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

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

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

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

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

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

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

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. :)