This is why we keep doing this

Got a hug and a kiss today from a patient.

Another said "My family loved you!" She was a recent hysterectomy.

I got to hold twin A of the set that I delivered the other day. Twin B had a diaper blowout, so I declined. ;)

OMG!

I need to buy lotto tickets, because I'm living life right:

A managed medicaid approved my prior auth in the first phone call.

Booyah!

My favorite day

Thanksgiving. The name alone says it all.

I am thankful for my family. My husband is a saint for putting up with me. My kids are growing up into loving, wonderful people.

I am thankful for my friends. Girlfriends are where it's at.

I am grateful for my job - this hospital is infinitely better than my previous snakepit.

I am thankful for all of my dogs. They give unconditional love when needed.

I am thankful for the food in my tummy and the roof over my head.

I am thankful for my health.

The joy of coming back to work

I'm winning Press-Ganey over patient by patient.

No, I am NOT going to induce you at 33 weeks. Yes, I understand your back hurts. Yes, I know sleeping can be difficult. But no delivery. Nuh-nuh, no fucking way. Please go ahead and curse out my checkout staff. We love it when you do that.

No, there is no medical reason for me to place you on complete bed rest at 36 weeks. Yes, if your pregnancy is uncomplicated, I do expect you to work. And no, your complaints are typical late pregnancy complaints, there is no objective reason for you to be sitting on your ass. Thank-you for calling the patient advocate at the hospital and wasting 5 hours of my and my office manager and the VP of clinical care's time defending my medical decision making. Fuck you. And yes, if you wish to transfer, go ahead and sign the records release. They will be faxed so fast your head will spin. So sorry the hospital administration agreed with me.

Nope, not gonna prescribe percocet to you for back pain in your first trimester.

There's an old Twilight Zone episode about a guy who can see into the future and give you what you need. At first, it seems weird - a shoe or a pair of scissors. Who wants that? That is a part of my job - I should give you what you need, not necessarily what you want.

For my Dad, Grandfathers, and uncles...

1 week out

Saw my foot for the first time...it is literally twice the size it normally is, with a ton of swelling. Still has the orange dye from the hibiclens scrub all over, since it is in a dressing. It was put back into a new dressing without a wash. Reminds me of the Oompa-Loompas from Charlie and the Chocolate Factory. Ortho was pleased - "It looks great!" Three incisions about my ankle. He said that it was a mess in there.

Tried to go yesterday without the percocet. Will not make that mistake again, as sleep was elusive. I hate using it!

It's a production to get out of bed, shower, and get dressed. Which is why I've only done it twice since surgery. But I have got to go into work today to sign up for my bennies for next year and to talk to administration. Plus see people. I'm not lonely, but I miss talking to people.

Am arguing with our office manager - my schedule on the day I come back is very light. I'm telling her to open it up, that I can see a full load of patients that day. She's refusing, saying that she wants to ensure I'm OK. UGH! What's worse is I told her to look out for me, since I know I'll push myself too much, so I can't even get mad at her! (as if I would, she's one of my dearest friends here) She's also trying to take me off of call the second week I get back, which I'm not letting her do. She is as stubborn as me.

Doctors are horrible patients.

Shoe on the other foot

Surgery has come and gone. It's weird being on the other side of the bed.

For some reason, I got the XXL gown. I asked for a smaller one, as I did not need to flash cleavage at anyone. Or, to be more accurate, no one WANTS to see it. They found one. By 8:30, it was 5:00 for me, as the happy juice was flowing. I actually hate the feeling of the room spinning. I do remember thinking the OR was tiny compared to what I was used to at my hospital. I also had trouble moving from the cart to the table, I was so high.

Pain afterwards was bad, so was the nausea. The plan was for MAC anesthesia, but because of how bad my ankle was, the surgeon asked for me to be put under after he did the incision. (evidently, I don't remember this). I'm glad I had my partner call in Zofran and phenergan last week. Scop patch is still on as well.

I'm planning on back to work in a couple of weeks. I took myself off call for November (the advantage of making the call schedule). Guess I can do some online CME, watch a lot of food network, and sleep.

Ortho HURTS!

Smart-ass

So pre-admission testing called me yesterday regarding my upcoming surgery. Very last question : Have you been exposed to Ebola in the last 3 weeks?

It took all of my will-power to answer seriously. But I really wanted to tell her yes.

Rethink Breast Cancer - Your Man Reminder

Just for a smile

Up and down

Kinda defines my life right now.

