Friday, January 23, 2015

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.

Jeez, at one point my skates were immaculate.  They're not so pretty now.
At some point, I decided that black and white checks were going to be my "thing".  Raven had giant fuzzy leg warmers, Skates of Wrath had a truly B.A. helmet with fantastic decorations.  So I latched on to the duct tape, because you need something to keep your skates from getting too ripped up on cheese-grater sport court or concrete.

Of course, now that I've started skating again, I've been looking in every store for my elusive tape.   It was interesting to note that the patterns had expanded to include Mustaches and Jonas Brothers.  But no checkered tape in any display I looked at.   I started to take it as a sign that maybe I shouldn't skate anymore - without my "lucky" tape.

Amazon.  $6.07 (Prime Elegible)

So I'm ready.  (Of course, just getting TO tryouts involved a switch in my schedule call times, a favor from my partner, my babysitter willing to stay until 9:30 PM and not seeing Girlie until after she goes to sleep, since Nick is gone the entire Sunday they're being held on.)

Tuesday, January 13, 2015

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.  Honestly?  It felt like the first night of bootcamp, all over again.

So it reminded me just how much fun bootcamp was. (I am amused that even though I committed the sin of publicly picking out a Derby Name before i made the team, it all worked out in the end)


But there were still issues - I already feel like I'm stretched thin trying to get through an 84 hour work week and then pick up the pieces (and the groceries) after... while being a single parent every third day.  Why on earth would I add more?

Because it was even better to come back to boot camp as a veteran skater.   Because I see faces (or at least their trademark helmets) in this photo that I spent far too little time with in the last year, despite all our efforts.  

Because I take care of the sick and injured all the time.  And I tell every single one of them that they will get past this... that they will look back on this time in the hospital, when they felt broken and hopeless and it will be just a bad memory.  That their illness shouldn't define who they are, and they need to get back up and walking, to take care of their family and do what they love.


I have to take my own advice.  I refuse to be someone who's afraid.
Tryouts are the 25th.  

I fully expect to not make the team, because I am not Ellen Page and this isn't a movie.  However, wRECk league starts the next week - and I have coerced one of my Mom-buddies to come with me - that we will lay aside our guilt for one night a week and go hit bitches on the track.  (If you can believe it, her job requires an even greater tolerance of BS and shenanigans than mine).  

The one quote that convinced me to try out at the beginning of all this Derby stuff was "If it's important to you, you'll find a way to make it work."  So I'm deciding that it's still important to me.  Being a Mom and a Doc is great.  But neither of those are optional at this point... I need something in my life that I choose to do.   

Now, all I need is duct tape.  (But that's another post)



Saturday, December 13, 2014

"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 mesh with a White Coat (cardigans)

In truth, she and I were part of a rotating table of fantastic women in medicine, passing through during a special Holiday Lunch Service in the lounge - several were my colleagues, who freely exchange Tirades over weak admissions as well as hand-me-down baby clothes.  Others were subspecialists who I've worked with and looked up to for years and am now finding that their lives aren't so different from mine at this point.  (Heck, some might even be reading this - Hello!)  

The one thing we all agreed on, in between keeping small ones settled on our laps and checking the clock to make sure we were still on schedule is that paying full-price for any piece of Child's clothing is insane.  

Decades ago, the understanding was that a Doctors first and most important commitment was always to their patient.  They would come and see their families once the work is done, but if that was after dinner and bedtime, so be it.  (The scene in Scrubs where Dr. Cox bursts into his son's room, story in hand only to find him already asleep hits home for me)

These days, I have to figure out a way for my patients to get the best care I can give - but seriously, the Daycare closes at 7:30 and I have to be there.  And so I am relieved to see the physicians I respect and admire, who do provide excellent care day after day happen to also be mothers and active participants in their families day-to-day lives.  

I wasn't positive I could do it, to be completely honest.  I had to go back to work when small one was 5 weeks old - not even old enough for day care.  (Thank God for Grandparents and Dads who take extra vacation...)  

I dealt with this fact in a very mature fashion: spending one memorable morning holed up in the office crying and eating a box of leftover Christmas Cookies.  However, once the hormotions (hormonal emotions) passed, things did get easier.  I started to see the ways that Dr. D made things work - planning ahead, finding (and then trusting) people to help you, and always having a backup plan.

5 years later and my, how things have changed.  I have traded orthopedic footwear for stylish flats and paid a hip young person to tell me what clothes will make me look fun and professional (while camouflaging rogue booger wipings).

I still want to be her when I grow up, though.  

