Sunday, December 21, 2008

Holiday Haze

It's almost Christmas, a season that can turn the most placid of households upside down; so it follows that the chaos that exists on a daily basis in our house is multiplied three-fold during this time of the year. Shopping, cards, wrapping (or not wrapping as is our case), prepping the house, and controlling the building Christmas fervor from young CindyLou and keeping the Bean from upending the tree makes day to day life that much more, um, full. Ha.

Labor and Delivery is not immune to Christmas Chaos, either. Every induction slot is filled with patients hoping to check "have a baby" off of their pre-Christmas to-do list, much like the shopping for and wrapping of gifts. To be honest, I'm not really certain how I feel about that. Let's face it, no one, doctor or patient, wants to be in the hospital on Christmas Eve or Christmas Day. Doctors hope to spend those rare days away from the office with the people that they love, not in the nurse's station on L&D. Pregnant women with children want to be certain to secure the holiday for their children that have already been born. There are enormous familial pressures for these women to have their babies "home for Christmas." It makes for a lot of soft, elective induction calls, and sometimes, when a patient truly needs to have a baby for medical reasons, it throws everyone's nice, neat plans into a tailspin. I've seen a few of these holiday plans get ruined by a true medical emergency, and while it is unfortunate, sometimes I wonder if it doesn't serve us right for trying to control as much about labor as we do.

Personally, I have 2 patients due right around Christmas Day, one of whom has a potentially macrosomic baby, and, since they are both healthy and doing well in all other aspects of their pregnancies, we are not scheduling them for induction this week. I hope they will go into labor without medical assistance. It makes it difficult to make definitive holiday plans, given the unpredictability of my profession. OtherDoc and I try to split up Christmas Eve/Day, and New Year's Eve/Day, in order to get some of that time off with our families. I approached him about doing that this week, and he has not decided which days he wants to take call. I already worked the long Thanksgiving holiday, and I hope he takes that into consideration. I am almost giddy that I won't have to deal with this BS next year, and if I do work Christmas, I certainly won't be working Thanksgiving or New Year's. I. Can't. Wait.

So, I will end this rambling, no point post here. What ever your holiday plans may be, I wish you and yours a peaceful season. I enjoy sharing glimpses of life with you, and hope that you will continue to read here in 2009. Merry Christmas from all the Whoos down in Whoo-ville! :)

Thursday, December 11, 2008

Done, done, on to the next one...

Oh, my poor little neglected blog, how I have missed you. I am finally done with the oral least for this year. All I can think about is of what I should have said that I didn't (and what I did say that I shouldn't!) The exam was over quickly, mercifully, but the more I think, the more morose I become. No matter now, if I fail or if I pass, I shall not speak of it again on the blog. Suffice it to say that I am done and trying to get over it, and now must focus my attention to the holiday that is a mere 14 days (FOURTEEN DAYS!!!) away. I have cards, cookies, and call on tap for the weekend, along with a Christmas and a birthday party. Oh, and online shopping, the working woman's savior.

Our house is properly Christmas-ed, thanks to Mr. Whoo. We have made the the obligatory mall Santa visit, complete with non-screaming children in the picture, a coup! CindyLou is *beside* herself with excitement. It is so wonderful. To see her joy and wonder about Santa and the season does my poor, 3-sizes-too-small, grinchy heart so much good. Bean is fascinated by the tree and the lights, and while he doesn't quite "get" it all, he is loving the experience. Of course, my favorite moment of the season thus far comes from Mr. Whoo, explaining our nativity to CindyLou.

Mr. Whoo: "...and this is Mary."
CindyLou: "Oh! Like 'Mary Had a Little Lamb'?"
Mr. Whoo: "No, more like Mary had a little Jesus."

It was priceless...maybe you had to be there. Anyway, I'm back, and, if the pregnant ladies cooperate (ha), I will try to get back to more reliable posting. Promises, promises. :)

Saturday, November 15, 2008

Don't You Forget About Me

Although, I wouldn't blame you if you did. I know it has been over a month. I have a lot of great excuses that you probably don't want to hear right now. The long and the short of it is that I've been studying for oral boards, a lot, and working, a lot. When I'm not doing either of those things, I am lying upon my couch like a slug, it is my only defense (name that classic movie). In the meantime, I will post a link to my most recent post at Mothers in Medicine, and promise to be more present in the blogosphere in the coming weeks. Hope everyone is having a wonderful fall weekend!

Friday, October 10, 2008

In the Middle of the Night

It's time for my husband's annual "man weekend" with his high school buddies. For almost a decade, he and his friends find a cabin in the woods somewhere and behave (I am assuming from the pictures) as 10 year olds...that drink. Junk food, video games, and staying up way too late are part and parcel of the festivities. They look forward to it every year, and I'm happy to have him go. (The wives have a "girl weekend" in the spring, just to be fair.) So when I found out that he would be out of town for a weeknight (when I am on call for my patients), I thought to my naive little self, what's the worst that could happen? Ha. Ha. HA!

So I went about my regular single parenting duties in the evening relatively unscathed. Picked up the kids, got dinner on the table while Bean protested loudly that it wasn't fast enough for him, wrestled two squirmy kids through bathtime, and got everyone tucked in by a reasonable time. Then I prayed really hard that I could make it through the next 12 hours without having to leave the house. The peace lasted roughly 3 hours. The first warning bell came as a page from triage. A 38 weeker, possible early labor, contractions 20 minutes apart. The triage nurse said she was pretty sure the patient was "not doing anything" but we decided to observe her and let her walk for an hour. My second warning came at 1 am. The patient had indeed changed her cervix from 1 to 3 cm. A definite keeper. "Ok," I pleaded with the nurse, "PLEASE keep her comfy and pregnant for the next 5 hours so I don't have to pack my kids up in the middle of the night to come to the hospital." The nurse was fairly confident that the patient was not contracting regularly, and could probably coast until morning. I settled into an uneasy rest...until 2:30 am. I returned the page, thinking that I was going to have to drag in to cover for the patient's epidural. Imagine my surprise and dismay when the nurse answered the phone with "She's 9!"

Shit. Shit. Shit. It was off to the races...throwing on scrubs, rousting the kids up in their PJs, and flying down the highway in the middle of the night. "At least it will be fast," I chanted to myself as I sped to the hospital. I deposited the kids with one of the nurses and stepped into the delivery room just before 3 am. The patient was completely dilated and ready to push. She hadn't even had a chance to get *any* pain medicine, epidural or otherwise, due to how quickly she had progressed. So, the patient started to push, and *then* all hell broke loose. The first push sent the fetal heart tones down to the 30s. Ummm, surely that wasn't right! I placed a scalp lead to get an accurate tracing...still in the 40s-50s. Scalp stim...up to the 60s. Oxygen, reposition, knee chest. Nothing would bring the rate back up. The baby was at zero station. Too far up for vacuum or forceps. We tried a few pushes, but the head wasn't descending fast enough and the heart beat was a slow tick, tick, tick of a baby running out of time. After a quick verbal consent, we called the OR to let them know we were coming down for a crash section. "We aren't ready!" they said. They had another case going and needed to call in a team. "No time for that," I said, "This baby needs to come out now."

We ran the patient to the OR. The staff assembled a rag-tag team of recovery room nurses, opened the crash section cart, and haphazardly prepped. There was no time for a foley or to count instruments. Every second felt like an hour, though only 5 minutes had passed from calling the section to draping the patient. The patient went to sleep, and we got the baby out in less than a minute from the skin incision. She looked like a *million bucks*! She squalled as soon as she left the womb. She was pink! and happy! and had Apgars of 8 and 9! and didn't look at all like her strip suggested. I had truly feared the worst, the last terminal decel that I had seen like that, the baby had anoxic seizures after delivery. Luckily, this baby was great. The collective sigh of relief was audible in the room as I placed her on the warmer. The rest of the surgery proceeded smoothly, and I was happy to let the family know how well she had done.

As for the kids? I ran back up to labor and delivery to find them happily snacking on graham crackers and juice. CindyLou was entertaining the whole floor, and she kept saying how she wanted to be a doctor "just like mommy." (Oy.) We got them gathered together, I thanked the nurses profusely, and drove back home. "I like to go to your work, Mommy" Cindy Lou chirped, "It's still *night time*!" Once at home, the kids went back to bed without a fuss, and I crashed into the best 2 hours of sleep of my life.

The moral of the story? I survived! It could have been the worst case scenario, but we all made it. The kids did fine, the patient did fine, the baby did fine. It could have been a disaster, but it wasn't. I am ever so grateful for that, and never have I been so convinced that I *never* want that to happen again! Scary things do happen in the middle of the night, and sometimes the outcomes are not as good. I'm thankful for the nurses and OR staff that did what they could to make the surgery happen quickly enough. I'm grateful for the compassion the nurses showed to me and my children by caring for them when I had to care for someone else. Most of all, I am so thankful that my kids were able to take it all in stride and go with the flow. They are pretty amazing. I hope you all have a wonderful weekend, and are not bothered by scary things in the middle of the night.

Friday, September 19, 2008

Running on Ice

Where does the time go
Spinning my wheels
Standing still
It's like running on ice
I only gain a little distance when I fall

How did I become a molecule
In the concrete of this city
Indifferent to my endless motion
In a space too small to see
Nonetheless expected to be
I only get a little attention when I fall

And I'm falling
Falling down
Falling down

Cursed with reason
In a world so defiant
Without conclusion
This is the story
The story we live out
And it is the moral too
Look at me I'm falling for you

Shaking, crying
Hating lying to myself
I'm tired of telling myself it's OK
To be this tired
This sick and tired of the turns the world takes
And the people that it makes us be

And lately it appears to me that I'm falling down... --"Falling Down" Vertical Horizon

I searched the internet for a complete sound bite/ of this song, because the lyrics, while fabulously apropos to my situation in life, are nothing without the frame of the song. Alas, this song is so old/obscure, it hasn't even an entry! Anyway, 'tis a great song, and it sums up very nicely how I've been feeling these last few weeks. A whole lot of running without a lot to show for it. We have received contracts, had them reviewed, and have all but signed one on the dotted line. Yes, I believe I have found a new job and the start of a whole new chapter in the life of the Whoo family. Hopefully for the better! We have also begun readying the house to put on the market, and begun research on daycares and houses in NewCity. I feel like I can't totally relax until the ink is dry on the paper, yet I am anxious to move forward. It is an unsettling place to be.

