out loud!). Occasionally, I am my own cheerleader. Embarrassing but true.

5. If I want to be a true leader, I have to stop being afraid to own who I am and my thoughts and opinions. I have to establish my credibility by walking the walk and coming correct in spite of those who have different ideas of what the future should look like.

6. I want to be a true leader.

Sorry, that's six things I learned about myself. It was a good week.

Something Smells Like Band-aids

2011-07-26T16:55:00.003-05:00

Sometimes life slips you a little good when all you've been concentrating on is the bad. I like those times.

I felt like a proud parent this morning when one of the residents presented his first journal club as part of the Evidence Based Medicine curriculum that I'm now responsible for running. He did beautifully. In fact, it went off exactly how I envisioned it in my head. And I actually think he (and the audience) learned something. Bonus! My husband teases me and calls me the "Queen of all things Journal Club". I won't lie. I love journal articles and the conversation they ignite and the delicious calculations we can perform with the data. Crazy-town.

I'm about to sit on a panel for 4th year medical students to talk about one of my other favorite topics of all time. Why I chose Pediatrics! There's nothing that can ignite my passion for my career choice quite like explaining the why and wherefores to a bunch of blessedly altruistic medical students. Did I mention there's pizza?

On Thursday, I'm leaving for Kansas City to attend the Pediatric Hospital Medicine conference. I'm looking forward to lots of lectures, debates and nerdy networking. My husband is coming with me and we've decided to drive. We're still recovering from our most recent airline experience involving a "paperwork issue" that led to an hour delay and missed connection, a night spent in a hotel 30 miles from the airport with nothing but the clothes we were wearing and a free toothbrush, a $60 cab ride to said hotel, a broken toilet and general magnificent levels of incompetence. Oh, and it was my birthday. Needless to say, we're looking forward to a romantic road trip.

So, thanks life. Thanks for the reminder.

Welcome to My Thursday Night

2011-07-21T20:57:00.005-05:00

Here's what I'm up to tonight:

Real Housewives of New York City

A Skinnygirl margarita

Pedicure

Cake batter ice cream with crushed Oreos and peanut butter

Yes, this is my antidote to a rough week. Oh, and I'm taking a personal day tomorrow. I won't go into the gory details but suffice to say I wrote a few of my trademark "fussy emails". My good friend in residency coined the term and used it to describe indignant emails we would write when it seemed like the last resort and our frustration had reached a critical mass. Sometimes we sent them, sometimes we didn't. This week, I hit the send button after every email I wrote. Email can be dangerous. It allows you to say (write) whatever you feel at the time without having to see anyone's facial expression or having to look them in the eye. It is so easy to hit the send button. I don't regret any of the emails I sent this week. I always try to edit myself and send only what I would be comfortable saying. And I always double check that I haven't accidentally hit "reply all".

A few things happened this week that ended up being the proverbial straw that broke the camel's back and I was fed up. I channeled my emotions into emails and sent them to people I thought could help me fix the situation. Was there some fallout? Well, yes, I did have more than one person come into my office to "chat" but I do believe that good things will come to those who....fuss. I've talked before about being authentic and owning up to who you are. That's what I did this week.

In residency, an attending told me that I had an overdeveloped sense of justice. At the time I thought it must be something that I should correct or hide. As I get older, I've accepted that I have a passion for fixing things that I perceive as wrong, less than ideal, or yes, unjust. I will accept this, own it, and channel it to improve my situation and help others who may not have the confidence to speak up for themselves. If things don't go well, I can always fall back on cake batter ice cream and margaritas. Nothing wrong with that.

World, Meet Lucy

2011-07-11T15:57:00.007-05:00

Have I introduced you to my dog Lucy? She's a 12 year old fawn pug and she's my first baby. Her bug eyes are always leaking brown goo and small pieces of her crusty black nose fall off when we least expect it. Usually in front of company. She hates anyone touching her mouth and her feet so consequently, her breath stinks and she has really long toenails. I feel like Lucy and I have grown up together. We've been through a lot: breakups, moves, freezing winters, adding a hyperactive mutt and her owner to our household. There was a time right after I moved to Chicago and knew no one that I felt Lucy was the only soul in that city who would've cared if I died. Morbid, but true.

One thing about Lucy is that she is stubborn and hates change. How do I know this you ask? Believe me, it's obvious. She gets this miserable look on her face and her curly tail hangs at half mast when she is unhappy. The straighter it gets, the worse she feels. Once when she was a puppy I was walking her on the sidewalk around my apartment complex. We accidentally walked over a hot metal grate in the summer and it burned her little feet. For an entire year after that, she would not walk in that direction down that sidewalk. Nope, we could only go so far and then we had to turn back the way we came instead of completing a loop. Whenever I'd move the garbage can around the apartment while cleaning she'd bark at me until I put it back where it was supposed to be. She has gotten used to going to bed at a certain time so she will wait by the stairs and glare at me until I come upstairs and get ready for bed. When I've had guests over, she makes it clear that it's time for them to leave by sitting at the front door and glaring at them, ignoring their attempts to call her over and pet her. It's embarrassing how rude she can be! Over the winter, we let her in and out through the front door because there was less snow buildup in the front of the house. Now we'll sit out on our deck in the backyard but she insists on only entering the house through the front door, despite being let out the back door. My husband thinks she's stupid. I know better. The girl just knows exactly what she wants.

I'm telling you all this because I find myself acting more and more like Lucy lately. A new academic year has begun and all sorts of changes are being proposed in my division and in the residency program. I find myself wanting to push back and do things the way I think they should be done. I'm really struggling to remain open to others' ideas when I disagree. I'm trying to maintain a supportive and positive attitude. I tend to be very independent and find it easy, if I don't like the way someone does something, to just do it myself. I'm trying not to be the "rogue hospitalist" but rather to act in a mature and agreeable fashion. I don't want to be the Lucy of the group, as much as I adore her, because unlike Lucy, I know I'm not the center of the universe and the most important person in the room. I'm making a special effort this week to open myself up to the beauty of change and the possibilities of seeing from another's perspective. I don't begrudge Lucy her bullheaded obstinance. I'll just live vicariously through her.

Sweat the Small Stuff. You'll Be Glad You Did.

2011-06-25T17:19:00.004-05:00

Let's talk for a minute about small gestures with big impact and owning your mistakes. Because those two ideas were the bright spots in a week filled with too little sleep and not enough laughter. Did I mention that I'm in the midst of a 19 day stretch of work without time off? Yeah, so there's that.

One of my new goals is to be myself without apology or fear. I'm new to this concept, being someone who is a pleaser and a perfectionist who cares way too much about what everyone thinks. I once read a quote that said "What everyone else thinks of you is none of your business." It's hard to remember that sometimes! You know when you are trying something new and you aren't that great at it and you do it totally wrong? Well I am trying to make myself and my opinions heard more often at our division meetings. This week, I spoke up about what I thought about a certain idea the group was running with (in disagreement) and must have sounded uncharacteristically harsh because the room went uncomfortably silent. And my cheeks burned. After the meeting, the person who came up with the idea cornered me and tried to explain why they wanted to do things this way. I countered with why I disagreed but did make it a point to say that I would try it and see how it went. I left that meeting not feeling proud for speaking out but rather like I let my personal negativity and frustration and stress and fatigue speak out for me. I carried that around with me all night. In the past, I would've swept things under the rug and maybe been extra nice the next time around. But I felt that in order to grow and really feel true to myself I needed to own my mistake, and that meant going into her office first thing the next morning and apologizing for the way I came across. I didn't change my opinion, but I made sure she knew that I respected her and the group's opinions too and that I recognized that the way I went about speaking up for myself was not necessarily ideal. I am a work in progress and I owned up to it. In the end, I felt so much better and gained a new understanding of how to work within a group of strong-willed women.

Yesterday, as I'm frantically working on a project submission due on Monday, a physician I rarely see but always say hi to in the hall came into my office holding a pink box. He said "Do you want a cupcake?" and of course you know what I said. And he proceeds to pull out a red velvet cupcake and puts it on my desk. When I asked what it was for he simply said that he and his wife had lunch together and decided to buy some cupcakes for a few of us. I checked his back for wings as he walked out (there were none that I could see) and sat marveling at the way the universe speaks to you if you just listen. A red velvet cupcake? For no reason? Are you kidding me??!

I say you should sweat the small stuff, because in the end, that's the stuff that holds you up when you feel like you're going to fall.

I Almost Called This Post "Friends In Low Places"

2011-06-07T20:51:00.005-05:00

Let's talk about our guilty pleasures. Need a definition? A guilty pleasure is defined as "something one enjoys and considers pleasurable despite feeling guilt for enjoying it. The "guilt" involved is sometimes simply fear of others discovering one's lowbrow or otherwise embarrassing tastes." That's straight from wikipedia. And yes I will try to use the term "lowbrow" more often, thank you wikipedia. Need some help getting started? Ok, here are some of mine.

1. Red velvet anything. The other day I made red velvet cupcakes from a box mix and didn't even bother to frost them. Or share.

2. Barry Manilow. I've seen him in concert at least twice, maybe three times. I know all the classics by heart and used to make myself hoarse in the car singing "Weekend in New England".

3. I put on my pajamas when I get home from work. I didn't realize that was weird until my sister made fun of me.

4. The movie Coyote Ugly. So bad it's good.

5. Bethenny Frankel. You may know her from "Real Housewives of New York City" seasons 1-3, or from her shows "Bethenny Getting Married" and "Bethenny Ever After". Or you may not know her at all if your tastes tend more towards highbrow than low. This is a serious guilty pleasure. I DVR every episode of her shows and watch them multiple times. I recently read her book "A Place of Yes".

Now does it count as a guilty pleasure if it changes your life? I mean really changes your outlook which in turn changes your attitude at work, in love and in the way you fit into the world? Because this book and her ideas and advice have truly made a difference to me. A "place of yes" is an attitude that allows you to open yourself up to the world and to what your life is meant to be. It encourages you to live with acceptance, of yourself and others, and not to let fear make your decisions. It gives you permission to be yourself, make mistakes, embrace challenge and aim high. It reminds you that a life lived in truth is a life well lived.

I'm currently trying to put together a research project looking at a curricular intervention I'm developing. I've never done anything like this before and I feel completely overwhelmed. Daily, I struggle with the voice that tells me "This is way too much to take on. You'll never be ready to do this by July. The residents won't participate. You will fail and look like an idiot." I'm afraid that I can't do and be everything I want to and my knee jerk response is to give up, put on my pajamas and eat cupcakes. But, I've learned from a reality TV star that if I come from "a place of yes", I will always be better than good enough. And that's good enough for me.

Only the First Checked Bag is Free

2011-05-24T16:03:00.005-05:00

One of the best things about going on vacation is the opportunity to cast aside your everyday self and slip into a more adventurous "who cares nobody knows me here I'm on vacation" persona. During my travels in Europe, I truly lived in the moment. I ate when I was hungry, slept when I was tired, moved when I felt like moving, and lounged when I felt like lounging. It was incredibly freeing. I realized just how much baggage I carry around on a daily basis. I'm not talking about childhood traumas and emotional relationship "issues". I'm talking about the baggage that begins with the word "should". I should have known fellowship was not the right move for me. I should have more money saved for retirement right now. I should have worked harder at the gym this morning. I should have made that diagnosis. How many times a day do you say the word "should" to yourself? I would bet more than you realize.

I don't want the vacation me and the everyday me to be strangers anymore. I want them to take certain qualities from each other and blend to become the real me. Where do I start? Well, I want to practice saying what I really feel instead of being polite and nice and saying what I think people want to hear from me. I'm a pleaser with a guilty conscience and I will analyze a word or a glance or an unreturned phone call until I've created enough scenarios to make an entire "choose your own adventure" book. (remember those?) There is no shame in being your true self. When coming from a place of honesty, I have to believe that no matter how uncomfortable you feel, the result will be infinitely more rewarding. That's the first baggage I'm dropping, with you as my witness. I already feel a little bit lighter.

Don't Let the Door Hit Me On the Way Out

2011-05-11T10:52:00.002-05:00

Hey, remember that vacation I mentioned taking soon? Well, the day is finally here. Vacation!! It finally feels like summer here in the midwest and we're heading out. Oh well, I have a few months ahead to enjoy the sticky humidity. And my big humidity hating hair too. Anyway, we are heading off to Europe for the next 10 days. I plan to forget about work, schedules, email, cell phones and practicing medicine. For the next 10 days, I'm just Angela. Not Dr Veesenmeyer. Not Angela F Veesenmeyer, MD, MPH. Not "my kid's doctor". Not "the hospitalist on call". Just me. I plan to come back refreshed, re-energized and recommitted to spending more time being "just me" and not who I think I should be. I'll see you on the other side of vacation!

The Joke's On Me

2011-05-03T11:03:00.004-05:00

I looked up the weather late last night and saw that it was supposed to be sunny and 65 today. Naturally, I wore a cute flowered skirt and lightweight black top fully expecting to soak up the rays of sunshine on this post call day. As my luck would have it, I was actually reading tomorrow's forecast as I was checking the weather after midnight last night. So here it is, cloudy and 38 and here I am, freezing and looking ridiculous in my summery outfit. Such is my life these days. And my outlook on life. I am in need of a vacation. Badly. The good news is that I leave for vacation exactly 8 days from now. The bad news is....there really is no bad news. As I was whining this morning about the weather, my coworkers, the number on the scale, the bags under my eyes, my age, and that I can't, in fact, live like the Real Housewives of New York City, my husband gently reminded me of how good we have it. Of how I love my job (generally) and how we have a beautiful house and two very sweet dogs who both bring daily laughter into our lives. My family is healthy and my friendships are strong. I know all of this. I just need reminding from time to time.

Research supports the theory that a positive outlook leads to success in your career. Here are five ways to improve your attitude at work and hopefully, bring a little sunshine your way.

Begging For a Voice of Reason

2011-04-25T14:27:00.004-05:00

Can I share something that's gotten me a little freaked out? Starting in July I will be one of two hospitalists out of a group of ten who work full time. Eighty percent of my division will work less than full time. I just can't wrap my brain around that. It's not that I see myself as some sort of gunner who is married to her job. I don't think of myself as particularly more committed to being a physician than those who choose to spend more time at home with their families. But....I don't know what to think. Am I doing something wrong by working full time? Is there something that makes full time so much less desirable than part time that I'm missing? Did I get off track somehow? Was the path to job satisfaction supposed to be medical school --> residency --> find a husband --> work part time at the field that you love? A good friend of mine is a general pediatrician and initially worked full time but then cut back to 4 days a week a couple of years ago. She is single and has no children but felt that she was getting burned out working 5 days a week in a clinic and now loves having every Friday off. She is certainly not the only physician intent on preventing burnout and promoting life-work balance and job satisfaction. Check out this article

Here's why I'm anxious. I'm afraid of the dynamic of the group when only 2 of us are working more than everyone else. I'm afraid that I'm missing something important, some strategic career move that I'm not privy to. I'm afraid to be backed into a corner if/when I finally do get the memo that I too should be working part time and then can't. (Have you ever heard of an academic division made up entirely of part time physicians? Me neither.) I'm not judging anyone who has made the decision to work part time. I've just never pictured myself doing that. And now I'm afraid I should have.

Humbled.

2011-04-11T20:33:00.003-05:00

As I walked down the hall toward the next patient's room, I could hear an animalistic moaning coming from the partially opened door. "That's his room" the resident said, referring to my patient. Dominic (not his real name) is an 11 year old autistic boy admitted for having episodes where his "eyes rolled back in his head" and he wouldn't respond. A thorough neurologic workup had not discovered anything other than his baseline behavior condition. "Ok" I said, "so why is he still here?" The residents looked at each other and tentatively launched into a story about aggression issues and inpatient psych placement and the county and child protective services. Just as I was about to strategize how to tie up all these loose ends so I could send this child home the father of the boy came out of the room. We invited him to sit in the family seating area and tell us what had transpired overnight. That's when I got the real story. I don't mean the truth, because everything the residents had told me was true. I mean the reality of this boy's life and his parents' life.

When they first discovered he was autistic, they immediately starting seeking out resources in their community in Alabama. He was able to qualify for some basic therapy and an individualized learning plan (ILP) at school. The parents developed ways to communicate with him using a picture chart and quickly realized that if they stuck to a strict routine with him, his behavior was much better and things ran more smoothly at their home. However, as he got older and more withdrawn, his aggression grew. He did well while at school and with his dad around, but when alone at home with his mother and younger brother he was difficult to control. They exhausted the options the state and county had to offer but because he was "doing well in school" only a limited amount of services were available. They felt backed against a wall and were exceedingly frustrated as their little boy became more and more like a stranger to them. After searching the internet, they discovered that in Wisconsin the services were better for kids like him and that he could benefit from being entered in school here. They scraped together what little money they had and moved their family to a city where they knew no one and had no support. It wasn't long before the economic recession tightened the belt on early intervention and behavioral health services for kids. Although they immediately went to the school and county for help with their son, they were told they had to wait for a period of evaluation. And of course the county was short staffed and wasn't sure how long the process would take. They did their best, paying out of pocket for many services and scouring the internet for ideas. By this time, he had been started on multiple medications and was seeing a psychiatrist. Again, because he did well in school, his case was not given priority in the backlog of children in need of mental health services. His mother begged for someone to just understand that he was a different boy at home with her and to review his case. Meanwhile, he became more aggressive and violent. He began destroying their rented home in his fits, breaking all the windows at one point. He lost the toilet training he had learned and began having accidents multiple times a day. Because his parents still held out hope that they would get help and he would regain all that he had learned before, they didn't put him in diapers. His mother would do loads of his laundry every single day. So, they came to us a shattered and exhausted family willing to do anything to find their son some help. The county denied them services and wanted them to pay for the rest out of pocket but they had no money left. Three days before I met them, they had refused to be discharged from the hospital because his mother was afraid for her safety and the safety of her other son. They wanted us to find them a facility where he could live for a few months and stop all his medications. They no longer knew what was their son's personality and what was the medication effect. But they didn't feel safe doing that at home without support. Had we discharged him and they refused to take him home, we would have had to open a CPS case against them for "abandonment" and they could potentially lose their other son. They were a teacher and a nurse and they wouldn't have been able to continue in either of those jobs with that charge on their record. Can you imagine? After all these parents had done to improve their son's quality of life, moving to another state, using all their savings for therapies, they were desperate enough to take a chance that they would be charged with child abuse. All to save their son. So on this Monday morning, meeting this father for the first time, I felt completely impotent to help them in their struggle. Despite being a physician, I am powerless against the bureaucracy of the state and the economic times in which we currently live. I was humbled by this family's struggle.

