Message in a Bottle

Well, HELLO there blogosphere! Or is it blogesphere? Whatever, it's a sphere of bloggers.

Word reached my ears fairly recently that there are readers--actual, human readers with functional brains--who read my blog. Even more surprisingly, it sounds like some of these functional brained, human readers actually liked it!

It's been a long absence, it is true. Things in my sphere (VonB-ospehere, I guess) are great, and I am happy to announce that I, and those I love, all survived the past--okay, hang on, let me fire up my calculator watch--HOLY COW IT'S BEEN FIVE YEARS.

Well I feel each and every one of those five years, from my soggy brain to my possibly soggier ass. But I am an honest-to-God, board-certified, fully employed MD/PhD. I know, right?!?

Anyway I have no idea if anyone, anywhere still looks at this thing, and if so, if any of them would be interested in hearing more inane musings about the training process and what lies beyond from the mind that brought you such Nobel prize-winning material as "ChumpWork". But, I thought I'd throw a baited hook in the waters, and see what bites.

I'll keep a closer eye on things for a while. I might even think of some things to write about (off the top of my head: "Residency is an often soul-sucking roller coaster ride through the outskirts of hell").

If there is anyone who is still paying attention, and/or who still cares, I'll have an eye out--if you have questions, ask away!

And I hope that you have all had a mostly-good, sometimes-amazing, rarely-horrible last five years. I've missed this!

Woah

I start residency orientation a week from Monday.

What else can I say? It just feels so huge. It is still not real that I graduated and am an actual medical doctor. Perhaps this is because I certainly do not have the knowledge or experience required to be a medical doctor. Which makes it all the more terrifying that in one week I will be expected to do the job of a medical doctor.

It's funny, looking back, at how stressed out I was about rotations and exams and stuff. I mean, those were grades--that's all. And starting in a few weeks, I will have ACTUAL LIVE PATIENTS for whom I am ordering tests and treatments and medications. Before, I could fail an exam. Now, I could FREAKING KILL SOMEONE.

Now, all of you in medicine know that this isn't exactly 100% true. There are layers and layers of supervision and oversight designed expressly to prevent me, as an intern, from killing someone. But just because I can look down from the high wire and see the net doesn't make me feel all that much better about being up there. I mean, I could fall onto the net, then bounce off of it and land directly in the mouth of a hungry lion. I could fall right into the sole location of a gap in the net. The whole damn net could break, my skull along with it. I will be way the hell up there, and having a net below you is not equal to being on nice, solid ground.

What brought this panic on is the info I just got about taking my PALS (Pediatric Advanced Life Support) class, a two day long affair you have to spend some time studying for ahead of time. And, suddenly, it occurred to me that, holy cow, I might very well end up in a position where instead of hovering against the wall or, at most, being the bag mask girl during a code, I might be expected to actually run the code on a kid. And then I broke out in a cold sweat.

I know that this will pass, and that after a few months of trial by fire I will feel more sure of myself, and less scared. But I kind of hope that the fear never completely goes away; that I never feel totally confident in my abilities. It's a price I have to pay to be the best physician I can. It's the way to keep me on my toes, keep me reading, keep me trying to be better every day. Fear, my constant companion.

(Quick side note: Since I started medical school, every day I find it harder to understand doctors who have a huge ego. Nothing, nothing has made me feel more humble, more naive, less knowledgeable, less confident than studying medicine. And because of its nature, I can't imagine ever feeling differently. Just because you are an excellent swimmer doesn't mean you can just dive in swim across the ocean, no matter how long you train.)

In any case, I leave you with the advice that all those in the medical profession already know: for God's sake, don't get sick in July.

M.D. -> Patient -> Mommy -> Resident

Weird transitions to be happening so very closely together.
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A little over a week ago I graduated. The big one. THE graduation. The Grandaddy I've been working towards for eight long years.

Less than two days later, I was admitted into the hospital where I had been a student, into one of the rooms where I had delivered a baby as a medical student, to have a baby of my own.

About 13 hours after that, I became a mother.

My head is spinning. Doing this baby thing is completely overwhelming. Obviously I have tremendous support (which is the main reason I'm still alive) but still--insane.

Again I am faced with the same issues I was when Mr. Dr. Dr. VonB got sick. I know too much, and too little. Though I'm going into a peds prelim year in four weeks, there is so very much I don't know about healthy infants. Sadly, I know way more about sick infants, the result being that I have been one of "those" mothers, the ones who drive pediatricians crazy; wondering about every single little thing incessantly. Is she breathing too hard during this feeding (subtext: could she have a congenital heart defect)? What's up with her peeling skin and nails (subtext: could she have some kind of weird genetic connective tissue disorder)? Why is she so pale (subtext: could she have a red blood cell disorder? (real answer: because you and your hubby are dairy white, crazypants...))? You know. Crazy.