My grandfather passed away in the middle of all of it, and I think I am still coming to terms with the loss. Trying to explain death and dying to a four year old, while trying to keep yourself together is quite a task. CindyLou cut straight to the heart with several of her questions. (Why did he have to die? I liked it when he was alive. Are *you* old/sick? Why do people die?) We tried to be as direct as possible with her, but damn, that was hard. I'm also sad for my grandmother, who has lost her partner of nearly 60 years. It breaks my heart to see her try to pick up the pieces and move on. This loss has also solidified in my mind how important it is to seize this day/this moment, for we may not have a tomorrow.

As for day to day life, we seem to have found a nice groove lately. My schedule has been miraculously corrected (and it only took a couple of years of whining, begging, and groveling), leaving me a little more breathing room at the office. As a result, I've been getting out of the office on time, getting more home time with the kids, and am having, in general, more satisfaction in life. It's funny that everything started improving once I had made the final decision to move an abusive relationship or something. It makes you a little wistful for "what could have been," but it doesn't change the malignancy lurking just beneath the surface. I know the best decision for our family is to move upward and onward from here, but we will have fond memories of this place.

Also, fall is here, my very favorite season, and along with it, college football! Yay for cooler weather, changing leaves, and sweaty men fighting over the pigskin! I'm also really enjoying my most recent crop of patients. I have several this month committed to laboring on their own, and not pestering me for induction starting at 36 weeks. Also in the coming month, I will (hopefully) get to deliver the 3rd baby of one of my favorite patients (I got to deliver 1 and 2!) I feel so privileged to play a part in helping their family grow. So, for now, I am happy. Moving forward in life, enjoying my family, and looking forward to better days ahead. Life is good.

Wednesday, September 03, 2008


This is a response to the scathing comment below from a very "brave" (ha) anonymous poster, 9/3/08, 5:06 pm. Actually, I *am* quite fed up and burned out. It comes with the territory of being taken for granted and treated as less than human. Chances are, your physician(s) are too, whether you get to see it or not. I'm all about patient education, in the office, during normal work hours. Not at 2 am in the morning. Sorry, and I don't think you'll find another professional around who would be happy to "educate" their clients about trivial things in the middle of the night. (Just try calling your plumber to ask them which drain cleaner is best at 2 am, see how far you get.) Again, it's people like you, who seem to think that doctors should be superhuman, that are driving physicians out of the practice of droves. Also, anon nasty poster (9/9)that I chose not to publish. I'm glad you aren't coming back, and it is *my* blog, so *of course* it is self centered! Geez. Apparently *some* people don't get the concept of venting!

Friday, August 29, 2008

Annoying Things

I think I've been more than a tad touchy these last few weeks, as I contemplate major upheaval in my career and family life, so maybe I am noticing things that bother me more often. Never the less, I am going to post annoying things that people say and do that really piss me off, since it wouldn't be *professional* to say it to their collective faces.

~ Any referring physician (ER, family medicine, pediatrician, all are offenders) that tells their patient with unexplained lower abdominal or pelvic discomfort and a normal exam and ultrasound that 1) "You must have had a cyst that ruptured." or 2) "You probably have endometriosis."

First of all, sometimes, you can just have pain in a certain area with no pathologic explanation. Some people have pain when they ovulate, or right before their period, or when they move the wrong way, or have sex 3 times a day, every day (yes, one patient referred to me for vaginal irritation and pain admitted to this...hmm, wonder why you are so sore???) Second of all, there are a whole bunch of different things that reside in the lower pelvis, including bowel and bladder, both of which can be causes for significant pain in their own right. Why every woman with low abdominal pain must have a "female issue" is totally beyond me.

It isn't that women with pelvic pain shouldn't be referred, they absolutely should be seen and worked up by a specialist. However, I have found that these two phrases mentioned above are physician code for "I have no idea what is causing your pain, but instead of saying that, I'll scare you into thinking you have ovarian cancer or a chronic disease." Because that, my friends, is what the patient hears, and is scared to death until they come see the GYN, so much the better for all involved.

~GYN consultation in the hospital "for pelvic exam." I kid you not. Apparently I have been doing it all wrong, doing my own cardiac exams and lung exams on my patients when I should have been consulting cardiology and pulmonology. How silly of me! What, the patient hasn't had a pap in 4 years, has a broken femur, can't move her hip, and is on her period? Why *don't* we "just do it while she is in the hospital?" Freaking fabulous idea. Thanks, alot.

~"Annual Exams" that really aren't annual exams. By that I mean, I made an appointment for a routine health screen, but what I really meant was that I just had my pap and breast exam at the health department last month, *however* I think my boyfriend is cheating on me, and I need tested for all STDs, and it has made me really depressed (I think it is my hormones), and by the way, I have no libido....can you please fix me in 15 minutes??

~Referrals for a "dropped bladder" (gotta love that technical term) on patients that weigh 350+. There isn't a surgical procedure in the world that can combat the overall gravitational forces working on those bladders. Never mind that most of these patients also have multiple medical problems, making surgery a veritable nightmare to begin with, and if you mention losing weight to help with their incontinence they wonder aloud why you "can't just fix it?" Oy.

~When men come into the exam room with their wives/girlfriends, etc., proceed to speak for them the entire visit, ask to "look in there" when you are doing the pelvic, and then finally, when you have your hand on the door, reveal that the "real" reason they came was because he thought there was something "wrong with her" because she doesn't want sex as much as (the guy) does. Gee, I just can't imagine why she isn't all over you, buddy. Nice.

~People who tell patients (pardon the poor grammar, but this is verbatim) "Just call your doctor if you have a question, that's what they are there for." (or the variation, "that's what you are paying them for."). Actually, your physician is "there" to provide health care and ensure that you (and, if pregnant, your baby) are well.

They are not "there" so you can page them at 1:40 in the morning (this is an actual call here) when you notice that your right breast is just slightly larger than your left, and you wanted to be certain that was "normal." Also, "you" are very often *not* paying your physician to answer after hours phone calls, and neither is your insurance company. They are answering your questions *for free* on their own, scarce, precious home and family time. (Oh, what, you think that answering ridiculous phone calls are just "part of the job?" Then why do lawyers get to bill by the hour, phone call, and email? Why is a physician's time and expertise any less important?)

So quit thinking that doctors are automatons with no lives, that never sleep, who "deserve" to work for free, and live only for the next breathtakingly inane page about your deep ruminations about your inner workings, You're wrong. And amazingly inconsiderate. If you aren't bleeding, losing appendages, or dying, save your calls for office hours, please.

~Finally, the most annoying thing of all...being on call for the whole. long. holiday weekend. There's nothing quite like having someone wish you a great "weekend off" when you know you'll be living at the hospital and fielding midnight phone calls while every other American in the free world is getting their drink on, living it up with parties, picnics, festivals, and sleeping in. Bitter, bitter, bitter am I.

Luckily for me, (and you, I imagine) a change will soon be coming. And not a moment too soon. Thanks for letting me get it off my chest...oh, and have a great Labor Day weekend. Heh. :)

Saturday, August 16, 2008

The Evolution of a Pregnancy (a conglomerate of myths and multiple patients, seen through the years)

Pregnancy is supposed to be a sort of "golden time" in a woman's life. The media tells us this in softly muted images of unblemished bellies and serene smiles. Our own family members knowingly wink and talk about how grand their pregnancies were and how "you don't remember the pain" of labor once you are holding your little (angelic and sleeping) bundle of joy in your arms. Before you become pregnant, the state of gestating a life seems almost mystical, magical, and other-worldly. It seems like somewhere you really really want to be.

Then, you take the plunge, and if you are lucky, you become pregnant. It is then and only then that you realize you've been duped! All the blissful, sighing moments you imagine in your pre-pregnant state are replaced with the bitter reality of puking your toenails up morning, noon, and night, or breasts so sore that it hurts when someone dares to *look* at them. The heartburn burns a path from stomach to esophagus so fiery, you are certain that the 9th circle of hell is cooler, and the mind numbing fatigue turns you into a zombie.

Then, your family and friends, so encouraging prior to your pregnancy, suddenly morph into this raging band of harpies...right before your very eyes! Then, the "advice" and the subtle "judgement" from all sides. Oh, I *never* got sick with *my* pregnancy. Not one time! Are you sure everything is ok? Wow, are you sure you are pregnant? You just look chubby! You don't look like you are gaining enough weight. Oh, no, no, no! You are gaining *way too much* weight! You should always... You should never... You are going to eat *that?* My husband's sister's cousin's best friend's aunt had a miscarriage because she ate too many hot dogs, you know. What was the heartrate? Oh, then it is definitely a boy/girl/fire monster. Face it, people are mean to pregnant women.

Dutifully, you make lists, and bring them to your obstetrician, who spends a good 10 minutes each session systematically de-bunking the myths and reassuring you that the soft serve ice cream that you had last week will not, indeed, turn your child into a four-headed fire monster. As for the heartbeat, naturally it is faster when the baby is smaller, and slower as the baby grows. NO, you cannot tell by the rate whether it is a boy or a girl. Truly, you cannot. You go away feeling somewhat assured, but uneasy. After all, every one you know has an opinion about your pregnancy.

Then, you reach in the second trimester, and you must endure unwanted belly rubs from strangers in the grocery line, accompanied by clucking "you are *how* far along, dear? Oh my, you are (way too big, way to small, carrying *high,* not carrying high *enough*, OMG are you sure you aren't having twins???) Then, these expert eyewitnesses will attempt to divine the sex of your child, simply by looking at the curve of your belly or the, er, thickness, of your derriere. It doesn't matter what the ultrasound says, honey, look at how big your ass is getting! That is a sure sign of a girl/boy (take your pick)! Fifty percent of the time, it works, every time, you know?

