Boarding the Train to Mommyville

Yes it's true. I boarded this train at Christmastime and thankfully, am still riding. I'll arrive at my destination, Mommyville, sometime in late August. And waiting for me will be a perfect baby boy! It's been a fascinating ride so far and I've realized that everyone on board with me is experiencing the journey just a bit differently. Despite that, there is a sense of connectedness with this new culture. Many of the fears I have (am I gaining too much weight??) are shared by many. I'm not alone in my neuroses. Many of those who've already reached their destination have given me some helpful advice and also some strange things to look forward to. One of my friends told me she's obsessed with breastfeeding so if I have any questions, just ask her. In fact, her husband jokes that there are now four people in their family: the 2 of them, their infant son, and her breasts. Hmmmm, ok.

When referring to adjusting to a newborn, people including my husband, like to say "oh you will probably think it's easy since you're a pediatrician". Ummm, I take care of sick children. With a cadre of nurses and residents to help me. I don't know how long after you drink you have to dump your breastmilk. I don't know if you can put chapstick on a baby's lips. I don't know whether it's better to use a crib, pack 'n play, bassinet, Moses bed, or cosleeper in the first few months of life. Give me a baby with pertussis, I feel comfortable telling you what to do. A healthy baby of my own? No clue.

We've been practicing our parenting skills on our dog Swayze lately. She's run into some discipline problems and we're troubleshooting what we have done to cause her such angst. In the past month, she's eaten a frozen Lean Cuisine pizza, a loaf of sourdough bread, a bottle of ibuprofen and a tupperware container. This is in addition to the 1/2 pound of grass she eats on every walk we go on. She's begun howling at Jeff when he gets home if he pays attention to me first (as well he should) and if we don't show sufficient excitement at seeing her when we arrive home. If we are sitting together on the couch and watching TV, she'll position herself right in front of us and stare. It gets really uncomfortable. Does she sense that her position as dad's favorite child is about to be overthrown? Does she need more attention? Does she need less attention? We've decided to experiment with ignoring her for a period of time after we get home and only showing her attention when she's quiet. We are fully aware that this might backfire and we'll wake up with a dead rabbit in our kitchen one of these days. But we're willing to give it a try. Isn't that what parenting is all about? Trial and error? What works for one will epically fail for another? We've got about 4 and a half months to figure this out...

Alphabet Soup Overdose

I just returned from a conference where I was one of very few pediatricians surrounded by a mass of internal medicine physicians. I spent the week hearing case example after case example about PEs, anticoagulants, PSAs, mammography and stroke prevention. Ugh. Don't get me wrong, I loved the conference and learned a ton. But talking about medicine surrounded by physicians who don't care for kids is a lonely place to be for a week. They did try though. When I asked how a particular statistical method could be demonstrated using a pediatric case example, I was told "There's some great articles out there on otitis media." Oh. Is that what you think we spend hours and hours of studying and years and years of training to treat? *sigh* Such is life as a misunderstood pediatrician trying to make their mark amidst the high powered and intellectually complex yet lucrative adult medical world.

So you can imagine my delight when I saw this article in the New York Times by Dr Perri Klass, a pediatrician. She is the author of "A Not Entirely Benign Procedure" published in 1987, about her journey through medical school. I read this book while I was in medical school and loved it. This was well before I even thought about being a pediatrician! Writing this now makes me want to read it again before I start my position as pediatric clerkship director, if only to remember what it felt like to be that naive, awkward and endlessly excited all at the same time. The article in the Times is about what adult medicine can learn from pediatrics. It definitely gave me a boost of confidence after sitting through debate after debate about the merits of the latest study looking at the newest anticoagulation med for atrial fibrillation. My favorite line of hers is "When it comes to certain aspects of medical treatment, especially hospitalization, perhaps it's time to acknowledge that adults are really just big children." Everyone needs a cookie, a blanket, or a hug at one time or another, regardless of how old they are!

Hello March. I've Been Expecting You.

I have no excuse for being MIA for the past few weeks other than I was sucked into the black hole of February. I think this happened last year too. Yes, I just checked. It did. What the hell February?!