Being in the hospital was strange, too. All of a sudden, instead of the medical student dealing with a frustrated patient waiting hours to be discharged, I was the frustrated patient. Instead of fielding 1000 paranoid questions about a new baby, I was the one hurling them out there.

Having not been in the hospital in forever, I had forgotten how horrible it is being woken up every 10 minutes. At one point, when my husband was taking care of the baby so I could have the first nap I'd had in almost two days, I started counting: in 1 hour we had EIGHT people knock on our door to come in and examine me, examine the baby, tell us about the new study they'd like to enroll us in, offer to clean the room, examine me again... I was ready to die. The hospital is such a HORRIBLE place to try and get any rest or recuperation. And the worst part is that when you do want to see someone, they don't show up. Ever. The lactation nurse came by once, and I was anxious to meet one more time before we left, but of course she was two hours late and I was therefore discharged before I could see her. The attending came right in the middle of my nap, but when we were ready to be discharged (and I mean, REALLY ready), it took her three hours to get the orders in. Ugh. Things to remember when I'm back on the other side.

Speaking of which, that's right around the corner. I feel I have forgotten everything I've ever learned, and it's freaking me out. I have two weeks of orientation and then I'm fresh meat on the wards (though starting with a very easy rotation).

My other problem is that I never imagined I would be one of those women who finds herself crushed thinking about leaving her child to go back to work. I'm not heartless; I assumed it would be difficult. But I can't put into words how hard it is to think about now. I am 150% sure at least part of it is the hormones and the sleep deprivation, but still. This is going to be a doozy. Strangely, at the same time, I'm excited to be a real doc. It's remarkably difficult.

Well, baby is stirring and calling for the cow (me). At her next nap I am going to try to get some reviewing in, but I'm not holding out much hope. Lately whenever I'm not actually standing or walking I tend to fall asleep, and this time I don't think that even the fear of being an intern will be enough to keep me awake while reading about strep throat.

Graduation cometh

Well, this is it. Time's up. Graduation is tomorrow.

Last night we had our mudphud program graduation party. Today we had graduation rehearsal, so I got to hear them call my name, then say, "VonB, Doctor of Medicine and Doctor of Philosophy", then I walked across the stage so they could put the crazy hood on me. Then I sat back down.

I have to tell you--so far, this whole thing has been strangely and unsettlingly anticlimactic. Maybe it will be different when everyone has on their robes and hats, and the bleachers are full of friends and family cheering. Maybe it will be different when I have a program that has my name in it. I don't know. For now it's all just surreal and, well, tiring.

Little VonB has not made her appearance. I can't wear the dress I bought for graduation, both because I can't go without support hose now (by the way, 3+ edema is VERY uncomfortable; I have a whole new level of sympathy for patients who have it) and because I can't get my feet into any shoes besides sneakers. She's due on Sunday, and I am lucky enough to have an OB who understands that I am eminently beginning residency and was happy to schedule an induction on Monday should the tike continue to be stubborn.

So, it is looking like I will be able to waddle across the stage tomorrow after all. But like I said--it isn't as exciting as I thought it would be, somehow. I find myself not really hoping that Little VonB holds out until after graduation, but feeling more indifferent. It's like when I had my dissertation defense. Then, I blamed it on not having a graduation. But I see now it's not that at all. Maybe it's because I've been doing this thing so long, it feels much more like a job than anything else. Maybe it's because endings are often anticlimactic. Maybe it's my crazy hormones. I'm sure it will dawn on me soon and I will feel all kinds of emotions. But for now, I mostly feel: meh.

I admit, have been feeling sort of nostalgic and sad; a lot of it is for the friends who are moving away, but some of it is for my MSTP program itself. It's been like a family to me for so long. I've invested a lot in it, made a lot of changes I'm proud of. I hope I've left it a little better than it was before. And it isn't like I won't be around and able to check in from time to time. It's just... well, I won't be part of that group anymore. I'll be in a new group.

I think that's part of it, too. I'm excited to meet the new interns and get to know all of the residents I hadn't met before--but I'm nervous, too. And kind of tired just thinking about it. Although basically everyone would describe me as an extrovert, I'm shy in my own way. I'm also not good with change (I guess most people aren't, but still). Also, like when I started medical school, I'm hesitant to get too attached to a new set of people I will be leaving so soon. However, I always regretted not making more friends in my original medical school class, so maybe this is my chance for a do-over.