Rolling on to the third trimester, you start to fear how you will ever, ever get this growing baby out of your uterus, and your friends and family are now ready to regale you with the *horror* stories they've been keeping secret from you until you have reached the point of no return. Your already sleepless nights, filled with multiple bathroom visits as your precious bundle plays trampoline on your bladder, are now punctuated with fitful imaginings of epidurals that don't work, babies that get "stuck," episiotomies gone bad, and emergency cesarean sections. You turn to the internet for comfort, but instead only find more horror stories about Ob/Gyns that are only out to cut every woman that they have ever met, the evils of hospital births, and about how you should have had a midwife and a doula all along.

Alarmed, you present to your next visit, and try to determine whether or not your OB is one that will cut your belly in favor of getting home in time for dinner that night. Surprisingly, your OB seems reasonable about birthing plans and open to questions about cesarean rates and episiotomies, but you never know, the internets say to beware of medical professionals. Ultimately, you get to the final four weeks of your pregnancy, and you realize that perhaps you really don't care how the baby gets out as long as it does it soon. Your sister suggests that you should just "tell the doctor" to induce you, so you can have a Leo baby instead of a Virgo. You entertain the fantasy of asking the doctor to just "go ahead and cut it out, already," previous worries of cesarean section be damned. Your physician isn't swayed by your pleas for induction at 37 weeks. Heartless bitch.

The final week before your due date drags on. Your feet are swollen. You move like a 89 year old arthritic woman. You have the occasional contraction that makes you excited that the end of the pregnancy may be near, but nothing ever gets close enough. You visit triage once or twice, just to make sure you aren't in labor, and you get turned away, ashamed. You are tired of the "sure fire" ways to induce your labor. You've eaten enough Mexican, Chinese, and Eggplant Parmesan to induce 10 labors, but all it did for you was give you more heartburn (this kid better have some freaking hair!) You've walked the malls, rubbed your nipples raw, and had the most uncomfortable sex of your life, but there are no contractions to show for it. The due date comes and goes, and your OB tries to explain that the due date is more like a "4 week window" of when the baby is likely to come out, and not the day that you magically burst into spontaneous labor as you had been hoping. You are certain that you will be pregnant forever.

Then, one fateful night, you start to have regular, and (oh my lord) painful contractions. You begin to realize that all of the time you thought you were contracting, your uterus was just doing some minor stretching. These contractions? Hurt like hell. You arrive on Labor and Delivery with the bag you packed 5 weeks ago when you were hopeful that you were going to go early (because Aunt Melanie said she "just knew" you weren't going to make it to your due date). You are certain that you are already 8 cm dilated, because, holy hell, these contractions hurt. You are both dismayed to find that you are "only 4 cm," and relieved because you know you have reached the magical cervical dilation for admission. Your determination for a medication-free delivery wavers with each body-wracking contraction that you have. Finally, you just can't take it any more, and you "break down" and ask for the evil epidural. Only, it's too late. You are fully dilated and there is no time to do anything but push. Nothing ever felt so great and so horrible all at once. It is truly like your instincts just take over and your body works with you to finally push your baby out into the world. There's burning, stretching, tearing, grunting, and screaming, and then, relief...followed by a small cry and a warm, slippery body being laid upon your belly.

As you look down at your baby, and they look up at you, white with vernix, covered in goo, certainly not quiet or sleeping or serene, and hairless (heartburn be damned!) you know (despite what everyone else told you) with every ounce of your being that you will never, ever forget the *pain* that it took to get them here. You also know that it was worth it....all of it.

Sunday, August 10, 2008


It's what's for dinner! (Quite seriously, we've ordered every form of takeout you can imagine this week!) It is the theme of the week. I just can't get excited or motivated about a darn thing. I assume that this is a typical problem, adjusting back to the daily grind after some much needed time off; I just can't seem to get back into the groove. At the heart of the matter, I'm aware, is the cold hard fact that I am tired of being tired. I find myself mentally withdrawing from my current place of employment. It isn't hard when you are welcomed back to the office with 8 patients scheduled in your first hour of the day. I'm over getting fired up about it. I've drawn out templates, been nice about it, stomped my feet about it, and taken it to the office manager that hates me, and nothing has changed. I know very much where I stand in this office. The writing is on the wall.

I know that staying in this position is no longer a viable solution, and while I know this will open up the chance for a much better life for me and my family, I am very sad about my patients. I am going to *miss* (most of) them a lot! Of course, I haven't told anyone that I am even looking for another position, and hope not to be forced to do so until I have a reliable back up option in place. You know, just in case they tell me to go ahead and get lost when I do reveal that I am seeking another opportunity. I find myself seeing my annual exams, and writing for a 12 month follow up visit, knowing full well that I'll likely already be gone. I feel so *deceptive*. I want to tell them to start looking now for a new physician. I'm so torn between my desire to get the heck out of dodge and make my life better, and the guilt I feel about leaving my patients. I've already gotten an attractive offer, but the catch is that they would like me to start in the early part of 2009. Ack! I'm not ready! I'll still have pregnant patients due then! How can I leave them mid-pregnancy? Don't get me wrong, I suffer no delusions that I am so awesome that all of my patients will be just crushed when I leave. I am *just* the doctor to the vast majority, I am certain, but I do know a few that will be crushed. The worst thing is that I let this guilt come to be on par with my family's need for a better lifestyle. My husband tries to reason that it is "just a job," but, to someone in medicine, it really is so much more.

On so many levels, I'm past ready to move on. I know that the decision I am making will be the best one for my family. I think the apathy that I am feeling is a resistance to the change that is coming. If I don't get things ready for leaving, like putting the house on the market or making the proper preparations to leave one practice for another, then it isn't truly real. It *is* real, and I need to embrace it. There is much to I think I'll sit here and play on the Internet for a little while longer. Queen of procrastination, am I. If anyone out there has been in a similar situation, I'd love some advice on how you handled transitioning out of a busy practice. This is brand new territory for me, since leaving residency was inevitable, so I never worried about the aftermath of leaving. Sorry for such a downer of a post! I use the blog to get things organized in my mind, and this has been weighing heavily all week long. More fun filled L&D hi jinks soon, promise!

Monday, August 04, 2008

I'm Baaaaack

Ack! Long time, no blog, I know. I'm sorry. I suck. I missed you guys, too. A few bullet points to catch up, and a longer post later this week if the L&D gods are kind to me.

~ First and most important, my baby Bean turned 1 year old on July 19th. My *baby*! *sniff*

~ We celebrated with a cookout and cake. Bean ate and smashed his cake to pieces, had a bath, and then slept for 14 hours straight (sugar coma).

~ I had my second blogiversary. Whoa. (How do you spell that? It is a made-up word... makes it difficult!)

~ I delivered 20 babies in the first 23 days of July.

~ I then lapsed into a deep coma, er, "went on vacation."

~ My lovely office staff booked 22 patients (in 3 hours) for my "half day" prior to leaving for vacation.

~ This made me so happy that I started my trip with a "to go" cup of vod.ka and Sprite, just to get the party started right.

~ Driving for 8 hours in the car with a 4 year old and 1 year old (who is not yet big enough to sit facing forward) is a bitch. Even with the aid of vod.ka and Sprite.

~ Even so, my kids are awesome, and were quite well behaved 95% of the time.

~ I visited with my husband's family for 10, boring, I mean, fun filled days in which I subsisted primarily on hot dogs, turkey sandwiches, chips, and spaghetti. Oh, and vodka. So much for low carb.

~ I am fat. I love food. I am screwed.

~ I finished my oral board case list. Woot! Let the angsting over that on which they are going to grill me on commence.

~ I scheduled 4 more interviews. (I know, I said I was done...I wasn't, apparently.)

~ I went to not one, but two of my husband's family reunions. I deserve a medal for that.

~ I also deserve an honorable mention for spending 10 days without any form of air conditioning.

~ I wrote a post for Mothers in Medicine for the "birth story" topic day. Check it out if you want a long-winded account of CindyLou's delivery.

~ My grandfather had a heart attack, a couple of heart caths, and fortunately has made it back home ok. I worry about how much longer he will be with us.

~ Last but not least! Thanks to anonymous for the tip...I got linked in an article by Melissa Healy in the LA Times, y'all! (The LA. Freaking. Times.) I was linked along with some real giants of the blogging world like Kevin, MD, GruntDoc, and Dr. RW. Of course, the rant that was selected to quote I sounded the most unintelligent and angry out of all of them. In fact, I was called "ribald" which means of lowly status or base {boo} or lewdly funny {that's more like it}. I own that, and hey, it's the LA times.

So, I'm certain that lots and lots more than this happened, but these are some of the highlights. Now I have to go clean the house and do laundry so the cleaning lady can find the floors and counter tops tomorrow! It's good to be back!

P.S. Holy crap, it's August. Where did July go?

Sunday, July 13, 2008

It's the Most Ex*haus*ting Time of the Year

Ah, yes, OtherDoc's vacation is once again upon us. My days are spent running frenetically back and forth between labor and delivery and the office (seeing mostly his 4 billion prenatal patients), trying to figure out what the hell is going on with any problem patients (he doesn't chart a freaking thing), and deflecting pain medicine requests and ridiculous after hours calls (such as last night 11:40pm "*giggle* I don't know if this is an emergency, but I have a rash and it is getting itchy! Can you tell me what it is? I know I'm not due for two weeks, but can't I just be induced tonight?") My nights are peppered with pages from triage, roughly every 2-3 hours, with patients in labor, hoping to be in labor, who have a hangnail, or nothing better to do at 3 am, and if I'm really lucky, a dash to the hospital for a c-section or a delivery. I've delivered 9 babies since Monday, and there is one in early labor right now. I think I have had at least one delivery every single day except for Friday.

Also, dumbass that I am, I have decided to chose this same 2 week period to attempt a no carb diet, as a "jump start" to losing weight. I'm not very sure if I have made it clear in the past, but I freaking adore carbs. Were it up to me, I would never eat meat again. I would eat spaghetti every single night if it were socially acceptable and Mr. Whoo would let me. I'm going through withdrwal like a proper junkie, headaches, shaking, terrible cravings, etc. , and even though I have lost 6 pounds (and holding at this point) I am in such need of food comfort that it is a struggle to stay on the wagon. I would also like to drink a couple of gallons of wine, but, since I'm running to the hospital all hours of the night, definitely not a good plan, plus, not low carb, either.

