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.