Lighting up the Darkness

It’s “that” time of year again – it’s dark when my alarm goes off in the morning, and more often than not, the sun sets before I leave work.  My car has frost on the windshield in the morning, and I’ve returned to wearing a hat and scarf.

I was about to write that I don’t like this time of the year because I miss the sun and it feels like it takes me a long time to warm up once I’m cold…but the truth is that while I miss seeing the sun, I like the feeling of settling into my house, and look foward to climbing into my bed – the one that is piled high with quilts and a down comforter.  The idea of hibernating appeals to me, and I think I’d be happy to just stay home reading, knitting and drinking tea.

For the last few months I’ve been openly exploring Judaism. It has appealed to me for the last few years, and after almost two years of reading about the rituals and following the calendar, I met with the local Rabbi and have started the process of studying in preparation for my conversion.  I look forward to the Friday evening services, where the candles are lit and the prayers are chanted. Slowly I’ve gotten to know members of the community, and they have welcomed me with the proverbial open arms.

Lighting candles to welcome (and end) the sabbath means a great deal to me, even more so now that it’s dark earlier in the evening. This year I will light the candles of a Menorah, and I’m looking forward to watching as the glow grows over the course of the 8 nights. (it may have to be modified for the nights I’m on call, but I am still looking forword to it!)

What does this mean for my friends and family who celebrate Christmas? This year, it doesn’t mean things will have changed a whole lot. Next year and future years? I’m not sure. My immediate family has shifted the focus of the 25th of December over the last few years – it’s now about spending time together as a family with a few small gifts. I suspect that it will remain this sort of day until there are kids running around again.

I have been spending a lot of time thinking about a lot of things lately – thinking about where I’m at in my training, where I want to be in two years (or ten years?) and what, outside of work, I am looking for in life. I’ve also been trying to find the snooze button on my biological clock – the drive to procreate is alive and well, but I’m not in a place where I can realistically pursue it right now. There are a lot of possibilities out there, and I’m trying to be ready for whatever comes next – whenever and wherever it appears…

(more patient composites to come – they’ve been in draft mode and I’ll finish them up tomorrow.)

Exhausted.

It’s difficult for me to explain how tired I can be – even to those who know me well.

Yesterday a long day.  It wasn’t a long day in the sense that I left the house at 7:30 and returned home again at 5pm, but it was emotionally exhausting and simply wore me out.

(I spent the day in the presence of a doctor and his staff who all voted for the other candidate. They were upset, angry, hateful. It was hard to remain joyful and my tongue was sore from nearly biting through it…)

I returned to my parent’s house, as they live closest to the office I had been in, with the edge of a migraine that I thought would pass. I had plans to head home to my house so I could change and attend a gathering for friends and their year old daughter, but that all changed when I climbed into the guest bed at 5pm and slept for a few hours. I got up and tried to be sociable, but the nausea sent me back to bed. I woke up this morning in my clothes from yesterday, finally feeling a bit more rested but still exhausted.

I hope that this level of exhaustion is just a residency thing and it’ll get better once I am in an office with a regular schedule. It can’t get worse – right?

(this isn’t the tone of what I was trying to do this month, and daily posting is likely to be impossible, but I’ll try to keep up!)

Changing Times

The time change was last weekend.

The American people decided it was time for a change today.

I look forward to the change that is still to come.

Condescending

for the umpteenth time today, I walk into the exam room to a patient who arrived for an acute appointment.

(again this could be any of my patients, male or female, old or young, one who comes in by themselves or with a whole family group.)

“I know my body,” she says. “I have had this sinus infection for weeks and I just need an antibiotic.”

She won’t answer my questions and doesn’t take me seriously when I ask her what over the counter meds she’s tried. “You know, everything. You name it, I’ve tried it.”

Neti pot?  “No, I’m not putting anything up my nose.”

Humidifier? “no, we don’t have one, and I’m not getting one.”

Menthol, vapor rubs? “No, they stink and make me break out.”

