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The worst (and best) phone calls

I dialed the number while sitting in my garage, because it was 5 PM, and that's the time of day when my house "kinda sounds like someone is being murdered over there." (in the words of one hilariously honest resident)
But the background chaos didn't matter.
Nobody answered.  I let it ring for an eternity, as I had been doing.  Nobody was going to answer.
Our patient had days, maybe hours - the list of what could happen to cause them to suddenly decompensate was a mile long, and included "Rupture of known varices in setting of multifactorial coagulopathy"
We knew this was coming, they knew it was coming - the only thing that was uncertain was when their family would arrive. 
A month ago, it was the 20th. A week ago, it was Thursday.  
The barely there, tarnished silver lining to this scenario is that we all had time.  The conversations had taken place - the ones held after hours when the commotion of the wards has quieted and there's that still quality t…
Recent posts

Third Time's the Charm.

Hokay, another inadvertent hiatus.  But I've been blogging since Geocities (oh, the glory of 90's internet), and I'm not about to let anything as simple as having a second child, moving our entire family cross-country after going through a hurricane, Nick going through Rookie School again, holding down temp jobs and moving twice before settling on my current job keep me down!

So again, with the blog.  And some new clinical context.
As much as I loved Hospitalist work, it was never my end-game.  I wanted to go and put in my years in the front lines of medicine, understand efficiency, disposition and clinical practice outside Academia before coming back to teach.  So when the opportunity came to return to Michigan, the natural inclination was to move to the next phase of my career.  

Actually taking the leap was.... exhilarating. (Terrifying, as the primary breadwinner.)  It seemed like Locums work would be my go-to while I searched for a full-time academic position.  I kn…

I got the duct tape. Now I can try out.

I am a deeply superstitious person.

It's ridiculous, I know.  Scientific training, educated reason, yada yada yada.

And yet I will continue to wear a piece of jewelry for an entire week if I deem it "lucky" in regards to work.  (Lucky being that the onslaught from the ER and consult services remains manageable instead of the full torrent)

D's Go-to-sleep ritual has become increasingly elaborate, in which you turn on a musical seahorse, hand her a stuffed tiger and cover the whole shebang with a polar bear blanket.

But there's reason to my madness.  The fall down, go boom practice was one of the very few I hadn't been wearing pearls.  We have days like today at work, where I end up with a daily rounding list of 27 patients.  And thankfully infrequent all night dance parties that Diana invites us to.

So I needed Duct Tape if I was going to go back.

At some point, I decided that black and white checks were going to be my "thing".  Raven had giant fuzzy…

Time Travel.

The "Timehop" phone app will, if you ask it to, show you a snapshot of what you were doing on this day in previous years.  It digs through your photos and social media, and has been an interesting reminder in just how significantly one's life can change in a relatively short period of time.

And for me, it's psychic.  It KNOWS stuff.   It knows when Girlie's response to everything is "NO! THAT THING (a nap, her shoes, toast) IS TRYING TO MURDER ME!"  (Adorable photo of sleeping 6 week old baby sleeping on my chest.)

It knows when I am absolutely fed up with work and need a laugh.  (The Kidnapping and Ransom of Dr. Armstrong's Elf of the Shelf.  Complete with dramatic rooftop return of the hostage in exchange for Christmas Cookies.)

It knew that I was waffling on whether or not to return to Derby.  I had gotten back on skates a few times, and each of them was a heart-pounding affair.  The idea of falling, which used to be no big deal, was now scary.  …

"I wanna be like her when I grow up." (Part 1 of 2)

The first rule of the residents lounge: Everyone Bitches about their Attendings.  It's the Goldilocks of patient management - this one is too Mean, this one has No Cojones, and that one never answers their phone so I guess I'll figure it out on my own.

Dr. D was the only person who was above lounge bitching.  She was fair, kind, capable and had an amazing bedside manner.  The kind of attending who didn't have to rip you a new one when you screwed up, because you were already berating yourself - "How could I have done something so stupid in front of Dr. D?"   Plus, she always looked professional and put together when I was still rocking Dansko clogs and dress pants that were always a little wrinkled.
In contrast to today - when I had a casual lunch with Dr. D, while we talked about balancing work and kids schedules (try and get as much as possible done before 9 AM), how the babysitter she helped me find was doing (fantastic) and the key item to making work outfits…

When we last left our heroine....

(Two freaking YEARS ago...)

I was a wee baby hospitalist.  I was finally "not a resident", but still too intimidated to actually EAT in the doctors lounge.  I had also just finished my first real season of derby, where I actually made rosters and scored points.

The not-blogged about fact what that my husband and I made the agreement to "stop not trying to have a baby... but y'know, after the holidays."

I was pregnant by February.  :)

So 2013 was the year of learning new skills: in the first half of the year, it was how to professionally exit a patients room in order to go vomit, and doing my level best to come up with reasons why I had to miss 6 weeks of derby practice.. "Oh, y, know... work..."  Later, it became how to scoop up Derby girls from the track and intubate patients even though I had... well, a person in the way.  

With our beloved Bone Collector temporarily relocated, I filled in at the team's medic for the season, still attending pra…

Level up

If the fact that I have a blog on the internet hasn't already clued you in, I'm a bit of a geek.  And by "bit of" I mean "was raised on video games and Dungeons and Dragons in the way that most teens gossiped on the phone after school or threw balls at things for points"

So to this day, if you give me some sort of objective number to measure and strive for in order to do a job well, I AM ALL OVER THAT SHIT.  If you really want me to get revved up, there needs to be a level of complexity that I can analyze and figure out if option A or B is the way to make number X go up or down.

Hospitalist medicine thrives on these kind of metrics.  Length of Stay, Case Mix index, mortality rate, core measures, relative value units... you can make spreadsheets for days.

It's funny, back in the day "being a good doctor" meant that all your patients were happy, nobody died when you could help it and you kept your white coat clean.  Now, with pressures from pat…