I don't have a heroic ending for you. I didn't save the day. I sent them home with their child with the plan for admission to an inpatient mental health facility in 2 days when a spot opens up. Dominic will likely only be allowed to stay for a week at most. I don't know what will happen with his medications. For so many reasons, I am proud to be a pediatrician. But this morning reminded me that I am only one in a sea of many and for all the children I save, there will always be some who are lost.

When One Door Shuts, Keep Knocking

2011-03-28T21:02:00.004-05:00

Recently, I didn't get a travel grant I applied for to attend a conference this summer in DC. I thought I had a good chance and sent in a fine application but there was someone out there with a better one. I told my husband how disappointed I was and he said "But you've gotten everything else you've ever applied for." Not true. Totally not true. There were at least two jobs that I really wanted in Chicago after I left my fellowship that I didn't get hired for. While I was job hunting this last time around, I learned I didn't get a job that I thought I was perfect for. A good friend of mine has since been hired for that very position. When I first joined the AAP, I ran for a position on the executive committee and didn't get the votes. In 6th grade, I ran for Treasurer. I still remember the posters I made with fake money all over them. I didn't get elected. A 7th grader was chosen over me. As a freshman in high school, I tried out for the cheer squad. Despite spending hours in my backyard practicing a dance to "Rhythm Nation" by Janet Jackson, I didn't make it past the first cut. In medical school, I waited for years for a certain person to love me as much as I wanted him to. Didn't happen.

Reflecting on all of these past 'rejections', I came to realize that the reason I keep 'applying' for things is that every denial I've experienced has led to something better. I love my job that I have here in Madison. It's exactly what I wanted and will open more doors than I can count. I have been given the opportunity to write this blog for the AAP and held plenty of other positions within the Academy since losing that election. Those 'failures' in junior high and high school? They've made me essentially unafraid of sticking my neck out publicly. And the many failed relationships in my past? I thank my lucky stars for my husband every day (some days more than others!).

So this most recent failure, if you can even call it that, is not really the end of something for me. In fact, it was the nicest rejection that I've ever received, complete with suggestions of other conferences/courses that would suit my goals and the name of a contact person who could help me reach them. You see, multiple doors are open and it is up to me to keep moving forward. But I won't stop knocking on those doors that appear shut because you just never know.

The Devil Wears Prada. And Scrubs.

2011-03-16T14:45:00.003-05:00

We've all heard about the epidemic of bullying in schools. But did you know that there is workplace bullying too? This is a real phenomenon of which I was unaware until it happened to me. True story. Sort of. I may be overreacting. At least according to my husband.

I was on service and was caring for a patient with a persistent pain issue. She had undergone multiple studies looking for the source of the pain but nothing was found. I consulted a surgeon to get some guidance as to where to look next. He made a recommendation that did not make logical sense to me, so I planned to say "Thank you for your time" and move on. Afterall, the patient was on my service. On a side note, I don't usually ignore my consultants' recommendations. In fact, I often err on the side of being overly gracious and thankful for their help. BUT, I feel very strongly that I am responsible for the well being of my patients and if I don't think that a recommendation makes sense I won't jump to follow it. Anyway, the next day the surgeon called me to ask why I hadn't done what they said to do and you know what? I suddenly saw myself as 3 feet tall and the surgeon as 6 feet tall. I got sweaty and clammy and stammered over my words as I tried to politely explain that I didn't understand their logic and didn't feel like I wanted to follow their plan. I did my best to dance around the fact that I was really saying "I don't agree with you and I plan to do what I want to do instead." The surgeon strenuously repeated his plan and I timidly danced around the phrase "I don't want to do that because I think you're wrong." He went so far as to threaten to move the patient to his service so that he could do what he wanted and I wouldn't be involved at all. Ugh. I felt completely undermined and self-conscious and wasn't at all sure I was ready, after being at this job for 8 months, to go head to head with an experienced surgeon. In short, I felt bullied. In a big way. But I went ahead and implemented his plan even though I felt sick about it. I knew it wasn't going to hurt my patient, but I firmly believed that it wouldn't help. The next day a new surgeon came on service and completely changed the plan that I had put into place after being bullied into it. And she got better. "I knew it! I told you!" I screamed. On the inside.

If you google bullying in the workplace you get a ton of hits. Did you know there is a Workplace Bullying Institute? There's also a blog called Bully Free at Work with links to a book and an e-course. Wow. Now you know.

The Flight of My Ideas

2011-03-04T20:37:00.004-06:00

First my apologies for being silent for so long. I really wanted to rescue that one blog in February from a life of solitude but alas, it wasn't to be. The last two weeks of February were a bit of a blur. I was on service and the respiratory viral season has finally hit the hospital. I had to get my hair colored twice in one week because my stylist missed a section of my head. How does that happen?! Then I came down with a mean case of the dreaded "influenza-like illness". Let me tell you, I've never felt muscle aches and chills like that before. I empathize with so many of my patients now. Somewhere during that illness I have a vague recollection of spending the night at an indoor waterpark in Gurnee, IL and eating dinner at IHOP. True story. On February 21st, my grandfather passed away in hospice after suffering from a stroke on January 8th, the same day as the shootings in Tucson. As my dad put it, that day the country suffered a tragedy and our family suffered a tragedy as well. Because I'm stubborn and hate paying exorbitant amounts of my hard earned money for poor service, I chose to snub 'the man' by driving instead of flying to Tucson for the funeral. My husband drove with me, bless his heart, for 1800 miles there and back. Two fingers on my left hand are still numb from driving but we did it and it was an amazing experience that we will never forget. Not only were we able to see my grandfather's brothers and sisters and meet my dad's cousins but we spent hours hearing stories of my ancestors and looking at old family photos. I returned to Madison with a renewed sense of pride and connection to my roots that I haven't felt in a very long time. My husband and I ate McDonald's and Cheetos and Corn Nuts and Twizzlers and in the process deepened our friendship and commitment to each other. And we learned we can sit in a car for 16 hours straight and still laugh at the end of the day. I am immensely lucky to be married to such a wonderful guy.

So here I am, finishing another week on service and still coughing. I see dog hair tumbleweeds all over my house and haven't talked to any of my friends in weeks. Our suitcases have yet to make it back into storage and I have a lingering feeling there is some bill I haven't paid. But I'm so happy to have the life that I have. And spring is coming.

Embracing Failure With A Smile

2011-02-16T11:07:00.004-06:00

A friend of mine once took an improv class by herself, just because. I remember thinking that was incredibly brave at the same time I was thinking I could never do something like that. She learned that the main thing that makes improvisation successful is the person's ability to build on what the other person says. For example, if someone says "If zombies attacked us right now I'd run upstairs and grab my samurai sword" and you say "Why wouldn't you just run out the back door?", it sort of kills the conversation doesn't it? However, a good improviser would say "Yes, and I'll follow you after grabbing a box of garbage bags because we'll need those when we hit the road for warmth and carrying things." Much better flow huh?

Here's some other tips for good improv.

1. Don't perform, just have fun. Embrace the moment in play rather than trying to control the outcome. When you aren't performing, you are less self conscious. When you're less self conscious, you are more responsive to people and they are more responsive to you.

2. Embrace failure. When improvisers are just starting out, they are taught to take 'failure bows' everytime they get that "oh crap I screwed up" feeling. The rest of the performers clap and cheer. The beginners are actually encouraged to have at least one 'failure bow' per class. When we aren't so afraid of failing, we take setback with more grace and are able to move forward more quickly.

3. Say "yes, and" not "yes, but". This goes to what my friend learned, build on what other improvisers have given you. "Yes, and" creates better conversations by validating what someone else has said and branching out with something new. Apply this concept to life in general: Say "yes, and" to life and accept what it has given you, good and bad, and take that and build on it. Saying "yes, and" implies an acceptance of reality and a willingness to move forward and take the next step.

If you're brave, you can use these ideas anywhere in your life. I'm currently pledging to use them at work. I will play when I'm teaching, take a 'failure bow' when I need to, and encourage positive interactions with my coworkers by striving to say "yes, and". And maybe, just maybe, this improvisation will spill over into the rest of my life.

How To Give Feedback. Or Not.

2011-01-31T15:42:00.004-06:00

I saw this article on feedback today and thought I would practice the suggestions here in this blog. Are you with me? Good.

1. When giving feedback it's important to focus on an employee's specific behavior, not the impression you had of it.

"I noticed you didn't read the journal article I chose for journal club this week and as a result, could not effectively contribute to the conversation. I will presume your perceived disinterest is not a reflection of me, but a result of something unrelated to work."

2. Feedback that is generic and vague is also useless. Be specific.

"You could have been more effective as a leader had you put forth the effort to support me in what you know is an undertaking of mine to bring more scholarship into our work as pediatricians."

3. Whenever possible, request to give feedback.

"I'd like to give you some feedback on how your actions, or lack thereof, affect not only my morale but the group's as well, especially when they see a person in a leadership position fail to complete what was billed as a mandatory activity."

4. Preface with the positive. Point out what the employee is doing well before delving into areas for improvement.

"I respect your knowledge and experience and was hoping you would bring some purposeful, focused advice to enhance our level of comfort in analyzing and understanding medical literature."

5. Try to look at your employees' work through their eyes and try to understand their approach to their work.

"Tell me, what was your understanding of you asking me to reschedule my journal club a week earlier on short notice because you were going out of town and wanted to be there? My understanding was that you wanted to be there in support and to provide valuable insight and experience. Oh wait, that's why I wanted you to be there. So, thanks for showing up. Maybe next time you could read the article? That way we both win.

Tuesday Morning Quarterback

2011-01-25T20:53:00.004-06:00

Coming up on my 6 month anniversary at my new job, I've realized that I am slowly but surely gaining confidence in my clinical judgement. Here's how I know. Last night I admitted a child with a complaint of limping and leg pain. The story was suspicious for infection, hence the reason for admission. However, when the residents examined him his pain was gone and he was well and playing. He's already admitted at this point, it's late at night, and the seed has been planted that this child may have a bone or joint infection that needs to be evaluated. So, I did what any self respecting physician would do. Nothing. I am a firm believer in these two ideas:

1. Don't just do something, stand there.

2. A child will declare themselves when the time is right.

I figured I'd give the child the benefit of observation overnight knowing that time would tell me what I needed to know...whether or not I should pursue a workup. I explained that to the daytime hospitalist this morning, feeling a little bit silly in the light of day that I admitted a child and then did nothing, but she seemed to understand and agree.

I ran into her at the end of the day and asked about the boy. Turns out, he remained well and did not have any leg pain throughout the day so she sent him home. Here's the rub. His labs suggested a high level of inflammation going on but that did not fit the way he looked. This brings me to a third idea I hold dear.

3. Treat the patient, not the lab values.

Unfortunately for her, another physician heard about the case and clearly does not believe in the three ideas I've listed above because he felt that more should have been done and that the child was sent home in error. Despite the fact that he looked like a peach from the minute he arrived on the floor. Then this other physician asked the dreaded "Who staffed this patient last night?!" Now, 6 months ago had I heard this story I would have turned red, my stomach would have dropped and I would not have been able to let that comment go without picking it apart, losing sleep and berating myself for missing something. But today, 6 months later? I just thought, "Huh. That's funny." And let it go. I will not lose sleep over this tonight. I will not let his Tuesday morning quarterbacking make me feel less than. And I will continue to practice by those 3 ideas, because that is what I feel is best for my patients. And I am their doctor.

Plug for PLA

2011-01-18T20:36:00.003-06:00

You’ve finished residency and are embarking on your career as a pediatrician. Maybe you are deep into fellowship and enjoying the challenge of academic life. Maybe you are comfortably settled into a group practice and building relationships with your patients and their families. Maybe you are trying to find your passion and traveling around as a locum tenens physician. And maybe, despite feeling accomplished and relieved that you are finally out of training, you ask yourself “What now?”

After finding myself in that exact position in 2007, I came across an advertisement for the Pediatric Leadership Alliance (PLA). At the time, I was struggling with how to make a name for myself in academic pediatrics as a young physician. I was intrigued by the opportunity to network with leaders in the field of pediatrics in such an informal environment and to be able to practice leadership skills in a practical, hands-on format. After attending the PLA, I possessed a renewed sense of confidence and felt part of a larger community of pediatricians who had the same values and drive to succeed. More importantly, I had the tools to channel my energy into a productive and exciting career path.

Over 3,000 pediatric professionals have attended the PLA and 79% of PLA alumni advanced into greater leadership roles within the Academy (including myself!), as well as in hospital, medical association, government and corporate environments following their training. Another PLA session is being offered March 23-25^th, immediately before the Annual Leadership Forum (ALF) at the Schaumburg Renaissance in Schaumburg Illinois. The PLA is specifically designed to provide real-life scenarios in order to practice skills and learn from one’s colleagues. Sessions include “Strategy Development: Charting Your Course” and “Dynamics of Change: Moving People & Culture”. A dynamic keynote speaker, Dr Lewis First, (Editor-in-Chief, Pediatrics) will describe his leadership journey and how leadership skills learned were embedded in advancing into more key roles in the profession of pediatrics. To promote networking among participants, the PLA has dedicated time for casual conversation during the reception, dinner and workshop meals. It was during this “downtime” that I was able to really form relationships with the other participants and facilitators. More than enjoying the company of my colleagues, I was inspired by the different people I met and by the work that they were doing.

In addition to the foundation for leadership formed at the conference, the participants will be encouraged to sustain their development through long term follow up and goal setting. Although a critical component of the workshop, the follow up is entirely personalized and voluntary – the support is provided by the PLA staff and the AAP as a whole but it is up to the individual to follow through on the goals set during the conference. This was the most difficult part for me personally, sustaining the momentum I gained at the PLA, but I was able to refer back to the PLA website and workshop materials including the book The Leadership Challenge by Kouzes and Posner. A full 13 hours of CME credit can be earned by attending this influential conference. Early registration (before Jan 30, 2011) is $395. Housing at the Schaumburg Renaissance is approximately $300 total for both nights. For more information visit www.aap.org/moc/members/PLA/ or email PLA@aap.org.

Please challenge yourself to answer the question “What now?” Consider sharpening your leadership skills with a group who pledges to “enable pediatricians to become effective learners and leaders to advance their profession, and to care and advocate for children”.

My Hero

2011-01-10T13:44:00.005-06:00

Let's be honest. There are a lot of topics that I avoid writing about in this blog because I don't believe it is the forum for my political opinions or to inflame anyone else's opinions. However, in light of the weekend's events in Tucson, I must comment. It has been surprisingly hard and very personal to see my hometown splashed all over the news. Glimpsing the sandwich shop my husband I ate at in November in the foreground of footage of the crime scene is surreal. Seeing the hospital where I did both my medical school and residency training as the backdrop for the neurosurgeons' press conferences is chilling. The flowers and candlelit vigils at various spots around town make me ache with sorrow, homesickness and pride, all at once.

However, I can't stop thinking of the little girl, Christina, who lost her life that day. She had just been elected to student council and was thinking about a future in politics. A neighbor thought it would be fun to take her to meet the Congresswoman Gabrielle Giffords. What a gift, for that little girl to have her dreams so supported. Do you remember what it was like to be 9 years old? The world was spread out before you and you had an infinite number of choices, each one more exciting than the next. The only problem was finding enough hours in the day to explore all the things you wanted to explore. When I was young, I wanted to be a writer, so I wrote. Then I wanted to be a lawyer, so I read. Then I wanted to be a doctor, so I went to medical school. I was blessed to have a family who supported those dreams, however lofty they seemed, and made me feel like I could do whatever I wanted. And here I am, tremendously satisfied with the life that I have chosen.

We'll never know if Christina would have gone on to be a successful politician. But, given what I've read of her and her family, I believe she would have gone on to be successful at whatever she chose because her dreams were valued. She is my hero because she died following the thread of a passion without fear of failing. I only wish that was as easy at 35 as it was at 9.

I hope you will honor Christina and all the victims of this vicious attack by pursuing your own thread of passion or by nurturing a child's dreams and allowing them to believe in themselves and the endless possibilities the world has to offer. Rest in Peace.

The Stupid List

2010-12-29T13:44:00.002-06:00

Do you know what a Stupid List is? I don't mean that thing you needlessly create everyday in your iPhone, planner, or head. I mean a list of things that routinely get neglected until something goes wrong and then you say "I can't believe I was so stupid!". That list. It's almost the end of 2010 and now is a good time to attend to your Stupid List. Want a practical example of what should be on said list?

1. Update dog's microchip when you move or else when she runs away and gets picked up by a policeman and taken to the Humane Society they will have no idea how she got from Chicago to Madison. Or how in the world to get ahold of you, her stupid owner who didn't update her microchip info.

See how easy that is? Here's another one,

2. Clean out email contact list so that when your account gets hacked you don't send emails selling *cheapest* electronics to your previous employer and your stylist who moved to Atlanta years ago and that guy you met on a cross country flight before you ever laid eyes on your husband.

On a practical note, how about checking when your passport expires? Wouldn't it be a shame to plan a big beer drinking trip to Belgium and discover that your passport expired the month before? And how about your Facebook privacy settings? Better check on that before you post those NYE pics, huh? Do you have any old email accounts that you don't use anymore? What if a long lost acquaintance sent you a holiday message? You might want to peruse your inbox. If only to remind yourself of who you used to be. My old email address is girlyhood@.... Why? I don't remember, but I like it. Oh and while you're checking old email addresses, google yourself in the advanced search option. It's important to see how you are being portrayed to the world, intentionally or not. Any random credit cards you don't use anymore? How do you know someone else isn't using them? Check your credit report. Like Wilford Brimley says about your blood sugar, "check it often".

Whew, don't you feel productive and organized? Just in time for the new year. You're welcome.

How To Live A More Interesting Life

2010-12-15T10:25:00.004-06:00

I have this friend whom I love dearly and is nothing like me. I tend to gravitate toward people who are living lives that I would love to be living, at least a little bit. She is one of those people who has a new adventure planned every weekend and has changed careers mid-life. She always seems to 'fall into' random experiences and has the most awesome stories. She embraces life daily and does not apologize for it. She is successful at making her life interesting. So, as I struggle with building a suburban life in the Midwest and holding down a very 'adult' job, I'm conscious of holding onto that small part of myself who still craves a little 'randomness'.

I came across this blog called "The Friendly Anarchist" and I want to share with you what he says about living a more interesting life.

The mistake when trying to find out about interestingness is to look at what interesting people are actually doing. Because this only leads to even more passivity on the side of the spectator:

“Oh, Tyler Tervooren can jump out of an airplane, but I couldn’t possibly do that because I don’t fly. Climate change is more important than having fun.”
“Oh, Sean Ogle is traveling to South East Asia and checking off the points on his bucket list, but I couldn’t possibly do that because I love my home and wouldn’t want to leave.”
“Oh, Karol Gadja is building a business around his Ridiculously Extraordinary blog, but I couldn’t possibly do that because I haven’t got any idea of internet marketing and writing.”