Then she adds, “oh, I’ve had a fever. I got hot, sweaty, flush.”

I ask her what her temp was.
“I don’t know, I didn’t take it.”

I explain that a fever is a temp greater than 100.9 degrees F.

“It was at least that,” she says, shooting me a look that screams “don’t mess with me.”

I look in her ears, mouth, nose. I listen to her heart and lungs, poke on her belly and look for any rashes.

“I don’t know why you have to do that when the problem is in my sinuses,” she says, after nearly every point in my exam. “I just need antibiotics. Why don’t you people listen to me?” She puts the neck of her expensive turtleneck sweater back up with flourish and huffs as I pull it up to examine her abdomen. When I’m done she sits up, immediately putting on her jacket and standing up to check her makeup in the mirror.

I look over her medication list, updating it as we talk. She swears up and down that she always gets antibiotics from us, but I only seen one in the last two years, despite her claim that she’s had seven sinus infections in the last year.  I calmly explain that antibiotics are not the best way to treat a sinus infection, and that she will likely get better on her own faster then she will with un’needed medication.

She sighs a very deep sigh, and then starts in on a tirade about how long this has been going on (the magic term is “a month” as she’s probably heard before that she can’t get abx without having symptoms for 4+ weeks), how nothing else will work, how she can’t ever see “her” doctor and when she was seen at a different office they would just send abx to the pharmacy when she called.
I’d really like to ask her why she left that office, if she always seemed to get what she wanted.

I explain what she should do to prevent bloody noses; I don’t tell her that I saw evidence that she’s been picking her nose, but instead dance around that point and let her know that another bleed is likely at some point today. She denies that she’d ever put *anything* in her nose, as she’s “not that kind of person.”

I encourage her to put boiling water in a bowl,  lean over it with a towel on her head to help  open things up.

“But you’re going to give an antibiotic, right? I came here for an antibiotic.”

I then tell her that the best thing she could do would be to use a nasal spray, as it will get to work right where it needs to go, and will help things clear up faster.

“I’ve tried them in the past and they don’t work. I’m not using that stuff, it’s messy and just gets on everything.”

I take a deep breath, look away and start typing in the computer.

“I need amoxicillian because that’s what I had last time, and it worked great.”

I look back at her and say that it isn’t the best choice and that if she had that recently it’s a sign that it didn’t work.

“Oh it worked, this just came back.”

I enter another medication into the computer, and also send a script for a nasal spray to the pharmacy.

She has a new bounce in her step as she leaves the room as she pulls out her cell phone, dialing a number as she walks away from me. She then adds,  “I know my body. I know what I need. If you had just listened to me in the first place we wouldn’t have had to go through all that.”

(Where is the line between good medicine and keeping the patient happy? and why does that line change with every patient I see? )

Questioning

I can tell when I walk into the room – either by myself or with another doctor.
The patient and whoever else present look me up and down. They see my scuffed shoes, the pens sticking out of my pockets, the outline of my pager protruding from my waist, my nametag (the one that is usually facing the wrong direction) and my gray streaked hair that is pulled into a messy ponytail. They look me in the eye, studying my face as they take in my pale skin, the occasional breakout and blemishes, the dark circles under my eyes, the glasses that are slightly tipped to the left.

There are several common reactions to what they see – some see me looking at them and look away quickly, as though they’ve been caught staring. Others continue to take me in, and it isn’t until I start talking that they refocus and look away.

“How old are you?” they’ll ask  Some will add an “I don’t mean to be rude and you don’t have to answer if you don’t want” and others will simply say aloud, “Are you sure you’re old enough to be a doctor?”

I try to feel them out – are they asking because they think I’m too young to be their doctor? Is there a chance that they have children my age and they can’t imagine their child being the one to take care of them? Was their last doctor much older or male? What were they expecting to see, I wonder, while I think about what I can say.

There are times when I take a moment to ask them how old they think I am, but this question is usually met with silence or a comment about how they’ve never seen a doctor so young.  I once asked someone how old they thought a doctor should be, but they weren’t able to give me an answer and I haven’t repeated the question. Perhaps I should.