Thursday, November 6, 2014

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 practice when I could and watching my fresh meat class grow.  :)

Happily, I birthed a healthy baby girl in November, enjoyed my holiday maternity leave and even got right back on the hospitalist horse 5 weeks later. (I may have cried and eaten leftover christmas cookies in the office for a few of the mornings... but I got back to it!)


  And of course, returning to derby!  The excitement was building.  After months of keeping all manner of hormonally boosted emotions bottled up - AND no booze, I was certainly ready to "hit a bish" as we say on the track.

My first practice back, I pulled myself out after an hour because I couldn't do one of the drills in what I felt was a safe manner - seems that gestating does take a bit out of your endurance and cardio status.

So imagine my surprise when at the next practice, I fall and break my ankle doing a totally routine, no impact, low speed, fresh meat drill.

FUN FACT:  You lose a significant percentage of bone density while post-partum and nursing.  Guess when I learned that fact?



Yeah, it sucked.  When I am old and sharing stories with all the other old demented ladies at the nursing home, I'm sure I will repeatedly tell the tale of how I broke my leg and was non-weight bearing for 6 weeks with an infant at home, in a two story house and a husband that worked 24 hour shifts.  (And still going to work!  And nursing!  For every woman who's weighed whether she can have a glass of wine between feeding sessions, I learned how to stretch out a Lortab like a champ...)

Thank God for my parents.  For serious.  Especially because my orthopod nixed my plan to just deposit Diana in the little basket in the front of my three wheeled push scooter.

So 2014 was unfortunately not my triumphant return to skating.  I did sell the shit out of some merchandise, thanks to an adorable little helper.  :)

And where does that leave us now?  Well, my good reader - now that I have finally come to grips with the guilt that defines almost every working mother (see future post "You HAVE to shower" for details).  I'm starting to train back up.

And I'll tell you about how I actually talk to other attending physicians now.  Sometimes I even call them by their first name.

Except for Dr. R.  Because I suspect God himself wouldn't call someone that badass simply "Jim."

Wednesday, November 14, 2012

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 patients, insurance companies, healthcare reform acts and your own hospital, it means:

"make the patient better as quickly and inexpensively as possible in a way that meets national standards and they stay healthy once they leave.... and while you're at it, document everything that you did in a way that will maximize the amount of money we get paid by insurance so we can keep the doors open and the lights on."

(For extra fun, try and say all of the above in one breath.)

But hey, I knew exactly what I signed up for when I got into this whole "medicine" thing.  Because I love it, and I do want to be a good doctor.  So we come up with better history & physical forms to make sure we've documented all our patients' multiple and colorful chronic ilnesses, so we can take better care of them and get more money at the same time.  And my numbers go up and I'm happy.

And then when I'm exhausted from all of the above, I put on my running shoes and flee from hordes of shambling zombies.

No, really.

As a blocker who is thinking maybe.... just maybe this jamming thing might be fun too, (Click here if you don't remember the difference) I've had to up my cardio and endurance training.   Given my crazy schedule, I needed something that could be done at almost any time with minimal equipment... which means running

I hate running.

But I love zombies.

Enter Zombies, Run!, a smartphone app that turns running into a pseudo role playing game - you run, and while you're pounding the pavement, the program breaks in with "radio broadcasts" as you listen to a playlist of songs.  Even better, it tracks how far you've gone and lets you pick up items to take back to your base to build up your defenses and open new missions.  So yeah, all of a sudden running is fun again.

Especially when you turn on the interval training mode and it forces you to sprint by playing sounds of zombie moans getting closer and closer... 

But it was the amount of data they collect on you that really got my motor running.  


Now I know which songs I run faster to, how steady my pace is over the run, calories burned and how I do on the sprints.

I should amend that the data in the first screen cap was on skates.  Turns out the only drawback to using this program while on 8 wheels is that you occasionally come to the end of a neighborhood cul-de-sac and even the fastest turnaround-stop means you get your brains eaten. (Hence why I only evaded 1 mob on that particular mission).

The best part, though?  It's kind of like having Eenie Meanie, the vet I always thought of as my derby mentor with me...or at least the zombie version of her.  (You thought doc-roller girl was a good combo? Try undead derby badass.)




Sunday, October 28, 2012

Today You, Tomorrow Me.

One of the things I have noticed among my roller derby teammates is that everyone keeps their gear bag stocked with "extras".  Tampons, tylenol, toe-stop wrenches - the essentials for skating.  And it's an unspoken rule that we all share.... even down to the mouthguards.  (Yes, really. Thanks LowBlo!)

