Wednesday, June 27, 2012

A Day in the Life. Internal Medicine. Day shift.

5:07am alarm. No snooze, means shower. Snooze, means, well, no shower. Yup, I admit it, I don't shower everyday.  Sometimes I need those extra 15 minutes. Sometimes I don't shower, just so I can stop at Starbucks on my way to work.  Somedays, you just need something to look forward to in order to get out of bed, and for me, that is a Caramel Latte. For timeline-sake, let's say no snooze. So, I shower.  If George woke up and ate during the night, I continue on to get dressed, make some coffee, pack up my pump equipment and walk out the door.  If he didn't wake up, I get him out of bed, and force him to eat, then scramble to get out of the door on time, but likely, I will be 4 minutes late for check out rounds.  Somedays I remember breakfast, somedays I don't.  Generally, there is food lingering around that is available to eat while on inpatient medicine, so I rarely starve. Somedays it's too busy to really care or be concerned about eating.

6:15am (if I successfully made it on time) is check out rounds.  I meet up with 4 or 5 of my fellow residents, and the overnight call person who managed the entire list of 7-34 patients depending on the current census while admitting all the new patients, from 7pm until 7am, tells us about their night.  Some nights are nice.  Some nights you get no admissions.  Some nights are hell.  You get 8 admissions, then someone codes, then a "bad baby" is being born on the OB floor and you have to rush off to assist in the delivery and maybe even intubate a newborn. Meanwhile, you have not answered the last 11 pages that are "FYI" pages from the nurses.  Some of these "FYI"s are helpful, responsible, necessary pages.  Some of them are, wtf, why do I give a sh*&, please don't bother me with this kind of information pages. 

Anywho, back to the day person shift, we are not talking about nights.  This time. So, we listen to the overnight resident, jot a few items down on the patients we are expected to follow, and then, the most relaxing part of my entire day, until about 9:40pm (or 9:53pm which is the time it is at this exact moment) is over.  Oh wait, you didn't think those first 2 hours of my day sounded relaxing?  Huh. Strange.

7:00am let the fun begin. Let's say, on this particular day I have only 5 patients for which I am responsible.  Only 5 patients that I must read about, do extensive research finding out their past hospitalizations, tests run, labs drawn, how much they've peed, how much they've pooped, have they vomited, are they eating, are they conscious, are they breathing, if they are breathing is it at a normal rate, what does their heart sound like, oh crap, it doesn't sound normal, which valve is the problem, is it even a valve, eff it, I'm consulting Cards, are they getting fluids, did we replace their potassium, which medications did they get, what medications should they get, I am not actually sure how we are supposed to treat that, let me search for it on Up To Date...shit. It's 7:30am and I have only looked up one patient.  I quickly sort through the charts of the other 4, make a little chicken scratch and head off to see the patients, 5 of them, in 25 minutes.  Actual face time, with the patient to ask them how their night went, do a physical exam, explain labs, medications and the plan of care is 5 minutes.  And there goes the pager.  It's 8:36, rounds were supposed to start 6 minutes ago.  Rush back to the resident rounding room.

8:37am rounds.  We head to the ICU first, here, the whole team of 6 residents, 2 attendings, some pharmacists, a few med students and a nurse or two all enter a room.  If this so happens to be MY ICU patient, I present the patient to everyone.  I speak, in front of a group, and try to put all my research from an hour ago into one, nice, succinct, presentation.  I attempt to appear as if I know exactly what I am doing, and what I plan to do.  While in my head, I am panicking, because I kind of don't know what I am doing. I really dislike talking in front of groups. I am not good at it.  Even if I write everything down, my mind is bouncing like a bee bee in a rubber room, and it all comes out scrambled. Crap, now, even if I did know what I was doing, no one believes me. I just hope the med students can answer the questions from the attendings...

...the rounding continues, and now, it's after 10am.  I NEED to pump.  I can no longer concentrate on the task at hand. I am walking around with 2 bricks on my chest, and it's just going to continue to get worse.  I start sweating, I kind of get chest pains, and am on the verge of an anxiety attack, and it's my turn to present again.  Whatever comes out of my mouth at this point is on auto-pilot.  It's all I can do to quickly record the suggested changes to the plan from my peers and attending. I am still sweating.  It's a cold sweat.  Perhaps, I am even nauseous at this point.  And I feel like am being judged. All morning.

