Sep 8, 2015
As is usual when a person graduates to the next level of the heirarchy, I had NO EARTHLY IDEA how much paperwork and general minutia would be a part of my everyday life as an attending. My first schedule had a few half days with no clinical activity assigned and I thought WOO HOO! This attending life is amazing! Little did I know that those times are built in not only for professional development or meeting with mentors/mentees or going to the dentist but that they are there so you can finish your damn charts.
I've only been a grown up for a few weeks now and already feel so overwhelmed by the amount of paperwork. And, of course, it is not actually on paper but just a thousand little clicks. I wonder what my click-per-hour rate is... If I were a website and getting this many clicks I'd be rolling in gold dubloons.
This is not a new question, but I don't understand how medicine go to be this way. Why is the emphasis on clicking instead of talking? On sitting in front a computer as a data-entry clerk instead of making medical decisions and taking care of people? It is an evolution of necessity for insurance companies and law firms, but both the doctors and the patient suffer.
My father, an old timey country doc, has been complaining about this for years, but it is a sharp contrast for me. As a resident, my job was to take care of people, learn from them, and write down what I saw and did. I thought this was a lot of busywork at the time, but I had no idea how much worse the billing component makes it. I spend more time on the billing and charting than I do with any patient, and it makes me so, so sad. I don't think physicians go into medicine to be data entry clerks, but I think it is why a lot of physicians get out of medicine.
A good friend of mine and I were recently talking and she said how burned out she feels. Exhausted and drained, feeling like nothing she does makes any difference. She says that these phases happen sometimes to everyone and that this one will fade like the others have, but it is disheartening to know that someone who views her purpose in life is to help other people, one patient at a time, feels like she is failing. And drowning. I wanted to lift her up, to assure her that she is making a difference, but that was not the point. It doesn't matter what I see, it's what she feels. And she feels exhausted and tapped out.
How do we protect physicians from feeling this way? How do we bolster and encourage those who sacrifice so much for the betterment of others? Money and bonuses and vacation time help, but in these times of dwindling reimbursements and corporate owned practices, we are unlikely to see an increase in that benefit. And we know from "the good old days" when doctors were better paid that they still were burned out and disenfranchised. In this and all things, financial returns are not the way to happiness.
The answer is to find meaning in the work and value in the care of others and ourselves. Though self-care is largely beaten out of us in our training, we are our most important patient and serve as an example to others. Support among the physician and health care community is critical but clearly deficient. As a new faculty, I need mentoring and support, but it is hard to find because EVERYONE needs those things. But we're all too busy and buried in our charts to help each other.
Surely there is a better way! Being new around here, I don't know what it is yet, but I'm still young and rested enough to want to find it. Because I don't want to feel burned out. I'm so excited to be here, a part of something so big and amazing and yet intimately personal. Being excited is not the same as feeling valued, but I am determined to maintain both.
(image credit: doctordocs.com)
Love, Katie! at 3:10 PM
Sep 4, 2015
Colin, being a bad ass first grader now, has joined Cub Scouts. The pack is brand new, this is the first year. We're trying to get things off the ground and Colin loves being a part of it. He looks forward to it every week and was obscenely quick at learning the Oath, handshake, laws, Pledge of Allegiance, and the other required learning. It is a neat group of kids and provides fun, adventure, companionship, blah blah blah.
It's yet another after school activity that requires me to drive the kids somewhere and sit to the side, bored out of my mind, while my kids have fun and be enriched.
It's not that I don't want them to be enriched, obviously I do. That's why I sign them up and pay for all this stuff. But I get bitter that, after all this time and hard work to be a grown up and earn enough money to afford to enrich my kids, why don't I get to be enriched too?
Not that I don't appreciate the friendships I make with the other parents, but it's hard to maintain those relationships. Everyone is busy with their own families and lives, so often it is a temporary friendship out of convenience that quickly dissolves once the activity has ended. At least that's how it is for us. Every time.
It used to be that the kids needed me to watch them for encouragement or discipline, but now they mostly take care of themselves and, often, will behave worse if I'm paying attention. So I think that there should be some Away From the Action activity for parents of these kids. Let the kids have fun and be enriched/exercised/educated/etc and let the parents grow a little too.
Which brings me back to Cub Scouts.
As I said, the pack is in its infancy and, as a result, all the parents who showed up to the first meeting were forced to volunteer (what?) in order for the group to actually form. I am never availble to go to anything, ever. Except that one day. THAT ONE DAY when everyone present had to pick a volunteer assignment. And so I am honored to tell you that I am the new Advancement Chair for Pack 72.
Turns out it is exactly what I needed. Last night we met for our first committee meeting to plan out the first few months. We met at a new start up place and planned, schemed, and laughed over beers. We talked about the kids but also about the parents. We talked about the families and how they could all be involved, not just the elementary school boys. Topics for meetings were discussed and included safety, religion, culture, exploration, adventure, and self-awareness, all for the whole family.
I know part of this is the actual structure of the Cub Scouts, something I had no idea about. But a lot of it is also the small, fun group of parents who appreciated the opportunity to get out of the house, away from the kids, act like an adult, but put forth effort to contribute to and better the activity for their children.
Turns out, I love this extra-curricular activity and can't wait for this year! The kids will love it, but, if all goes as planned, so will the families and so will I.
Aug 31, 2015
The best part about being an attending physician is being able to act like a grown up.
Aug 20, 2015
It has been four years since you've seen my kids and you would NOT EVEN BELIEVE how big and old and grown up they are. Let me re-introduce you! Have a seat friends, the flood gate of kid stories is opening.