Anyway, let's talk about careers. Big news this week....I was just selected to be the new Director of Pediatric Medical Student Education at my institution. Basically, I will be in charge of all things 3rd year medical students + pediatrics. Score! I'm super excited and see this as a big opportunity for me to advance in the field of education. I'm also nervous...I've never been in charge of something so important before. I'm struggling with the fact that I will have to cut back on my clinical time to half of what I do now in order to have enough protected time for my new job. This is awesome for me, not so awesome for my coworkers. Yes, my guilt fairy is in full force, sounding like Piper Laurie in the movie Carrie "They're all going to resent you! They're all going to resent you!" I'm hoping we can hire someone to fill the gap I'm leaving and I can make the transition with a minimal amount of unrest. This is about as likely as Kanye West saying anything that sounds halfway intelligent, but a girl can dream.

I caught up with a close friend of mine from residency, also a pediatric hospitalist, and she shared with me her dissatisfaction with her job. She just started this job last summer, but already the honeymoon is over. What we've failed to realize until now is that no matter how hard you worked in medical school and residency, there is no one person, group, or institution who will value you as much as you value yourself. There are always flaws. Much like marriage right? You gather pieces from all over to put together the house of cards that is your life and hope like hell a strong wind doesn't blow through. And if it does? You build again. Over and over again. The most important thing I learned from my life coach was that we make our choice of how to view the world, every day. We create the constellation of our life and consciously choose to whom we give our emotional energy. I choose to put my family, my friends and own personal growth at the center of my constellation, with other things scattered near or far depending on how much weight I give them. And most of the time it works.

Speaking of creating and careers, my husband just made his very first batch of homebrewed beer. He ceremoniously tasted it over the weekend. If he was going for a watered-down Bud Light flavor, he nailed it. I'm proud of him for trying something new and exploring something he loves (beer, not watered-down Bud Light). He'll try again and I know he'll achieve whatever flavor profile he wants with a little practice. Can a scientist move from the lab to the brewery and be successful? It's spring and new things are sprouting all over the place. Why not?

WWSD? (What Would Swayze Do?)

The following happens every single morning at my house. Our dog Lucy gets up and walks to the other side of the room to crawl into bed with our dog Swayze. Swayze does not like being woken up by a smelly, snorting pug snuggling with her and growls to let her know. She then proceeds to put her head down and pout. Lucy continues the snuggling. So goes the morning at our house. Every. Single. Morning. Why does Swayze put forth the effort to growl every morning if she knows that Lucy doesn't care and snuggles anyway? This has been going on for months and neither of them are willing to change their habits. Isn't that the definition of insanity? Doing the same thing over and over and expecting to get different results?

I caught myself doing this today. I was ranting about how physicians who do not feel comfortable taking care of kids should not take care of kids. Sounds so simple right? But it happens all the time. And I complain about it every single time. I live in a city where there are plenty of pediatric providers, why on earth are adult doctors trying to take care of kids? I understand that I am supposed to show compassion for them and volunteer to hold their hand. After all, show me a 70 year old patient and I will show you someone who doesn't have a clue how to adjust their blood pressure meds or soothe their aching joints. I watched a video with a group of family medicine doctors during a lecture on doctor-patient communication. The video was of a typical clinic encounter between a doctor and his 50-ish patient with diabetes and depression. We were supposed to critique the communication style. The FM doctors commented on how easy and familiar the interaction was and how this must've put the patient at ease. I couldn't help but focus (and feel appalled by) the way the doctor asked about the man's WWJD t-shirt ("WWJD? What's that all about? Do you really care what Jesus thinks?" conspiratorial chuckle) and how he said "If it's not a hell of a lot better give me call." Hell? He said "hell" to a patient?? See? Different worlds, different worlds.

I love my cozy, familiar, non-expletive containing interactions with my pediatric patients and their families. I feel very protective of kids when they're sick and don't want anyone who doesn't know how to care for them doing so. That this will continue to happen in community hospitals everywhere is unfortunately inevitable. I can choose to continue to growl about it every morning or I can choose to amicably share my bed for the greater good. Wait, that sounds weird.

I stepped off my soapbox today and called the offending adult physician and generously offered to write orders for the child's care and to update the family. I hated that I was rewarding bad behavior and enabling a practice that I don't agree with. But ultimately, I choose how I react to a situation. And grumbling day after day is not helping anyone, least of all my patients. I like to think I'm not insane. Swayze however, will come to this realization the day she develops opposable thumbs and starts speaking instead of howling. Until then, I'll enjoy our daily morning ritual because they're my dogs and I love them.

Art Projects For The Creatively Disinclined

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)

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

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.