I am also in the process of weaning. Bean has become less and less interested in nursing of late. I can only get him to really focus early in the mornings, and even that is inconsistent. I cut my AM pumping session first, followed by my pre-bed pumping session last week, and I am down to only pumping at work during lunchtime. I'll probably drop that session this week. I've survived so far with only a mild case of mastitis. Part of me is sad to let it go, but Bean seems really ready, and I don't mourn the loss of pumping sessions for certain. I always had a goal to make it for a year, and Bean's birthday is on Saturday (can you believe it??)

The job hunt is still on (especially after putting up with all of the BS this week). We are actually considering moving closer to family and friends, to a place we would never have considered in the past, but now it seems to be all that we are thinking about. I've had a few promising leads and conversations, but any interviewing will have to wait until this crazy month is over.

Last but not least, I'm spending any spare time completing my case list for Oral Boards. I have all of my OB and GYN cases entered, but am struggling to get the office cases picked out and entered (too indecisive). I have my case list construction seminar this week, and it will be a welcomed break from all the insanity. I hope that they don't expect the entire list to be finished! I'm a little worried about the breadth of my case list (92 GYN cases, 110 OB cases) because I had a 7-8 week maternity leave in this last year, and I had also cut my patient load before delivery, so I was only getting back to full speed on OB for the second half of the year. The list is due on August 1, so I want it to be done quickly after I return from the seminar.

Well, enough whining for one post! Mr. Bean just crawled into my lap to snuggle. Aw. Hope you are having a wonderful Sunday!

Saturday, July 05, 2008

Is there life out there?

Wow, has it really been a month already? June was a veritable whirlwind. I finished out that last call and then embarked on a 3 week "tour of duty," visiting friends that we hadn't the opportunity to see for 2 years (eek) and also doing some interviewing. I wish that I could say that I've found the perfect job and everything is going to be happily ever after, but so far that hasn't happened. All of the interviews that I have had have gone wonderfully well, but it seems that I just can't find the dream combination. For example, I interviewed at a rather prestigious "big city hospital" and loved all of the aspects of the job. The facility, the physicians, the work schedule and call schedule were all great. The compensation was good, and, as cities go, the city was really nice. is still a city. The housing prices, property taxes, and available homes are a little less than desirable, and while there are good schools there, I worry about raising my children in a larger city. At least there, I would have better chance of participating in their lives. I am moving forward with the next steps to see if this position is the right fit for us.

I also interviewed at another practice, in an area of the country where Mr. Whoo and I have always wanted to live. The practice was nice, hospital was beautiful, and, of course, the area was everything we wanted, but I sensed an underlying air of malignancy amongst the physicians working there. I could sense that they really were not friendly outside of work, there were several family member with controlling shares of the practice, and there were a few warning flags raised when discussing the financial aspects of the practice. So, while the area was perfect, the job was not. If anything, the visit cemented in our minds our desire to one day live in this area. We are continuing to look for other practices there, but so far, nothing has panned out.

I do know, as I've gone through this process, that there *is* life out there. Every day that I spend in this particular position, I am missing out on a better lifestyle. It gives me a lot of hope to see that I can still do the job that I love while simultaneously enjoying my life and family. It is just a matter now of finding the best fit.

In other news, it is crunch time for finishing my case list (due August 1!), and I find myself once again in the midst of 18 days straight of call (boo). My little baby Bean will be one year old on the 19th of this month (impossible). I am also very honored join a new blogging group of physician-mothers, Mothers in Medicine. This is an amazing group of women (regular posters and guest posters alike), and what they write hits home with me so much, I find it difficult not to comment on every post..."Me too!" "Oh, that's exactly how I feel!" etc. Check them out! I hope everyone is having a great weekend, and for my readers here in the US, I hope you are having a great time celebrating our country's birthday!

Friday, June 06, 2008

Seriously, people

Do not page your doctor on a Friday night because you are pregnant and notice a mucous-y, creamy discharge (not bleeding or pain) after sex. It is semen, you rocket scientist, and we really, really did not need to know that. Also, it is not an emergency, like the message says when it provides the number to have the doctor their home...taking care of their family...who has to take time away from that family to hear about the effluent from your nether regions after your feelgood Friday night. Seriously, think before you page, and have a heart. Doctors are *people*, not 24 hour information hot lines. Dr. Google is open 24 hours a day for "emergencies" such as this. Thanks so much. Heart, your overworked, cranky doctor.

Saturday, May 31, 2008

L & D Concierge

I know I have said it before, but, it takes an amazing person to be a nurse in general, and an L&D nurse in particular. This week, as I sat at the computer behind the nurse's station, back to the counter, signing off charts and awaiting an epidural to be placed in one of my labor patients, I got a small glimpse into what ridiculous requests the nurses (trained and skilled professional people) had to stop their work and fulfill with a smile.

This day was fairly busy, 3/4 of the rooms on the floor were full (LDRP and post surg beds). There were 3 in labor, several postpartum ladies with babies, and a few post-op patients, triage was steady in and out, oh, and there were only 4 RNs. The deluge started with about 4 family members standing shoulder to shoulder at the front counter, not saying a word, but not moving, either. After about a minute of silent staring at the back of my head, I turned and asked if I could help them. They replied that they needed a nurse in room 10 (laboring patient). I checked the board, found the nurse hanging medications in another room, and let her know that the patient needed something. I went back to signing charts. Moments later, room 10's nurse came back out of the room, obviously flustered. When I asked what had happened, she sighed and said the patient was fine, but room 10's family needed some cokes. She handled it far more gracefully than I would have, because I would have been inclined to tell them where to stick their drink order. From there it just got better. As I sat/observed for that hour or so I heard requests of the nurses for:

~ socks for a postpartum patient (who had a scheduled induction and should have packed her own fragging socks)
~ cups of ice for kids to *play* with
~ pieces of paper and pens
~ putty to hang up a sign (um, WTF?)
~ a request from a visitor to a different floor for a *free* binky, since they forgot to bring their own for their child
~ extra diapers and a *case* of formula *to take home*
~ for the nurse to launder some one's own personal baby blanket that got a teeny bit of spit up on it
~ directions to the hospital from another state
~ a phone book
~ 7 cokes and 4 cups of coffee
~ a toothbrush
~ for the nurse to "re-do" a baby girl's hair because mom didn't like the *bow* color
~ for a nurse to take out a patient's garbage
~ and (the kicker) the snide comment to a nurse sitting to feed a "boarder baby" whose parents were sleeping, "Oh, I'd love to do what you do! Sit and hold babies all day!" GAH!

Not to mention beeping IVs, meds, labor checks, and other, more legit responsibilities. It was like I was observing a full service concierge desk at the Hilton instead of a hospital. As if being a responsible medical professional was not enough, they must be the waitress, janitor, Wal.Mart, Goog.le maps, Depot, hairdresser, and babysitter. The worst thing, though, was that I don't think that I heard, in any of the above requests, a "please" or a "thank you." Unbelievable. So, remember to thank your nurses, people, and maybe, just maybe, go get your own damn coke.

Saturday, May 24, 2008

Musical Musings

Hello again! No, I've not fallen from the face of the planet. Just running like crazy. You see, once you take time off you *must be punished* for your time away! I think I blinked and missed the whole month of May. We had a fabulous time at the wedding. Everything was beautiful, and it was so fun to see everyone. The meeting of the other woman was completely bland and uneventful (as we had planned, there's been enough drama). I was cordial, but did not engage either she nor Cheater any more than I had to in polite conversation. It went as well as could be expected. This person is no dummy, so I am certain she could feel the chill from Mr. Whoo's and my shoulders, but no awkwardness was made...I think. At any rate it is over, so that makes me happy.

Bean and CindyLou were superstars on the car trip. Such amazing kids! We are truly blessed. As is often the case on road trips, Mr. Whoo and I resorted to music to keep our trip interesting and fun. This time, we busted out an artist we haven't listened to in a little while, John Mayer. Don't get me wrong, I know he is so 2001, and has gotten uber weird and into himself, and dates flaky arm candy that doesn't mesh with his "I am an artiste!" persona, and he does weird things with his mouth when he plays guitar, but he can turn a hell of a lyric! Anyway, I got to revisit some of my favorite lines, and am posting them here, as well. Have a great holiday weekend, all!

When Autumn comes, it doesn't ask,
it just walks in, where it left you last.
You never know when it starts,
until there's fog inside the glass around your summer heart. - Something's Missing

You asked to kiss me once goodbye, but you already did,
on somebody else's lips. - Why Did You Mess with Forever? (No videos, bummer...great song.)

Today I finally overcame trying to fit the world inside a picture frame. - 3x5

And I will go to my grave with the life that I gave
Not just some melody line on a radio wave
It dissipates, and soon evaporates, but a home life doesn't change. - Home Life (weird little video, but the song is unmarred)

Oh, another social casualty. Score one more for me.
How could I forget? Mama said "think before speaking."
No filter in my head. Oh, what's a boy to do?
I guess he better find one soon. - My Stupid Mouth

Numb is the new deep. Done with the old me.
I'm over the analyzing, tonight. - New Deep

I can't wait to figure out what's wrong with me,
so I can say this is the way that I used to be.
There's no substitute for time. - Split Screen Sadness

So what, so I've got a smile on. It's hiding the quiet superstitions in my head.
Don't believe me when I say I've got it down. - Why Georgia

Check your pulse, it's proof that you're not listening to the call your life's been issuing you.
The rhythm of a line of idle days.
Scared of a world outside you should go explore,
pull all the shades and wander the great indoors. - The Great Indoors

Oh, if only my life was more like1983.
All these things would be more like they were at the start of me . - 83

Sunday, May 11, 2008

Happy Mother's Day

Happy Mother's Day to all of you Mothers, would-be-mothers, and glad-you-aren't-mothers, We had a great active weekend here. CindyLou had her 4th birthday party (dinosaur theme, of course, every girl's dream), and the Bean was baptized this weekend. I also was on call, but so far the call gods have been kind to us! May has been a crazy month, with lots of travel, and busy-ness in general. I am hopeful for the summer. I am looking to interview with other practices in the coming weeks. I am also going to meet "the other woman" this weekend at a mutual friend's wedding. Give me the strength to be civil and polite to this person with whom I regard with contempt. Apparently they are going to become engaged soon. It blows my mind how my friends can call her a "nice person" when I know and she knows that she is a home wrecker. Hopefully I won't get drunk enough to tell her what I really think of her! Today I am thankful for my perfect babies. They are truly the best Mother's Day presents of all!

