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?