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

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

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

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

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

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

Feedback Sandwich With A Side O' Chips

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

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

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

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

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

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

Pick A Little, Take A Little

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

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

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

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

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

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

Chocolate Chips Do Everything But Get You Promoted

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

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

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

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

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

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

How the Other Half Live

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

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

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

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

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

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

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

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

A First For Everything

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

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

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