Up: Paid off my student loans.
Down: From my inheritance - not how I would wish it.

Up: Paycheck skyrocketing.
Down: Damned polar vortex. Our deliveries are up 38% from an average month.

Up: Awesome parent-teacher conferences.
Down: I HAVE A HIGH-SCHOOLER?!?!?!?!?!?!?

Up: I have a definitive diagnosis for my foot.
Down: This means more surgery.
Up: But it means FMLA time off for me...

Up: My friends are awesome.
Down: My sister is still a fucking lunatic.

Up: My weight.
Down: Because of emotional overeating.
Down: I have no dress pants that fit!!!!

Fuck it All Honest Finals Version Full Screen

This is kinda how I'm feeling about my job this week.

NEJM articles and musings on changes

Interesting article in this week's NEJM regarding the ethics of testing of procedures. A lot of what we do in OB/GYN is procedures - surgeries, office procedures. And a fair amount of what folks do is based on shoddy science and cool tools (I'm looking at you, DaVinci).

But science is linked to asking the how and why questions. And we change practices if we can be shown (some people may need to be beaten about the head with the evidence). Episiotomy rates have plummeted - I was a resident when these studies were coming out and most attendings drastically decreased that procedure fairly quickly. Early term inductions as well - my first practice they wanted to deliver everyone by 38ish weeks. Vaginal mesh is now rare...thank goodness. Digging it out of the vagina is a hot, unpleasant mess. I'm happy to say I was an early disadopter of the various meshes.

Sterilization methods may be revolutionized as well if some of the newest data from Canada holds up, but it'll be another decade before we can see a reduction in ovarian cancer because of changing the method of tubal ligation. Plus, some new data from Essure is showing long-term, it's not as effective as we need it to be.

Guess I'll always have something new to learn.

Really?

Today was a facepalm kinda day. Sorta like this:

You know, FOBs talking about how THEY plan on breastfeeding, telling me "I didn't shave the kitty", or getting knocked up by a guy who has multiple girlfriends tends to make me do that.

Like I told a coworker, "I got whacked with the crazy and stupid stick today."

Sigh.

Tired

Of people assuming I'm stupid because I'm female.

Of teens who show up 30+ weeks pregnant.

Of my house being a flipping disaster.

Of administrative bullshit. I may have told a VP of the hospital that he was a roadblock to progress.

Of always being asked to pick up extra.

Of my stupid ortho injuries. Yes, plural.

Of pushing with first time moms at O'dark o'clock.

gah. Thanks god for a long weekend.

Venting

Why the HELL do people think a degree from fucking Dr. Google trumps my experience and education?

I went to med school for 4 long years. I then did a residency for another 4 incredibly long and painful years. I have been out of residency for 8 years. I know shit. I know OB. I've done thousands of deliveries. I can tell you what is likely to happen if we do things your way. Doing things my way leads to a HIGHER chance of a vaginal delivery!

SO FUCKING LISTEN TO ME when I make a recommendation at 8 am. And then you won't have to be telling me at midnight "You were right." DAMN STRAIGHT.

Lucky

Have had several days recently where every patient was NICE.

All toddlers were cute and so proud of "their" baby.

New patients almost completely (and correctly) worked up by the referring physician.

Surgeries that go exactly textbook.

I just jinxed myself.

Best. Call. Ever.

Wake up at 3:22 am to the sound of a dog howling. Get her calmed down.

4:00, decide sleep was no longer an option. Boot up computer to goof off. Hear a wet farting sound behind me to see a dog having a diarrheal episode. Throw her outside, where she has more and then wipes her butt on the grass. Turn around to realize that I've locked myself out of the house. Get into the garage, banging leg against lawnmower. Find the lightswitch so I can find the #$%&^%^^*$##$@$$%&^% key.

Let myself back into the house and let the dog back in. Gather supplies to clean up living room. Enter living room to find our dipshit lab trying to EAT the mess. Start yelling and wake the husband up (again). I'm dry heaving as I'm cleaning up the mess. He takes over. I go into kitchen to find coffee.

At 7 am, decide that dozing sounds like a great idea...The newest dog jumps into bed. Fine. Until she pees on the bedspread. FML.

By this time, I've decided that I'm just going to sleep on OB from now on.

Grateful

For friends who let me text and email to bitch about life in general.

For office days where every single patient is nice and sane.

For two terrific kids.

For a husband who is my rock.

For reasons to celebrate - weddings and babies are on the calendar (not for me, obviously...)