10:24am sweet silence. I sneak away for 15 minutes to pump. In order to "let down" and have a successful session, I need to relax.  So, I turn on the TV in the resident on call room, it's Roseanne.  This show used to remind me of my mom and dad and my family.  Now, it reminds me of Matt and I. Gross.  I find it amusing anyway. I finish, re-pack all my gear and scurry back to the rounding room.

10:46am radiology rounds.  The whole team (residents and attendings) make the trek to dark radiology reading room.  We crowd into a teeny space.  The anxiety, cold sweats start again.  I am beginning to realize that I am claustrophobic.  We look at CT scans, chest xrays, ultrasounds, mostly it's boring. Every so often it's fascinating.  I could never be a Radiologist, wish I could.  We file back up to the rounding room.  Now, it's the race to finish with the paper trail.

First, I must discharge the people going home. I have to schedule follow-up appointments. Make sure they are equipt with all their medications, write scripts, even for refills of meds they should be getting from their primary care doc. I have to write a discharge note, and make a discharge order, and make sure all of their labs and tests have been completed.  Then I finish daily notes on my other patients. I call Cardiology, Psychiatry, Surgery, the lab, Radiology, all to find out how the tests went, when are the tests going to happen, oh the tech is out today, we have the keep the patient one more night just for an Echo, you want them downtown for an MRI, can I advance their diet, can they get another pain med, did you want morning labs, did you mean to order those labs, why aren't there any labs?

Before I know it, it's 12:15.  We are required to go to a Noon Conference daily.  I am interrupted in my work flow.  Well, nevermind, there was never any flow.  I get lunch and attempt to make it to the lecture. I get there, it's 12:34, the lectures almost over.  I don't really listen, I need 20 minutes time to let my brain shut down for a moment. Time to refuel. Absorb the energy from my tiny lunch. I don't eat much. I am, of course, trying to lose 30lbs in the meantime.  Somedays though, you just gotta get the meatball sub and a Snickers. I'll lose weight another day.  Back to the floor.

1:01pm admission time.  I am over the hill, I see the end in sight.  Just a few more notes, one more phone call and I am done.  Perhaps, I will have a chance to finally make my required daily check of my work email, or my personal email, or I can fax the paperwork for my loan consolidation that was due yesterday, or tomorrow, or was it last month?  Have I paid any of my bills? Do I have money in my bank account? Or I can text my husband or nanny back.  Or take a quick peek at Facebook on my phone to see if the real world is still out there.  Pump without feeling rushed. Then, the resident in charge comes over to me, "hey, we've got an admission, you ready for it?" No.  But yes.  I smile, say something to the effect of, "I was wondering when you were going to bless me with an admission, things have been too quiet."  I appear to gladly accept the patient, while on the inside there is a constant stream of curse words, no reason to ruin someone else's day by obviously being annoyed by having to do my job.  It's my job.  It's what I get paid a measly little salary for, I signed up for this.  And I say I am not good at acting...

...I will spare you the details of the long patient interview, and there are too many to pick from; the drug-seeker, the frequent-flyer, the chest pain, the dizziness, the homeless-I-need-a-place-to-sleep, the drunk I ran out of money so am going to withdrawl, or the truly sick and maybe even interesting patient.  I put in the orders, I write the History and Physical, I call the attending, I tell them about it, they tell me more orders. Somewhere in there, I sneak off to take care of my mommy duty.  Ahh, it's 4:30pm.  Time to check out.  We run the list again. I tidy up my work, and I leave.  It's 5:17pm.

In the car, I call Matt.  "What do you want for dinner".  No reasonable response, usually, it's just, "We'll worry about it when you get home." My favorite idea.  Yes, instead of discussing this while we are both quietly driving home in our cars, let's wait until I walk in the front door to 3 loud, attention-seeking, missed-their-parents-all-day, on the verge of meltdown due to starvation boys, and one large, thinks the end of the work day means it's time to relax boy.  It's is now nearly 6pm, and no dinner plans have been made.  Sometimes we get take out, sometimes we make something from the freezer, sometimes, but not usually during an inpatient month, I have gone to the grocery store and planned out meals.  We make something, it's 6:45pm, we all sit at the table together and eat.  It's not real relaxing, but it's nice. I am over-joyed and so happy to be with my family. I am exhausted, but all is right.  I made dinner, Matt does the dishes. Matt made dinner I do the dishes. No dishes get left for tomorrow, they pile up way too fast. It's an unspoken rule. 
7:15pm family bonding time.  Depending on the weather, this is walk time.  Perhaps even a trip to TCBY or a park. If the weather or energy level is too low, it's play with the kid time.  If it were up to Matt, it would be lay on the couch while the kids crawl all over me time.  He get's his way sometimes.  Perhaps I will do some laundry or tidying up during this time as well.  And every 3rd night, or so, it's bath time - the boys love it. I don't. 3 kids stripped, bathed, shampood, rinsed, dried off, lotioned, diapered and dressed - not easy. Not relaxing. The result is wonderful though, the smell addicting, and I can't get enough of my clean babies.