One thing is for sure: You will always find reasons not to do something interesting, even if other people are doing it. Often enough, these reasons will be pretty good. Sometimes, they won’t. But you’ll definitely find some!

I believe we have to look at what these people are not doing. And then we have to stop doing that, too. For example:

Stop worrying 18% of your life.
Stop overthinking everything.
Stop remaining seated comfortably.
Stop accepting things as they are, even if they suck.
Stop taking the path of least resistance.
Stop living the life other people planned for you.
Stop worrying 18% of your life. (This comes twice, as it’s really the basics.) The good thing is that interestingness doesn’t always have to be confronting pickpockets or jumping from airplanes. It may be small things:

Buy unknown food at your supermarket (or an Asian / African / Latino shop) and try to cook something tasty with it.
Go to a new bar / restaurant instead of always going to your old favorites.
Watch a recommended movie from a genre you normally ignore.
Engage in a street fight.

It may be big things:

Quit your boring job.
Write and publish that novel you’ve got inside.
Sell everything you own and travel the world.
Have and raise five children.

And it’s really your personal choice. Each of us is different, each of us has different ideas of how to live an interesting life.

There’s one thing interesting things have in common, though: They make us feel at least a tiny bit uncomfortable. Anxiety is the perfect indicator. Instead of worrying about or trying to ignore it, maybe we should let it be our guidance. This is not about becoming an adrenaline junkie, though. It’s not about extreme sports, about permanent travel, or about becoming an entrepreneur. It’s about taking the direction that you want to take in order to make your life more interesting.

Just wanted to share something in the blog-o-sphere that brought a little bit of clarity to my day. Hopefully you get something out of this and make a small change today!

Another Awesome Word I Didn't Create

2010-12-09T20:41:00.003-06:00

Intrapreneurship. Know what it is? I didn't think so. It's another awesome word I didn't come up with myself. Like 'bromance', 'bootylicious', and 'staycation'. It is defined as follows:

While an entrepreneur ventures out on their own to pursue an idea, an intrapreneur does this within the organization in which they already work. It could be creating a new product, coming up with an innovative idea, or improving a service.

I'm an intrapreneur right now and I didn't even realize it! Here's what i'm up to. As part of an academic hospitalist division, I felt that we needed to do more...academic things. So, I am in the midst of trying to drum up enthusiasm for starting a divisional journal club. That's important right? We are responsible for teaching and modeling for medical students and residents so we should attempt to uphold the academic standards on which our profession was built. Here's my issue, albeit a minor one. I'm not sure that everyone is quite as passionate about reading journal articles as I am. So let's say that only half of our division wants to participate and the other half aren't that interested. Should I make it totally voluntary? I foresee that becoming pushed by the wayside when other 'mandatory' things come up. Soon enough it might be a club of 2 members. And that's sort of sad. But, if I make a schedule with everyone assigned to a month in which they are responsible for journal club, I'm afraid I will make some enemies. And they will whisper "who the hell does she think she is?!", preferably to my back and not to my face. Yes, I worry about these things.

So, the concept I am "intrapreneuring" is a division journal club. But really maybe I should be inventing a way to make learning a passionate endeavor for all.

I'm Ridiculous: Part 2

2010-12-06T15:33:00.002-06:00

I just finished up a weekend of call and I'm exhausted. Yes, I slept in my own bed. No, I did not have any "middle of the night" admits. So why the heck am I so tired??!! If you read the first year of my blog you will understand how ridiculous this is. I spent 2 years working nights and weekends in the NICU and would've been overjoyed to have a job where I could sleep in my own bed at night and not be up for over 24 hours multiple times a week. Our call from home currently requires us to personally see every admission within 2 hours regardless of acuity or time of day/night. But herein lies the rub.....I like to be prepared for whatever situation may befall me. "Plan" is my middle name. So what do I do when i'm on call from Friday night to Monday morning and I don't have any nighttime admits? I anticipate them. I lie in bed and anticipate the beeping of my pager. I anticipate dragging myself out of bed at 2 am. I anticipate getting into the car and driving to the hospital in the 10 degree weather. And I anticipate getting home with just enough time to get comfortable before my alarm goes off signaling a new day of rounding on patients. I think subconsciously my body does not want to relax because it is so much harder to get out of bed during a dead sleep than not. So I lie awake waiting for the inevitable admission that never comes.

This is problematic on so many levels. There is no way I can justify being tired after a night of call when I don't even get called. I have to carefully conceal the bags under my eyes and tell my coworkers what an easy weekend of call I had. I can't blame my less-than-enthusiastic teaching and blunted affect the next day on the rough call night I just had. Sometimes, and I can't believe i'm saying this, I think I would sleep better if I just stayed at the hospital. The mere anticipation of leaving my bed and driving to the hospital in the wee hours of the morning clearly throws off my tenuous grip on stability and sends me into a spiral of anxiety the likes of which prevents my brain from shutting down. Any advice? Meditation? Hot tea? Peanut butter chocolate chip cookies? My battle against sleep deprivation continues...

A Gentle, Hairy, Non-English-speaking Co-pilot

2010-11-23T14:49:00.006-06:00

Have I ever told you about our dog Swayze? Well, she's crazy. She's part Boxer and part Lab and part Wookiee and super excitable, especially around other dogs. And squirrels. And fast moving children. When we lived in Chicago, our back deck was surrounded by a high fence and whenever she would hear people or dogs she would go crazy whining and clawing at the fence to get out. So, when we moved to Madison we bought a house with a big yard and no fence. Solved that problem didn't it?

Under the influence of our realtors and the fact that we could not imagine the ridiculousness of putting Swayze on a leash to walk her in our front yard, we had an invisible fence installed. The way this works is that she wears a special collar when she goes outside that delivers 'an uncomfortable sensation' when she gets too close to the perimeter of our yard. The discomfort level is really variable dog to dog and since our dog has bloodied her own paws while playing we honestly had pretty low expectations that this would work for Swayze.

It took a couple of weeks for her to 'get it' and make a definite association between straying to the edge of the yard and getting 'shocked' but alas....it happened. Now when children ride by on their bikes and couples walk their dogs by our yard and a squirrel darts across the road, sometimes all at the same time, Swayze automatically sits and wags her tail and stares. Sometimes she trembles with the effort, but she makes herself stay far from the edge of the yard. She knows that the 'uncomfortable sensation' is a powerful motivator for avoiding that situation.

A coworker was in an unfortunate situation last week where she felt she had not managed a patient in a manner in which she felt proud. The patient was ultimately transferred to the ICU and there were rumblings about her 'sitting on the patient' for too long. She was in my office beating herself up about this and she asked me "How do I get over this? How do I move on?" And I responded that the only way I have gotten over this same awful feeling is to remember it and the situation that gave birth to it. Not trusting your gut and deferring to someone else just because they have a few years on you = this same awful feeling. So, next time I encounter that situation, I remember and I make a different choice. A choice that will hopefully allow me to avoid the 'uncomfortable sensation' of feeling like I failed a patient.

Learn from your mistakes and move on. Take comfort in that. If Swayze can do it, so can you. Trust me on this one.

Feedback Sandwich With A Side O' Chips

2010-11-17T19:04:00.004-06:00

I went to a faculty development session the other night about feedback. Who knew there is so much to learn about feedback? I know when I was a medical student and resident, I craved feedback from my attendings. But only if it was positive. Then when I was a fellow and pseudo-attending I just wanted to be told if I was doing something wrong. Now that I am faculty, I just want to be told how I can be successful.

I raised my hand and admitted at this session that I was uncomfortable giving feedback because I don't like to hurt anyone's feelings and I want everyone to like me. Do you know what the speaker said to me? He said "The people who are most worried about hurting another's feelings are the least likely to ever do so." Wow. I don't think I could have felt better if he had said "Have you lost weight? Because you look thinner." Well, maybe a little better, but you get the point. In that instant I lost so much of my hesitation to give the students and residents with whom I work 'constructive criticism'. I now see it as a chance for me to help them to be successful...without having to wait until they are faculty.

When I started on the wards this week with my new team I warned them in advance that I would be giving them feedback immediately after their presentations in front of the rest of the team. I've done it in a way that is matter-of-fact and nonjudgmental, all the while thinking of how I want them to be better doctors because of their experience on my team. I'm not perfect at it, but I think they are learning....and I think they still like me.

When You Play This Record Backwards, It Says "Get Over It"

2010-11-02T20:08:00.004-05:00

Have you ever held your tongue when you really wanted to speak up but didn't think it was your place? I know everyone has. Being a quiet person by nature, this happened to me often growing up. I would stew and vent and replay all the things I should have said but the same thing would inevitably happen to me in another situation. My mom used to tell me "Angela, when you get older and more confident you won't care so much what people think and you won't be so afraid to speak up for yourself." Weeeeelllll, I'm definitely older, and maybe a tad more confident, but I'm still not speaking up. When is that magical age when I won't defer to someone older and more experienced to make a decision that I should feel confident making?

I was in a situation (again!) last week where I didn't listen to my gut. I allowed the opinion of another physician to comfort me and didn't think independently enough to make my own decision. Everything ultimately turned out fine, but in a much more circuitous and unattractive way than I would have liked. I have been beating myself up about this for 6 days now...I've replayed all the things I should have said and done numerous times and you know what? It feels different. I can't explain why but for some reason I feel like a switch has been flipped and this won't happen to me again. At least not like this. I am done with this feeling of insecurity about my lack of experience. I may not know all the answers but I know that I can trust my gut to lead me to someone who can. I think if I say this mantra to myself enough times, I just might believe it by the time I'm another year older.

Pick A Little, Take A Little

2010-10-25T11:52:00.004-05:00

You know what's been on my mind lately? Baked goods. Lots of them. I think it's the weather. Nothing sounds better to me than cakey, doughy sweet goodness for breakfast, lunch and dinner. To get my mind off of said baked goods, I've also been thinking about mentors: being a mentor, finding mentors, having secret mentors, having no mentors but wishing you did. Yes, all of these things. Let me tell you about my experience and you can think about yours.

I recently volunteered to be a faculty mentor to one of the pediatric interns. We met for lunch and were given a list of 'helpful topics' to discuss. Talk about awkward! It felt more like a job interview at first with me looking down at my paper and saying "Let's see. How are you handling stress and what makes up your support system?". Let's just say I recognized the awkwardness and nimbly manuevered away from its impending destruction of our mentor-mentee relationship. Once we put down the 'helpful topics' and starting really talking with each other I realized that there was so much about her that I recognized in myself and it was comforting. I felt like I really had some worthwhile experiences to share with her. And the best part? She has done some things that I totally admire and I felt like I learned from her. That, my friends, is what makes the best mentoring relationships...learning from each other.

As a young faculty member I am charged with creating a mentorship committee for myself made up of senior pediatric faculty who have experiences and goals that align with my own and who will guide me down the road to promotion. I have spent hours researching who would be good people to have on my committee. I'm at the point where I've narrowed it down but have to actually ask them. The problem is that I don't know one of them yet. I've read her CV and she has been recommended to me by multiple coworkers but we have not had occasion to meet each other yet. So then it becomes like a blind date...I'll email her and tell her a little about me and suggest we go for coffee and then she can decide whether or not she likes me enough to spend the next 7 years answering my panicked phone calls for advice and pleading my case to the administration to promote me to the next level. Ugh. Yes, I know. Time to grow up and just do it.

I have a secret mentor too. Although I'm not sure I can call this a true mentor relationship because she doesn't know I exist. I don't provide any benefit to her whatsoever. She happens to be a peds hospitalist who is active in the Section on Hospital Medicine and posts frequently on the listserv to which I subscribe. She is brilliant and funny and thoughtful and has the same educational values that I do and sees through all the smokescreens to really get at the heart of what pediatric patients need. I save her posts to the listserv and read them multiple times. On second thought, maybe I am less of a mentee and more of a creepy stalker chick. Either way, she is an excellent role model for me.

Lastly, I have been in a place where I could not for the life of me find a mentor. I was surrounded by people who did not share the same values and style and vision that I did. I did not feel valued as a person or as a peer. More importantly, I did not feel known. Now, I recognize that I played my own role in this failure of mentorship but the bottom line is that I was not meant to be there and it was not the right arena for me to advance and achieve my goals. So I left that place and it was the hardest thing I've ever done but I am so much happier for it.

As professionals, we can't underestimate the power of having mentors. Take stock of your surroundings and find people who support the different pieces of who you are. You have to invest time in a lot of different people in order to find the ones who will change your life. Sort of like dating isn't it?

Chocolate Chips Do Everything But Get You Promoted

2010-10-18T14:55:00.003-05:00

Today I read an article titled "10 Most Common Excuses for NOT Making Ideas Happen" and I just had to jot down my thoughts. I've recently been coming from a place where I second-guess myself. A lot. There are all sorts of ideas I have about what I want to achieve and areas I want to explore because they get me excited to come to work in the morning. But when someone asks me the dreaded "So, what are you interested in?", I feel like what comes out of my mouth completely pales in comparison to what I envision in my head. Then I feel like a lame. A lame who should go home and make pumpkin chocolate chip cookies to make herself feel better. But I digress.

Number 2 on the list is "I'm afraid of the competition." How many times have you read a published study and thought "I totally could have done that" or "I thought of doing that a long time ago"? I do it all the time! Now when I think of something I want to study, I convince myself that someone has already thought of that idea and is putting their infinite supply of resources and time to that very project. The author makes a point that "competition validates your idea by creating a category". Hmmm, point well taken.

Number 5 is "I have to plan it out properly first." I think this would be the title of my memoir! Truly, "spend more time doing, and less time planning." Thanks for the reminder.

Lastly, I love "I can't overcome the inertia". According to the article, setting "lofty goals from a resting start" is a recipe for failure and discouragement. Setting smaller, more manageable goals allows momentum to build and powers you through to the big picture. I use this all the time when I clean the house (I'm just going to start with the dishes, then we'll see how it goes from there) and I never thought about utilizing this idea more often with my career.

Here's the link to the full article. Check it out.

http://www.openforum.com/idea-hub/topics/managing/article/10-most-common-excuses-for-not-making-ideas-happen-behance-team

How the Other Half Live

2010-10-14T15:09:00.004-05:00

Here's what I've been up to.....holding the cutest damn baby for hours on end and loving it! That baby happens to be my new niece. People who know me well are surprised that I am so head over heels about this baby because, despite being a pediatrician, I've never been a "kid person". I dislike chaos and sticky hands and saliva. It's no secret. But I can stare at that little face for hours (and I did!) and be endlessly entertained.

As luck would have it, she developed hyperbilirubinemia on day 3 of life and was admitted to the hospital for phototherapy. I went with them to the hospital and for once was not in control of the admission because I was on the other side of the process. It was a weird feeling to just sit in the room and not recite her history and physical for the residents and let them know what the plan was. I am not a laid back person and believe me when I say it took a lot of effort to stay in the background so as not to embarrass my sister and be that obnoxious family member we physicians are all so familiar with. You know, the one who makes us whisper "A little bit of knowledge is a bad thing" and roll our eyes when we find out one of our patient's parents is a physician.

However, I did learn some things that I will take with me back to the wards.

1. When a large group of 'medical people' walk into the room of anxious, sleep deprived parents it can seem a little like being in front of a jury arguing for your life while trying to do your taxes at the same time. Not at all fun and slightly terrifying.

2. Dividing and conquering, ie one person is examining the baby while another is asking the questions while another is entering orders while another is watching the cardiac monitor makes parents jumpy and unfocused. Don't try to distract them with detailed questions while handling the most precious vulnerable little responsibility they will ever have and love more than they could have imagined. It's just not nice.

3. Consider how every little decision you make will affect your patient AND their family. Putting a baby on a cardiac monitor for hours with no compelling reason to do so while the parents have to constantly hear the alarms (called alarms because they are alarming to those not used to them) and freak out that something is wrong when really the pulse ox isn't 'picking up' is unacceptable.

4. If the family is going to be stuck in the room waiting for something, anything, to happen and there is a delay, someone should come and update them AND apologize. I realize things move slowly in an academic center but when you are the one waiting it is very frustrating to be lost in the "waiting for the doctors to enter the orders" wasteland of time. Come on people, start the phototherapy already so we can be done with this and go home. Remember these are new, sleep deprived, anxious parents.

Do you know how often I've thought about these things when I've been the person on the other side of the curtain? I am ashamed to admit...almost never. That experience with my niece will make me a better doctor, I guarantee it. Just one of the many things she will teach me, i'm sure.

A First For Everything

2010-09-26T17:34:00.006-05:00

For the very first time I felt, at the end of this week, that I was tired of treating sick children. Don't get me wrong, I love my job. I love being a pediatrician and I love hospital medicine. But not this past week. That love was on hiatus.

Never before have I felt so "drug out", as the father of one of my patients kept saying to describe his previously healthy son who was unable to speak after a viral encephalitis. The kids I took care of this week took my previously in check emotions and took them for a joy ride down Depressing Road. I came home every night thinking about what lay around the next corner and how impossibly lucky I've been thus far in my life. When we wake up each morning we can't possibly know how our lives might irrevocably change that day. The mother of my 5 year old patient couldn't have possibly imagined how their morning bike ride would end...with her son severely brain damaged after being hit by a van. I could tell you more of what I saw this week but that's not really the point. I walked out of the hospital at the end of the week yearning to see a happy healthy child. In fact, I craved it.

I've seen all of these things before and have been able to deal with them in stride, just like every other day on the job. But last week it got to me. Those kids got to me. This week, for every night that I walk in my front door and my husband and two dogs are there waiting for me, I will give thanks for that day.

Let's Face It. I'm Ridiculous.

2010-09-15T20:06:00.006-05:00

I just got off the phone with a dear friend of mine and she was updating me on a situation she and her husband have been struggling with for awhile now. The theme underlying this struggle is regret. That awful shoulda-woulda-coulda feeling that we have all been humbled by more than a few times. It's a painful place to be. In short, they are strongly regretting their choice of residency program. They feel that they don't fit in with the people, the program is not family friendly, and they don't have the social support they thought they would. This is all compounded by the fact that they have a young daughter and residency at even the greatest program is still not a conducive environment to spend lots of quality time with the fam. I listen to her frustration and hear her talk about all the places they liked that they could have gone but instead made the misguided decision to choose this particular program and my heart aches because we both know that they have to grit their teeth and survive for the next 2 years. Just surviving is no way to spend your days. I've done it. It ain't pretty.

I'm embarrassed to share with you a regret i've been struggling with. When I tell you this, you will roll your eyes and then I will feel better that you think I'm ridiculous because that validates the fact that I should just let this go. And sometimes I need someone to roll their eyes at me so that I stop taking myself so seriously. Here it is.