A rewrite of Abba's Dancing Queen

You can cut, You can sew,
Having the time of your life
See that girl, watch that scene, digging the Section Queen.

Friday night and the lights are low
Looking out for the place to go
When they stop dilatin'
And the heart tones go
Waaay too low.

You are the Section Queen, Not needing sleep, cutting seventeen!
Section Queen, working with the breathing machine.
You can cut, you can sew, having the time of your life
See that girl, scrub that skin, digging the Section Queen.

Randomness

Doctors are THE WORST FUCKING PATIENTS!!!!! And for once, the patient is not me.

I need my head examined when scheduling fibroidy uteri for removal.

Writing eulogies is hard & I suck.

The house is really quiet without the boy running around (he's at summer camp this week).

I am never going to California again.

I don't even want to know how much I've spent on airline tickets the last few months.

Shit, I now own 2 homes again.

I need to go to the casino - I figure I should have good luck, regression to the mean and all.

I did NOT need the van conking out last week. I don't have time for that shit.

So long and miss you

Some thoughts

Yesterday was a decent enough day in the office. Lots of OB visits. Cute siblings bragging about "their" baby. Talking about birth control with some postpartum patients. Nothing unusual. I tell my patients when everything is fine: "You're boring." I said that a lot yesterday.

Boring is good. Boring means that things are going the way they are supposed to go. Boring means healthy moms, healthy babies. Boring means I may not know your name until 37ish weeks. THAT IS NOT A BAD THING!!!!!! Nonboring means I'm having the pre-eclampsia discussion at 33 weeks. Talking to you about scheduling a version versus a section. Sending you to the ultrasound room because I haven't found heart tones with the doppler.

Trust me, you want to be boring. And quite frankly, I'm too old for non-boring. Excitement is not a good thing in medicine.

Meditation

One of my dearest friends texted me recently. Her mother died after being in Hospice for a few weeks. My partner's dad just died. On Facebook, announcements of various teachers' obits are a regular on my newsfeed. I'm waiting for my mother to finally pass.

That's what being a 40-something is. We're staring at the realization that soon we'll be the oldest in the family. That we can't ask those ahead of us what to do. I look through our wedding album, only to realize that quite a few are now gone. Aunts, uncles, family friends. The giants from the past now exist only in our mind.

If that's being a grown up, take me back.

Misunderstanding

My mom has been pretty sick the last few weeks. She was septic and pulled though, much to everyone's surprise. My conversation with her a few days later.

Mom: Doctor said I had three germs in my blood, that's why I was so sick.
Me: Really? What ones?
Mom: One was Proteus, I think.
Me: Yes, that's a common bug.
Mom: The next one was chlamydia.
Me: Are you sure it's not Klebsiella? I'm pretty sure you weren't septic with chlamydia.
Mom: No, I'm positive it was chlamydia.
Me: ?????

At this point, I don't argue because what's the point?
Mom: I don't remember what the last one was.

Beatles- Let It Be

Ugh

Those OR days when nothing goes right. Had one recently. Knew my first case was going to be a bitch, because I'd scoped her in the past. As an aside, I really hate endometriosis. So you set yourself up for success - extensive counseling about possibly needing to convert from a scope to an open procedure. Book extra OR time. Have the most experienced partner as an assist instead of using a nurse first assist. Have in the room anything you may possibly need (not opened, but in the room). And the case went well, although it took the extra time allotted. Next case had difficulty. Final case of the day I was hoping would be a slam-dunk scope. Put in the camera.

"No. Not today. I don't want to deal with that."

"I think I'm going to start swearing now."

Yeah, not how we want to start the case - with big ugly adhesions everywhere.

Thanks to a friend who shared this with me

Help

Insanity: doing the same thing over and over and expecting a different outcome.

We need to do more for the vets who come home. We need more mental health caregivers. We need more help. Or else more of the same will keep appearing on the news with depressing regularity.

Jinxing myself

I think ortho removed a certain magnet...this is kinda scary for my calls to be this q-word.

Not complaining.