Thursday, April 24, 2008

72 hours (In bullet points, because I'm just that tired)

Listed below are 3 days (in a row) that I have had the pleasure of undergoing recently. You can't make this stuff up. The only thing that makes it better is wine. So for those of you wanting to "know what it is like to be an OB ," here you go.

Day 1

2:00 am - Page #1 - Induction for preeclampsia, asking for pain meds for contractions. Nurse didn't bother to check the orders I had called in the evening prior, for pain meds, for contractions. Oops.

3:00 am - Page #2 - Triage - 32 weeker, pain with urination, no contractions, cervix closed. UA, Rx antibiotics, see in office.

5:00 am - Page #3 - Induction requesting epidural, IV bolus running. Please come in?

5:01 - 5:15 am - Lie in bed and curse the universe.

5:15 am - Shower, dress, warm Bean's am bottle, label bottles for daycare, prep CindyLou's breakfast, take upstairs to Mr. Whoo, drive in to hospital

5:40 am - Arrive, find a place to pump while epidural gets placed.

6:00 am - Check now comfortable patient, 6 cm, BBOW, no contractions picking up on the monitor, AROM, IUPC

6:15 am - Start rounds

7:15 am - Triage patient, term, in labor, 4 cm. Write admission orders.

9:00 am - Induction patient now 9 cm/0 station, variable decels, FSE. Call office, cancel AM patients.

9:30 am - Breakfast, pump, rest in empty labor room.

10:30 - 11:30am - Dictate delinquent charts, field office pages for various "emergent questions."

11:30 am - Labor patient gets epidural, induction patient complete, but too numb to push...laboring down.

12:00 pm - Check labor patient, 5 cm, SROM after epidural (she had thought she had peed) comfy.

12:30 pm - Pump, induction patient pushing.

1:30 pm - Labor patient feeling pressure, complete, starts pushing.

1:45 pm - Deliver labor patient's baby, placenta, get called away before laceration repair to catch induction patient's baby.

1:49 pm - Deliver induction patient's baby, sew 3rd degree laceration (14.5 in head).

2:10 pm - Return to labor patient's room, repair 2nd degree laceration. Write orders on both patients.

2:30 pm - Sign off NSTs, head to office, stop for fast food lunch on the way.

2:45 pm - 6pm - Office patients.

6:30 pm - Arrive home. Make dinner.

6:32 pm - Page # ???? - Triage patient, 38 weeks, oligohydramnios. Admit for induction.

7:30 pm - Baths, stories, and bedtime.

8:30 pm - 12 am - Dishes, bottles, tv, and sleep.

Day 2

7:00 am - Page #1 - Triage patient, 39 weeks, labor, 4 cm. Admission orders.

7:30 am - Rounds, oligo induction 3 cm/60% effaced, start pit, encourage ambulation.

8:45 am - Arrive at office, pump while signing off labs.

9:00 am - 5:30 pm - Office patients (32, not too shabby!), charts, 20 min for lunch and pumping.

5:35 pm - Page #2- Labor patient 9 cm with BBOW, call Mr. Whoo to pick up kidlets, drive to hospital.

5:50 pm - Check oligo patient (who's been walking the halls all day long on pit). No cervical change. Decide to rest overnight and restart in the AM.

5:54 pm - AROM Labor patient, complete, fetal decels, resolution with O2 and reposition. FSE placed.

6 pm - 8 pm - Intermittently push with patient. Get hemorrhoids. Pump with "fred" the hospital pump. Fun times.

8:15 pm - Maternal exhaustion, deep variable decels, successful vacuum delivery, repair 2nd degree episiotomy.

8:30 pm - Write orders. Check on induction for post dates for the AM. Finally leave fragging hospital. Curse universe once again. Get page from UTI triage patient...still with painful urination. Encourage to continue antibiotic.

9:00 pm - Arrive home.

9:15pm - 11 pm - Dinner, Ti.Vo, and bed.

Day 3

6:30 am - Get up, pump, see kids for 2.5 seconds, drive to hospital. Eat breakfast bar. Yawn. A lot.

7:00 am - Rounds. AROM oligo patient, place FSE/IUPC.

7:30 am - 1st surgery of the day. L/S, endometriosis, ovarian cystectomy, lysis of adhesions. Dictate. Talk to family.

9:30 am - Check on postdates patient, getting epidural. Pump. Round some more.

10:45 am - 2nd surgery of the day. L/S, endometriosis, adhesions, H/S, endometrial ablation. Smooth. Dictate. Can't find family.

12:00 pm - Check back with postdates patient. 4 cm, AROM, IUPC. Contractions not nearly as impressive on the IUPC.

12:15 pm - Oligo patient's epidural not working. Re - do epidural. Pump. Consider eating, but get called for...

12:30 pm - 3rd Surgery of day - LEEP, easy. Dictate. Reassure overanxious family.

1 pm - Grab bag of vanilla creme cookies from Doctor's Lounge for "lunch." Get paged to speak with 2nd surgery's family. All is well.

1:10 pm - Check Oligo patient. Cervical change! Yesss! 5-6 cm, comfy.

1:30 pm - Finally finish rounding on 10 patients. Write orders and scripts and discharges.

2:30pm - 4th Surgery of the day - D & C, endometrial hyperplasia. Lots and lots of curettings. Pray for no cancer. Dictate. Talk to family.

2:55 pm - Check post-dates patient. 6 cm, sleeping. Check oligo patient, sleeping, no cervical exam.

3:00 pm - Circumcision on 39 weeker's baby.

3:30 pm - Leave hospital, get fast food snack (mmm, french fries), go to pick up kids a little early from daycare. Feel like a good mom.

4:30 pm - In the midst of gathering kids from daycare, get urgent page. Oligo patient complete and ready to push (!!!) !@#@*#&(*!&

4:31 pm - Drive like a crazy person to the hospital, with kids hanging out in the backseat. Leave frantic messages on Mr. Whoo's cell to pick up the kids at the hospital.

4:45 pm - Arrive at hospital. Hand off kids to kindly nurses. Feel like a terrible mom. Go catch a baby.

5:15 pm - Repairing laceration and working on post partum hemorrhage. Guess birth weight exactly. Get word that Mr. Whoo has arrived to pick up the kids. Also, post-dates patient is 8 cm.

5:30 pm - Finish paperwork, check post-dates patient - 9 cm. Call Mr. Whoo, check on kids. Kids are sad and miss the mama. Feel like a criminal. Cry a little.

5:30 pm - 8:00 pm - Hang at the nurses station. Pump. Feel sorry for myself. Whine a little bit. Check post-dates patient. Patient begins pushing once night shift nurse is ready.

8:00 pm - 10:00 pm - Pushing. More hemorrhoids. Anguish. Bitching at the nurses station. Occasional fetal decels, and, finally, fetal tachycardia.

10:10 pm - Have "come to Jesus" talk with post-dates patient. Decide to place vacuum. Successful vacuum with one push. Berate myself for not doing this 2 hours ago. Repair 2nd degree episiotomy. Get the birth weight right within one ounce.

10:30 pm - Finish paperwork. Hear about term fetal demise getting admitted (not my patient, but still devastating.) Leave the god forsaken hospital. Curse the universe, once again.

11:00 pm - Arrive home. Shower, dinner, and bed.

Glamorous, is it not? More wine, please?

Sunday, April 20, 2008

9 months and mobile

The Bean just turned 9 months old. It seems that he has had quite the spurt of development in the last few weeks. He got 2 new teeth, he started pulling up, he started crawling "for real," and he started to cruise. Just like that! He is a "big boy." I'm not ready! He is my *baby.* In so many ways. He still prefers the mama. He still dive bombs the boobs. Such a boob man, is he. I am breastfeeding longer than I had with CindyLou. She had little interest in the breast starting around month 8. Mr. Bean, however, is all about the boob, and I fear that it will continue that way until I say, "No more." Gah. I look at CindyLou's almost-4-year-old self, and I can barely fathom my little Bean growing as fast as she. Alas, I know it is inevitable! I have made a makeshift baby corral in the living room. He is such the explorer, it is hard to keep him contained! I am ever so grateful for the daycare's ability to accommodate his growing need for exploration. My living room , unfortunately, is less prepared.

This week has been crazy, nuts. Not in a good way. Deliveries and rescheduling of patients...the bane of my very professional existence. My office staff insists on scheduling me 7 patients in an hour. I am not pleased. I find myself actively fantasizing about other jobs. Less call, more life. Less than 40 patients seen per day. I spoke with another hospital this week. I find myself looking more toward relocating than staying and making this place work. This is a change, but with OtherDoc's wife as an "office manager" and the writing on the wall WRT any immediate change in the office and/or call schedule (not happening). I find myself invigorated by the possibilities out there. I am young, female, American trained, with a decent (I think) personality, and a strong work ethic. There is a lot of opportunity out there for me. I hate the concept of moving again, but, it may be worth it if I can find a job with one day call per week, and one weekend call per month (instead of 4 paltry days off per month, pathetic). Thanks to all of you for still checking on me! More detailed bread and butter OB/GYN in the next post, promise. Happy Weekend!

