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.)

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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.

happiness is…

once upon a time, on a former blog of mine, I tried to come up with weekly lists of things that helped me to see the little aspects of my day/week that made life better. Given that my posting here is spotty (at  best) I thought I’d dig in again, and see if this will help me be a bit better about writing.

 and so, without further ado…

 happiness is…

- Izabelle meeting me a the door and nuzzling my forhead with hers while purring a “welcome home” greeting. (I am fully aware that it may be a “please feed me” greeting, but am choosing to be more positive…)

- a post-call shower. There is nothing like hot water to help me wash all of the craziness of call down the drain, and climbing into bed or collapsing on the couch feels much better after I’m warmed up and changed into clean clothes.

 - Girl Scout Cookies. I can’t help but refer to them by their “former” names (the ones they had when I sold them) but most everyone knows what I mean when I say “tagalongs.”

- sock yarn. My knitting time has been hard to come by (or plan on) but when I get a minute, there is always a sock on the needles to knit a row or two on. At some point I’ll start on the second socks of the pairs I have…the pull of a new yarn often distracts me from finishing the set before I start a whole ‘nother pair…

- St. Brigid. I love the pattern, the yarn I’m using and how the two are working up. It may be months before it’s finished, but I figure it’ll be cold again about the time I get it all done, so the timing with be damn near perfect.

Overall things are going okay – I’m back on the OB service, so my nights and days are confused right now. (26 hours on, 22 hours off, 26 hours on, 22 hours off – rinse, repeat, and then throw in a few days at the clinic and a day off.) Last night was a particuarly busy night and there was at least one emergency that may or may not all work out in the end. At this point, all involved are doing okay, but it’s hard to tell what the future holds.

On a different note, I’ve found that there are several personality types that are common within my fellow residents, the other doctors we work with, and the nurses on the various floors. Being aware of this has helped me to figure out how to keep on everyone’s good side, but I’ve had several internal convesations about why some specialist doctors assume that we’ll all ask “how high” when they say “JUMP” or why some doctors are more than willing spend many minutes telling me how busy they are – when those minutes would have been better spent answering the patients questions and talking with families. (instead of ending a 20 minute long discussion on dirty political jokes and the price of gas and then complaining that there is “too much to do” in the “remaining free five minutes” they have.)

I have never claimed to be a type A person – in fact, I’ll be the first to admit that my laissez-faire (or type Z?)  attitude isn’t a plus in the crazy field of medicine. However, it has allowed me to let some things roll off my back (snarky nurses comments for example), which has helped my self-preservation.

 I tend to put the patient first – educating them on what I’m going to do (and why), what the strip with numbers means and why I look at it, and taking the time to answer their questions. Over and over again I’ve been told that I’ll have “no time” for this in the future – but my observations are that the ones who don’t understand what is going on are the ones who call the most during the “off” hours, and make several appointments and clog up schedules. They also understand why I’m not worried when I send them home - and once they can explain to their partner, mother, mother-in-law and next door neighbor what is going on or what that test result means - they feel more comfortable overall.

 If it were up to me (and I ruled the world of medical education) then more time would be spent on how to effectively interact with patients and work with all levels of staff. For example certain words and phrases can lead to defensiveness – I’ve found that saying “you should” or “you need to” simply makes the patient or nurse in front of me shut down and raise their defenses. This became clear to me once I realized that *I* stop listening when someone says “you really need to…” to me. As a result, I use a lot of “I” statements and I try to talk about things in the positive, instead of the negative.

I don’t cross my arms or legs when I’m talking with a patient (which sometimes takes great effort), their family or the staff (nurses, pt/ot, secretaries) and I try to joke about things when I can; as a student I had a chance to watch a lot of anxiety levels go up when the doctor talked with the patient and then crossed their arms; it’s subtle, but when I made a point to pay attention to it, it was obvious. Simple phrases such as “good morning” sound better than “hi” and asking about what the weather is doing outside (outpatients) or what they had for breakfast (in patients) gives them a chance to answer me so I can see where they are at. (one word answer? likey anxious or nervous or worried. Long rambling phrase? good to know so I can gauge which questions to ask to help keep the conversation on target. Answering me with a question? they likely have questions of their own that are weighing on their minds, and so on….)

 I am not claiming to know the motive of my patients or have answers to conflict with the staff, but I’ve noticed (or observed?) several dynamics between my collegues and the nursing staff that make the tension on the whole floor become thick and heavy. It’s not my place to get involved, but I do wonder if things wouldn’t be easier if everyone simply followed the golden rule and treated others as they actually wish to be treated.  

The Teeny-Tiny Runway Challenge, part one

Ann (of Mason-Dixon knitting) has issued a challenge: pick a model (stuffed or statue’esque) and knit it something fabulous.