Observations

1. My daughter is turning into an absolutely lovely young lady. Inside and out. Last night, she was wearing just lip gloss and the wind caught her hair while we were taking a walk...Wow. I'm pretty sure I'm not ready for this. On the upside, she was asked to the spring dance and told the young guy no - stuff like that is not her thing.
2. Not drinking caffeine will cause me to hit a wall right around 2 pm. This sucks for the late afternoon patients.
3. Seeing the birth of your first child universally is amazing. Yesterday's dad spoke no English and I didn't speak his language (my patient is bilingual) but I could easily understand the tears that streamed down his face as he cut the cord while beaming.
4. I can't do it all...need to temporarily hire a housecleaner. I'm spending 4 days a week with my mom and 3 days a week at home. Balls that used to be up in the air are being dropped. My house is a disaster (by my standards).
5. 4 am is NOT an appropriate time to be awake and typing blog posts.
6. I had to laugh at my vet on Tuesday, as he was delayed because of an emergency. As I was leaving, he was apologizing left and right. I pointed out that I completely understood...
7. And my chow-chow looks at me as if saying "Just TRY to get me to take that pill!" I think she's more stubborn than me.
8. I haven't drunk Diet Coke since my surgery. Have switched over to water and tea. A first step towards getting healthier. My daughter wants us to join a yoga class. Maybe THIS will be the exercise that can't injure me.

Scheduling Rules

1. A new patient will NEVER be the first one in the morning or the last one of the day.
---Because they have a higher no-show rate than established patients.

2. 15 minute slots
---for most patients

3. Certain types of appointments get a 30 minute slot or barring that, block a 15 minute slot later in that same half day.
---Certain procedures we do take longer. Removing an Implanon, for example. Fitting a pessary. New patients. These take time.

4. Only 1 pessary FITTING per day. Any number of pessary rechecks allowed.
---Because we only have 1 fitting kit and it takes time to sterilize it between patients. My area of interest is prolapse, so I do most of the pessaries in the group.

5. No back to back paps.
---Not for me, they're easy for me. But it takes my M.A. time to deal with the paperwork associated with paps. Not having them back to back gives her some catch-up time.

6. I have a list of needier patients. They cannot be the last patient of the day.
---I'm selfish and just want to get home. So sue me.

7. Easy stuff (OBs and acute slots) only on my call days.
---Because if I get called out for a delivery, my partners can work them into their schedules. And I return the favor ("Hi! I'm not Dr XX, she's delivering someone...mind if I see you to help you avoid a wait?")

So when you call in and ask for a specific type of appointment, there may be a good reason as to why we can't see you for a few weeks. Please don't take it out on my awesome front staff.

Evil

So I have a partner who is like my twin - we think alike and have the same general sensibility about the world. I love her to death.

The other day, a mutual acquaintance was texting her every 20-30 minutes or so. And my partner was getting really annoyed, because she doesn't really like this other person (I don't either). My partner was also on call that day...so that night I texted her every 30 minutes or so just to bug her. Best part was when she had to run out of the shower only to see it was me. I even sent her a text saying "And you can't turn your phone off!"

I'm still waiting for my payback.

Baby steps...

Was given to OK to go back into the OR but start with easier cases. And have a partner assist, just in case it gets bad in the middle of a case.

I'm actually more worried about a difficult vaginal delivery. I know that pre-operatively, there were some hairy deliveries that I did. And the next 1-2 days after them, I paid the price. If I have a bad looking strip and I think I can get the kid out faster with a vacuum, that's what I'll do. But people don't realize the physicality of that. And there's no time to call for back-up, I'll just have to do it.

And I was scrubbed into the section, but my partner wouldn't let me do anything other than cut suture and announce gender. I was more useless than a med student! It's funny, I literally did nothing in the case but the parents are thrilled that I was there. One of the grandmas works at the PT place I go to and at my appointment today, she came over to thank me. And I told ortho at my appointment, he had already known (small hospital...lots of people ratted me out)

Looks like I'm going to be the D&C and lap tubal queen for awhile. I have 2 cases booked that I know are going to be bad...I decided to push them out to June and torture my senior-most partner with being the assist on those 2 cases. Just going to wish for no surprise endometriosis in my cases for quite some time.

Follow up

It's 5 am, been up for hours thanks to landing wrong on my shoulder whilst sleeping. Trying to keep off narcotics is meaning that sleeping is now dependent upon me staying off of the bad side. I frequently fail to stay off the bad side. I gave up and took a Percocet around 3. Hopefully it'll wear off before I need to work today.

Someone asked previously if this and my mother's situation has changed me as a doctor. Yes and no.

No. I've always tried to treat people how I want my family to be treated. It's just the right thing to do. Am I perfect? No. But I honestly try. And I do care about my patients. Don't tell ortho, but I'm assisting in a section next week because I really like my patient - and she really likes me. I delivered her first child. We are lucky in OB, we get to build relationships like that.