Most of the time I simply answer 29, which I realize is only true if I round 28 and 11/12th up. I started saying that I was 29 when I started my second year of residency…maybe because it didn’t feel like it was enough to be a second year resident, and I wanted to feel a whole year older.

The patients who are my age are often taken aback – I can almost see them doing the math and their eyes sometimes squint as they wonder aloud how much schooling it took to get to where I am.
The older patients pause, before they start recounting what they were doing at my age. Some were housewives, and pregnant with the fifth, sixth or seventh child. Some were breaking out on their own, or travelling to other parts of the country. Some were returning from military service, or changing careers, or burying their parents.

Where am I from? Where did I go to school? are questions that are quick to follow, and I have come to understand that this means that my age is no longer an issue – I have “passed,” if you will. I’ll give the name of the high school I graduated from, or tell them I was born at the hospital across the street, rather then simply give the name of the town we’re in. There can be a subtle moment of pride here, especially if they are also from the area. This opens the conversation up for stories about how they played football or softball or how they were a part of the student-run production (that has been going on for 100+ years).  There is usually a visable softening at this point, as being from the same town/county/state must imply that I know how things are “done.” I must know them, and what is important and it makes up for my youthful appearance.

The whole conversation about my age and such may only take a minute or two, but it happens several times a day, generally with patients I’ve never met before. I’ve never had a patient say that they want to see an older doctor, but I won’t be surprised if it happens in the future.

November

er, Hi. Fancy meeting you here. Don’t mind the dust and cobwebs – they should be out of here soon.
I have tried numerous times to get this post going, but all attempts read like a child’s excuse for not having the homework done (my dog ate it) or I try to catch you up to where I am now and ramble on for paragraphs that can be summed up in 9 words – halfway through my second year of residency and tired.The exhaustion is chronic, and won’t likely let up anytime soon. The almost half way through part? music to my ears.

I am hoping to post daily this month – not with the goal of posting daily beyond that, but to try and put some of my experiences from the last 15 months down somewhere. NaNoBloMo is a challenge that is perfectly timed for me because it’ll give me a chance to do just that.
Not a whole lot about me has changed in the last few months, but I thought I’d recap so I can bring everyone up to speed…

- I bought the house I grew up in from my parents. It’s a great house, with mostly great neighbors.

- Izabelle and Beazlie are still my cats/housemates

- I’m very much an introvert – I *thrive* on time to myself and become quite cranky without it.

- If it were up to me, there’d be naptime daily from 2-4pm. Followed by snacktime.

- I love to knit but haven’t finished a project in a very, very, very long time.

- My favorite color is deep plum.

- There are days when I wonder what I’ve done with my life, and I often wonder why I thought going into medicine was a good idea.

- I’m not sure I’d have gotten this far without my cats and their twisted sense of humor.

- I know I wouldn’t have gotten this far without my mom and her ability to help me keep things in perspective.

Here’s to this next month, and the stories it will bring. (all names/ages are not real and one person may be based on numerous patients I see or have seen.)

The joy in small things…

My second year started with a bang – or a whiz’pop’whoops’zing!-bang. I started the year with a rotation that is new (and “improved,” as they keep telling me) but being in the first set to “try it out” means that the other resident and myself are the ones discovering which things weren’t quite 100% right. (missing vacation days that have since been found and finding out a mere hour before the start of call that I am the one on call (!) have made for memorable experiences.)

My time at home has been a balance between doing nothing (sleeping, napping and sitting around in the shade) and being very busy.  The yard has had to fend for itself (as it wasn’t high on my priorities this summer) and I think it took on the challenge with gusto. 

(figure 1: a lily that bloomed by itself. ) (note: I used to peel the unopened blooms like they were bananas, despite my mom’s urging to leave.them.alone.  I’m sorry mom. You can come over and enjoy them now.)