 Step one: pick a model.

 say you have at your disposal, the following:

- one floppy, very soft pink pig (that pic is from ebay; my pig can be see here, on the bookcase in the background)

- one tall and plump’in’a'pear sort of way duck (the “duck for president!” duck)

- one missing in action grey elephant (who stands on all fours)

- one adorable white mouse puppet

 Which would you choose? Is it worth trying to find the elephant? Should the notion that this is an election year propel the duck further ahead of the others?  

 Help.

(please.)

 (getting back into the groove of things was hard this morning, but by mid-afternoon I felt like I’d never left. All in all this isn’t a bad rotation to return to, despite how hard it was to get out of bed this morning.)

the “back to work” blues

I have much to say and lots to share, but I can’t seem to find a positive way to do it right now. Hopefully things will shift (ever so slightly?) I’ll feel better about what I’m putting out there.

 Tonight is the last night of my vacation and I’m doing all I can to avoid the bitter taste of having to go back into the craziness of my intern year tomorrow; I avoided email until tonight, and after signing in a bit ago, am now feeling behind on all of my charting and paperwork. This (anxious w/knots in my stomach) feeling is a lousy way to enjoy my last night “off.”

While I go huddle under a few quilts and a down blanket (I realized earlier tonight that I am nearly out of oil; this fact isn’t helping my general mood right now….) and gather up all I need for tomorrow AM, enjoy a few pictures of Izabelle and Beazlie:

(I am still trying to figure out how to put pictures into wordpress – click to embiggen and see more clearly….I’ll work on it.)

 Tomorrow I’ll be (re)introduced to the world of surgery, a half hour north of here. I suspect it won’t be too different from the last surgery rotation I did (two minutes south of here), but I’m keeping an open mind, and trying to be positive….

one foot in front of the other…

December, eh?

I’ve started numerous attempts at this post – my first jump back into virtual journal keeping since early summer. When I stopped updating the knitting med student site things were going well: I had moved into the house and was in the process of making it “mine,” was enjoying the extended “welcome to residency” orientation (5 weeks of getting to know each other while spending lazy afternoons at the faculty homes on various lakes, doing paperwork and reviewing lots of things) and life was good.

 And all remained well and good until I realized that the hoop jumping is far from over.

 Add to the mixture that I am exhausted, and it’s made for a few rough months.

 I did a stretch of time that *just barely* met the work hour requirements – in a 25 day time period I had a single day off.  I worked 17 days in a row, and if I was on call (which usually meant being up all night), I’d round on patients in the hospital or see outpatients the next day until 1pm. The rest of my day would be spent sleeping, before I had to get up and go back into the hospital at 6:30am the next morning.

 By the end of that stretch I was questioning what I’d done with my future, and if medicine was really where I wanted to be. (nevermind that I spent 6 of those days having to prove myself over and over again. (that is simply the tiny tip of a very large iceberg that still raises my blood pressure to unhealthy levels.))

I haven’t recovered from the lack of sleep yet, and am frustrated with how my long nights and high patient numbers (seeing 6-8 patients in a three hour time period with very little sleep = hard) was somewhat belittled by my fellow residents. If I hear “but think of all the experience you’re getting!” one more time, I think I will officially lose it. (as opposed to all of the unofficial times I’ve lost it.) If this is a trial by fire, I am officially burned.

 I’ve developed a black cloud – meaning that when I am on call, strange/bizzare and obscure things happen to people who I see in the hospital, and the patient lists were longer than they’d been in months. Between my senior resident and myself, we’d see 12-16 pts a day, admitting and discharging people several times a week. (each admit or discharge creates a lot of paperwork that all needs to be done)

(The list right now for that service, now that I’m not there? It had two people on it yesterday. Two inpatients for the two residents to see. Record lows – but espeically bothersome because two weeks ago we were seeing record highs.)

 In my currently exhausted state I’ve become bitter, and the frighteningly familiar loss of motivation and sense of barely staying afloat - that I remember from my last bouts with depression – is back. I had a meeting scheduled with the residency administrator today, but my current schedule (obstetrics – essentially 24 hours on, 24 hours off, rinse/repeat x 28 days) didn’t take into consideration that my black cloud would follow me into OB, and I didn’t get out of a delivery in time to meet with her. I will reschedule it, and see what sorts of accomodations can be made, but that may or may not help how I am currently feeling.

 (The floor ran out of beds last week because they had so many people come in actively laboring. I did 7 admissions my first night on OB, and was at 5 deliveries on my first 24 hour shift. For this relatively small community hospital, that’s a whole lotta kids.)

I would much rather have written this first post about what I’m knitting (socks, socks, socks) and what I want to knit (things other than socks) and what I need to knit (mittens for me, as my hands are cooooold), but my knitting time has slowly disappeared.

 Please, if you get a chance, knit a few stitches for me. I wish I had time to travel and meet up with people, and,  overall I wish I was in a better space to enjoy the time I do spend with people.  I know that this will pass – it always has – but it’s hard to appreciate that right now.

(more on things that are a bit lighter soon. (that means cat stories and pictures.))