Saturday, April 12, 2008

Home again, home again...

jiggity jig. Only I went on vacation to *become* a fat pig, rather than to *buy* a fat pig. We had a wonderful, whirlwind, exhausting trip to Florida to visit with both my family and Mr. Whoo's family. Bean had sufficiently recovered from the pox to be his normal, sweetheart self, and I think this is the first time that CindyLou actually could appreciate being on vacation. We beached, we swam, we went to kid-friendly museums, went to the river to fish, and we ate...and ate...and ate! Having to drive long distances with an 8 month old and a nearly-4-year old was, erm, challenging, at times. However, I don't know how our parents did it without today's modern conveniences like DVD players. Mr. Whoo and I actually did our best to break out the DVDs as a last resort. We played the license plate game (Mr. Whoo and I) and I Spy with CindyLou, and she really enjoyed it. A steady supply of crackers for CindyLou, and an arsenal of new and interesting toys to play with for (backward-facing) Bean kept me quite busy. Oh, and pumping in the car to be able to make fresh bottles for the Bean was quite a joy, as well. I'm sure some truckers got a really good look at the girls at a few points. Tres exciting for them, I am certain. Ha. Weight gain verdict...6 lbs for me 8 lbs for Mr. Whoo. Time to consider to think about maybe at some point trying to exercise. Mr. Whoo and I have made a commitment (after seeing my mother's house and all the food that she hoards) to do our best to clear out our freezer and pantry and to only buy essential perishables. We are so bad about holding on to food, then buying more.

We've been back for a week. Of course I paid in spades at work for being on vacation with a really booked office schedule and a rash of deliveries the moment I arrived back in town. Not a single one of my patients delivered while we were on vacation! I am, of course, on call this weekend. Unfortunately, my day started with having to tell a forty-something patient that she has at least stage III cervical cancer (hydronephrosis). It is really terrible, but she hasn't had a pap or pelvic in over 10 years. It is so frustrating to see an advanced cancer that may have been prevented with routine screening. It is my 3rd cervical cancer that I have diagnosed this year, all were due to delaying routine screening. Go get your annual exams, ladies, you don't want to get the kind of news I had to give this family today. I am also in the midst of compiling my oral board list, re-applying for hospital privileges, and had to bring home patient charts to write since I was so busy in the office this week. Oh, I also need to dictate. And we haven't unpacked yet (!) But, for now, the sun is shining, the trees are in bloom, and my family and I are going to sit on the patio and grill lunch...and then go run to work it off, that's the ticket! Have a happy weekend!

Thursday, March 20, 2008

A Pox Upon Our House

Oh, what a sense of humour the universe has! The health of the Whoo household has been less than stellar this past week. Last Wednesday, Bean had his 6 month shots (at nearly 8 months) and got diagnosed with an ear infection for which he started Augm.entin. Last Wednesday evening, I decided to get a sympathy ear infection and spent the next 3 days in the most pain I have had since labor, and I started Augmen.tin and any other decongestant I can find to clear the constant sensation of my ear being filled with fluid. Sunday, on call, with the ear infection, I delivered a baby at 6:30 am, shipped a 32 week pre-term labor patient to the high-risk hospital, rounded on various complications of the post partum variety including an adrenal hemorrhage and a vaginal hematoma, labored a patient all day long, sectioned her for failure to descend past zero station despite pushing for 2 hours, and admitted a complex ovarian cyst. Monday, noticed a couple of raised bumps on the Bean's head, chalked it up to his sensitive skin, and whisked him away to daycare. Got to clinic, saw the 7 patients that were scheduled between 9 and 10 am, and got a call from the daycare that Bean's rash was spreading. Mr. Whoo picked up Bean and brought him to the office, where it was obvious that he had the chicken pox. I felt like the worst mother in the world for not noticing it that morning. I took him to the pediatrician on my lunch break, who confirmed the diagnosis, and canceled the rest of the day in the office to care for my poor sick baby.

I took Monday afternoon and Tuesday out of the office (but not off of the pager, which continued to sound every 1-2 hours like clockwork) to care for the Bean, and went to see the ENT on Tuesday. He essentially told me what I had already deduced; I had an acute otitis with an effusion. The otitis was clearing but the fluid in the middle ear (which is giving me moderate functional hearing loss, BTW) could remain until almost a month. A fragging month! Feeling like I have fluid lolling all through the right side of my head, and torturing my family with the high tv volume, and muttering "Huh? What? 'Ay?" like a little octogenarian with her "listening cone" anytime someone tries to speak to me for another freaking month. Fan-tastic. He added a Me.drol Dose.pak for extra fun with steroids to my treatment regimen.

Wednesday I had a 12 hour surgery/work day, made stressful by a surgical complication on one of my favorite patients. Mr. Whoo stayed home with the Bean, and proved himself un-house-husband worthy by failing to have dinner ready when I dragged myself and an exhausted CindyLou through the door after 6 last night. Mr. Bean had a particularly fitful, itchy night last night, so either of us slept very well, and today I am again taking out of the office, but on the pager to care for him. Call me crazy, but I am running out of patience and sympathy for the patients that just have to be rescheduled *next week* due to the fact that their golden ticket, ahem, "free" medical card runs out at the end of the month. Go to the freaking health department for your pap, for goodness sake, it's still "free" (ie. I will be generously subsidizing 30% of the salary for which I work 24 hours a day/26 days a month, so that you can play Wii and smoke weed all day long and still not have to pay a whopping fifty bucks for a pap smear). I'm just about all out of doctorly concern, and eyeing up my liquor cabinet right this minute, even though it is not quite noon yet.

So that, dear readers, completes your lovely week-in-review from the Whoo household. So, how are *you* doing?

Saturday, March 15, 2008

Ow ow ow ow ow...

This is the full extent of my vocabulary for the past three days. I have a rip roaring ear infection. I don't believe I've had one since I was a kid. Thank goodness not, because the only thing that hurts worse, my friends, is labor. No epidural for this kind of pain, either. I have been eight kinds of miserable these last few days. It started on Wednesday, after the Bean (finally) got his 6 month (!) shots. Coincidentally (or not) he was also diagnosed with an ear infection. That evening, I heard a rubbing noise in my right ear, followed by an immediate sensation of fullness that did not resolve. I took and antihistamine and a decongestant and woke up the next morning at 4 am with severe pain. As I lay in bed, trying not to move, lest the fluid crackle and make my ear hurt even worse than it already did, the pager went off signaling the arrival of a labor patient. Grudgingly I got up and showered, finding my movement extremely limited. I couldn't even bend over to wrap up my hair in a towel without twinging my ear so badly it wrought a stream of curses.

I arrived on labor and delivery, caught a very fast baby about 10 minutes later, and started to move slowly through my hospital rounds. I stopped a kindly family med doctor, whom I begged to check my ear. (You see, I must relate that ears completely squick me out. The fluid, the hair cells, the little bones that *articulate*, the membrane...ick, ew, and gross. Funny, I know, coming from a specialist in one of the arguably more gross professions around. To each their own.) I was just *convinced* some wandering spider had laid eggs in my ear and they were getting ready to hatch. My colleague allayed my fears, but told me that, indeed, my ear was "cherry red" with fluid bulging behind the TM. Great. I got an Aug.mentin script called in, finished rounds, and did a post-partum tubal on my morning delivery patient. Then I headed to the office, where I proceeded to throw a minor hissy fit because I had 21 patients scheduled in roughly 3 hours (of which there were at least 3 new patients, 3 problem patients, and an I&D of a perineal abscess on the list). My hissy fit was for naught, however, as about 10 patients later, I was called to attend another delivery. I happily canceled the rest of the day and rushed back to the hospital.

As I sat waiting, my ear pain kept escalating, throbbing, and ringing. The nurse caring for my labor patient was forever messing with the electronic charting and not helping the patient (a primip) to push in any significant way. The baby kept deceling and the nurse kept ignoring the strip and focusing on the computer, and my ear kept twinging. I did the best that I could to encourage the patient. Her family stood stock-still, lined up against the farthest wall of the labor room, and her nurse hadn't even turned on the baby warmer. At last, in just a hour of pushing (would have been less, had my nurse been more patient focused and less documentation focused) I delivered the baby through a triple nuchal cord and placed her on her momma's belly. Then, I handed her a sterile towel to start drying the baby, since the nurse was still ignoring us both in favor of the computer. Thankfully the baby pinked right up and no resuscitation was needed. I finished sewing the lacerations, and held my ear and moaned all the way home.

Flash forward 'till today, I have had over 48 hours of antibiotics, have been living on m.otrin and sud.afed, and I still don't feel any better. The whole right side of my head is clogged, my ear feels full of fluid that shifts and crackles, and oh, the pain is still there. No real fever, just hovering around 100.0, and I still have to hold my head perfectly still or pay the consequences. Now I'm googling Mastoid.itis and generally being a hypochondriac about the whole thing. Oh yes, and I am also on call. I can only pray that the call gods are kind to my suffering soul.

In other news, I updated my CV and sent it out to a few "backup plan" opportunities. Mr. Whoo says my health is suffering because of the lifestyle I have been living the last 3 years. Maybe he is right, because I feel 100 years old right about now. Hope you all are having a wonderful, spring-like weekend, wherever you are. I'm going to hold a hot pack to my ear and whine about it some more.

Friday, March 07, 2008

Check, check, check, check it out...

Lots of things swirling around, but nothing cohesive...hence, bullets, it is!

~I turned another year older this week, and I was pretty surprised to see that a couple of my favorite bloggers had a birthday this week, as well. Pisces rule...woot! So funny, since we're supposed to be all reclusive and whatnot.

~Last week I pretty much had a baby a day, so I was pretty busy. No birthday babies for me, though. Too bad for them. Hee.

~I'm looking at other job opportunities in other areas, just as a back-up plan, and I am meeting with the physician director later this month. Here's hoping they want to keep me around, 'cause I really don't want to move.

~I discovered Project Playlist last weekend, and have been slowly adding songs to my list. If you want to check it out, just scroll all the way to the bottom of the page and click the play button. It is fairly eclectic, but I am loving listening to it. I need to make a CD out of my playlist!

~We are doing some sleep training with Bean. It is time to move from Mommy's bed to Bean's bed. He's doing really well going to sleep in his bed, but he still wakes to eat in the night. It works for at least 6 hours a night, then it is time to nurse and cuddle. Is it wrong that I just am not ready to give it up yet? They are only babies for such a short time.