On my first day at my new job, I was at morning report and the residents were presenting a case that had been seen in the hospital the week before. It was one of those puzzling cases about an adolescent girl, a soccer injury, and neurologic symptoms. Everyone is calling out potential diagnoses and tests they want ordered and focusing generally on the injury. All along I'm thinking "this sounds like something i've seen before, I know what this is." I want to open my mouth and say the diagnosis because no one has said it yet but we are in a big room with all sorts of attendings and residents and my department chair is sitting right next to me. I keep picturing myself croaking out my diagnosis and then the room going quiet and everyone turning to look at me and thinking "who the heck is that and why is she so stupid?" My heart is racing and my face is red and hot and I want to say it but my mouth won't open and my hands are trembling and then I give up. The residents go on with the case and show the answer and you know what? I was right. All I remember from that day is thinking over and over about what would have happened if I had said the answer. Do you know how much mileage I could've gotten out of that one right answer?? How awesome would that have been to outsmart everyone, even the department chair, on my very first day on the job? Awesome. Alas, I didn't open my mouth for fear of looking stupid and I regret it. I think about this at least 3 times a week. I keep hoping for another chance at morning report to reclaim the glory but those times happen so few and far between. I might never get another chance to look that mysteriously brilliant. Is this a ridiculous story? Yes. Will this ever happen to me again? Sadly, it probably will. (cue eye rolling)

Niche is a four letter word

2010-09-08T19:26:00.005-05:00

Here's an honest to goodness conversation that just took place between my husband and I.

Me: I'm feeling inadequate today.

Him: Why?

Me: Because I went to our division meeting today and everyone seems really really smart. Much smarter than I am.

Him: Well, they have more experience than you. I'm sure they think you are smart too.

Me: No, I don't have much to contribute during the meetings. Also, everyone has their niche that they are working on. You know, one person is doing global health, another is palliative care, another is family centered rounds. I don't have a niche yet. And what's worse is that I don't know how to get one! I don't have one singular passion to focus on. What if I can't figure out my niche and I just languish here in this job and I never get promoted?? I need to start being productive and adding to my professional portfolio!!

Him: Ummmm, you've only been there a month.

Me: So?

Him: So, you've only been there a month.

This conversation is what happens when a perfectionist like myself lets a little insecurity take charge of my brain and graffiti it with the word "should". I "should" be more productive. I "should" be uber-accomplished. I "should" be a rock star. I am reminding myself (with you as my witness) that it is ok to get settled into a new job for the first several months. It is ok to be inexperienced and still learning. It is ok to not be perfect. It is ok to take a breath and relax. It is ok to just be. Just be.

A Shout Out For Skills

2010-08-31T13:09:00.007-05:00

You know that feeling....that feeling where you make a decision because you think it is the right one and then everyone comes down on you and wants you to change your mind? That's not a good feeling...especially on your first day as a hospitalist in a new hospital. It's better when the decision is to not have dessert and then everyone tells you you're silly for cutting calories and you should enjoy life and just eat the freakin' dessert. Much better. But I digress...

To set the stage in the vaguest possible way, I decided based on the clinical history and the impression of my colleagues when this particular baby was admitted, that I would treat for 14 days with an intravenous medication. I stress relying on the impression of my colleagues because it was a situation where I came on the scene on day 4 of admission and the baby looked very different to me than she did when she was admitted. I have faith in my fellow physicians and it does take a leap of faith to base a difficult treatment decision on a physical finding no longer present. For various reasons, this baby had to complete the entire 2 weeks of therapy in the hospital. You can imagine how the family received that news. Here is a rough approximation of how that conversation went as if you were only listening to my end...

"Unfortunately, the baby has to stay in the hospital getting this medicine intravenously for the next 9 days."
"Yes, I know all the tests were negative."
"Yes, I agree she looks great and has a normal exam today."
"I do feel strongly that this is the necessary treatment course for your baby."
"I know it is a hardship for you to drive here when you live an hour and a half away."
"You have a 2 year old at home? Wow, yes that will be tough for you."
"No, I won't change my mind on this."

It was difficult hearing the nurses whisper about what an inconvenience that was for the family and how sorry they felt for them. Difficult because I felt responsible for that hardship, it was ultimately my decision to make. A comment on a recent post of mine mentioned celebrating "the moments when I own my skills". I read that comment on the night that this happened and it reminded me that my responsibility is to ensure, as best I can, the health and safety of that baby. I own that responsibility and am grateful everyday to have the opportunity to practice my skills in this awesome career that I chose. That is something to celebrate. Thanks for the reminder.

Spare the Rod...Please

2010-08-25T20:12:00.005-05:00

Can we talk about something sad? Not sad so much as vile and disgusting. Call it whatever adjective you will, but I have seen 4 cases of child abuse in the hospital in the past 3 weeks. These range from a broken leg in a toddler caused by 'falling off the bed' to a 3 month old beaten to within an inch of his life. When I see these children, I can't fathom what they did to incur the wrath of an adult punching, slapping, and shaking them before they even have the means to run away. It makes me sick and, i'll admit, I do pass judgment on the alleged perpetrators before they have been 'proven guilty' by a court of law. I'm human. And I have dedicated my career to ensuring the health and wellbeing of those in our society who do not have the means to advocate for themselves.

So I thought it timely when I ran across an article about spanking and domestic abuse. A study found that children who were at the highest odds of being spanked were those whose parents were aggressive towards each other. This aggression took the form of slapping, kicking and emotional abuse such as not letting the partner see his/her family. The article suggests that spanking is part of an overall 'environment of violence' in US families today. Essentially, child abuse like i've seen over the past weeks is likely a continuum of abuse stemming from the parents, who likely suffered abuse as children, who were abused at the hand of their parents, and so forth. Spanking is an act that I don't believe children can separate in their minds as discipline vs. physical oppression of another person for purpose of control. Hence, the link to abuse. The AAP has this to say about spanking:

Corporal punishment is of limited effectiveness and has potentially deleterious side effects. The American Academy of Pediatrics recommends that parents be encouraged and assisted in the development of methods other than spanking for managing undesired behavior.

I wish that I could build a dam to block the river, but instead i'm throwing life preservers to those who are drowning in the rapids.

The Voices in Your Head

2010-08-19T12:04:00.003-05:00

I had this attending my intern year who would always send us in to see a patient and then ask, when we came out of the room, "sick or not sick?". I spent my 3 years of residency honing that skill, that gut feeling supported by experience and clinical knowledge, which allows me to assess a patient within minutes (sometimes seconds) as perhaps someone who needs more critical care than I can provide. To this day, I ask myself "sick or not sick" anytime I see a patient on the floor.

I had the opportunity to listen to this voice last week. Another physician from a hospital a couple hours away transferred a patient to me billed as more puzzling than anything. They had run multiple tests and thought they had a diagnosis and were ready to discharge her when her symptoms returned and gave them pause. I accepted the transfer and proceeded to wait for her arrival to the floor. However, there was something nagging at me. Something about the story was troubling me but I tried to reassure myself. After all, she had already been in the care of another physician who I'm sure has more experience than me. Surely they would have noticed and ruled out the very things that were scrabbling around my brain and causing me to have my 'nervous stomach'. Right??

As tends to happen on a Friday afternoon when the residents are all at lecture and I am finishing my first week on service...I walk into the room as soon as she arrives and my 'gut voice' is screaming "sick! sick! everything you thought was going on IS going on!". My gut voice doesn't have much tact, but she is phenomenally insightful. I'm learning that I should really listen to her more often. Thankfully, I had the support of the critical care team and specialists right away and she was taken to the critical care unit, where she remains today. Looking back, I should have been more focused and skeptical in my questioning of this other physician. I should have trusted my instincts and told the ICU about the patient and my suspicions before she ever arrived. As a young and fairly green hospitalist, I am quick to defer to others' judgment. This experience taught me that I can and should rely on my clinical assessment. I may not always make the right diagnosis right off the bat, but I can tell sick from not sick and that is the first step. Now I'm the attending who sends my interns into a room and asks "sick or not sick?".

Checking In (Or Taking A Break From Flogging Myself With Impunity)

2010-08-10T17:12:00.000-05:00

Just finished my second day of my new job. Wait, has it only been 2 days?! Oy, yes it has. Not that things have been awful. On the contrary, things have been wonderful. But you know how it is when you come off of a loooonnng vacation and jump right into busting your hump and trying to look like you know what you're doing? I'm there.

My first night call is tomorrow night and i'm a bit freaked out. Not so much about the medicine....more about the finesse it takes to practice said medicine over the phone. I haven't done that in awhile so I will be exercising certain clinical muscles that are flabby with disuse. And speaking of flabby muscles....i'm not sure how I did this as a resident. By this I mean work all day running around the hospital maintaining control and order with a professional yet pleasant demeanor while fitting in teaching AND learning 'on the fly'. And then fit in a quality workout and cook a well balanced dinner. I did this as a resident, a mere 4 years ago, and I have no idea how. Because i'm certainly not doing it well now!

I'm currently propping my eyelids open and doing PREP questions on the Pedialink website. Must. Learn. Everything. But i'm not putting any pressure on myself....

Not So Lonely Only

2010-07-16T10:21:00.003-05:00

I've done lots of important things lately. Let's see....I've moved to a new state, bought a house, bought a car, bought a lawnmower, am starting a new job, reached advanced maternal age, and made pancakes with beer in them. Did I mention I moved to Wisconsin? See, now the pancakes with beer thing makes sense.

With all these big changes, what do you think is next on everyone's mind? I'll give you a hint. It starts with b and rhymes with maybe. Dang people, give me a break. I'm crossing things off the checklist o' life as fast as I can. So I started thinking...when is the perfect time? My husband has an advanced degree and is moving forward in the academic science world. I am starting a new career as an academic pediatric hospitalist. There's no downtime in the near future for us. And by near future I mean 10 years. We've looked at each other various times and said "we want to have kids right?" and the answer has always been "yes, but not right now." Both of us have career goals we have yet to meet and are looking forward to reaching those goals. I personally love what I do and can't imagine not being a pediatrician. It has become an indelible part of who I am and I won't apologize for that. Ever. So how do we fit a family into that mix?

Fortuitously, as i've been struggling with this question, there appeared on the cover of Time magazine an article about the trend towards stopping at one child. The article focused on couples' reasons for stopping at one and the debunking of the myth that only children are maladjusted, social misfits who are selfish and secretly long to fill the hole left by the lack of siblings. Until I read this article, I didn't realize how much my personal bias against only children was a product of this very myth. Having one child makes sense to me. Economically, personally, intellectually, it is a compromise and a way I can wrap my head around the concept of having a family and the career and life that I currently love. I wonder, how different would it feel to know that this pregnancy would be your only pregnancy and this sleepless infant stage would be the only one you would go through? Would you complain less and enjoy more? Would you wake each day with anticipation of the milestones knowing that your experience would be limited to this one child? Just food for thought. I'll be chewing for awhile...

Celebrity Deathmatch: Oatmeal vs Pop-Tarts

2010-07-02T13:51:00.005-05:00

I've come up for air, bought a new computer, completely unpacked and now i'm ready to start this new year of blogging. I might even get a little fancy and start posting pictures too so watch out.

Last time I wrote I said we would discuss finding your niche in your career/job in my next post. But I changed my mind. Work is far from my thoughts and I just can't make myself think about starting my new job right now. Fair? Fair.

A report published recently by the Trust for America's Health and the Robert Wood Johnson Foundation stated that 16% of kids ages 10-17 years are obese and another 18% are overweight. You only have to walk around the mall this summer to see the uncomfortably tight t-shirts and jean shorts kids squeeze themselves into to get an in-your-face glimpse of our Western diet wreaking havoc on the health of our future generations. Did they ever really have a chance?? Why eat plain oatmeal and fruit when you can get fiber and "7 vitamins and minerals!" by eating a strawberry frosted Pop-Tart?

My husband likes Pop-Tarts and, I confess, there were many nights on call when a package of these tasty toaster pastries called my name and I listened. I figured they can't be that bad because they have fiber and real fruit (!). So I read the ingredient list and here is what I found:

ENRICHED FLOUR (WHEAT FLOUR, NIACIN, REDUCED IRON, THIAMIN MONONITRATE [VITAMIN B1], RIBOFLAVIN [VITAMIN B2], FOLIC ACID), CORN SYRUP, HIGH FRUCTOSE CORN SYRUP, DEXTROSE, SOYBEAN AND PALM OIL (WITH TBHQ FOR FRESHNESS), SUGAR, CONTAINS TWO PERCENT OR LESS OF CRACKER MEAL, WHEAT STARCH, SALT, DRIED STRAWBERRIES, DRIED PEARS, DRIED APPLES, CORNSTARCH, LEAVENING (BAKING SODA, SODIUM ACID PYROPHOSPHATE, MONOCALCIUM PHOSPHATE), MILLED CORN, CITRIC ACID, GELATIN, CARAMEL COLOR, SOY LECITHIN, PARTIALLY HYDROGENATED SOYBEAN AND/OR COTTONSEED OIL†, MODIFIED CORN STARCH, XANTHAN GUM, MODIFIED WHEAT STARCH, COLOR ADDED, VITAMIN A PALMITATE, RED #40, NIACINAMIDE, REDUCED IRON, PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), YELLOW #6, RIBOFLAVIN (VITAMIN B2), TRICALCIUM PHOSPHATE, THIAMIN HYDROCHLORIDE (VITAMIN B1), TURMERIC COLOR, FOLIC ACID, BLUE #1.

I don't know about you but the words modified corn starch and xanthan gum get my salivary glands working overtime. Note the 2nd, 3rd, 4th and 6th ingredients are some form of sugar. Our bodies are not engineered to handle mainlining simple sugars in this quantity. How many natural foods (aka real foods) contain so many different forms of glucose already broken down and speedily available? None. Even fruit has fiber and vitamins to enhance the slow release and absorption of glucose. Is it any wonder that kids, when bombarded with Spongebob characters extolling the virtues of Pop-Tarts (fiber! 7 vitamins and minerals!), are no longer satisfied with the humble whole grain?

We can't fight the food manufacturing industry as a whole. We as pediatricians have tried and have found it to be a sisyphean task and one that will take years and billions of dollars to sort out. So, here's my challenge for you. Think about what you are eating today. Really look at it. Is it a 'real' food? Or one that has been processed and shaped into something that approximates something in nature with its nutrients stripped and then replaced chemically one by one? For just one day, eat real. Taste food the way it is meant to be tasted. Forgo artificial sweeteners, microwave meals, 'fortified' white foods, and any foods that are called the same thing in any language e.g. Cheetos, Big Mac, etc. When you go to the grocery store, shop only the perimeter. Check out a local farmer's market.

If we don't start modeling a way to eat healthfully and humanely no amount of healthcare reform will save us from the catastrophic public health issue gaining steam on our watch.

Excuses Get A Bad Rap

2010-06-10T13:51:00.004-05:00

Ok, before you yell at me for slacking off, let me tell you where i've been. Since my last post, i've

1. bought a house
2. bought a car
3. filled out a forest worth of paperwork for 1 & 2
4. been getting ready to move with all the annoying minutiae that entails
5. driven back and forth from Chicago to Madison no less than 5 times
6. been scheduling "I want to see you one last time before I leave" dinners and lunches
7. watched our good friends' two lovely dogs
8. vacuumed up 2 pounds of dog hair that our two lovely dogs and their two lovely dogs shed
9. ran a 10 mile race
10. tasted the best ice cream on the planet. No joke. It's at Southport Grocery and Cafe if you're ever in Chicago. I think about it everyday, multiple times a day. I only wish I had found it sooner. My thighs are grateful that I didn't.

My next post, if you want something to chew on before hand, is going to be wondering aloud about where I want to make my niche in my next job. Everyone needs a niche. Or so i'm told. For now i'm wondering when I can eat more of that ice cream.

Savory and Sweet

2010-05-20T23:30:00.003-05:00

Growing up, my mom would often warn me to "be careful, you're wishing your life away" when I would wish fervently for some day in the future to be the present. I would just roll my eyes and think "yes, that's exactly what I want to do...wish this waiting part of my life away so I can get to the good stuff". As i've gotten older, I am more aware of the preciousness of time and how it seems to have sped up as the years have gone by. But, I still catch myself 'wishing my life away'. You only have to read my last post to witness the evidence of that.

For months now, I have longingly thought of the day when I wouldn't have to work nights anymore, when I could move on to the next phase of my life and next exciting career opportunity and feel like I was truly moving forward instead of casting about. And now that moment is here. And I feel sad. Could it be that when I was so focused on counting the days (nights) remaining I ignored the fact that I was developing friendships with the people who surround me and support me and make me laugh during those long nights? Did I not realize that the very smiles I look forward to seeing on a regular basis are the same smiles I will miss the second I walk out the door, the same smiles that make this job so much more than just a job?

When I step out into the sunshine tomorrow morning after my last shift I will be excited to move on, excited to begin my new career in a new place where I plan on raising a family together with my husband. But for now, I will be happy here, right now, in this place. I will savor the smiles, and be grateful I had the opportunity to be here at all.

Four

2010-05-11T21:08:00.005-05:00

I have four night shifts left. Four. That's all. After two long years of nothing but nights...I have four left. I try not to obsessively think about those nights and how they might drag on and on and be the most painful of my nights at this job. I try to boost myself up and think "only four nights left!" with a gleefully insane grin on my face. My husband tried to rally me with an analogy about a frog and boiling water. I understood the relevance but I don't think anyone else would. That's why we're married. It doesn't always work. The rallying part I mean.

But then I have an experience like I had the other night and it slams me back into the here and now and pushes me to think of each day (and night) as a gift. I have the privilege of coming to work at night. I love being a pediatrician. I am able-bodied and (fairly) young and I have a job and am secure in the knowledge that my loved ones are safe.

A few nights ago, we were notified of the impending delivery of a term baby with a congenital heart defect who would require immediate transfer and eventual surgery. The parents were my age and they had a 2 year old little girl at home. I met with them shortly before the delivery and answered their questions. Composed yet anxious, they told me they had not found out the sex of the baby so it would be a surprise at the delivery. Hours later, we stood in the delivery room watching as the husband coached his wife and she pushed like a soldier. I found myself holding my breath as the baby slowly slid out - head, then shoulders, then belly. No, I wasn't nervous about the cardiac defect or the resuscitation or whether we would have to intubate the baby right away. At that moment I was completely caught up in what my friend calls "one of life's great surprises". The dad threw up his arms and yelled "It's a boy!" and they started crying and we started cheering. He was pink and screaming and perfect. For that short window of time, those parents forgot all about the trauma that was inevitably awaiting them. For that short window, they were a healthy family of four. It wasn't until the OB brought the baby over to us that anyone even remembered that we were there, or why.

