Saturday, May 28, 2011

How time flies

I keep meaning to blog, or at least finish up some of the ones I've started over the last few months, but there just aren't enough hours in the day. While medicine is much improved hours-wise than surgery, my ability to get things done outside the house has not improved. The only reason I am even blogging now is because I am on call this weekend and I haven't gotten an admission yet. If I was home, my to-do list is long enough that I would be busy for weeks!

It's tough to do a general catch-up note on what's been going on, so I'll just give you a brief overview and then fill you in on what's up right now. First, surgery is done, praise the lord. I honestly didn't mind the procedures, but the constant pimping, the scut work, the terrible hierarchy, and the lack of focus on the patient's care really turned me off. Maybe it was the thrill of doing something other than surgery, but within a week of starting medicine, I thought this was what I wanted to do.

I like that the patients are complicated. I like that the focus is on patient care. I like that (generally) you are out when you should be--there are some late non-call days, but if you've got your work done and everything is stable, you sign out at 5. The long calls (till 11 PM) can be stressful, and since med students don't stay overnight, we don't get to be post-call like the interns and residents. So that means I'm in 7A-5P every day, with 7A-11P schedules every four days. For example, this is my "black" weekend. It means I am on call today from 7A-11P, then I come in tomorrow from 6:30A-till everything is done (around 1 P), then I am back on Monday (since Memorial Day is not a holiday in the hospital). So the weekend is "black" because I don't get a day off.

I did have my "golden weekend" (off both Saturday and Sunday) two weeks ago, which worked out perfectly. That Saturday was a family party for my brother's graduation, my graduation, my West Coast sister being home, and Josh's first birthday. Then on Sunday, I walked in my PhD commencement ceremony. That was actually more emotional than I expected. I had originally not planned to walk, both because I thought it was weird to walk 6 months after I defended and because I didn't want to shell out the $900 for regalia. However, between my family and my lab mentor, I was convinced to do. I am actually glad I did. In my institution, they let the family walk across the stage with the graduate, so Tim, Sophie, and Josh walked with me. Then I got to be hooded by my lab mentor. It was a very surreal experience to be called "doctor" for the first time--my family has teasingly called me doctor for years, but when the announcer did it, it was for real.

That golden weekend was a nice break. Although the weekend was crazy busy, it was at least nice not to be spending all my time in the hospital. My schedule since the beginning of March has been almost unbearable--and to think that it is only a taste of what residency will be like! If it wasn't for my mom cooking every few weeks, we'd probably starve. She's put meals in our freezer that have gotten us through many nights of being too tired to cook. We almost never order out, but we do eat more quick fix meals than I'd like.

I just really have no time or mental capacity to do anything outside the hospital. Tim does 99% of the daycare dropoffs/pickups (unless I am magically out early one day). The nights I am on call, he has the kids by himself, unless we've gotten lucky and have family up that night. The laundry manages to get done on the weekends, mostly by Tim (but sometimes I help, really!). Everything else though--cleaning, organizing, cooking--generally doesn't happen.

I sometimes get a few hours here or there and try to catch up. Unfortunately, usually it is just enough time for me to get started but not enough for me to finish. For example, Josh is now in 18 mos clothes. I still have 6-9 month clothing to sort and put away. He has clothes all over the spare bed in his room sorted into piles, but I haven't been able to just commit a few hours and clean it up. It's a similar story for the downstairs, where the wet spring has turned our tile floors into muddy messes and the dining room table is covered in stacks of Sunday newspapers that I haven't had time to read.

And forget about doing the drugstore deals, clipping coupons, and hitting the sales at the grocery store. I am actually out of shampoo and will need to (gasp!) pay for it because I am not up to date on store deals/coupons and don't know where it is free at the moment. We've been buying as few groceries as we can to get us through, and obviously we buy what's on sale vs. what's not, but I don't have time to stockpile good sales. I call it "guerrilla shopping."  We buy milk, bread, eggs, etc when we have to, buying the cheapest brand, but we don't buy anything we don't need right then. It's not my preferred tactic, and it means we are always scrambling to make dinner with what we have, but I don't have the time to plan things out like I used to.

I have a week off at the end of June, once medicine is done. Initially we were talking about going to my in-laws' condo in Florida; then we decided we couldn't afford airfare and didn't want to drive for two days each way. Then we talked about maybe visiting friends in Pittsburgh for a few days, but we weren't sure we could make our schedules work. Then I was just going to keep the kids home and spend time with them. Now the plan is to keep the kids in day care for a day or two just so I can clean the house, and then I'll keep them out so we can have some time together. I love the kids dearly, but there is no way I can deep clean the house the way it needs to be with both of them running around. Seriously, it's disgusting. I feel like one of those reality TV cleaning people should come over and talk about the filth. I mentally will feel better knowing that at least the house is livable and not harboring disease.