~I've been playing around on Facebook more than I should. I heart Oregon Trail.

~My grandfather is quite ill, and has started dialysis this week. He has multiple medical problems, and I know, I *know* we don't have much time. I saw him last week and we are taking the kids to see them this weekend as well. The hardest part is that he is still so mentally sharp, his body is just failing him. I am just trying to soak up all the time that I can, and I hope that CindyLou may remember him, even just a little bit. He is such a great man, and I am not ready to let him go. Sniff.

~I am loving Amer.ican I.dol this season, and I heart them a little bit more for featuring the Graham Colton Band as one of their "goodbye" songs (Best Days - the last song on my playlist if you wanna listen). I will go out on a limb and predict the finalists to include Ar.chuleta, Davi.d C.ook, Br.ooke Wh.ite, Sy.esha Mercado, Micha.el J.ohns, and Carl.y Smi.thson.

Sorry for the short, sweet post, but I haven't the ability to mold and shape the roundy thoughts filtering through my brain right now. Hope all is well in your respective worlds. Happy weekend!

Saturday, February 23, 2008

Wake Me Up Before You Go, Go

In my younger years, when this song first came out, I sang the next line, "...don't leave me hanging on a lively yo-yo." Hee. What exactly a "lively" yo-yo is, I cannot describe. What can I say? I wasn't the champion lyric interpreter that I am today. This song got stuck in my brain because, you guessed it, someone woke me up before he went (went). Mr. Whoo had an early morning service commitment that required him to be up and out of the house before 5:30 am, and CindyLou took that as a clue that she needed to be awake, too. Telling a 3 year old that it's too early to be awake just doesn't fly when Daddy is already up, showered, and out of the house, so no sleeping in for me! I am soooo sleepy, but Mr. Whoo and CindyLou are napping, and the Bean is happily awake. No rest for the wicked! He and I are hanging out, watching Tivo'd Ameri.can Id.ol. (We are just at the end of the group sing, and....Jazz Hands! Hee. The Bean seems to favor Michael J.ohns, maybe he has an ear for this sort of thing?)

It has been a harrowing week. I have had a couple of really sick patients. One patient had HELLP with platelets dropping into the teens before she finally turned the corner. The other patient got a high spinal instead of an epidural (!) and we were *this close* to having to intubate her. Luckily, the worst of it was that she felt particularly crappy and was incredibly numb from the chest down for nearly 3 hours. Basically she labored right down to the perineum before she could feel too push. She had a happy, healthy baby, didn't feel a thing for another 2 hours, and, thankfully, has no residual effects from the misplaced anesthetic. Yikes. I feel like I have worried enough this week to sprout several gray hairs. It also seems like all of my March babies are preferring to be born in February instead! I am on call this weekend, so I am hoping the next couple of days are more low key.

I've been thinking of what my ideal practice would look like, as my contract is coming due in the next year. Something like a true group practice (shared OB patients, but individual GYN pts), with 4 or 5 docs, each with one 24 hour "labor deck" call during the week (which would include all labors/inductions/rounding for the entire group for that day, with no office duties), the day post call off, maybe doing surgery during your call day, and doing office the other days of the week, taking weekend call every 4-5 weekends. Sounds nice, but I am unsure if it exists in a workable form. We love just about everything about where we are now except for the call coverage (or lack thereof) and the office manager, of course. I am going to initiate some discussion now, so that we don't have to scramble at the end of the contract for a new place to go, should it come to that. Hopefully it won't, and we can work out an acceptable deal. On that note, Bean just filled his pants...during Paul.a's new video. Another sign of his ear for talent? I think, yes. Have a great week!

Saturday, February 16, 2008

A Good Day's Work

Some days this job is frustrating, irritating, exhausting, and difficult, other days this job is exhilirating, wondrous, amazing, and wholly satisfying. I was fortunate to have such great day in the not so distant past. It was edifying to feel as if I was doing exactly what it is that I was made to do. The morning started out like most others, rushed and sub-frantic, prepping kids for school, consolidating bottles and pump parts, and departing for work just not quite in the nick of time (ie. just enough to be about 5 minutes late). This day the gods were smiling upon me, and the operating room was behind by about 10 minutes as well, so my surgeries were not delayed due to my tardiness. It was also fortunate that the OR was running a bit behind, as I had a moment to check up on one of my patients that was admitted overnight for observation.

This young girl (YG), a long standing patient of mine, seems to carry the very weight of the world on her shoulders. She was pregnant with her fourth child, six years after her youngest child; a child that was very much wanted, as she had prolonged interval between pregnancies. The day we diagnosed her as pregnant she cried in dismay rather than joyful tears. YG, you see, has severe depression. The depression had been somewhat controlled by several medications that she had weaned in anticipation of the pregnancy, but now that the pregnancy had arrived, she feared the long road ahead without the medications that worked best for her symptoms. Of course we attempted a different, safer, regime to continue throughout her pregnancy, but it was not as effective. The pregnancy was long and fraught with many tearful visits, poor weight gain, and many fears, as her previous delivery had been by emergency cesarean, and she desperately wanted to VBAC. She also approached her due date with apprehension, as she had an induction of labor with all of her previous deliveries, and, while I explained that natural onset of labor would give her the best chance of a successful VBAC, she dreaded the unknown sensation of a spontaneous labor. This initiated no fewer than 14 triage visits in the the weeks leading up to her due date.

Fast forward to this morning, where she had been admitted for irregular contractions early in the morning. Before my surgery began, I checked her cervix, and it was 3 cm, a change from her office visit earlier that week, but not by much. Labor and delivery was full, and the nursing staff was a little short, so we continued to "expectantly manage" her, we felt, very early labor. The thing about VBACs in my hospital is that the OB must be on hospital campus during the duration of the labor, for saftey reasons. So she and I were there, both waiting.

My first surgery was a hysterectomy on a 4 pound fibroid uterus, a little tricky, as it was quite enlarged, but extremely satisfying, and only 100 cc of blood loss! I saw YG walking the halls in between my cases, and hoped for cervical change, for both her sake and mine! My next case was a repeat cesarean section. It was truly a beautiful moment, as the baby was delivered, both mom and dad could see her lifted from the womb, they had chosen music to play in the OR, and they cried along with the perfect baby girl. Say what you will about cesarean deliveries (and this patient was offered VBAC, as well, but she declined emphatically, citing 72 hours of hard labor and little cervical dilation in the previous pregnancy) the birth was still beautiful, and it made me very happy to be a part of it. After the cesarean, I scurried up to check on YG, now contracting every 2-3 minutes, and dilated to 4-5 cm. She requested and recieved her epidural, water was broken and internal monitors were placed, and I went back down for the last case of the day, a short and sweet endometrial ablation.

After my third surgery, I grabbed a little lunch and retreated to the doctor's lounge to catch up some dictations, anticipating a somewhat long wait for YG's baby. I was surprised to get a text page, a mere hour later, that she was 6-7 cm and feeling pressure. I quickly wrapped up my dictations, and luckily so, as in the next 5 minutes I got the "get here now" page. I sprinted up the stairs and into the labor room to see that the "get here now" was a bit premature.

I was already gowned and gloved, so I settled in to help YG with her pushing. Something for which, I admit, I am not often present. It has always bothered me a bit when the nurses get a little yelly with their counting, all in the patient's faces and tell them to "get mad" to push their babies out. I just don't feel like "getting mad" and pushing out your baby jibe all that well. This labor nurse, despite the whole "get mad" business, was really very sweet and supportive, which YG needed most of all. I tried to get YG to listen to her body and let the pressure she was feeling guide the baby out.

After about 45 minutes of good pushing, the crown was visible, with thick, wavy hair, half-dollar size at the introitus, and I knew that this baby was going to be a very nice size. YG was starting to doubt herself, and I told her that her baby was going to be delivered at 3:45pm (in about 10 minutes). She laughed, a rare sound, and renewed her efforts. After a few more pushes, I eyeballed the nurse to get ready for a possible dystocia, and YG concentrated all of her energy to deliver her baby to the world. The head delivered oh-so slowly, I reduced the first nuchal cord on the perineum, felt the shoulders give a little catch which resolved with only McRobert's and a little bit of suprapubic pressure, and reduced the 2 additional nuchal cords as the baby's body was delivered up to his mothers waiting arms at precisely 3:45pm. She had an intact perineum and only a small right sided periurethral tear. Her largest baby prior had weighed 7 pounds 11 ounces; this young man was 8 pounds 11 ounces! YG was ecstatic, and back on her old medicine regime. She has a long road ahead, but she seems hopeful and empowered by the birth of her new son.

So a VBAC, a hysterectomy, a c-section, and an endometrial ablation, all before 4 pm. All in a good day's work, helping different women in different ways. This is what keeps me going through the less savory aspects of my job. Weird for me not to whine, for once, huh? Have a great week.

Monday, February 11, 2008


So much for posting 4 times a month. It's been almost a month since I had a minute to sit down, and, unfortunately, the only reason I have this minute is because the entire Whoo household has been stricken with a nasty little GI bug. It started out with the Bean. I picked him up from daycare on Thursday and he promptly annointed me with copious amounts of vomit. He continued puking for the next 24 hours. Poor little man, they just look at you after puking like "help me!" Mr. Whoo stayed home from work with him on Friday. I was on call for the weekend, and by Sunday the Bean seemed to be feeling fine. That's when CindyLou picked up puking, followed shortly by myself. She and I puked all last night, and now Mr. Whoo is starting to get the chills and nausea, and, we just got the call from the daycare that Bean picked up vomiting again this morning (odd after almost 2 days with no sickness!) We are a sad little family today. Just pitiful. CindyLou and I slept in, and have just ventured on to ginger ale and crackers. Hopefully we are turning the corner soon!