Two hours later, after mom had recovered and I had put lines in and we had started the prostaglandin drip, they arrived at his bedside. The transport team that would spirit him away in an ambulance arrived shortly after with their 'hospital in a bed' and started preparing for what would be the first of many dangerous journeys for this little boy. I watched as the mom sat in her wheelchair beside his bed and looked at him with a sadness i've never felt. The look seemed to be saying "If only I could put you back in my womb where I could protect you and keep you safe from all of these prying hands and we could have our quiet moments together before we go to bed and first thing in the morning and I feel every movement you make and I love them all." I watched her as they loaded the baby into the isolette on wheels with all of its attachments. And I watched her as they wheeled him out of the room and into the hallway and the nurse wheeled her in the wheelchair right behind him. I couldn't tear my eyes from the beauty of the moment. Just then a nurse grabbed my attention and asked me to clarify some orders on a different baby. And then I turned and the family of four was gone.

Alex, I'll Take Tattooing and Body Piercing for $200 Please

2010-05-01T07:48:00.002-05:00

I fully intended to blog last night. I really did. But I ended up spending 3.5 hours taking an "open book" test on the computer for my Wisconsin medical license. After that, words kept sliding around on the screen and I felt like my eyes were carp shooting. Weird analogy, I know.

I have to admit, I didn't really take this test seriously. Until I started reading the questions and paging through screen after screen of subheadings such as Application for and issuance of special plates and Credential denial, non renewal and revocation based on tax delinquency. I paged back to make sure I wasn't actually taking the bar exam. Of course the questions based on these subheadings weren't all hard. Many focused heavily on controlled substances. For example, my personal favorite question was "Nasal inhalation of cocaine before performing an appendectomy is an example of unprofessional conduct. True or False?" Now, I know they tried to trip me up by saying 'nasal inhalation' instead of the more common term 'snorting' but I think if this came up for a vote the medical licensing board would frown upon that particular scenario. Another one was "In addition to maintaining meticulous chronological records of the dispensation of controlled substances, a physician must also record the name of the substance. True or False?" Umm, difficult to call your record keeping meticulous if you don't even note the name of the drug you are recording isn't it? Unless of course you are in a situation where giant insects are flying out of a thick mist that has blanketed your town and you need to race to the pharmacy risking being snatched up and rolled into a giant cocoon just to get some narcs for your hurt companions back at the grocery store. Then record keeping goes out the window. That's the reasoning I used to outsmart these test writers and select the correct answer.

I'm proud to say that I passed the test with a 97% despite the craftiness of the medical licensing board and my inability to pin down the relevance of the questions to my particular practice of medicine. I shouldn't be so negative though....that might be construed as an example of unprofessional conduct. :)

Lying Fortune Cookies and the Women Who Love Them

2010-04-28T22:15:00.006-05:00

For some reason, working at night makes me hungry. So hungry that I can't seem to stop snacking. It's bad. I don't get hungry like that at home. Why must I be so hungry at work? Tonight I found myself scrounging at the bottom of my lunch bag and I came up with stale fortune cookies. I won't lie. I ate them. I'm not proud.

One fortune said "You will be successful in whatever you do." Really? That's good to know. I was worried about that. Especially since i'm starting a new job this summer. Maybe I should actually start training for that triathlon i've been planning to do for the last 8 years. Sweet. But how do I make sure that this fortune cookie is not just blowing smoke...in my face? After all, what does it have to lose? I was going to eat it one way or another so why not just lie? I'm paranoid like that. Don't judge me. I decided to look into this whole idea of success. Where did I turn? To the business world. Those people do nothing but focus on being successful. Here's what they taught me.

Success is a choice we must make daily. In other words,
1. Decide to do the different every single day. Ever notice how much more you see when you take a different route to work? The different is a minefield of discovery. Leave your comfort zone, if only for a little while.

2. Just ask. You can't win if you don't play. When you don't ask for what you need, the only answer is no.

3. Learn something new everyday. Kindergarteners do it. Why can't you?

4. Be active. This one is my personal favorite. I love exercise and being healthy. I've never found it especially motivating to lounge on the couch for hours watching tv, much to the disappointment of my husband!

5. Choose carefully who you hang out with. Surround yourself with people who you admire and respect. Do a quick friend and colleague check. Do they make you a better version of yourself? If not, consider seeking out those who inspire you and minimizing interaction with those who don't. I know, it's easier said than done.

When Everyday Feels Like Wednesday

2010-04-21T15:17:00.004-05:00

For those of you who don't know, the ACGME and RRC began enforcing resident work hour (also called duty hours) limitations in 2003. The highlights are that residents can admit new patients for no longer than 24 hours straight but can continue to work another 6 hours to finish up their work and/or participate in educational activities for a total of no more than 30 consecutive hours worked. The weekly work hour limit is averaged at 80 hrs/wk over a 4 week period with one day off in 7. I got used to the look of horror when I told non-medical people that the new work hours were great, we only had to work 80 hours a week now.

I happened to begin residency in 2003 and was therefore part of the "80 hour workweek" class. Defending ourselves against the onslaught of disdain from our senior residents and attendings became the norm our intern year. We were seen as privileged, lazy, and not concerned about patient care and learning. We, however, didn't know any differently. We were forced to compress our considerable intern workloads into 80 hours a week without the support of faculty members and try to learn how to be a compassionate physician at the same time. Oh, and learn enough pediatric medicine to not look like a buffoon on the wards. Although I championed the benefits of the duty hour regulations, over the course of my 3 year residency I realized its shortcomings as well. It provided an easy cover for those residents who wouldn't have valued educational initiative anyway and evened the playing field between those residents who would not walk away from 'loose ends' and those who had no qualms about doing so on a regular basis. Now we all had to be comfortable signing out work until we could come back in the next morning.

Now as an attending, I see a permutation of the duty hour regulations affecting the residents I currently supervise. They seem to have lost the pride in patient ownership that I remember feeling as an intern. Residents now have been forced to evolve into number crunching, note writing, order entering and work hour tracking doctors in training who actually spend the shortest allotment of their time at the bedside. I am constantly amazed at how much medicine is now practiced in front of a computer screen.

The reason I bring this up is not to play the "when I was a resident" game and disparage those trainees coming up through the ranks. It isn't their fault the duty hour regulations exist, just like it wasn't ours in 2003. But I heard something disturbing the other day. On a listserv to which I subscribe, a post was written about new regulations that will further cut down on the number of hours residents work. In that model, more of the daily work will fall on the attendings so the residents will still have time to attend educational activities as well. I fear that if this keeps happening, a pediatric residency will need to be extended to 4 years from 3. And from what i've been reading, this fear is warranted. However, I fear more the pediatrician who graduates from residency and is adept at studying and attending lectures but has no idea what to do with a difficult family or an acutely ill patient!

This issue will be revisited again and again in this blog in the upcoming year, especially as I transition to an academic pediatric hospitalist position and work with residents and medical students full time. And yes, I did just say that I will be writing this blog for another year. Thanks for your support!

Even Uncle Sam Wonders When You're Getting Married

2010-04-14T23:10:00.004-05:00

I've been married for a year and a half. I told a friend this weekend that I feel more passionate about my husband now than I did 2 years ago. And I plan to feel even stronger 2 years from now. Yes, I plan that sort of thing. You know the saying "Failing to plan is planning to fail"? I might as well have that tattoed on my arm. Where did I learn how to be married? I don't remember ever hearing about marriage in school. My pediatrician certainly never brought up the topic of marriage during my yearly well child checks, even as an adolescent. So where do children learn how to be successful married people as adults? The popular vote would be that we simply learn by watching our parents. But what if our parents are divorced? Are we simply doomed then to be unsuccessful at marriage ourselves? It seems to me, as a pediatrician concerned about the future wellbeing of the children for whom I care, that I should be imparting some sort of guidance on thriving in a happy marriage. But does it even matter? As it turns out, it does.

Research has found that children raised by parents in healthy marriages have certain benefits not seen in those from unhealthy marriages. Those benefits include the following:

More likely to attend college
More likely to succeed academically
Physically healthier
Emotionally healthier
Less likely to attempt or commit suicide
Demonstrate less behavioral problems in school
Less likely to be a victim of physical or sexual abuse
Less likely to abuse drugs or alcohol
Less likely to commit delinquent behaviors
Have a better relationship with their mothers and fathers
Decreases their chances of divorcing when they get married
Less likely to become pregnant as a teenager, or impregnate someone.
Less likely to be sexually active as teenagers
Less likely to contract STD's
Less likely to be raised in poverty

A healthy marriage benefits society as a whole too. Consider this. The Deficit Reduction Act of 2005 provides funding of $150 million per year for healthy marriage promotion. Healthy marriage promotion awards must be used for eight specified activities, including marriage education, marriage skills training, public advertising campaigns, high school education on the value of marriage and marriage mentoring programs. I've seen this campaign in action in the form of posters on the bus that read "He's not always Prince Charming, but he'll always be your prince" under a picture of a man yawning in a woman's ear while spooning in bed. Sweet. I've often wondered about the point of that poster. Now I know.

For more information, check out the Healthy Marriage Initiative on the Administration for Children and Families section of the Health and Human Services website.

From Farm to School

2010-04-04T18:06:00.004-05:00

Remember the days when you could (and did!) eat anything you wanted and not give a hoot about nutrition, your carbon footprint, your pant size? I remember those days well. I'll confess...I was never one for healthful eating. Thankfully I was always active in sports so my weight was never a problem. But I think about the way I ate as a child and teenager and I cringe.

Once or twice a month my school had "hot lunch" days. We didn't have a cafeteria so we all brought our lunch routinely except on those days. Those days you could bring your money in a sealed envelope with your name on it and get a nutritious choice of Burger King or Pizza Hut. Wow. I guess they thought since we brown bagged our lunch most of the time we could afford a little artery clogging fat lest we forget the joys of empty calories and processed, overpriced, low quality food. In high school, my friends and I routinely ate fries, chicken nuggets, and this mysterious deep fried bean and meat burrito thing. From the school cafeteria. Am I the only one disturbed by the idea that our schools are promoting eating this way??

Millions of children everyday eat lunch and sometimes breakfast at school. The government invests only $2.68 per day for each school lunch. Some of us remember the "four food groups" model of nutrition: meat, milk, fruits and vegetables and breads and cereals. Meat had it's own quarter of the pie!! Thank goodness we've graduated from that 1958 embarrassment to the "food pyramid" of today. But we're still a long ways off from impacting the eating habits of children in this country. Although I cringe at the crimes i've waged against my body with my poor noshing past, I am committed to lead my children to another way of living and eating. That is why I am very much behind the goal of Chef Ann Cooper and The Lunch Box initiative to lobby Congress to invest one more dollar in every child. Without a change in the obesity epidemic affecting our children, they will have a shorter life span than you and I. Shameful.

My Olfactophobia

2010-03-31T00:29:00.004-05:00

So, I survived the whole winter without getting sick. I evaded seasonal flu, H1N1, RSV and even a bocavirus or two. I religously wash and sanitize my hands, at work and at home. In fact, I drive my husband crazy nagging him to wash his hands right when he gets home from work because A) he takes the bus B) he works with Pseudomonas (that's not a person, but a nasty bacteria) and C) I have a strong aversion to smells on hands, even those that aren't my own.

Despite all of that....I came down with a raging cold that bloomed into a sinus infection just in time for my annual "March Madness" vacation. On antibiotics and breathing freely, I am back at work 2 weeks later. And back to blogging. Now just in time for the historic health care reform passage. Atul Gawande, of whom i've spoken before, writes a thought-provoking editorial for The New Yorker calling on physicians and communities to take responsibility for the success of the reform and the repair of our damaged health care system. The battle has just begun.

The Top Five

2010-03-11T22:09:00.005-06:00

My husband and I, when we were first dating, used to play the "top five" game. You know, when you ask each other for your top five books, movies, teams, songs, bands, etc. It was a great way to get to know each other and the game served to ease us through the awkward "chatting with you over dinner before this bottle of wine kicks in" phase. (so glad that's over!) In fact, we just played this game and listed our respective top five Stephen King novels (over a bottle of wine coincidentally). I happen to be a huge fan of the author and my husband, well, was more of a fan in junior high than now. But we can't all be highbrow with our literary leanings.

There was recently a fascinating editorial published in the New England Journal of Medicine regarding "top five" lists. The premise is this:
The Top Five list would consist of five diagnostic tests or treatments that are very commonly ordered by members of that specialty, that are among the most expensive services provided, and that have been shown by the currently available evidence not to provide any meaningful benefit to at least some major categories of patients for whom they are commonly ordered. In short, the Top Five list would be a prescription for how, within that specialty, the most money could be saved most quickly without depriving any patient of meaningful medical benefit.

Working in a neonatal intensive care unit, where we routinely keep babies alive artificially and often for great lengths of time, I witness firsthand the miracles of medical technology. And the failures. And the ethical dilemmas. And the extraordinary costs of doing things because we can. I also witness my friends in general pediatrics working long hours and fighting everyday to spend enough time with their patients and families under the constraints of billing and 'moving them through'. It's no secret that the 'doing' specialties are reimbursed far more than the 'talking' specialties. Technology pays. An interesting spin on the healthcare reform debate...

Thank God for Unanswered Prayers. Because I Said So.

2010-03-02T14:04:00.007-06:00

Let's be honest here. There was once a time when I naively believed that as professionals we would look out for each other and treat each other with respect and kindness. That was until I was offered my first real employment contract. This was about two years ago, after I had decided to leave my fellowship and was floundering about trying to figure out what the heck I was supposed to do with my life. In the process, I had interviewed with a private practice in an affluent community, a community health center in an underserved community, a private practice in a middle class community, a pseudo-academic peds hospitalist group, a community peds hospitalist group, a neonatal hospitalist group and an ethics fellowship. Oh, and I tried to submit an application at Borders but my husband wouldn't let me. I was clearly a bit directionless. That being the case, when I was offered a position with a private practice, I jumped at the chance to settle into a life polar opposite to what I was living as a fellow. After getting the contract (a 20 page monstrosity) I decided to have it looked over by a lawyer simply as a formality. That flip decision ranks as one of the most important in my life to date. Who knew? This blog, my friends, is dedicated to the road not taken and I hope that a little tidbit from here makes a difference to at least one little starfish...

Lessons I Learned About Contract Negotiation, Part 1:
1. Don't treat yourself to a celebratory dinner and bottle of wine until the ink is long dried on the contract that you successfully negotiated to your liking.
2. Spend whatever you have to on a lawyer experienced in physician contracts to look over yours. Just do it. Please.
3. Don't be so enamored with your base salary that you ignore how your raises and bonuses will be determined. "Physician's base salary will be reviewed and adjusted if necessary" does not cut it. If it's not in the contract, it doesn't exist.
4. Tail insurance coverage = big deal. Typically, the tail is about twice the cost of the annual premium. So, if the 1st year premium for you is $6000, the tail is $12000 for that first year. In many practices, until you become partner/shareholder (more on this later) you are responsible for the cost of your tail (or a portion) if you leave for any reason. This is why some say that joining a private practice is like getting married. You better be damn sure that's what you want or else it will come back to bite you in the tail (I couldn't resist). This could potentially be thousands of dollars you will owe the practice when you leave. Ouch!
5. Restrictive covenants are standard nowadays. They are otherwise known as 'non-compete clauses'. Make sure that they don't prohibit you from practicing anywhere else in a reasonable drive from where you live. E.g. a radius of 7.5 miles in Chicago is pretty rough. In Phoenix? Not so bad. Get out a map and use it.
6. Termination. It could happen to you. The following sentence is a red flag "Employer may terminate this agreement immediately if...Physician engages in conduct that, in the sole discretion of Employer, is detrimental to patient care or to the reputation or operations of Employer." Wow. That basically says that they can make up a reason not to like you and fire you immediately. Here's another one, "... the other party shall have no rights to cure or contest the termination of this Agreement." I can't even contest it?? This clause smacks of the "Because I said so" mantra of my mother when I was young.
7. Here's another one of my favorites. "Physician agrees...not to make any disparaging remarks to any third party concerning Employer or any of its officers or directors...throughout the term and at all times thereafter." Really? You mean I can't say anything nasty about the unreasonable and freakishly controlling contract you offered me? I can if I didn't sign it. ;)
8. Clarify your vacation time/CME time/sick leave. Especially if you see a rule like this one. "Excused time for illness extending more than two days requires a consultation with your primary care physician." Ignoring the obvious fact that you are a primary care physician, when was the last time you needed a note from your doctor to prove you were ill? Wait, am I actually reading that application for Borders? Sadly, no.

That wraps up Part 1 of contract negotiation, otherwise known as "Learning from my Almost-Mistakes". The statements quoted above may or may not have a basis in fact. They may or may not have come from a contract I was once offered and still have if only to remind me of how close I came to misery. That lawyer charged me $800 to review my employment contract. Pricey? Sure. Priceless? Absolutely.

Crazy, But That's How It Goes

2010-02-21T20:54:00.004-06:00

Whoa! Where the heck have I been?! Don't ask me, I don't know. Well, I do know. I was in Las Vegas. Vegas baby! Pretend I didn't just write that.

It was so nice to take a sunny break from the (not so bad this year) Chicago winter. Vegas had me dehydrated from drinking, sore from walking, poor from shopping, pissed off at slot machines and completely ready to come home after 4 days. Fabulous. Oh and note to self...spending said Vegas vacation with dad and his significant other makes time with my husband scarce and precious. Along with my sanity.

So I get back from vacation all tanned from the sun and glowing (still) about my new job and the following exchange occurs:
Neonatologist: So Angela, I hear you're leaving us.
Me: Yep, I sure am. I'm moving to Madison!
Neonatologist: Wow, you look so happy about it. I'm sorry Bill (boss) had to run you out like that. But you know, we are so tired of taking call and he hired a neonatologist to take your place so that means fewer call nights for us. I'm sure you understand.
Me: Uhhhhh, what? No, I wanted to leave. I wanted to find another job. Did you just step off the crazy train lady?! This was me! All me!! Are you freaking kidding me?!

Yep, true story. Mostly. Except the part where I freaked out. That took place in my head. With that i'll leave you with a website I file under "Things I Adore". Dang it's precious.

Like A Wink and A Smile

2010-02-12T00:43:00.004-06:00

Something pretty awesome happened today. I typed in the website pedjobs.com, as I do at least weekly in my ongoing job search, and I realized...I don't have to anymore. Because I have found a job!! And not just any job, but the job description I would've written for myself had I been asked 6 months ago to write a description of my ideal job. Yep, it's that good. Maybe even a career maker. Am I being a little effusive? A bit too optimistic and naive? Maybe...but you know what? I'm going with it. Not often in life do you get to thank fate and your lucky stars and your own perseverance for giving you exactly what you wanted. So for the time being i'm walking around on clouds and reveling in my little corner o' the world. It's pretty darn sweet here.

Social Networking = Free Money

2010-01-28T21:36:00.006-06:00

Seriously people. The social networking craze has gotten out of control. There is now a facebook fan page for everything. Even my favorite egg and cheese bagel sandwich has a fan page. And Clark Griswold. Pretty soon ostriches will have their own fan pages and twitter feeds and maybe sell some stuff on etsy.com. Or maybe not.