Sad, right? This is only the second week off I've had since I had Josh a year ago. I got along without vacations before, but I used to have two day weekends every weekend. Even if I was in lab on the weekends, I somehow still had enough time to keep up with my life. Now, I'm in the hospital at least one day every weekend for long hours, and I feel like the one day a week I do get off should be devoted to my family. That leaves little time for anything else. Honestly, if my bills weren't auto-paid online, I'm sure I'd be behind on my bills--and if you know me, you know that is the absolute last thing I would ever allow.

I just feel so disoriented--I am sure I could not pass a mini-mental exam. When I ask patients what the date is, I usually have to double check and make sure they are right. The time has gone so fast overall, and yet there are so many days (especially on surgery) where it feels like time is frozen.

How is my son already 13 months old? And my daughter is closer to 4 than 3? Tim & I will be married for 9 years this fall. Unreal.

I know that med school (and soon, residency) is really just a means to an end, but the hours are rough. My lab hours were often tough too, but they were flexibly tough. If I had a doctor's appointment, I could set up my experiments so that they wouldn't interfere. Now, I can't take time if my kids or sick, or I am sick. There's no time to schedule things. And I've missed invites to baseball games and other activities because of my call schedule. Luckily, other than my graduation, there hasn't been anything mandatory yet that I've needed to beg to have my schedule adjusted. But what if I had a wedding to go to, or something similar? And forget just taking a long weekend to get away. Tim's parents sold their camp last year, but even if they still had it, there is no way I could get time off to go.

I've been told that fourth year is much more flexible, with electives making life seem worlds different than third yet. I do have acting internships (one in September, one still unscheduled) to do, which will be tough. Otherwise I am looking forward to taking a breather.

And even though I like medicine, it's still caused me to stop and think about what I really want to do. I had my first patient pass away earlier this week, and I have another patient who was just switched to palliative care and will likely pass away before the weekend is out. That isn't an easy thing to deal with.

I also have the worst luck ever and will be on a difficulty team starting on Monday. My last two teams have been ok--the first was intense but educational, and my current team is not interested in teaching and just wants to be done (it is composed of two prelims, a chief resident serving as attending, and a third year resident--all of whom are moving/transitioning to fellowship in July). Starting Monday, I am going to be on service with my former PI, Dr. B, who made my life miserable for 3.5 years. I was initially worried about being on service with him before I even started my rotation. I debated talking to the clerkship director ahead of time but decided that would seem unprofessional. I worked out the chances of being on service with him at about 4% (using number of attendings, # weeks service/year, and # medicine services in the hospital). I thought a 4% chance should keep me in the clear. Unfortunately, that is just my life.

I did try to contact my clerkship director once I found out that Dr. B would be my attending. Unfortunately, I didn't find out until after rounds yesterday, and when I tried to get in touch with the director, he wasn't around.

I think I am just going to deal with it. It will be extremely uncomfortable, and I am sure he won't give me a very good evaluation--which sucks, because I am working really hard so that I can hopefully get honors in medicine. However, it is two weeks, and I dealt with him for years--at least this point has an end in sight. One of the residents also told me that he comes in for rounds, wants to be super quick, and then you don't see him again. So maybe I won't actually have to spend much time with him.  I just think it epitomizes my luck that I had a 96% chance of not working with the one person in the entire system I was trying to avoid, and I ended up working with him. Such is my life.

In general though, I am feeling more and more comfortable with medicine as my choice. I was worried, since I had done everything else and was having a hard time sorting through the choices. I like that medicine is complex (even though I constantly feel stupid). I like that it involves relationships with patients. I like that it allows me many opportunities for different types of practice, depending on what specialty I decide to pursue. I like that (unlike surgery) sometimes people do have lives outside the hospital (and I am hoping I will learn how to do that too).

There are other fields that have pros and cons, but I think medicine is a good match for my personality. I will still specialize in something, though I am unsure what exactly that might be. The other nice perk of medicine is that my home program has a good reputation for it and places people into great fellowships--which means I at least have the option to stay here for medicine if I want to. I will probably apply other places, and if there is a program that jumps out at me, I'd be willing to move. But at least we have the option to stay for residency and then move for fellowship.

Anyway, sorry for the random train of thought. I can't promise I'll be better about updating for the next month, but once medicine is over (and I have my house clean!) I'll try to be a little less sporadic.

Of course, I'll be here late tonight, since it is past 1 PM and I don't have an admission yet. By the time I see the patient, write the note, look up meds/diseases to tweak my assessment/plan, and then staff the patient, it usually takes >6 hours. My team's a bit chaotic, so I am sure that is not the norm, but that's actually a bit optimistic if past patients are any indication. Oh well, such is life. I guess I have all weekend in the hospital to study--that's being optimistic, right?

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