(figure 2: a better picture of what is actually going on out there. The pansy there in the front? the one growing in the grass? It was chopped down to nothing when my brother mowed the lawn last month. Now it’s back, without any help from me.    The primrose has grand plans to take over the whole flowerbed – it doesn’t know that the coneflower is getting ready to put on a show too.)

4/5ths of the neighbors I have now are the same people who have lived on this end of the block for the last 20 years. The guys have plows on their trucks and are happy to accept cases of beer in exchange for making sure I can get in and out of my driveway in the winter.  This known, I shouldn’t have been surprised to come home after a night on call to find that my lawn had been mowed. (only problem being that I have no idea who did it – beer for everyone!)

Izabelle has tasted the world on the other side of the screen and would like everyone to know that it’s horribly unfair that I am allowed outside while she is not.

(figure 3: Izabelle, mid-miaow.)

There has been spinning.

Thanks to a great morning with friends, I now know how to ply yarn.

And! I know what I had to do with my wheel to fix it, so I can ply yarn on my own.

(it’s easier to see in my flckr account – the left hand section of the cross piece was screwed into the clear piece too far down; now it’s even and spins evenly both directions, which means I can ply.)

It’s the little things that will make this year do-able.

Simple, little things.

The 53rd week.

This week was the 53rd week of my intern year.

The new interns arrived this week, bright eyed and bushy tailed and seeming more than ready to dip their toes into the ocean that is residency education. As that ocean is vast and filled with things like computer training, getting’to’know’you activities and patient encounters that ease them into the system, they won’t start rotations for another four weeks.

 Today I looked around at my class – we’re the “rising second years” - and noted that we appear a bit worn around the edges, and perhaps a little weary. I saw some looking a bit wistful when watching the new med school graduates couldn’t help but wonder what, if given the chance,  our ”now” selves would tell our “then” selves about the long year ahead. I know I’d remind myself that it’d come to an end eventually (and that it’s possible to buy pairs of socks at the grocery store if/when I run out of them…).

The soon’to’be graduated seniors (or third years) are all preparing themselves to be flung into the atmosphere of true medical practice. Over the last several months most have applied, interviewed and secured jobs that come with “real” paychecks (the ones that offer hope we’ll eventually pay off our loans), vacation days that can be taken at any time, and the joy that comes with deciding what type of practice they want to be a part of, and what kind of medicine they want to do (hospital? obstetrics? rural or not?). It’s been fun to observe the process and it’s allowed me a chance to ponder what I might eventually want to do. The notion is exciting, but at the same time I am grateful for another year or two of the coziness of the familiarity in this residency program. 

This year was long (long, long, long) but I am still standing (or sitting as the case may be), and I won’t ever have to do it again. Today I feel like I might actually make it through the next year (because, really, it can’t be any worse than this year?).

 (I’ll admit I’m hesitant to outwardly show the euphoria I feel of being done (done, Done, DONE!) and worry that I’ll be tricked into something that has points as low as the dips of this past year.)

                              ***************************************************************** 

I have learned a lot about myself in the last few months and the one thing that was hardest to come to terms with was how I internalize and react to criticism. I usually blow off compliments before taking them to heart and really thinking about what has been said, but someone saying something that I “did wrong” or “could work on” can ruin my day. My classmates and I have realized that the “shit sandwhich” is popular – saying something complimentary followed by criticism, then ending the conversation with something else “positive.” This is a lovely theory of how to present feedback, but it leaves lots to be desired when I greet every compliment with hesitancy because I’m waiting for the “but clause.”

 example:

 ”I think you have a great interaction with patients, but it would be nice if you talked faster so more information could be covered in the same amount of time. All in all you are doing better than you were.”  (poor example, but I can’t come up with something that better explains the contrast of positive and negative.)

 I’m not sure how to focus on the positive, but may need to come up with something tangible to remind me to hold on to the good and let the not-so-good go. I know that I have a lot to learn and that I always have things I can work on, but when so much of the feedback I get is “user dependent” it’s hard for me to not take it personally and/or become mad at how outrageous some of the suggestions are. I’d like to learn how to graciously say thank you, then let it roll of my back like a duck.