But (there's always a but) here's one social networking site that will earn you some cold hard cash. Or at least some plastic. The caveat is that you have to be a member of the AAP. So mom, while I appreciate you faithfully following my blog, the rest of this post will not apply to you. Go put your feet up.

Here's the deal:
Log onto the YP Connection website and create a profile (just like facebook)
For the next 7 weeks, you will be awarded points for logging in, joining a group, leaving a comment on a blog post, etc.
The first week the person who gains the most points by being active on the site will get at $50 American Express gift card. The awards will increase each week and the final week the grand prize will be a $400 Am Ex gift card.

Can it get any better than that?! Well, yes it can. The ultimate reward is that you will have become an active member of the Young Physician community and networked your way across the country. Maybe you'll find a new job, a new book or a new 'special someone'. But you'll never know if you don't check it out. Check it out.

Who I Am Not

2010-01-26T16:36:00.005-06:00

I've got something to vent about and I'm going to use this blog of mine to do it. Are you with me? Here we go...

In the midst of this job search that has become the white noise of my life for the past 6 months I have realized something. And no, it's not the futility of fitting all of my toiletries into 3oz bottles and putting them in 1 ziploc bag. Although that's true. I've learned that physicians can be as a group some of the rudest most unprofessional people. Sad but true. And since I'm a pediatrician and dealing with other pediatricians, you know I am referring to the nicest of all specialties, pediatricians. I know, I am surprised too.

I write this as I sit here in a not unfamiliar position of waiting to hear from a physician who I was supposed to speak with an hour ago to discuss a job. This is the second (maybe third?) time I have been in this position. Is it so hard to remember an appointment to speak with a professional colleague? If you are running late, I understand. But I have been waiting for an hour. Not cool my friend, not cool at all. And to everyone who decides that an email is not worth answering for a couple of weeks, even if it comes from a very nice and talented physician and contains a letter of interest and a CV? This blog post's for you. What about those who say "I'll get back to you at the end of (blank) month" and then the end of the month comes and I have to send a 'friendly email reminder' (or two) that I am still here and still waiting and still interested in your opinion of me and what I have to offer despite now feeling like I am the gum on the bottom of your shoe. Shame on you.

I can't change the behavior of my colleagues. But i'll be damned if I will forget what this feels like. And when the situation is reversed, as it will be someday, I will acknowledge the efforts of young pediatricians trying to advance in the scary and often intimidating world of medicine. I will remember that we as physicians are not above simple manners and kindness and be humbled. Until then, I believe in karma and gut feelings and the healing power of red wine and chocolate chip cookies. And i'm a better person for it.

In Over My Head

2010-01-18T22:46:00.005-06:00

I had to do something today for which I felt totally unqualified. It had nothing to do with my patients or procedures but everything to do with my lack of years in this field of neonatology. I've explained before that I am a general pediatrician (and proud of it) who wears a neonatology hat for a living. At this point in my career, I feel pretty darn comfortable with it too. Gone are the surges of adrenaline everytime the phone rings and we are called to a delivery. Gone is the should I call for help or should I tough it out on my own internal struggle. I no longer feel like a minor leaguer playing in the majors. Until today.

Today I was asked to speak to a woman pregnant with twins at 23 weeks gestation about what to expect if she were to deliver in the next 24 hours. I don't need to give you the statistics, but the chances of these babies surviving is small and the chances of them surviving without any disability is slim to none. The gestational age is so early, in fact, that we give the parents the choice of whether or not we attempt to resuscitate the babies at delivery. Parents are completely within their right to allow the infants to pass peacefully, without the long and painful torture of hospitalization and a certainly uncertain outcome. So, I was asked to speak to this couple about their long sought after twins and help them to come to a decision. They would listen to what I had to say and then make the hardest decision of their lives.

There I stood, armed with my statistics in hand and a description of what constitutes a major disability vs a minor disability. I had all the information I needed yet knew absolutely nothing. I watched them listen to my words with tears in their eyes and struggled to keep my own opinion and my own bias out of the inflection of my voice. I wanted so badly to say, "I don't know what you are going through or how you feel but here is what I do know, because I see these babies day after day and month after month and I see their parents at their bedside for every setback and procedure and infection and I see the weariness in their faces and the strain on their marriages and I see their children with tubes and lines and tracheostomies and open abdominal wounds and blindness and blown veins and I see how overwhelmed they are at the prospect of taking their developmentally disabled and medically complex child home with a list of specialist appointments to be made and I see. I see. And I know you can't possibly know what to expect based on these statistics that i've given you. I know and i'm so sorry."

The truth is that I read them the book when what they really needed was to hear the story. The truth is that I don't want them to make their decision based on what I tell them. The truth is that I felt that my hands were tied and I don't have the experience or courage to tell them what I really want them to know. I just pray they make a decision that brings them peace over the coming dark months. Regardless of the outcome.

What I Believe Today

2010-01-17T11:42:00.001-06:00

This is what I am loving today. Take it and use it however you see fit.

"Do not let your fire go out, spark by irreplaceable spark, in the hopeless swamps of the approximate, the not-quite, the not-yet, the not-at-all. Do not let the hero in your soul perish in lonely frustration for the life you deserved, but have never been able to reach. Check your road and the nature of your battle. The world you desired can be won. It exists, it is real, it is possible, it is yours."

ayn rand

Be. Look. Love.

2010-01-09T21:03:00.005-06:00

Happy New Year! My first post of the new year and I have to tell you I am already so excited about what 2010 will bring. For starters, there seems to be love in the air. Do you notice that when things are happening to the people around you you are forced to hold a mirror up to your own life, whether you like it or not? It's been happening to me. My best friend recently met a man about whom she is completely crazy. I've never heard her gush about anyone like she gushed about this guy. I've told her so many times that she deserves the best and I'm not sure she ever really believed me. I hope someday soon I can tell her "I told you so." My college roommate, like a sister to me, recently visited me here in Chicago and brought her new boyfriend along. Second verse, same as the first. They seem so happy together and in love. I left them feeling at peace that she had found someone who finally would see her as the special person she is. And then some. I had dinner last night with a good friend who, after three years of dating, is still amazed at what a fabulous person her boyfriend is and feels blessed to have him in her life. Precious!

A few years ago, I would have held up a mirror to my life and felt....lacking. I had done it over and over again as a naturally competitive person and as my toughest critic and own worst enemy. And now? Now I look at the love of my life and feel an overwhelming sense of gratitude that we found each other. I no longer wish to be anywhere or anyone but here and who I am. So as we feel our way into this new year, I am comforted knowing that my life and the lives of my dearest friends are pretty dang rosy. I can't ask for much more than that.

Note to Self

2009-12-30T23:38:00.003-06:00

Dear Future Self,

A year ago, you were sitting at a computer wondering where 2009 went and what 2010 would bring. You were worrying yourself sick about making perfect and absolutely correct decisions. You were changing your mind on a daily basis. And you were driving your poor husband crazy. You're lucky he stuck around! Don't you feel silly now Future Self? Looking back on all that worry...it didn't change a thing did it?

You found a job you really love. And guess what? You're good at it too. When it came down to it, the job found you. All the agonizing about where to live and whether to move closer to family or be in a city you love came down to following your heart. So simple.

Those goals you had for yourself? You know the ones...finish a triathlon, practice speaking spanish, conquer your fear of making bread from scratch, learn how to knit. Well, you reached them all. Not so bad for a year! So stop being so hard on yourself and just appreciate the little victories because they add up to something pretty special.

Future Self, you may not believe me but there will come a time when life is crazy and you and your husband can't hear each other over the noise of screaming kids and you are feeling burned out by the practice of medicine and you no longer have the time to bake bread from scratch. And you will long for these days.

So, a bit of advice from 2009 me to 2010 you. Learn from this year. This wonderful amazing year. It has gone by so fast. Let go of the angst and enjoy the ride. The memories you've created will get you through those crazy years ahead. Promise.

Love,
Present Self

And To All A Good Bite

2009-12-17T22:14:00.004-06:00

I've admitted before that I have this fetish...I love to read recipes. I love to cook too, but not as much as I like to read about cooking. I love imagining spring-green blanched vegetables, a creamy roux, a rich gratin, and a perfectly golden seared scallop. In a cookbook, every recipe comes out perfectly. Every tablescape is delightfully understated yet classic. Everybody cooks seasonally and organically and uses the term 'farm-to-table' as if we were raised with fatty ducks waddling around our backyards waiting for the chance to become a smooth foie gras. Life is orderly and measured and you know that if you put in A and B you get C in the end.

Recently, waiting in the airport for my plane to take me to my next job interview, I settled in and pulled out my New Yorker magazine. Reading The New Yorker is a special indulgence I allow myself when I fly. I always buy one at the airport magazine stand and allow myself a few hours of reaping the reward of other's intelligence. Anyway, I read a passage that stuck with me and i'll share it with you.

When you start to cook, as when you begin to live, you think that the point is to improve the technique until you end up with something perfect, and that the reason you haven't been able to break the cycle of desire and disillusion is that you haven't yet mastered the rules. Then you grow up, and you learn that that's the game.

I'll be honest, when I read this passage I can't explain to you exactly what it means, but I love to take it apart and examine it. And it kept coming back to me as I struggled once again with trying to portray my 'perfect' self and find the 'perfect' job. What exactly is the right formula? What combination of factors will make a job that will be 'perfect' for me and I for it? Where is that ideal city where both my husband and I will find fulfilling careers and ample social opportunities while nurturing our spirit of adventure? Or am I missing the point entirely?

Soul Food

2009-12-09T22:21:00.007-06:00

Ok, i'll be straight with you. I've been circumventing a truth because I don't know how to explain said truth without sounding like a caricature of myself. But, i'm getting a head start on my New Year's Resolutions (how's that for overachieving?) and i've decided to come clean. Here goes...I came to Chicago to do a fellowship in pediatric infectious diseases. I knew after the 2nd month that it was not the right thing for me. Whether "it" meant the field or the people or the hospital or the program, I don't know, but I suspect "it" encompassed all of them. Do you know how long it took me to call it quits? Two years. Two long years. I spent 22 months after realizing that I was nowhere near where I wanted to be, trying to prove that everyone else was right and I was wrong. It's been a year and a half since I turned in my badge and pager and I've explained my reason for leaving countless times. Every job interview, every new resident I work with, friends, family, they all want to know the road I traveled to get where I am now. My answer is as familiar to me as my bathrobe and no less honest than the vegetables I buy at the farmer's market. But here's another truth. It has taken all of that year and a half for me to make peace with my road. I am a perfectionist and a pleaser and a planner and nowhere on my list of life goals is quitting a fellowship. I don't recommend it.

So what does this have to do with New Year's Resolutions? Well i'm working on something. And that something is authenticity. Authenticity is defined as not false or copied, genuine, real. Isn't that a lovely concept? Paying attention to how something or someone makes you feel, and then honoring that by allowing it/them into your life (or not) is a way to live authentically. I am evaluating my relationships, the foods I eat and the habits I hold onto and holding them up to the standard of whether or not they truly satisfy my soul. In fellowship, it took 2 years for my head to realize what took my heart 2 months. I read somewhere that time is not given, it is taken. I don't have anymore time to give. My hope is that if I take time to do this, really do this, come New Year's I will be well on my way to being a happier more peaceful me.

Holler for a Dollar

2009-11-30T15:07:00.005-06:00

Did I tell you i'm looking for a new job? No? Well, I am. Don't worry, it's all on the up and up. My current employer knows already. Let's just say that when your heart tells you enough is enough, time to move on, you better listen. Good advice for jobs and relationships. Not to mention for chocolate glazed doughnuts from Dinkel's Bakery in Chicago. But I digress.

I'm sure everyone remembers the pain of their last job interview. Maybe it was for your first job, or your first 'real' job, or fellowship or residency. Either way you cut it...painful. Walking around in your interview suit and heels with a confident smile pasted across your face all the while thinking...when is it appropriate to ask to go to the bathroom to check my hair, teeth, and awkward stiff collar? Not to mention the feeling of being sick of yourself. Yes, i've plunged myself into this world again. All in the hopes that I will find a job that satisfies me intellectually and emotionally and sates my need for personal challenge. In a warmer climate.

Here's how I would like a job interview to go:
Them: We've already looked at your CV and cover letter and loved it. Now we just need to know who you really are and what makes you tick.

Me: Oh ok. Well, i'm really good at spelling. I was one of the finalists in my elementary school spelling bee but I lost on the word 'bizarre'. Not because I didn't know how to spell it, but I failed to ask for the definition and spelled the word 'bazaar' instead. I'm still beating myself up about that one. I have a picture of myself with Steve Kerr, you know the Chicago Bulls star from the championship era? Only I was in sixth grade and looked like a boy so I am ashamed to display it publicly. I had some serious fashion issues back then. Haunts me still. When I hear the sound of silverware clanging together I want to suck my teeth out of their sockets. I find it hard to believe that I am the only one who feels this way. Speaking of teeth, I am looking for the perfect time to use the word 'toothsome' in a sentence. That word has been banging against my lips for days, begging to be let out. Well, that's about it in a nutshell.

Them: Fabulous! We think you're perfect for the job. We'll be sending a contract your way. Welcome aboard!

I'll keep you posted on my ongoing job search. And if I do have an interview like this? Oh yes, you'll be the first to know.

I'm Watching You December...

2009-11-17T23:25:00.005-06:00

December is a mere 2 weeks away. How can that be?! It seems like just a few weeks ago I was telling you about all my summer discoveries. I'd like to bury my head under my pillows and wake up when it's spring again. Of course, here in the windy city, that might not happen until June. How did you sneak up on me December? Did you push November into the slot normally reserved for October? Because I have to say, I don't remember October having much of a presence this year. Hmmm, I am giving you the stink-eye December. Don't think I don't remember how you tried to imitate February last year with all your snow and freezing rain. Even shoving your holiday cheer in my face won't make me forget wrapping my living room in saran wrap just so I could sit on my couch and STILL freeze. Damn you.

When I introduced myself (and this blog) to you I mentioned that I was from Arizona. The first question I get, after a look of amazement, is "Why did you move here??". I have answered this question so many times over the last few years that I feel I have it down to easily digested little nuggets. Here are the highlights (expounding to be done at a later date):

I moved here because someone I respected and trusted said it was a good place for me to be.
I moved here to explore a passion.
I moved here because I thought I would fit in and be successful anywhere, no matter how far from my family and friends and familiarity I traveled.
I moved here to discover that things don't work out just because you want them to. Really badly.
I moved here to remind myself that I make mistakes, I am far from perfect and that is ok.
I moved here to experience the dissolution of a dream and an identity and to create new ones, however different and unfamiliar they may appear to me still.
I moved here to rely on the company of myself and my dog when things got lonely, and learn to be ok with that.
I moved here to discover what I really want to be when I grow up.
I moved here to eventually take a job that would push the limits of my confidence and hold a mirror to the ethical principles in which I truly believe, as unpopular as they may be.
I moved here to meet my husband and his dog.
I moved here to grow and struggle and be lonely and make friends and be a pediatrician.

Now you know.

A Loss Rich With Things Gained

2009-11-11T20:59:00.006-06:00

Some things are only noticed in their absence. The hum of a fan when you are falling asleep. The tension in your shoulders after a deep massage. The leaves on the trees after they have all fallen to the ground.

I did not notice the anger and tension I carried with me everytime I walked into a particular room in the NICU. The infant in the bed in the far left corner, through no fault of her own, inspired in me a jaw-tightening, face-flushing frustration of a strength I am ashamed to admit. And I only realize that strength now that she is dead.

She was delivered at 24 weeks gestation and had the usual early lung disease and inflammation with which the extremely premature infant struggles. Her parents wanted us to 'do everything' and we abided by their wishes. We did everything medically at our disposal and pulled out all the stops until we were sure she was going to survive. There is a difference among living, existing, and surviving. Surviving is a physician's goal for their patient, especially if their patient is at the beginning of their life. Living is what a parent wants for their child; to hear them laugh, to see them smile, to watch them observe and learn from the world. My friend in the far left corner was doing neither. For 8 long months, she struggled to pull air into her lungs that were for all intents and purposes, the consistency of leather. During this time, a tracheostomy was placed so that the breathing tube would not wear through the roof of her mouth and she would be able to suck on a pacifier when she was upset. She never sat up. She never cooed and babbled. She never rolled over. Her lungs were so badly damaged that everytime she got agitated she would become hypoxic and her heart rate would drop dangerously. Because of this, we gave her ever increasing doses of sedation and pain medicine. Towards the end, we could barely let her wake up at all for fear of losing grip on her tenuous oxygen saturations. She was merely existing. And yet we kept going.

After watching a baby struggle so hard to live, it hurt me to watch her struggle so hard to die. I realize now that my anger came from walking into that room and feeling like I was playing on the wrong side of the field, fighting for a cause in which I didn't believe. I don't make the big decisions here. I'm not sure that I could. I make critical acute care decisions so these infants will survive until morning. I looked at her night after night and silently told her that I was sorry, so sorry for doing this to her.

A week ago I walked into that room and reflexively glanced at the far left corner. She was gone. I felt the weight lift from my shoulders and the breath that I had been holding let go. There was a lightness in the room that hadn't been there before. What was left behind, for me, was that her struggle was not in vain. She won after all. I choose to believe that she is at peace. Finally.

A "Novel" Landscape

2009-11-08T19:25:00.004-06:00

Is anyone else sick of hearing about the flu? I mean, i'm safely sequestered from the masses up here in the NICU, which typically shows no bias for any season, and I can't tell you how many times I have been asked about the novel H1N1 flu. I walked into work the other day and the charge nurse practically tripped over her own feet trying to aim a loaded needle at my deltoid with one hand and waving a consent form in the other. To be completed simultaneously no doubt. I felt like I needed to hold up my armored shield. Renaissance-style.

The visitation policy here has become severely restricted since the epidemic hit (just in October here in the suburbs of Chicago). Only the parents of the infants here can visit....no siblings, no grandparents, no aunts and uncles. Regardless of whether they have been ill or had contact with anyone with flu-like symptoms. For some, this sounds like no big deal. Common sense even. But, for the woman I spoke to earlier this evening, whose 30 week twins are threatening to arrive any moment now, it was a crushing blow that her mother, who traveled all the way from Israel to be here for the preterm birth, cannot see these babies in person for the foreseeable future.

Are we overreacting? Are we responding to mass hysteria surrounding the H1N1 flu? Is the pandemic really severe enough to warrant fast-tracking a vaccine through limited testing to be produced in limited supply? Will the worst of the wave be over before those 'priority groups' even have access to the vaccine? Yes, I get my flu shot every year like a good health care worker. My response to those who say "I've never gotten the flu so I don't get a flu shot" is this...Do you not wear a seat belt just because you've never been in an accident? And yes, I did get my H1N1 flu shot this year as well (the nurses were coming at me with needles like darts at a dart board!). I am not a conscientious objector. But I do wonder...