On the other hand, as we recently discussed over on OldMDGirl's blog, it can be hard making friends with people who are so much younger than you, with such different life experiences. Maybe residency will level some of that out. Hmm. Not holding my breath, but still hopeful.

Now I'm just rambling, which is my cue to sign off. When next I post, I will be VonB, M.D., Ph.D. For reals.

Weird.

Residency, husband, baby, nervous breakdown

Old MD Girl recently posted her thoughts on "The Good Life", specifically the musings about it she had heard from a male lecturer. It got me thinking a lot about my experiences so far and what I am facing down when it comes to being a mudphud, married to another mudphud, looking down the barrel of us both being interns and then residents, with a baby on the way and hopes for at least one more in the future.

Like Old MD Girl, I have also been privy to the musings of many a physician or practicing mudphud when it comes to "lifestyle", "goals", "balancing career and family", etc. The striking thing is how differently this is talked about by males vs females.

I do hate to generalize and certainly hate to generalize based on gender--Lord knows I resent it when anyone else does--but I would be lying if I said there wasn't a persistent difference in my experience. So far, without fail, when a man is talking all about how "you CAN have it all", how he has a thriving practice, two grants, and three great kids, he says it all has to do with balance and good decisions and careful planning. I always ask these men: "What does your wife do?" And so far, without fail, they look slightly abashed as they answer, "she stays at home with the kids." Aha. So she's the one running the parts of your life that aren't lab or patients; she's the one that makes sure that when you are at home you get Quality Time with the Family, because she's already done the laundry and the cooking and the shopping and the cleaning and the paying the bills and... well, you get my point.

When women mudphuds or physician-scientists talk about Life Balance, they almost always say you can't really have it all, that something has to give. They talk about hiring help; nannies, cooks, maids, whatever you need to get through. They talk about having to cut back hours sometimes, and finding lots of good after-school programs; about working part time if you have to, and having a very supportive spouse (interestingly, they always bring this up without me having to ask. So far, none of the men have).

There was one exception to this. We heard from a couple who were both physician scientists and had a young child. I'm sure they are perfectly lovely and accomplished people but please believe me of understatement when I say that after hearing their presentation on "balancing" professional and private life, my husband and I wanted to shoot ourselves. Their system went something like this: one would go in to to work around 4am while the other kept the baby until the nanny arrived; then they would both work all day; then the one who went in at 4am would come home around 6 or 7pm and relieve the nanny, while the other would stay at work until around midnight. The one who stayed at home would work from there, writing grants. Sometimes, they said maybe once a week, they would both be home and have dinner together--although this meant one would have to go back to work until 1 or 2am.

Horrible, horrible, horrible, we thought. There must be another way. I don't know about you, readers, but I can't live like that. As I said when I was interviewing for residency and was repeatedly asked why I couldn't expand my geographical area and just live away from my husband for three years: I married him for a reason. I like having him around, and honestly being apart for three years is not an option I am willing to consider. Sorry; life is too short not to be with the ones you love.

Likewise, I can't imagine never seeing my children. I have no delusions that I will not see my daughter as much as I'd like this coming year; however, I can manage because it is a temporary situation. The couple described above intended to keep up such a schedule for at least three years until their fellowships were completed (and hinted it would be many more before their labs were established enough they could give up such a schedule).

I'm sorry, but since when did becoming a doc mirror entering the priesthood? Is it reasonable to expect us to give up any chance at having a life outside of work? Although we both love our chosen fields, my husband and I picked ophthalmology and dermatology partially because we knew those areas gave us the best shot at being able to be fully functional mudphuds--patients and research--without guaranteeing that we would suck at one or the other (or both), and without having years of never seeing each other or our children. Had one or both of us chosen medicine, followed by a fellowship, it's hard to image a way to escape the misery of the docs described above.

I feel there has to be a better way to do things. I worry that by asking so much sacrifice, the most talented people are being driven away from medicine and research, and particularly those fields where they are most needed (primary care, etc.). And the sacrifices seem to only get bigger as time goes on--more debt upon graduation, more hours spent on billing and insurance, more days on the phone with some random dude who has a bachelor's in rhetoric and communications and is trying to tell you how to treat your patient, more years working such long hours that you don't have anything to give at the end of the day to research, much less your family.