Colin, who was once The Turnip.
Colin is now 6, almost 7, and in the first grade. He reads and writes, loves to be outside, and makes friends easily. Already he is an impressively loyal and trustworthy kid and his friends love him. Even older kids want to be with him because he is genuinely happy, positive, creative, and fun.
The kid is one of the most sensitive people I have ever known. When he started kindergarten, he was so upset by being separated from Caroline that he asked his teacher to call the day care several times a day to check on her. It was almost debilitating, so we switched Caroline to the preschool at Colin's school. Since then, he has flourished and it's incredible to watch.
He rides a gigantic bike, he begs for bike rides daily, and can ride circles around the rest of us. It is somewhat embarrassing, actually.
If I had to predict his future, I would guess a social worker. He likes to take care of people and make sure everyone's okay. Constantly checking on people and bringing them stuff to make them comfortable. When he's not absolutely losing his marbles because of how sensitive he is, the kid is an absolute joy of a human being.
Caroline, who was once The Secret Child.
Now 4, Caroline is, by all accounts of anyone who meets her, awesome. Truly, in the same way that masses adore celebrities even when they're poorly behaved and make incredibly bad decisions. Caroline has this way of attracting a crowd, wooing them into her graces, and then terrifically abusing her power.
She is smarter than I know what to do with and more clever than is fair. Once, when she asked about where the rain came from, I told her about evaporation and precipitation, getting all science geeky about it. She took it all in, paused to consider it, and then told me, "Mommy, I don't think you know what you're talking about."
I remember worrying about how I would teach a baby girl to respect herself, to stand up for herself in this world, but it turns out I didn't need to worry about it. The girl could teach a course on self-respect and self-defense. I would pay to go. Recently she was sent home from school with a report of getting into a fight. Apparently she and a little friend (a boy) got into an argument. The boy got angry and started yelling at Caroline, getting right up in her face. According to the teacher, Caroline got a terrifying look on her face, said "You are not being respectful to me and I don't appreciate it."
If that were it, I would throw her a party. However, she then grabbed a Mason jar full of water and clocked him.
If I had to predict her future, I am going to guess either President of the United States or assassin. Not sure which yet, and not sure which is worse, but either way, we are in trouble with this one.
We are different than the last time you saw us, but I can't wait for you to get to know us again!
Aug 14, 2015
It has been a long, long time since I've been here.
I read through my last few posts and it was like reading someone else's writing, glimpsing into a different family, reading a blog written by an acquaintance. When I last visited here, I was a new doctor, still learning how to work the computers and OR instruments. My kids were babies and, while I can feel the fatigue in the words written, the world was still sparkly and new.
And don't worry, the world is still wondrous and beautiful, but the sparkle has changed.
I finished residency a few months ago. Shortly following graduation I took the first part of the OB/GYN Board Exam, which gives the coveted "board certified" title. The push to the end of residency was on a road made of textbooks, study guides, and highlighters for this exam, which I took on a rainy Monday at the end of June.
And then it was all over and I had six weeks of vacation, during which time I relearned how to sleep and read books and hang out with friends and family like a normal person. While Patrick still worked quite a bit, the kids and I were inseparable, making messes and memories in a way we had never, ever done before. Weeks stretched on and we lounged in the luxury of time and love. It was not until the last few weeks that I finally felt awake again.
The last four years were incredibly difficult. There is no way to describe the level of exhaustion following residency. Profound, pervasive, endless exhaustion, which seeped into every aspect of my life. There is no denying that I gave my best at work and mostly left it there. What little was left was earmarked for the children to allay my fears of incompetence as a parent and that left nothing for myself or for Patrick. While I neglected friends and ignored my family along this journey, it was my marriage that suffered most. It is nothing short of a miracle that we are still married. It may be because we were too busy to bother separating.
As I recovered, my sisters said, "It's like we haven't seen you in years" and my kids remarked more than once "Mommy, you've never been this fun before", which is at once exhilarating to be BACK but also heartbreaking that I subjected everyone to this, including myself.
I have never once regretted my decision to go into medicine, but I often questioned my motives. Was it for equal respect as my husband and father? Am I trying to prove my competence, intelligence, worth? If so, to whom? With physicians in my family, I knew how hard this would be, and yet it was so much harder than I could have imagined.
Not to say that the last few years were miserable, not at all. I love my work and it makes me truly happy, which carries over into my mood at home. The joy I feel with my kids (despite tantrums and fights and the usual family drama) is relatively unaffected by my exhaustion and occasionally helped to refill my draining emotional reservoir. For this, I am eternally grateful. People often said, "I don't know how you do it, being a doctor and a mom!" but I don't think I could have made it without them.
Last week the kids started school. Colin is now 6 and in the first grade. Caroline is 4 and in preschool at the same school, one that we love. After getting them settled, my grown up job started this week. I am a licensed, credentialed, actual physician, my friends. I have my own office, an administrative assistant, and OR pick sheets. People are interested in my opinion and want my involvement in their projects.
Somehow, when I wasn't looking, I grew up.
After my summer vacation, I am ready to be who I really am again. I am obligated to be the best I can be, not just to myself but mostly to those who put up with me through this journey, who believed I could do it, who waited for me to come out the other side.
This blog has been a source of joy, confidence, and opportunity for me. Residency was too overwhelming to write about, but I am ready again. I promise ridiculous stories and lighthearted jabs and too many photos of my kids in the near future, but I needed to tell this story first to break the silence.