It's somewhere between 8:15 and 8:45pm. Bedtime.  Matt brushes the older ones teeth, pajamas them, reads to them and kisses them goodnight.  I nurse George, cuddle him, and get him to bed.  When he finally settles, I am off the clock.  It's my time.  I should study, catch up on some work, check my bank account, do something productive. But I can't.  I just can't do it.  So I veg out. I watch a TV show, get on Facebook, Pinterest, maybe even blog if there is time.  I stay up way too late.  I look at the clock, see it is 10:43.  Crap. This means 6 hours of sleep at the very, very most.

I trudge upstairs.  I don't really want to go to bed. I want to continue to enjoy my quiet time.  I brush my teeth, put on my PJ's.  Check my phone one last time. Turn off the light and roll over to turn on my alarm, it's 11:17pm.  Not even 6 hours of sleep now.  And there is always that chance that George will wake up.  Close my eyes.

Ding!! It's 5:07am.

Wednesday, June 20, 2012


 I keep smiling, randomly throughout the day. I hope none of my patients, fellow residents or attendings are paying close attention to me, because they might think I am "special".  My children are causing this spontaneous smiling condition, and since the day Brock was born, I have never been able to get rid of it.  I must admit, it worsens with each child, and the frequency increases while I have a little, nugget baby, such as George.  The image of him - just chillin' with his huge double chin, kind of looking a bit serious and/or worried until his eyes meet another person, whether it be me, his dad, his brothers, or even a complete stranger at Starbucks, and then a huge grin erupts - keeps popping up in my head.  And I smile.

I remember Matt coming down the stairs laughing, after putting Curtis and Brock to bed in their shared room. He told me, that as he left the room he said, "Goodnight boys, and Brock, no getting out of bed." To which Brock replied, "You got it, Dad!"  First of all, never heard him say that phrase, second of all, he is never ok with going to bed and not coming downstairs. And, he didn't get out of bed.  Ha! You got it, dad.  He didn't even need to say that for me to smile at the image of Matt putting those 2 to bed.  The whole situation is adorable and hilarious (and frustrating).  Curtis loves brushing his teeth, in fact, he has a meltdown, every night, when you take away his toothbrush.  He also loves imitating his brother.  So we have 2 boys jumping on the bed while Matt attempts to PJ them, and a giant hound dog puppy barking at the chaos, every night, while I try to feed and settle George to sleep.

I still look at George and try to figure him out.  Recently, Matt and I looked through some baby pictures at the O'Laughlin's house, and yup, George is a spitting image of his father.  Chin and all.  A while ago, I decided he has his father's demeanor, but now I know he has his looks as well (as if it was ever any question that George was all O.)  George is by far the fairest of them all.  And his body type seems drastically different from his brothers - not that Brock and Curtis match with the older being long and lean and younger being quite thick, but they are both real solid.  George is mushy, and seems just a bit more unsteady. He can only sit for about 3 seconds - the others were pretty much sitting up on their own by this point.  He does roll all over the place, front to back, back to front, and even uses his hind legs and pushes himself forward.  So I think he's got the strength, and even coordination, but it's not the same.  Perhaps, it is lack of practice, I spend so much less time with him, he is getting poor training.  He did giggle before the other 2, and is extremely vocal.

I was trying to look back through the the other 2 boys 4 month posts to see where George stacked up.  And overall, despite what seemed like a 1 pound head start, he trails his brother's by quite a bit.  He is almost a pound less than my skinny little Brock!  14lbs 14ozs.  Curtis weighed over 14lbs at his two month check up!! And he is a half an inch shorter.  And he still wakes up once a night.  But just once. And he doesn't always need to eat.  And sometimes he sleep all night.  But either way, he is behind.  I am kind of fine with this extended infant period.  It makes it seem like he and Curtis are further apart than only 15 months, and I love babies.  If he keeps this up, perhaps it will stave off the baby fever a bit longer than usual.