Going Back to Cali. Cali. Cali.

2009-10-30T23:05:00.005-05:00

I just returned from a fabulous trip to Washington DC where I had the pleasure of attending the AAP National Conference and Exhibition. The fact that I was able to hang out with my closest friend from residency and see some colleagues I had lost touch with made it even better. The conference is an enormous conglomeration of pediatricians combining learning, networking, reconnecting, and socializing (with the aid of a drink or two) and it all runs like clockwork. At least it appears that way to my untrained eye! There is a welcome reception on the first night and I can only compare it to a wedding reception complete with a band, buffet, open bar and embarrassing numbers of uncoordinated doctors dancing. The next day is kicked off with talks beginning at 7am. No, I didn't go to any of those. There is a limit to my passion for learning... The next night the conference attendees were able to take over the Smithsonian American History museum and left to wander for 3 hours. An amazing opportunity to see the museum without hordes of tourists. So fun! And do you want to know my favorite part? Julia Child's kitchen. Oh I drooled over her pots and pans and the counter space! Holy heck! The Young Physician's reception the following night was another opportunity for free food and drinks and connecting with residency classmates from around the country. All in all a great time for everyone...except maybe the circumcision protesters hanging around outside for 4 days. They looked a little lonely. And cold.

Can I let you in on a little secret? I'm charged with planning the Young Physician Section programming for next year's conference. The topic is advocacy and so far i'm really pleased with our potential speakers. This is timely in the wake of health care reform and the legislative battles being waged. Don't you wish you knew more about how to get your voice heard? Or how to get the people around you excited enough to want their voice heard? It's hot. It's fresh. It's delivered right to your door and all you have to do is meet me in San Francisco next October. And don't forget to wear flowers in your hair. Or something to that effect.

Guilt is a 4 Letter Word

2009-10-11T14:46:00.003-05:00

The strangest thing happened to me this week. I woke up one morning and literally could not move my neck to the right side without a searing pain shooting up into the back of my head. Sort of like someone surprising you by yanking on your hair as hard as they can. Or greeting you by whacking the back of your head with a baseball bat. Yep, some morning. Of course I cursed myself and my pillow for lack of a better etiology of said immobility and proceeded to take ibuprofen and get on with my day. I taught my PBL class as usual and the plan was to meet my husband for lunch and then head home to rest (and take more ibuprofen) before heading into work for the night. I got through class alright but while eating lunch discovered I could not lift my fork to my mouth without a spasm of pain. In fact, I couldn't use my right arm much at all without being reduced to a cringing mass of tears and yelping. I judiciously checked my self for nuchal rigidity and fevers. Nope, no meningitis or novel H1N1. Just a good old fashioned...neck pain? My dear husband put pathetic me into a cab for the ride home, sparing me the embarrassment of wailing on the bus. Once I got home I had a dilemma. If I couldn't use my right arm and neck pain was getting worse (I was just waiting for the fever, rash, and photophobia so that I could run across the street to the ER and cause a public health panic), could I really perform procedures and resuscitations and stay up all night while giving my job the focus it requires? Well, no. But does that mean I should stay home? I literally sat at my kitchen table (with a heat pack around my neck) for 30 minutes pondering this reality. I came to the conclusion that I couldn't do it. At that point I couldn't even undress myself. And I was scared. What the heck was going on?! So I called my boss and told him I couldn't work my shift that night and explained why. He completely understood and told me to let them know how I was feeling the next day. And do you know what I felt when I got off the phone? In equal amounts to the physical pain I was feeling (plenty, I'm no baby) I felt...guilt. Guilt because I was a physician who couldn't repair myself well enough to fulfill my obligations. Guilt because my boss was so generous even though he would have to scramble and find someone to cover for me in the next 3 hours. Guilt because that meant someone would have to spend the night unexpectedly in the hospital after a full day of work. Guilt because that someone would likely have to apologize to their families for not being able to come home because "someone called in sick". And it didn't end there. Back at work last night, everyone was gracious enough to ask how I was feeling and tell me that if I needed more time (I didn't) they would have covered more of my shifts. The attending who covered for me that night has a 3 month old breastfeeding baby at home AND was up all night performing an exchange tranfusion on an infant. Oy! If my thighs were as well toned as my guilt muscle I would be strutting on the beach til December.

I started to think about this. Why on earth did I feel so guilty about something over which I had little to no control?! I know plenty of people who will call in sick when they have the sniffles or a headache or just need to take a 'mental health day'. Some of you may identify with the feeling that as a physician, we are supposed to perform our duties unless we are patients in the hospital ourselves. Physicians who come to work come hell or high water are revered as being 'committed doctors'. I know a critical care attending who spent so much time in the hospital his wife would have to beg him to come home to spend time with the family. He was exalted as a model to which we should strive. But really? Does that make one a better physician? The novel H1N1 protocol for healthcare workers at our hospital states that anyone with a fever and influenza-like symptoms must stay home for 7 days from the last day of fever. Anyone. The nurses take this very seriously. The doctors? I bet you dollars to doughnuts they are laughing and wondering how they can evade the infection control officers. Unfortunately, I'm afraid in this culture taking an unscheduled week off work is tantamount to handing in your 'good doctor badge' and who really wants to deal with the guilt when there is work to be done?

Need A Netflix Fix?

2009-09-29T22:34:00.004-05:00

Whoa! So sorry it's been this long since I last blogged. My excuse is that I was out of town (hiking in Boulder, CO! Awesome!) and then came home with a brewing cold (damn those dirty airports!) and then, well...I had writer's block. I tried and tried to think of something thought-provoking, timely, pertinent, or witty and came up empty again and again. As I was complaining about my scarcity of creative juices to my husband, he flippantly said "Why don't you write about your favorite movie?". And I thought, perfect. The movie I have in mind is both pertinent and thought-provoking and somewhat timely as it came out in 2008. This film is a take your breath away, punch in the gut, nauseating emotional roller coaster and I highly recommend it. I dragged my husband to see it on an icy weeknight last spring and I still don't think he's completely forgiven me.

The film is a documentary called Dear Zachary: A Letter to a Son About His Father. The brief premise (no spoilers here) is that the filmmaker's best friend, a Family Practice resident in Pennsylvania, is brutally murdered by his ex-girlfriend. This ex-girlfriend reveals after the murder that she is pregnant with his child, Zachary. The filmmaker knows that Zachary will never know his father so he sets out to make a documentary about his life by interviewing everyone who ever knew him. Meanwhile the murder investigation is still going on...If you can resist, don't read anything else about the movie before you see it. It is most powerful if you go in not knowing what to expect. You might sob uncontrollably. But it is so worth it.

Old Habits Die Hard

2009-09-20T21:37:00.004-05:00

Have I mentioned yet that I love Fall? I love the weather, the leaves, the back-to-school sales, the food. Not to mention that my 1st wedding anniversary is coming up this fall. One thing I haven't gotten used to since making my move from Arizona to Illinois is the change in my outdoor activities. See, in Arizona people take the summers off from outdoor sports due in part to the very real risk of death from heat exhaustion. Third degree burns from a seat belt is not an unheard of occurrence. You've heard that people in AZ can bake cookies on the hood of their car in summer right? Anyway, I would cut back on my running and resign myself to exercising in the gym. My friend Barry always laughed at me when I heralded the "start of the running season" come mid-September. Right about now in fact, when it is cool enough to run outdoors at 6am and not die. I practically bounded down our running path because I missed it so much over the summer.

The opposite phenomenon occurs here in Chicago. People come out in the summer in droves. Most major races are in the fall assuming a summer well spent outdoors training. See, I just can't get my head around that. I do my best running Oct-April. Old habits die hard. So what did I do this summer during my running hiatus? Bikram yoga. If you are unfamiliar with this particular form of torture, errr, exercise, let me enlighten you (so to speak). Picture a large room heated to 105 degrees and 40% humidity, lots of scantily clad people dripping sweat while folding their bodies into vertebrae-curling, tendon stretching, muscle-quivering positions and holding them. For an hour and a half. Hmmm, well I do enjoy a challenge. My goal was to do this class everyday for a month. That lasted about 2 weeks. What they don't tell you is that along with the enlightenment, serenity and peace you feel comes a boatload of laundry. A towel to lay on your mat, a towel to wipe your face, a towel to dry off after class (because the other ones are soaked), a change of clothes (because who wants to ride the bus soaking wet? I don't and neither does the person sitting next to me), then another change of clothes because the clothes you rode home in have become soaked because you can't stop SWEATING. See what I mean? I actually liked Bikram yoga and plan on trying it again someday when I don't have to ride the bus home (I have my limits). But what I really got out of taking that class, what I earned was a new appreciation for running. I missed it so much, just like the old days back in Arizona. Now when I head out to the park for a run in the chill evening air I feel that old giddiness. Welcome to the start of my running season. Bring it on.

Remember When?

2009-09-14T22:40:00.005-05:00

There are moments in which I am reminded of the passage of time, and the increasing speed with which this occurs as I get older. Remember when the world seemed pretty much the same to you when you were age 10 as when you were 9? And then when you were 12? Sure your body and your friends may have been different, but the world was essentially the same. The same actors were hot. The same bands were cool. The same man was President. This summer, I realized the world was essentially different. This began with the death of Michael Jackson. So much of my childhood involved idolizing him. My younger brother used to 'dance' like Michael for the rest of my family in our living room and he always thought we were laughing because he was so good at dancing. But reality was he was just so damn funny trying to be MJ. Patrick Swayze died today. One summer, my sister and I made it a point to watch Dirty Dancing everyday. I'm not sure why, it was just something we had to do. Chevy Chase is playing a part in a new TV show premiering this Fall. Again, the Vacation and Fletch movies have singlehandedly allowed my brother and sister and I to have conversations composed entirely of movie quotes. Now Chevy looks like a puffy, squinty-eyed, snow-haired version of himself. Barely. But in a good way.

When those figures who defined your youth are gone, is your youth gone too? And if it is, did you send it off with fantastic fanfare? Or did you let it trickle away like the bathwater through a hair clogged drain? Call a friend or a brother or a sister. Play the 'remember when' game. If for nothing else than to celebrate that while the world is changing, the best things remain the same.

Winds of Change

2009-09-08T15:33:00.006-05:00

At what point does one go from being "with it" to being "old school"? I guess I should know the answer to this question because clearly I passed it a few years back. Let me paint the latest scenario for you...I taught my first Problem Based Learning (PBL) session today for second year medical students. What a fun experience! It was so refreshing to be among students who really get excited to use such terms as tachycardia and hypotension and who volley back and forth the merits of exotoxin vs endotoxin in the production of fever with as much fervor as a Wimbledon match. I sat back in my chair beaming like a proud grandparent much of the session. But the fact that I am a good ten years older than all of them doesn't bother me, I hardly notice. No, here's what did it. We had a tutor kick off meeting before the actual sessions began. The PBL coordinator started talking about different technological resources to utilize in order to enhance our interactions with the students. Then, out of her mouth came the words Twitter, mesh terms, portal, and RSS feeds. I know about half of you reading this blog are thinking "Yeah, so what?" and the other half will understand when I say I began to feel like I had missed that lecture and there was now going to be a quiz.

I know what Twitter is. Scratch that, I've heard of Twitter but never actually used it. I find it vaguely uncomfortable to say things like twitter and tweet and take myself seriously. Thus, I have found a way to exist happily without it. And that's not all. I only recently created a Facebook page after increasing levels of peer pressure. Mostly I look at other people's pictures. I did not have a Palm Pilot in medical school or residency. I do not have a Blackberry, iPhone, iTouch, and only use my iPod on shuffle when I run. I prefer books and paper to screens and stylets. My white coat pockets were always stuffed with reference books and notes and never once did I fall victim to a dead battery when I needed information. My cell phone does not have a camera, a keyboard, internet access or the ability to make playlists. In fact, it was free with my phone plan and was once lost by Wrigley Field and returned to me the next day by someone who tracked me down. The thing is the size of a stick of butter and indestructible.

I used to snicker at my parents and grandparents for being so overwhelmed at the thought of using the internet or paying bills online or downloading pictures from a digital camera. And now I am that person who is frightened by this 'new fangled' technology. When did this happen?! Apparently, if I want to continue down this road to being a clinician-educator, I need to open my mind to the wonders of modern communication. Ok, i'll embrace change if it makes me a better physician. But don't expect me to tweet. That's where I draw the line.

Love Is A Battlefield

2009-08-31T21:55:00.006-05:00

A recent New York Times article shed light on the phenomenon of post traumatic stress disorder, or PTSD. What made the topic unique was that it referred to a study from Stanford that looked at the incidence of PTSD, usually seen in survivors of war, rape, extreme physical trauma, etc, in parents of infants who were hospitalized in the NICU. Their symptoms, after leaving the NICU with babies in tow, included avoidance, hyperarousal and flashbacks or nightmares. One woman in the article is quoted as saying "The NICU was very much like a war zone, with the alarms, the noises, and death and sickness." Geez. That's harsh.

I've been thinking about this war zone analogy. Where do we as physicians fit in? I suppose we'd be like the generals, leading the weary soldiers through the battlefield, making strategic moves and countermoves, reconnoitering, losing some battles along the way but not for lack of a valiant effort. Are we then, the ones responsible for leading these parents into battle in the first place? I've written before about my struggle with knowing how much is enough or more than enough. In the NICU, this is an ethical dilemma played out on an almost weekly basis. Infants who are clearly not ripe for this world nevertheless are 'incubated' in our artificially created environment until their lungs can breathe air, their skin can protect vital organs, and they can process life sustaining nutrition.

Most level 3 NICUs will resuscitate infants down to 23 weeks gestation. In the case that delivery is inevitable, we are often asked to speak to the parents and give them outcome statistics and discuss their 'options', one of which is to only provide comfort care and not proceed with aggressive resuscitation. We ask them to make a decision, to tell us what to do. I can't imagine how unbelievably agonizing this choice of theirs must be. Or maybe it is an easy one, because how could a parent not want everything done in the hopes that their child will fall on the rare side of the statistical teeter-totter? But, we have an n = hundreds and they have an n = 0. The soldiers bravely follow the generals into battle, with limited understanding and information but with the desire to continue fighting for what they believe in.

We are so focused on caring for these infants that we often neglect the emotional trauma the parents are going through on a daily basis. And what about when the baby is ready to go home? Amid the joy and relief at finally being able to have their infant home comes the realization that they now have to care for an infant on various medications, juggle multiple specialist appointments, become proficient at tracheostomy care and be hypervigilant for any respiratory illness that might compromise their tenuous breathing. If they are lucky, they have the support of a partner and family close by. But not always. Thankfully, there is an online support community at shareyourstory.org through the March of Dimes. Check it out.

The Virtue of Regimentation

2009-08-21T12:25:00.005-05:00

The other night at work, a very astute nurse came to me with what appeared to be a medication error. The dosing seemed strange so the resident and I sought to find the reason for the anomalous dosing. Here's what we found: When the patient was initially admitted to the general peds floor for respiratory distress, the dose of this home medication was ordered as 3mg. Now, looking through the patient's discharge summary from his previous stay in the NICU, it appears that he was sent home on 0.3mg which was the recommended dose for his weight. For reasons completely unrelated to this medication, this patient's condition worsened so that he was transferred back to the NICU (he is a former premie, hence his previous stay with us) after 3 days and when this medication mishap was discovered, had been in our unit for another 3 days. In other words, he had been given this 10 fold dose of medication for a week while in the hospital.

It is tempting to look at the original admission order writer and place blame there. But, that is an oversimplification of the checks and balances that are supposed to be in place in hospitals to prevent medical errors. The collective "we" failed this patient on many levels. This dose got by the doctors, the nurses, the pharmacists, the computer ordering system on a daily basis. For a week. Why did this particular nurse decide to check the dose before giving the medication that night? Was she just being diligent? Was she following a protocol that says that nurses need to review medication doses periodically? I have no idea. But I do know this. Mistakes happen, we are human after all. Therein lies our responsibility as the deliverers of healthcare to police ourselves. Yes, its nice to expound on the 'art of medicine' and to delegate our brains as the keeper of all minutiae pertinent to our respective fields and maybe even deem ourselves a bit above 'following the protocol'. But is that best for our patients?

Atul Gawande, a physician writer and a man I credit for opening my mind to so many things in medicine, wrote a fascinating article about the value of checklists in the ICU and the resistance to implementing such a simple change. Checklists, he postulates, are a way to assist memory recall for mundane matters that are easily overlooked in patients undergoing more drastic events. In our patient, his home medication had nothing to do with his breathing issues and his subsequent transfer to the ICU. But, it was an error nonetheless. There are multiple checkpoints in place to catch these errors before they ever reach our patients. But, checkpoints and checklists are only as good as those enforcing them. Kudos to the nurse who that night, considered diligence a worthy endeavor.

You Say Hotcakes, I Say Heaven

2009-08-16T19:25:00.006-05:00

One of my fondest memories of my childhood involves pancakes. My mom used to make me pancakes as a special treat in the morning before school. Mmmm, I have clear visions of their thin pale yellow buttery goodness. All she had to say to get me out of bed was "Do you want pancakes?". Occasionally, she would go so far as to put chocolate chips in them. How many kids get to have homemade chocolate chip pancakes before heading off to school in the morning?! Not many I bet. I'm a lucky girl.

You can imagine my disappointment when I learned that my husband hates pancakes. With a passion that I cannot fathom. So, pancakes aren't a welcome guest in our house as often as I would like. BUT, my grand plan is that our children will love pancakes. And then he'll be outnumbered won't he? I imagine weekends filled with the smell of homemade (with real buttermilk) pancakes. Blueberry, banana, whole wheat, peanut butter, oatmeal, chocolate chip...yes, all kinds of pancakes smothered in real butter.

Did you know that kids can develop a taste for things that their mom ate during pregnancy? Yeah, now you see how my plan will unfold right? Check out this great article in the Miami Herald about raising "foodie" children. What was I doing reading the Miami Herald you say? I say, why not?!
http://www.miamiherald.com/living/story/1182212.html

Lonely Sandwich Hater Seeks Same

2009-08-12T09:06:00.004-05:00

So I have this thing. You know how everyone has at least one food that they really really hate? I mean can't even stand the smell of? Mine is peanut butter and jelly sandwiches. Hate em. Can't force myself to eat one. Get nauseated at the smell of them. I can't even stand when my husband gets a bit of peanut butter in the jelly jar. As far as I know, I am completely alone in this hatred of mine. PB&J might as well be the American flag, I feel so unpatriotic hating it. Others hate things like brussel sprouts, mushrooms, stinky cheese, asparagus. But those people can usually find a handful of others just like them without trying too hard. Heck even cilantro haters have their own website! I'm lonely. So i'm putting it out there...are there any other PB&J haters?