Yes. I'm frustrated with my mom's situation. It seems to have spiraled quickly. Communication from her docs (and admittedly, I'm getting this via my sister and mother) is lackluster at best. This has made me re-evaluate my communication skills & hopefully work to improve them.

Waiting. Wait for this result. Wait for that appointment. I'm better at giving patients a timeline now for when info will be available.

Pain. For those with diagnosed diseases, I'm more liberal. I'm still cautious prior to the work-up, but I'm very sympathetic now to just how draining pain is on your life. Putting in a full day of work right now is about my limit. Another reason for me to hate endometriosis.

Perfection

Residency, in gif form.

ETA: go back and read the whole damn thing. The very first posting is classic. Thanks to my sister from another mister for finding this.

Just venting

About my aging body.

I'm 40, soon to be 41. And I just hurt.

My shoulder is killing me today after PT. PT makes me nauseated, such that I can't wait to get home to down a Phenergan. If I have a driver, I take pain meds prior to PT. Today, I didn't so I sucked it up and took both meds as soon as I got home. Now the room is spinning.

I've now lost 4 pounds since surgery. Tuesday was the first day I ate all 3 meals. I spent yesterday barfing. Today, I'm just nauseated.

It just hurts. I'm not sure if it's better or worse since surgery. My arm has passive ROM that's nearly full, but there's a lot of weakness. Dressing myself is a challenge. I can't put on my winter coat, which sucks right now with these temps. I can't do anything with my hair except for a headband - no ponytails or braids. Sleeping is interesting - land wrong and you wake up with shooting pain.

I knew going in that it may not be a cure. And maybe I just need to be more patient. But I'm getting frustrated.

Narcotics

Took another one early.

I admit, I have a hard time understanding narcotics addiction. The side effects seem to be so bad for what is an ephemeral feeling. And as a doctor, I'm trying to care for the patient as best as I can. But there are trust issues (both ways) that impede this.

I have no solutions. Just a sad shake of my head.

Thank-you

For the kind thoughts.

I'm typing this one-handed, so it'll be short. Ortho found a fixable mess in the shoulder, something no amount of PT would have fixed. So it looks like I made a good choice.

Back on the Percocet diet - haven't had much to eat since before surgery because of nausea. I'm still amazed at how much ortho surgery hurts!

Decided that my plan to return to work Monday was a wee bit optimistic. Just like everyone told me it would be. I'm surprised that my office manager hasn't tried to strangle me yet.

Life goes on...

And I'm a hot mess. Literally. My mom is getting very ill, I'm spending most weekends in my hometown. She can't be left alone and is refusing assisted living. We've cobbled together a group of people to help. Fortunately, both of us married local boys, so our extended in-law families are pitching in. Cousins, aunts/uncles, and our MIL/FILs. We're lucky to have that support.

My hometown airport is so small, there are no bathrooms past security. And no food. There is a pop vending machine - Grumpy would hate it because it was Pepsi. I signed up for United FF miles, since they're the only ones who fly into this airport.

I feel bad for my sister, her husband has H1N1 and has been hospitalized. She's a little stressed.

Viral gastroenteritis is a lousy way to lose holiday weight.

My shoulder's getting worse, not better. I went back to operating. It's not a good thing. I can't manipulate the fucking overlight lights in the OR. Vaginal surgery, my specialty, makes everything worse. The 2 D&Cs I did last week damn near killed me - had to go home and ice it and pop pain meds. A D&C!

Surgery is scheduled for next week. And then off for "at least 6 weeks". No surgeries, no deliveries, but I talked ortho into letting do paps in the office. DH will kill me if I don't obey ortho. So I'm looking at conferences to go to, figure I might as well get in my CME. One partner is pissed about needing to pick up a couple of extra calls. So help me god, I may strangle her. Especially since she took a 4 MONTH maternity leave last year. I wonder if she has realized that she'll be picking up extra call when another one of us goes on maternity leave this summer? I'm cranky enough not to point that out just yet.

Vicodin doesn't take away the pain, it just makes you high so that you don't care.

I'm in the middle of contract renewal. I actively avoid dealing with administrators on a regular basis. It's just better that way. But my jaw hit the floor yesterday (in a good way) when I heard the offer. I'm not used to that. My husband & I have a theory that only psychopaths go into administration. It seems to be true in healthcare and he says it's true in academia.

Okaaaaaayyyyyyyyy......

I didn't need a yodeling demo in the middle of your pap.

That was interesting.