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.

No Pain No Gain

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

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

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

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

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

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

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

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

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

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

"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

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

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

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

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

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

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

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

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

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

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

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

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.

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"

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

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

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

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

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.

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

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.

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

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

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.

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

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

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”.