Saturday, April 28, 2007

2 Weeks Post Call and Whiny

(I know I've posted a similar whine in the past, but humor me, this is on my mind.) Yes, it is just as it sounds, I have been on call, 24/7, for the last 19 days. Granted, I haven't been in the hospital/office the whole time, but it takes such a mental toll! Call as a private practice doc isn't anything like call when I was a resident. In residency, being "on call" means being in the hospital for 24 hours (and, prior to the 80 hour restrictions, up to 36 hours) at a time, working with a team of other residents/attendings, and caring for multiple patients, including surgical, laboring, antepartum, and post-partum. It was grueling, but the time was finite. Even on the worst of days, there was a definite time when I could turn the pager off, and take time only for myself. On days that I was not on call, I was generally out of the hospital around 5-6 pm, with no fear of having to return to the hospital until the following morning, as another resident team was shouldering the workload.

Now when I am on call, it is all me, and only me, on call for all of the patients that I have ever seen, and, over the weekends, on call for all of OtherDoc's patients, as well. Most of the time the calls I get can be handled from home with a phone call, and I can go about the rest of my day. Of course for deliveries and surgical emergencies, I need to be in the hospital ASAP. The hardest thing for me is that I can never quite mentally disengage, as at any time, I have to be ready to race to the hospital. I can't ever go further away than 30 minutes from the hospital, and if I am doing something with my family, we often take separate cars, "just in case" I get called. The pager can go off at any time, and you just never know what is going to be on the other end of the line.

When I was looking for positions post-residency, this was not what I had in mind. I was somewhat mislead into believing that call was split Q 3, and weekend call was to be every third weekend. What actually happened was that I was on solo call for a whole year until I could beg, cajole, and finally convince OtherDoc to at least split weekend calls. The other hospital OB has no interest in sharing call whatsoever, and only wants call coverage for vacations. Now there are some perks for being on call so frequently. I do get to deliver most of my own patients, and when I get calls for problems, I know my patients' histories and personalities fairly well, and can advise them accordingly. I also have fewer patients to cover than a group OB would, so that means less trips to the hospital/phone calls/ etc. while on call. I think that in the next 2-3 years the hospital is looking to hire another OB/GYN, and I am desperately hoping that this person wants more of a life and will go for sharing weekend call, and possibly sharing weekday call, as well. As CindyLou and the Bean grow up, I want to be available for sport games, recitals, and school activities without fear of having to leave to the hospital. I knew what I was getting into as an OB/GYN, and honestly, I don't mind being on call for my patients, because I know that they need me and trust me. I just need to strike a better balance of being available, mentally and physically, to my family and friends as much as I am for my patients.

I am now 27 and 2/7 weeks pregnant, and I am starting to physically slow down. Some days I feel just like a little old lady, whining about my "sciatica." Ha! I am rather short in stature, so the belly is quite "out there" and it is already inviting "due any day now" comments, which is maddening. My office has actually started to pare my schedule, and now, instead of 40-50 patients on my full days, I am averaging closer to 30-35 patients on a full day. This is infinitely more manageable, especially when it comes to charting, but now that I am moving slower and a little more tired it still takes all I have to get through those full days in clinic. My "half-days" are still averaging upwards of 20-28 patients, which is also difficult, but so far I am making it work.

It's funny (read kinda sad), because my patients are always commenting that it must be "so much easier" for me to be empathetic to my pregnant patients, as I am pregnant, myself. I am finding the exact opposite. It is hard for me to commiserate with the patients angling for time off work, complaining about common discomforts, and lounging about muttering about how *tired* they feel. Some days it takes all that I have not to tell them to "suck it up and deal!" It isn't a fair attitude to have, because I *do* know how miserable pregnancy can be, and misery is relative. Just because I feel like I am *more* miserable than they, doesn't mean that my patient isn't experiencing more misery than she ever has before. I do find it interesting that the majority of my patients that are having an "easy" pregnancy do not work, and those that are having the most complications are the working mothers.

For now I am going to close this post, because the whining is starting to annoy *me* so I know it must be most unpleasant for all 6 of *you* still checking back to see if I am still alive. I have some really good cases to discuss as soon as appropriate time has lapsed, so I will try to get around to updating in less than 2 weeks time. Happy weekend to all!

Friday, April 13, 2007


Your comments on my previous post are all awesome, and I promise to respond to each of you in the comment section. I have decided to accept the gifts gracefully and to send out thank you notes to the patients at their homes. None of the gifts have been over the top, and I really do feel blessed that my patients want to celebrate this little bean with me. What's really funny is the patients asking me how *I'm* feeling. That takes a little getting used to, and I find myself getting all flustered and embarrassed. It made me realize what an interesting physician/patient dynamic there is with respect to disclosure. We want to know everything about our patients, medical problems to marital status to sexual history (and for good reason). Yet we disclose little, if any, personal info about ourselves in return; so much so that when patients ask how I am feeling or how the pregnancy is progressing, I feel uncomfortable speaking about myself on "their time." Does that make any sense? Anyway, I'm getting used to it, and it is kinda nice.