 (quack, quack, quack.)

perhaps I need to knit a pocket duck? or find a duck charm to wear on my nametag, or on a necklace?

three weeks til I’m a second year.

despite a long weekend (using up the very last of my vacation days) this is all I’ve got.

 
Iz and her tail, round one from kristen on Vimeo.

 

It’s Izabelle, on one of her calmer “tail chasing” sprees. Both Izabelle and Beazlie have been troupers during this recent change in schedules, though they have been “helping” me move yarn around the house. (That story is best told by Katie, one of my best friends from college, who came north this weekend to help me find some of sanity. Kate’s blog is here…. ) 

It was hard to miss MA Sheep and Wool last weekend – I spent a great deal of the weekend awake in the hospital on call.  Hopefully I’ve done “my” Memorial Day call and won’t have to do it again next year (or the year after…). It is hard to think about how much fun I would have had there, and harder than I thought it’d be to read about who was there (many friends I haven’t seen in awhile) and what I missed.

(big deep sigh here.)

Three weeks of my intern year left, then I’ll be a bonafide “second” year resident.  I’d be lying if I said I didn’t have high hopes that next year is better than this year.

Inertia

the end is near – my first year of residency is over in less than 8 weeks. 

(I can’t figure out how to keep writing because that alone is such a big “stand alone” sentence for me. This year has been simultaneously flying and dragging along and the notion that my residency is now nearly 1/3 over means that I may not be stuck feeling like this forever.)

It’s taken me some time to realize that the thing bothering me the most about residency is how little of my “own” time I have. My schedule isn’t my own – if they switch it around and I’m on call, then I have to be on call (and potentially up for 30 hours straight); if they decide I can’t have a day off, then my plans are no longer my own.  

Given that there are still only 24 hours in a day, and I need to sleep at some point in the week, it was only a matter of time before something had to give; this point became clear when I forgot to get back in touch with everyone regarding my application for a fiber workshop scholarship and  didn’t realize until well past the date everything was due. Had I found time to check my email I would have been more on top of it - but email checking is now a “want” and not a ”need” and when time is of the essence, it’s one of the things that goes by the way-side. 

(I still tear up when I re-read those drafted appology emails to Laurie, Cassandra and Kristen – it was something I wanted so much I’ve already put in time off to go – but it fell off my radar screen. I am so sorry I never got back to you and will get back in touch with you soon.)

I am worried that my friends who aren’t doctors see my presumed “dedication” to medicine as a voluntary withdrawal from the fiber circles and activies that helped me to get through medical school; please know that this isn’t the case at all. It’s a lot of work to be friends with me right now – even my family has all but said it’s a one sided relationship at times. My emails are weeks behind and it’s easier to ignore my bloglines subscriptions than to try and find the time to go back, read and keep up.

Even though I am busier than a worker bee, I am lonely.

In a class of 10 residents, I am the only one who is single. I have said over and over again that I don’t have time to be with someone else right now (see: above) and my parents have truely gone above and beyond to help me when I need it. My mom has watched this year unfold and saw first hand how out of control things at home became; laundry piled up, dishes sat in the sink and boxes remained unpacked – simply because I didn’t have the time or energy to take care of things.  At one point, early in a day that would fade into a night on call, my pager went off and my home phone number appeared. I called my house and my mom answered by saying “I am here to help you get organized.  What is off limits?”

Newton’s Laws of Motion state that an object at rest will remain at rest until an outside force is applied.  She was the outside force that helped me tame my out-of-control home, and she has continued to help me see that this “this too shall pass.” My ego stood in the way of asking for help and she did as only a mom can do and saw through what I was saying to act on what I needed.

The rest of this year is going to be busy and chances are good I will continue to be out of range for another 8 weeks. Once my second year begins, however, I will be back. My schedule isn’t my own, but I will have more control over my own time.

thank you for waiting – and for helping me get to this point.