Thursday, June 14, 2012


All the way back in 1989, my mother started a group.  I know it was 1989, because she was pregnant with my youngest brother, Timothy. This group played a dice game once a month, on a week night, I believe it has been Wednesdays for these last 23 years.  This dice game is mindless, it is completely left up to chance, and was really just an excuse for a group of 12 women to get together, and drink, gossip and show off their homes and cooking abilities. It was mainly Visitation Grade School moms.  A few mom's of my classmates, a few mom's of my sisters' classmates, and a few mom's who were friends of the mom's with kids in our classes.  Kids were not allowed.  I remember my dad keeping us contained upstairs or in the TV room.  And all I wanted to do was go join in the game. And eat the awesome food.  My sisters and I would inevitably become overpowered by this desire to be part of the event, and "sneak" into the kitchen to nibble on food, and wave to our friend's mothers.

Eventually, by high school or so, we were actually allowed to join in the game if a sub was needed.  The pride, and joy I felt the first time I was asked to sub is a feeling I have not forgotten.  I also have not forgotten that I proceeded to win both Bunkos and Most Wins!  I think at that time it was a $5 or $7 buy in, which means I won close to $50...if my memory serves me correctly, it was $53. The mom's weren't real happy - no one likes it when a sub wins, and they definitely don't like it when the child-sub wins.

I went on to sub multiple other times, and not just when my mom was hosting.  I think they enjoyed my competitive spirit, and could tell I knew what Bunko was all about...or I am just the loser that was always available.  I prefer to believe the former. So, it dawned on me one day, I have a house, I have lots of friend's with houses. I think it's time the next generation carry on the tradition and begin a Bunko League of our own.  So I did.

We have struggled these first 3 months to get 12 players.  Lots of last minute drop outs.  But I am confident people will slowly make this a priority, as they see how fun it is.  And as we all buy houses, complete renovations, and learn to cook as well as our mother's did, we too, will enjoy showing off our goods.  The drinking and the gossiping?  We've got that part down, pat.

Tuesday, June 12, 2012

Add THORNS to the list.

After a 2 year-hiatus, the Smith family has returned, yet again to the Bunker Hill Resorts.   As stated by the placard hanging in the mess hall, "Time Stands Still at Bunker Hill". Truth.

Our ventures on the Jacks Fork River, are extremely reminiscent of Girl Scout Camp in the Summer.  We stay in perma-tent-like cabins which have been updated!  We finally have AC.  Usually, the near 100 degree weather makes our little trip to BFE Missouri a little bit miserable.  The only way I could convince Matt to take our 3 littles on a 5 hour road trip to play in a river, was the newly installed air-conditioning. And we never even turned it on.  The weather was perfect as perfect could be.  Hot enough in the afternoon to swim, cool enough at night to sleep.

We even ventured over the hills and through the woods to find a cave.  We made this hike 4 years previous, while I was pregnant with Brock, on THE hottest day of the Summer.  The entire trek to the cave, I kept remarking about how I couldn't believe no one died from heat stroke that day.  I mean, my over weight and out of shape husband and brother, my 50+ year old mother, my sister and her husband dragging their 2.5 year old, my other brother smoking the whole trip and my gravid self all made it!  The only one that didn't surprise me was Leah, and she did beat me back to the top by a few steps.  This year?  It was in the 70's.  The only one having a problem was my sissy little city boy.  The spider webs, and bugs, and heaven-forbid thorns! Oh My!  Seriously, don't mention thorns, he is terrified of them.  The inside of the pitch black, 15 degree cooler, eerily still cave didn't sit so well with the kid either.  Looks like we need to get out more, and away from the sheltered suburbanish lifestyle Brock has grown accustomed to.

And yes, you are seeing right.  On our way out, we needed a few supplies and stopped in, what is the only option out in the boonies of Missouri, Walmart. There, we discovered t-shirts that really captured the spirit that is Bunkerhill - and most Smith family vacations: a bald eagle with an American flag backdrop, a wolf howling at the moon, and a tie-dyed herd of mustangs.  During this trip to Walmart, my mother remarked on the way Curtis walked and suggested be might be pigeon-toed (something I brought to her attention the day he started walking, but whatever.)  We continued to discuss this idea, and were interrupted with an obviously well-educated opinion from, what I can only assume, is a regular Walmart patron who lives in the surrounding area: "They all walk like that at that age. Don't worry."  Really?  They ALL do?  Do you realize that it appears you haven't showered for days, your missing teeth, and you are informing a mother of 5, grandmother of 4, and caretaker of many, along with a family physician who is trained to know what "normal development" is for a toddler, that "they all walk like that."  I mean, I am not trying to be a snob, it was just a bit too ridiculous.  And she just continued to follow us and talk.  The only more 'people of Walmart-esk' moment was when the man in a straw cowboy hat strolled by with his ragged little dog in the child part of the cart.  One trip to Walmart and my site-seeing was done for the day.
Overall, despite missing a few family members, Leah running a marathon, and Timothy getting stuck at work, it was a great time, some quality bonding, and some new experiences for the boys.  I guess, despite the thorns, Brock enjoyed himself.  Just the other day, out of the blue, he informed me that "Bunkerhill is his favorite".