So far my Friday the 13th has progressed in standard crappy fashion, I started the morning off puking my guts up. I had been off of the Z0fran for a solid week and was feeling too cocky. Next I got to explain to the young girl in her early twenties (who was admitted to the hospital for unexplained ascites) that she has a pelvic mass, and, in all likelihood, has a large ovarian cancer. She has never been pregnant. She has never even had sex. Therefore, she had never seen an OB/GYN. Please go get pelvic exams, ladies, even if you aren't having sex. I can't help but wonder if the mass would have been caught so much earlier if she had only had an exam.

Then I saw a million and a half patients squeezed into a "half day" of appointments, not to mention a large wound infection (on a section that my partner did, thankyouverymuch) that I had to open, drain, and pack in the office. While the rest of the office staff breezed out of the office by 2pm, I caught up my charts and sifted through mountains of paperwork, FMLA papers, consult letters, and lab results. This weekend I am on call, and so I am fielding asinine phone calls from OtherDoc's patients wishing for me to phone them in narcotics (I won't) and diagnose anemia over the phone. Sigh.

In positive news, I am 25 weeks and 1 day. My last appointment my blood pressure was awesome at 124/80 (yay!) my weight was up for a total of 10 pounds for the pregnancy thus far (boo!) and everything is measuring right on target. The Bean is a mover and a shaker, and he particularly likes to party between 9-11 pm. In other big news, Miss CindyLou Whoo is all but done with diapers. She has been dry for almost 2 weeks solid now! Woo HOO! We still put her in a diaper at night (more as a failsafe than a necessity) but she only wears panties during the day. It is sad to be so excited, but we were hoping to get her good and out of diapers before the Bean makes his debut. So far, so good! I hope you all had a better Friday the 13th than I, and I also hope that you are having nicer weather wherever you are, it is too fragging cold and icky for APRIL 'round these parts! Have a fantastic weekend!

Sunday, April 01, 2007

Life Gets in the Way

Hello to the four of you still checking to see if I'm updating! I have had a busy, busy March, both professionally and personally. The week after my last post I had 9 deliveries, and this past week my mother has been visiting and spoiling me by caring for CindyLou, doing laundry, and cooking! I have also been doing a little catching up on blogs, and I've been concerned with all of the uproar regarding HIPAA and medical blogging physicians getting threatened with lawsuits. I was really leery for the last 2 weeks, because I saw that I was being frequented by an IP near to my location, but then I found out that it was just my husband checking up on me! Whew. I do want those that read here to know that details of the medical anecdotes are altered and the time frames are changed and finer points are obscured so that the similarity to the actual cases is nominal. The way that I feel about the cases and my reactions, however, are 100 percent accurate. At any rate, I'm taking a bit of a break from the professional this week.

On a more personal note, the pregnancy is clipping along very well. I am 23 and 3/7 weeks, so therefore in a state of perpetual anxiety with regards to viability. Of course 24 weeks is the "benchmark" by which the pregnancy has about a 50/50 chance of survival. Survival, that is, with significant intervention and the very real possibility of far reaching disability and devastating, lasting damage. Next to the first trimester, the weeks lasting from 24 to 32 weeks can be terribly nerve-wracking for those of us that know too much. I'm trying to keep those niggling thoughts at bay and focusing more on the Bean's ever increasing movements, punches, and kicks. I'm also noticing occasional Braxton-Hicks contractions, which, while I know it can be normal, freaks me out just a little bit.

For all I know, I may have had these in my first pregnancy, and was just unaware of what they actually were. They are not painful or frequent, so I'm chalking it up to mild over-exertion for now. I was working much harder with my last pregnancy, and I did have a pre-term contractions scare, necessitating meds and bed rest for a few weeks, so I'm hoping that I will not have a repeat performance in this pregnancy. On the bright side, my nausea is becoming less and less frequent. I don't have to take meds every day, and I only puked twice this week! Woo Hoo! I'm up a total of 6 pounds for the pregnancy, but I started out well ahead of the weight curve, so my goal weight gain is only 15 - 20 pounds. (Trust me, I have plenty of fat.) I dropped so much weight breastfeeding with CindyLou, but like a dummy, didn't keep it off after we weaned. Since this may be my last pregnancy, I vow to keep it off this time.

I have an etiquette question for you budding Emily Posts out there. What is the protocol for accepting gifts from patients? Now that I am no longer able to hide my growing pregnant belly behind bulky white coats and baggy scrubs, plus the fact that news travels fast in a small town, the word is out that I am expecting, and my sweet patients are responding by bringing in baby presents for me to their office visits. I'm truly touched by their kind gestures, but, by the same token, it makes me somewhat uncomfortable. I purchased Thank You cards this week, and I am planning on sending them to the patients' home address. Is this acceptable? I don't feel like the patients need to buy me presents, but I feel like I would insult them to decline their kindnesses. It's a sticky ethical situation, so if anyone has any insight, I would love to hear from you.

I hope you all have a wonderful April Fool's Day. I haven't had much success with April Fool's pranks, though Guinness Girl from Red Red Whine to this day holds the "gotcha" award for best April Fool's prank played on me. Today I plan to finally call one of my friends that still doesn't know that I am pregnant. I hope she doesn't think it is an April Fool's Joke! Thanks for reading and don't give up on me!