Let me take you one step further into my psyche. I've been thinking a lot about professional isolation. What causes it? What does it feel like? How do we prevent it? Here's where I'm coming from...I work in a NICU, at night, as the only physician in house. As a matter of fact, I am the only non-neonatologist or neonatologist-in-training on the medical staff in my division. Yep, the lone general pediatrician. I see my professional colleagues briefly at the beginning of my shift for sign out and at the end of my shift for the same. Occasionally, I am lucky enough to be on with a resident. Professional isolation does not only refer to geographical isolation, although this is the easiest to define and understand. I am not in a rural practice. I am not a senior physician who has loads of personal experience to draw from and an aversion to technology. I do not have a narcissistic personality disorder or practice some obscure form of alternative medicine. These are all risk factors for feeling professionally isolated. Yet that's how I feel. I miss working side by side with other pediatricians more than I can express. My colleagues in the past challenged me, made me laugh, bored me to tears, ruffled my feathers, pushed me beyond my comfort zone, and competed with me in a way that made me a better physician, a better teacher and a better learner. Willian Osler wrote in 1897, "The medical society is the best corrective, and a man misses a good part of his education who does not get knocked about a bit by his colleagues in discussions and criticisms."

Fairly recently removed from residency, I did not consider isolation when accepting this position. Would I have done anything differently? Probably not, considering all that I have gained from doing what I do. But, I would caution a young physician from isolating themselves from their professional colleagues and mentors. The learning curve is still so steep that it would be a shame to not have senior brains from which to pick. I look forward to the day when I can jump back into the mix and "get knocked about a bit".

In the meantime, here's how I cope. I am an active member of the AAP both nationally and locally and hold a position with the Section on Young Physicians. I try to attend 1-2 conferences or professional meetings a year. I am on the Section on Hospital Medicine listserv. I volunteer to teach medical students Problem Based Learning. I remind myself that this experience has forced me to trust my judgement and function independently and confidently while practicing within my limits. And I write this blog. So thanks for listening (reading!).

Food for Thought

2009-08-05T21:14:00.009-05:00

As I've said before, I love food. Everything about food. I watch the Food Network while I'm at the gym. I read Food and Wine magazine. I have a cadre of recipe websites that I check daily. I shop at farmer's markets and purposely buy something random and then try to find a way to use it in a recipe. I test said recipes on my poor unsuspecting husband. For example, over the weekend I decided to make my husband a vegan chocolate avocado cake with avocado buttercream frosting. My husband is neither a) vegan or b) a fan of cake or avocados. But, it seemed like a great idea at the time. The result resembled 2 soil-colored discs with a sinkhole in the middle covered with a gelatinous supernaturally green ooze. Picture asphalt covered in the "ectoplasmic residue" made famous by the movie Ghostbusters. Go ahead, i'll wait. Got it? My dear husband gamely ate a slice and then said "Well, I think I'm put off food for the next couple of days." Eh, you win some you lose some.

Because of this divine appreciation for all things edible, it becomes necessary for me to remain physically active virtually everyday. Lucky for me, I like exercise. BUT, as I get older my metabolism tends to go on holiday more and more often (I fear the day it retires) and this combined with the looonnng Chicago winters finds me digging at the bottom of my motivation well more often than I care to admit. So, in a moment of wisdom I bought a treadmill! I want to name him, because I have a feeling he and I are going to become good friends, but I haven't thought of anything suitable yet. My theory was that if the opportunity and means to exercise was sitting right in my apartment, how could I ever resist? Because it was available to me, I would use it more. Right?

Ok, I admit it. I trapped you a little bit. Did you think this blog post was just going to be about me and my treadmill and avocado cake?! The reasoning I used above can actually be extrapolated to demonstrate a theory called "moral hazard". Moral hazard, in the context of healthcare, is an idea that economists put forth to postulate that health insurance can change the behavior of the person being insured. I liken this to an all-you-can-eat buffet. Have you ever seen the waste that goes on in those places?! Just because we can? In other words, if universal health insurance were provided, the citizens of the US would just use healthcare willy-nilly. Thus, the "lack of enthusiasm" some display for universal healthcare. To look at it another way, those who are un- or under-insured are actually efficient users of healthcare. Make sense? No, I don't think so either. This presumes that people will treat healthcare like they treat a buffet. And have you ever known anyone who would rather check themselves into the hospital for a host of painful and invasive tests than go to the beach? Or wait in the waiting room of an ER instead of watching a movie on the couch with popcorn? Just because it's available? Me either. Here's a link to an article that describes this myth much better than I.
http://www.newyorker.com/archive/2005/08/29/050829fa_fact

Food for thought. Food for thought.

On Dreams and Discoveries

2009-07-31T20:12:00.006-05:00

I have this recurring dream. I am in a hurry, on my way to somewhere. I come across an all-you-can-eat dessert buffet. I try a few things and they are so good that I want to taste more. But I don't have time because I have to be somewhere else. I am filled with disappointment and longing. And then I wake up. Hungry. Weird huh?

It's amazing what you can discover when on your way to somewhere else. Here's a few things I've discovered this summer.

Garlic scapes- These guys look like a cross between a plant and an octopus but are actually the above-ground chlorophyll colored stalk of the garlic bulb that we know and love. They have an amazingly fresh and mild garlicky flavor and you can use them as you would garlic. My favorite is to make a pesto sauce out of them (no need for basil!). If you see them at your local farmer's market, grab some. You won't regret it.

Brown butter- Or Buerre Noisette if you're sophisticated in a way that I most definitely am not. This is actually a way of cooking the butter that completely transforms its taste. Heat butter over medium heat in a stainless steel pan. It will melt, the top will turn white, it will start crackling, then the magic happens. It quickly turns a shade of light brown and that is the time to remove it from heat. You've just turned the milk solids in the butter brown and created a wonderfully nutty earthy sauce. I used it in a blueberry muffin recipe and they were like rich cakey dessert muffins. Mmmm, big fan of this ingredient that can wear a sweet OR savory hat!

Rose wine- Ahhh, the perfect summer wine. Not to be confused with "white zin", the sweet gateway wine that marked my entrance into the wine-drinking world but that now I wouldn't drink if I had a choice between that and Nyquil. A rose is a beautiful deceptive pinkish-red color that surprises your palate by tasting dry like a white with a hint of deep red berries like a red. It is served chilled so is great for toting to the beach or drinking on your porch on a hot steamy summer night. I can't believe I've lived this long without it!

Columbus, Ohio- What a gem of a city! I loved the wide streets, the green trees, the cute neighborhoods, the field of cement corn cobs, and Graeter's ice cream. Let me say that again. Graeter's ice cream. I ventured out of Chicago and discovered that the rest of the Midwest might not be so bad. Who knew?!

The Pediatric Hospital Medicine conference- Have you ever felt like a stranger in a strange land? And then discovered a group of people who thought like you, spoke like you, and had the same vision as you? Then you know how I felt at this conference. I came back intellectually stimulated and excited about my career and future all over again.

On a side note, this weekend is my husband's birthday. When we met, my impetus for moving to Chicago had not turned out the way I planned and I was in a rush to head off to somewhere else. I 'discovered' him while I was in the midst of this transition. Now my reason for being here is completely different (and infinitely more satisfying) than what brought me here. But sometimes, if you're lucky, that's what happens. Take a pause and linger at the dessert buffet. You might be glad you did.

Cool Party Tricks for Cool People

2009-07-27T13:50:00.007-05:00

I know, I know, I've been MIA these last couple of weeks. I figured my last overly lengthy post would tide over my faithful readers for a least a good week. I've also been traveling for the past week and have had spotty internet access. That said....I have some good bits of gristle to chew on since coming back and I hope you'll stay tuned!

I visited my good friend in Ohio and we had the chance to catch up on our lives, personal and professional. After a year-long stint as a pediatric hospitalist in an academic center she switched over to the general peds division and did outpatient clinic, adolescent medicine, and staffed the juvenile detention center. In an unfortunate maelstrom of events, the division decided that they could no longer support one physician's salary and since she was the most 'junior' person, she was told that at the end of June her contract would not be renewed. So much for job security! My friend, being the resilient and laid back person that she is, decided to take a 'forced sabbatical' and hang out at her parent's house for awhile to see how the other half lives. Hence my minibreak in Ohio. Let's face it, it's no fun being unemployed by yourself. My friend (let's call her Janet) became my rock during residency and one of the people I credit for keeping me from needlessly clouding my life with regret by acting on completely irrational urges. Everyone needs a friend like that, don't you think?

Anyway, we're similar in so many ways except how we view our entry into the world of medicine. Medicine found me on my way to law school. Really. I remember sitting on the floor of my dorm room and brooding over the course catalog and asking myself "Which of these series of classes feels the most right?" In other words, when I close my eyes and picture myself doing one or the other (law school vs med school), where am I most at peace? It felt like a key sliding into a lock and turning smoothly. The answer was clear and I have never looked back. Hearing the answers from my heart was so much easier back then as my voice of doubt had not yet found its stronghold. Medicine was and always will be the career that I chose for myself. The tenet along which I've aligned my life, for better or worse. Such is not the case for Janet. Her older siblings are both in medicine. When she graduated from undergrad she wanted to join the Peace Corps. Her dad told her to wait. So she went to med school. When she graduated she wanted to join the Peace Corps. Her dad told her to wait. So she went on to residency. After that she did a chief year and then you know the rest. Since I've known her, she's always had a sense of restlessness about her. Contrary to some beliefs, you don't have to love medicine to be a good doctor. She is a great doctor and one who practices diligence at a level I aspire to. But she doesn't love what she does. Over a glass of a really smooth Zinfandel she explained to me how she feels about medicine. She said it's the same as how she feels about playing the piano. It's a great skill to have and to pull out when you need it (like at parties, or on an airplane when someone is seizing) but not something you want to do day after day. Hmmm.

I feel like I understand her better now that she simplified it for me. And that makes me all the more grateful for listening to that feeling I had sitting on the floor in my dorm room. As someone who is quickly approaching a crossroads in her career, I only hope that I can sift through the static and that damn voice of doubt (why is it so loud?!) and find peace again when the time comes to make a decision. As for Janet, I hope that she finds her passion. But I think that for now, she's still waiting for it to find her.

A Day in the Life

2009-07-14T16:03:00.007-05:00

As I've said before, lots of people cock their head at me when I tell them that I'm a neonatal hospitalist. So, instead of trying to explain what I do I thought I would share with you a little slice o' my life. During my last 24 hour shift, I kept a diary of my time at work. Lucky for me (and you) there was no shortage of activity. Here it is...the first installment of A Day in the Life.

830am: Rounds start and our team gathers around computers on wheels. The resident reads off numbers and tells us what happened with each baby during the day and night before. I enter orders into the computer (so convenient!) and the attending writes their note. Everything is electronic which is supposed to make things streamlined but not without some hair pulling and keyboard jabbing. You know, the harder you hit the enter key, the better the system works.

11am: Rounds wrap up and I'm thinking about what I'm going to have for lunch when I get called into a room because a breathing tube has slipped out of a premature baby who in fact, does need that breathing tube to live. These things happen sometimes which is why we have experienced respiratory therapists who never leave the unit. They have a new tube ready for me before I even walk in the room. Breathing tube replaced, crisis averted. Mmm, now for lunch.

1230pm: We get called to the delivery of a 33 weeker whose mom was induced 2 days ago (yikes!) for high blood pressure. The baby comes out stunned and not at all happy to be born. So unhappy in fact, that she refuses to breathe for a good 2 minutes. I know she'll come around eventually so I support her with positive pressure ventilation (oxygen by bag and mask) while the nurse stimulates her and dries her off. She gets the whole breathing thing down and we put her little hat on and show her to mom before we whisk her away in her isolette (a heated incubator). I get her settled and draw her blood which involves a radial arterial puncture. So far everything is going smoothly in NICU-land.

7pm: The afternoon has been filled with a smattering of issues here and there. Most of my attention is focused on a baby with suspected Noonan syndrome. She has a heart defect that causes her oxygen depleted blood to mix with her oxygen rich blood coming from her lungs. She also has RDS (respiratory distress syndrome) due to being a bit premature and kidney issues. She's currently on a high frequency oscillating ventilator so we are checking blood gases every few hours. Her big brother and dad visit and I answer their questions as best as I can. Her brother asks me if he can touch her and I want to give him a big hug and tell him that everything will be fine. But I don't, because I don't think it will.

830pm: We are called to a delivery because the OB is going to use the vacuum to help this woman finally have her baby after 5 hours (oy!) of pushing. The vacuum is attached to the top of the baby's head and the OB pulls and pulls and the woman screams and screams and finally this 10 pound baby is born and is pink and fat and doesn't need us at all. I decide to have an elective c-section when the time comes.

9pm: We get a call from labor and delivery that they are going to take a woman who is 27 weeks pregnant for a c-section because she has a placental abruption and is bleeding. I ask when and they say in the next couple of hours. Thankfully, I know not to trust pregnant women who are bleeding. I rally the troops and get a breathing tube ready, order up surfactant and scan through the mom's chart to see what we are dealing with. Her water broke a week ago and she has been on bedrest since. Uh oh. The longer the mom has been ruptured the higher the stakes for the baby.

920pm: See, a couple of hours turned into 20 minutes. The woman began bleeding more heavily and now they are taking her for emergent c-section. We're ready. The baby is larger than we expected (good!) and tries to take a few breaths on her own. I intubate her on the first try (I must be feelin' it tonight) and the resuscitation goes smoothly thanks in no small part to the team of experienced nurses on with me tonight. We take her up to the unit and prep her for line placement. I insert catheters into one umbilical artery and the umbilical vein. Her first blood gas shows that she's doing well and I don't suspect she'll need the ventilator for very long. The whole process takes a couple of hours but without any issues yet, I think she'll sail through the night.

Midnight: Oh it's my lucky night. The nurses are having a party for the July birthdays and there is a potluck going on in the lounge. A snack is just what I need right now. There's nothing that quite mimics my enthusiasm for potlucks in the middle of the night. Ritz crackers and cheese have never tasted this good.

1am: I'm done with my night rounds and find that the sickest baby needs one of her umbilical lines adjusted a bit. Meh, no problem. I'll do this and then head off to bed. Ha! Famous last words. In the process of mucking around with the line a hole appears and the line starts leaking. Please tell me this is not happening. I ask the nurse what meds are going through that line. She says "everything". You know how people say "you are your own worst enemy"? Well not tonight. I know by the way that nurse looked at me when I told her I somehow poked a hole in that line. I take a deep breath and gather all the supplies I need to replace the line. My plan is to thread a new line right beside the old one so that the vessel doesn't close up when I pull the old line out. Seeing as how I haven't had to do this often, I'm a little nervous. But, what can I do? I have to solve the problem I've created. After an hour and a half of MacGyver-like maneuvers I successfully replace the line and everybody is my friend again. I'm bone tired and sweaty but so relieved I almost skip to my call room to take a well earned nap.

230am: On the way to my call room a nurse stops and tells me the micro lab called and one of the babies has a positive blood culture. Ooohhhh darn. I review the baby's chart to see why the blood culture was drawn in the first place since I knew he had been pretty stable. Turns out he had some apnea the day before and as a precaution the team drew a blood culture and complete blood count. Well, now we know why he had apnea. I ordered antibiotics and did another radial artery puncture to send more blood for testing.

330am: Whew! Everything seems to have quieted down and my eyes are getting scratchy. I notice that my stomach is rumbling again but I have neither the desire nor the energy to go in search of food. We are called to a delivery for meconium. The baby comes out not breathing and covered in poo (for lack of a better description) and I intubate to suck out any that might have dribbled below his vocal cords. Nope, nothing there and the intubation was sufficiently obnoxious to him that he lets out a lusty cry and our services are no longer needed. We clean him off a bit and hand him over.

4am: As I cruise back into the unit a nurse stops me and says that the baby we delivered earlier, the 33 weeker, has a positive blood culture for gram negative rods. I'll be honest, I'm a little deflated at this point and hope that she's joking. She's not. Because this type of bacteria can also cause meningitis in neonates, I have to do a lumbar puncture. Did I mention this baby weighs 1200 grams? No probably not because I didn't expect to have to stick a needle in her back! Now, my tried and true method of LPs in infants involves inserting the needle as slow as you can. And then slower. Doing it this way, I rarely go through the space creating a bloody tap. My favorite NICU attending in residency showed me this and I am forever indebted to him. However, the nurse holding the baby in position is not a huge fan of this method. Sorry, getting spinal fluid trumps your charting. I'm feeling a bit tart at this point in the night, errr, morning. I also do an arterial stick for a repeat blood culture and order up some antibiotics.

530am: Getting into my call room bed as the sun is coming up is pure joy. My feet are throbbing (I need to start gellin') and my eyes feel like they are sunken into my head. I have a sour stomach and even more sour breath. I am sticky with dried sweat. Yum.

620am: My alarm goes off and all I can think of is putting both feet on the ground and moving forward or else I'll roll over and close my eyes against the bright sun and even brighter lights of the unit as the day shift nurses roll in with their freshly washed hair and casual chatter. I feel like a troll. I sign out to the oncoming resident and attending. As soon as we finish there's a call for a delivery. I look at the resident and say "It's your turn now." I gather my things and head for the train that will take me home. Home sweet home.

A Letter of Gratitude

2009-07-07T09:20:00.003-05:00

Dear Father Who Thanked Me For Being At His Child’s Delivery,

Remember when you said to me “Thank you for being here” and I just looked at you and smiled and said “Sure thing”? Well, here’s what I really wanted to say to you, only I didn’t realize it at the time. I’m not very good at ‘on the fly’ and ‘spur of the moment’. As I said before, I’m a planner. Anyway, I wanted to thank you for acknowledging my presence at your child’s delivery in what must have been a moment of extreme fear and stress for you. Rarely do parents think to do that and I never expect it. I wanted to tell you that this is why I became a pediatrician. To help parents escort children through life until they can pave their own way. Your gratitude was beautifully heartbreaking and I carried that with me for the rest of my shift. You made me feel like I make a difference each and every time I attend a delivery whether I give oxygen and chest compressions or simply dry the baby, wrap her in clean blankets and hand her over to mom and dad.

Your baby did fine, didn’t even need me after all, but I’m glad we were there. More for my sake than yours. See, you gave me such a gift that night. I’ve been walking a little taller, feeling a little less run down, and generally feeling a sense of peace about my career path that I haven’t felt in awhile. So, although I will never see you again, I want you to know that as much as my presence impacted you that night, yours had the same effect on me. Thank you for being there. Thank you for your unabashed sincerity.

Best,

The Pediatrician At Your Child’s Delivery