In work related news, I had this lofty goal of not having any inductions this month. (To be honest, that is my goal every month, but with just a handful of patients due, all relatively healthy with few risk factors, I felt I'd actually be able to accomplish it, for once!) Well, that came back and bit me big time, as of this morning I have 2 40+ week patients with severe oligo, and another 39 -weeker threatening pre-ecclampsia. All three are now on the books for induction, thankfully not today, since I'm most uncomfortable straying too far from my bathroom! Also in the works in the coming months, I have 2 sets of twins on the way. I keep waiting for the 3rd set to complete the trifecta. I have noticed a little more activity on the billing front with respect to OMFH. I have a meeting scheduled to go over financials, so I'm sure she's scrambling to set things right. My application for oral boards is looming due at the end of this month. I am scared to take these boards! Any good advice for review courses? I was thinking of trying to do one before I have to turn in my list, so someone can look it over.

Sorry so short, but feeling sick and looking at computer screens does not go well together! Thanks to all that have been checking in on me. I will try to be more present in the blogosphere in the coming weeks.

P.S. Hah! This is my 100th post. A post about puking, how un-monumentous!

Saturday, January 19, 2008

6 Months

The Bean is six whole months old today, and I find myself feeling as though I have blinked and missed it! He is growing up so very fast. With CindyLou, I remember always looking forward to the next big milestone...I couldn't wait for her to smile, sit, crawl, walk, etc. With Bean, I find myself feeling the opposite, he is hitting milestones and *I'm* not ready for it yet. I suppose it is because I have hindsight from watching CindyLou, knowing how fast she is growing up (and she tells us every day), coupled with the fact that Bean is, in all likelihood, our last baby. Whatever it is, I'm not ready.

Bean is such a happy baby, though. He loves to play, he is starting to clap his hands, and he really loves singing (lucky for him!) He weighs a little over 15 lbs., which, I know, is still pretty small compared to most kiddos. He is starting to eat "real" food, too. So far we have tried (and liked) rice cereal, sweet potatoes, and applesauce. Teething has been in full force for a few weeks, now, there is much drool and chewing involved, but no visible teeth yet. Bean has nearly mastered the tripod sit, but still hasn't shown much interest in rolling a lot (he's done it once or twice) or trying to crawl. He loves the exersaucer and still hates sleeping in his own bed (the record thus far is 4-5 hours). We are still nursing/pumping, and I don't see him giving that up any time soon...quite the boob man. He does something that I have never seen a baby do in my life; he scratches the living daylights out of his teeny head, sometimes drawing blood. We've tried baby oil, bathing more and less frequently, hypo-allergenic soap, lotioning him (head included) within an inch of his life, and of course, keeping a hat on his head and his nails as short as possible. He still goes after his scalp with both hands and digs as if it kills him. Anyone else have this problem? Our pediatrician has not been overly helpful in this arena.

Today is the first day I have had off of call since 12/30/07 (last year! Ha!) It goes without saying that our house has transitioned from utter disarray (the "normal" state of being) to uncontrolled chaos. It makes my brain hurt, and Mr. Whoo and I have been up and working since early this morning. Laundry, folded but not put away, had been residing upon our bedroom floor for far too long; so, I took it upon myself to finally place the clothes in their proper homes. Whilst putting the Bean's laundry away, I realized how many outfits in his drawers were clothes that he has outgrown. I pulled sweet baby onesie after sleeper after teeny booties and hats out to place in storage bins and just had to sigh. I know that if we do our jobs as parents correctly, our children will grow, leave us, and one day begin the cycle anew, having children of their own, but no one told me how it makes your heart ache, just a little.

We are planning to take the kids out to a movie this afternoon, so I've not a lot of time to post individual responses to all of your wonderfully helpful comments to my previous post, but I will, I promise. You are all the best, and I really appreciate every person's input. I had a bad feeling about going in to a situation like this to begin with (spouse being the office manager) but felt, at the time, that the good aspects outweighed the bad. My contract is coming up in about a year and a half, so I am taking some steps now, as suggested. More on that in the comment section, maybe later tonight. Again, I cannot thank you all enough, your feedback keeps me sane! I hope that you are having a wonderful winter weekend!

Sunday, January 06, 2008

So ya say you wanna Resolution, weellll you know...

we all wanna change the world. Happy New Year, everyone! I am fervently attempting to keep up all resolutions, at least until the end of the month, ha! Some are going well:

-drink more wine, check! I'm liking Syrah, right now.
-blog more, check!
-play more/make friends, check! I got a DS for Christmas, and I am addicted to Brain Age and Zelda already. Today I went on a play date with CindyLou and got to chat with her playmate's mother for the afternoon. Woo!
-tell manager where to stick it, check! (Um, well, sort of...more on that later.)

Some are not going so well:

-take less call. Well, OtherDoc is on vacation for the week, so I am taking call for him. I actually have had call all weekend by myself with the kids, as Mr. Whoo was out of town in a wedding. Luckily it has been the "q" word...shhh don't tell anyone!
-lose weight/cook real meals. HA! That is all.
-be an understanding physician. I'm just being bitter, I guess, but I am O-V-E-R the calls for pain meds. I got a call from a pregnant person requesting meds for a migraine, and, as this was a legit request, I phoned the pharmacy. The pharmacy informed me that this particular patient had 2 different narcotic scripts filled in the last week from different physicians, so I opted not to call in the third script. I guess that's what I get for giving someone the benefit of the doubt!

As for telling my office manager where to get off, please allow me to elaborate. (Beware, a long, practice-related rant follows, likely supremely boring for most, but for my fellow OBs/physicians in practice, I'd love some feedback.) I know that I am still yet a novice, in my toddlerhood of practice, if you will. I will be the first to admit that I know very little about the "business" of medicine. I accepted a hospital-employed position for this very reason. Even though I am an employee, and get a paycheck regardless of the revenue I generate (in theory); I still need to generate enough to cover my expenses in order to "earn my keep," so to speak. When I first started out, I (naively, I admit), trusted that my office manager would assist me with any coding/billing of charts and/or surgeries in order to get paid the maximum amount for the work that I was doing. In residency, I had a cursory overview of coding, and I know a little, but I need to take a coding course (in my spare time, of course).

My office manager, however, had no such interest in making certain that I was billing to capacity, since she was too busy making certain that her husband (OtherDoc) was getting all he could. I was (and still am) considered second priority. I found out, almost a year after I had started practice, that my office manager hadn't been billing circs for me. When I asked her why, she said it was because I didn't pull face sheets on the patients. This is fairly standard procedure, and easy enough to do, except *she never told me* this was necessary for reimbursement. She had to know that I was doing them, she just didn't care to point it out until I asked. I know for a fact that OtherDoc does not pull facesheets (I've asked), nor does he do anything special to document his procedures. Our office manager (his wife) just checks his patient lists on the computer and does it for him. She, in theory, could do the exact same thing for me, but she doesn't. Instead of letting me know, however, she let me just "lose" revenue that I was honestly earning. Let me state that I do *know* that it is ultimately my responsibility to make certain I was being reimbursed, but I was naive. I just didn't realize that was good for the gander (in our office) did not apply to the goose!

There are numerous other instances of the gross inequality in our practice, like when she told the front office staff that OtherDoc was first priority when it came to scheduling, or when she flat refuses to let patients transfer from OtherDoc to me (illegal, anyone?) and insists that I (or my nurse) write all insurance letters myself while she writes OtherDoc's for him. I have become aware and wary of her motives, and have accordingly made adjustments. It really sucks to have an office manager that not only couldn't care less about how my practice is going, but openly attempts to sabotage it.

At any rate, I have been in a constant battle with the front office staff (no doubt due to her behind the scenes machinations) over the scheduling of patients. I have been trying to cut my patient schedule back to no more than 35 patients in a full day (down from nearly 50 a day). When I returned to work after the Bean was born, I wrote out a detailed, day-by-day (even hour-by-hour) outline of how I wanted my schedule to flow and gave it to her. I didn't expect it to happen right away, because I knew I had been booked through December before I even left on maternity leave, but I figured that things would start flowing by the end of December/early January. This past week, not once, but twice, I had 8 patients scheduled between 8:45a and 9:45a and 7 patients scheduled between 1p and 2p. This is extremely problematic, as it is damn near impossible to see that many patients in that amount of time, and therefore puts me far behind both morning and afternoon, eating substantially into my "lunch hour" (in which I chart, sign off labs, field office phone calls, eat, and pump) and keeps me up to an hour later in the office in the evening (exactly what I didn't want when I came back). I also asked for a 15 minute block of time in which to pump in the afternoons, which has increasingly been forgotten, forcing me to pump anyway and fall even further behind.

When I brought the scheduling discrepancy to the office manager's attention, she blithely replied, "Well, the girls are doing the best that they can. Doctor's offices run behind all the time, people expect it." To which I bluntly, and probably not very nicely, stated in no uncertain terms that I wanted my schedule the way I had requested (back in September!) and did not want patients overbooked on my schedule at the discretion of the front office staff. I realize that, compared to OtherDoc's schedule, my schedule looks like a cake walk, but I am *not* OtherDoc, I am a wife and a mother and I do patient care differently than he, and I deserve to practice the way I want to practice up until the time that it is shown that I am financially sinking faster than the Titanic.

After my short tirade, she countered, "Oh, and I've been meaning to tell you. We can't bill for your pre-op visits, so you should really quit doing them, and when you code your visits, the time limit means nothing (level 1, 2, 3 visits, etc.) in order to be compensated you have to have pages and pages of documentation." Say *what?* First of all, I think that the pre-op examination (an appointment the day or two before surgery to sign consents, answer questions, and do a physical exam) is crucial in many respects, not to mention the medico-legal aspect, and I don't care if it is included in the surgery fee, I'm still going to do them, thankyouverymuch. And huh? on the coding levels based on time spent in counseling? Is this something recent or is she smoking crack? I know that my attendings in residency used the same forms that I use (complete with review of systems, etc.) and were able to bill high level visits based on that documentation alone. At any rate, I said my piece, but I know it will be at least a week before anything gets done (if it ever does) since she and OtherDoc are now on vacation.

So I guess I am just wondering if I am being a completely naive Jackhole for wanting the things that I want for my practice? What is the average amount of patients seen in *your* office on any given day? 20? 40? 60? What is the proper role of the office manager? What about coding? What is standard practice? Am I expecting too much? So many questions...if anyone has any insight, it is much appreciated. Whew, now I am tired! Thanks for "listening."