Monday, June 11, 2012

"One day, you'll understand."

I cannot even begin to estimate the number of times my mother said this to me growing up.  The reasons ranged from my teenage, punk-ass self saying, "How is the house still a mess when you stay at home all day?" to my pre-teen years, "I don't think I'll ever want to french kiss someone, that seems disgusting." Now, almost 30 years and 3 kids later.  I understand.

I now see, that I will NEVER catch up on laundry. And I have been ever-so-tempted to load up the minivan and head to the laundromat, like we did every once in a while as children. I see that someone is always hungry, and always needs something, so there are always dishes to do, and something else that needs to be done at the same time. I understand why the cabinets were scarce at times, and why some grocery trips require more than one cart.  Not because of cost, necessarily (though, phew, 2 little boys eat A LOT), but more because of lack of time to get to the store!

I understand why bikes were left out of the garage. Why we were always running late. Why home improvement projects were started early in one calendar year and not finished until well into the next. Why some days you just have to sit, and drink coffee with a friend and ignore all the things you are neglecting by taking this moment to yourself. I understand why the oldest child has a full, organized, complete, thorough, perfect photo album and baby book, and the subsequent childrens' albums become sparser with each addition.

I now see why my mother would give the same replies, to the same questions over and over, despite the visible frustration given by the child.  I remember thinking, just give me a REAL answer! Saying "Sorry, Charlie" in response to a complaint, or "I'm Michelle, nice to meet you" in response to "I'm hungry" was done both because of exhaustion by hearing the same question for the 48th time, that hour, and because it's just kind of funny to watch your little one get so bent out of shape from one little sentence.

And, obviously, I now understand why a girl might want to french kiss a boy. And, I also understand why she might, well, like I said earlier, and 3 kids later...

I now understand, that though I pride myself in being particular skilled in objectivism, I still have lessons to learn, and life to experience.  I will continue to be told "one day, you'll understand".  And, someday soon, I will be repeating the same lament to my own stubborn, know-it-all, out-spoken, arrogant child - if I ever have one like that...

Monday, June 4, 2012

Fat and Happy.

And no, I am not talking about Curtis.

Today, I think I realized I must remain fat, to be happy.  This is the first time in a long time, possibly ever, during residency, that I just felt defeated.  I didn't want to be there.  I felt scrambled all day. I didn't get all my work done. I have 3 presentations to give this month and boards to take, while working 10 hour days and taking care of three children.  I have already taken 2 vacation days this month, and had to spend 5 hours of each of those days catching up on WORK!  Plus studying. Great vacation.  And this day just so happened to coincide on the first day of my diet.  I think my brain uses way too much energy on a daily basis to cut back on calories, and my milk supply for George will probably begin to suffer.

Lately, I have also been wondering if I shouldn't get on some kind of medication for ADD or anxiety. My mind is cluttered as cluttered can be.  And running a mile a minute, or faster.  I have so many thoughts, I can't even blog anymore. I can't keep up.  And this crowding causes me to be forgetful.  Extremely forgetful.  Tonight, in Target, I went with 3 things in mind that I needed and came home with $150 worth of purchases and only 2 of those 3 things.  I often blame this on "baby brain" then "post partum hormones" now "diet"...but maybe that's just me.  Maybe I am scatter-brained.  Maybe I do have an anxiety problem, and true panic attacks.  I think my swimming trained me to manage stress to a degree, but now, as children multiply and work hours increase, I can only do so much on my own.

I don't know.  Maybe it really is just the starvation talking.  But either way, I could use a really long break. I could use a few 8 hour work days that don't have every minute occupied.  My brain needs to quit playing catch up.  Too bad,  I don't foresee that happening for a few more years.  Guess I will just have to continue to eat.