We are going to have to face the fact that we would have more, happier, better doctors if we didn't abuse them so. I read that Obama is struggling to find the best way to address the current and growingly alarming doctor shortage. How about allowing them to have a decent quality of life? More debt forgiveness for those who go into primary care; more flexible schedules and hours (which would often mean hiring more docs); more autonomy from the HMOs in how they treat their patients.

Well, I've gotten off topic, but I'm sure you get the gist. I wonder--I hope--my hubby and I are doing the right thing. Most days, I feel pretty confident that our kids will be fine in daycare. We'll have time for them and for each other, and hopefully won't suck at patient care or research. I'm hoping that we CAN "have it all". I'm pretty sure I will need a maid, though, since I'm unlucky enough not to have a stay-at-home spouse running the rest of my life. To those of you who do, I salute you. Just be sure to thank him or her the next time you're bragging about successful you are.

T minus 18 days until MD

Crazy, no?

It's extra strange to me because I have been so completely focused on other things--lab, getting my medical license (pain in the ASS), doing the mounds of paperwork required to be a resident, getting ready for the baby (YIKES), the foils of pregnancy (being essentially handicapped with various ailments, frequent doctor visits, etc etc), and importantly the hubby's PET scan which is at the end of the week--that I haven't thought much at all about the fact that I am about to graduate and be a student no more. It's a mind scrambler.

In other news, I passed Step 2 CS, which is good, because it means that no one at the NMBE has to get a whupping from me. What a lame experience that was.

My internship starts June 15th, which is more than a week sooner than I had hoped. Mainly I am sad to have less "maternity leave"/time to recover from childbirth and attempt to build up a supply of pumped milk. By the way, though I have seen lactation nurses teach new moms how to pump I am not relishing the thought of having to pump myself.

Which actually kind of explains my whole take on this pregnancy/childbirth thing. I've seen a third degree tear up close and personal, as well as lots of C sections, births gone awry, or even those that go okay but still leave mental scars for those who had to witness them. Having seen so much from the medical end of things must alter how you view the experience, but I can't say, having only had the experience from this point of view. It's also weird because I am reading books about Lamaze, approaches to laboring, etc., most of which are pretty darn anti-medicine; however, clearly I am NOT so much with the anti-medicine. But apparently I am pretty susceptible to suggestion because I keep finding myself thinking, "Yeah! Why DO they make laboring women do that?!" It's very strange.

And even though all the books try to make you feel guilty about having any drugs, I am totally getting an epidural. Why? Because I've seen what happens to first time moms who don't, and... well, no thanks.

In any case, that's all for now. The countdown to labor and--gasp!--graduation is ON. Hopefully I will labor early enough to be able to go to graduation. It's going to be a close shave, as I am due the day after graduation. I think I would be pretty bummed to miss graduation; after all, this is a big end to a looooooooong road, and I feel I've earned hearing my name and walking across the stage. I guess there are more important things, but damn. Come a little early, girl, and let your momma have her day in the sun!

Now I'm back to all those chores and errands which somehow seem to take up WAY less time when you are working than when you are on vacation. How does that always happen?

What Capstone Taught Me

-First, I am even more scared to get sued than I was before. I don't think that is what they were going for with their "Don't worry, you can avoid getting sued" talk.

-By the way, malpractice insurance is frickin' expensive.

-Also, it now seems inevitable that I, or someone I know, will develop a drug or alcohol problem. If it is someone I know, I will be forced to report that person to the Medical Licensing Board and potentially ruin their lives.

-Say what you will about the MD/PhD pathway (Lord knows I have), but at least I am not well into six figures in debt like my classmates, who will have to work just as hard as me (who am I kidding, I'm going in to Derm... they will have to work harder) and be much poorer for a looooooooong time.

-Docs sure do seem to get the s*** end of the stick.

-I figured it would be awful to have to tell the family of a patient that their loved one might die because I screwed up; standardized patient family members have helped me realize that "awful" is the understatement of the year.

-Sometimes, there are patients who have had bad health care experiences who have a lot of valuable things to say. And sometimes, there are patients you want to smack because they clearly think they understand what happened to them, but in reality they got most of their information from qacks and you have to listen to their ridiculous nonsensical ramblings about how awful doctors are.

-Apparently--and this TOTALLY blew my mind--it's a bad idea to have sex with one of your patients, especially if that patient has borderline personality disorder. Holy Cow! I am so glad I sat through an hour long lecture to learn this gem, because otherwise I might have gotten into real trouble!

-Residency is hard. No, seriously.

-You won't have time to take care of yourself, but you owe it to yourself and your patients to take care of yourself. Whatever that means.

-Finally and most importantly: I am completely done with medical school. Holy 8 year training program completion, Batman!