Duct tape is especially crucial. Matching laces are just a bonus

Because we've all been the one to show up at scrimmage night with the wrong colour shirt (which recently led to some interesting announcing as two Maggie Kill'n'Brawls lined up on the jammer line... along with some nasty Maggie-on-Maggie violence.) and appreciate it when our teammates help us out.

The same rule applies in medicine.

It had already been a stinker of a day - the IT system maintenance that was supposed to end "in the morning" rendered every computer the equivalent of a LCD paperweight until late afternoon, we were short staffed despite being at No-Room-At-The-Inn capacity for three days straight.

So when the "uncomplicated pneumonia" patient my colleague received from the ER at 6:30 PM on a sunday turned out to be "Oh, Holy CRAP this one is sick" in that internal medicine way - only fixed by personally calling in three consults tonight, running a battery of tests and remembering which serologic marker is affiliated with which nasty auto-immune disease and marching down to the lab to check on the peripheral smear yourself, we rallied.

I knew one of the lab techs and called over to see if they could whip up a slide for us real quick so I could go down and render my verdict (using my pathology skills, which are limited to "That's screwed up" versus "That looks ok").  Anurita had the consultant's personal phone numbers and called both of them before it got to be too late in the night.  Everette had UpToDate open to see if there was anything we forgot to order.

In the meantime, the originally assigned doc had enough time to go back and review the fine details - oh wait, you started taking a new antibiotic a few days ago? - instead of scrambling to get all of the above done.

Which finally brings me back to the title. 

Recognizing that it could just as easily be you left without extra socks or with a patient who can't leave until someone gets them a prescription for their walker is what makes my teams work so well.  It's why I chose them, and it's why I stay.


Wednesday, October 24, 2012

We even have lockers.

High School never really ends.

Even though I've recently graduated from what could be considered 23rd grade, the refrain remains the same.  Where to sit, who to talk to, what's my locker combination... even the mortification of a bad yearbook photo is repeated when your well-meaning department uses your passport photo (taken after running into CVS through a rainstorm underneath aggressively unflattering fluorescent lighting) as the photo for the "Welcome to Memorial" slideshow that runs on a cycle in the lounge.
You also have a good view of awesome
visiting pharmacist lecturers

The "where you sit" is a big one.

As a resident, I had risen to the top of the food chain - the chiefs had standing "dibs" on the three seats closest to the door during all noon conferences, ostensibly because we were repeatedly getting called out to fix administrative problems or address concerns from the interns and attendings.  (More honestly, it was because we'd then be chosen after 1st and 2nd years for "And can anyone explain why we don't use cephalexin for complicated soft tissue infections anymore?" sort of questions)

But I had to earn it - I first had to sit allll the way on the lefthand table, with the attendings sitting between me and the door.  As upper levels, you graduated to the table near the door - but you still had to sit towards the front.

In front of said bench, with an early
version of my bout "war paint"



Same as the fresh meat.  We always geared up on the benches closest to the glass - at first because we were terrified of the vets and moved in a pack, like antelopes navigating the Serengeti.  Then it was because that's just where the meat sat, and we always had things to talk about amongst ourselves. (Usually about what new gear we had finally purchased or how we'll never understand the mechanics of "Cut Track, Major")

I'm happy to say now that I feel much more at ease among the seasoned skaters, and have graduated to the back bench on occasion.

The meat still stick together frequently, but now it's just because we're super-cool and have secret handshakes and whatnot.


So the last frontier is the RDL.  The mythical "Real Doctors Lounge", so named by the resident for its tales of free, actual breakfast (true.  And dangerous when there's freshly made biscuits and sausage for the taking) unlimited coffee (true, but... barely coffee) and secret cabals of attending physicians chanting incantations to punish residents who don't do their dictation summaries on time. (none that I've seen so far)

In the resident lounge, you could argue about which subspecialists in the hospitalist were the cutest (one of the gastroenterologists) or what shenanigans had gone on in the call room. (None, that I can verify)  We were all equals in there - equally stressed, equally low on the totem pole.

Now, when I walk through the RDL, I'm fresh meat again.  In derby, you're intimiated because Pinot Gringo's ninja hip checks are deadly or Ira Fuse's transitions are effortless.  At the hospital, it's because the cardiothoracic surgeon has been cracking chests since before I graduated high school, or that the pulmonologist has the precognition of Yoda when it comes to respiratory failure and septic shock.

Don't get me wrong - I'm happy to discuss my patients at length with these people, and I will call them at 4 AM if someone is crumping (highly techinical medical term for "They don't look so good"), and they will be friendly and professional in turn.

I just don't know if I'm ready to sit down at the lunch table and share my fries with them.  We'll see.