Days 146-148: The Zoo

Right now, I feel like LOML and I are zookeepers with the three cats and dog that live with us.  Boris, the oldest cat, is on a special diet for his grain/gluten allergies (shows up like celiac and IBD at the same time) so we're having to make sure he doesn't get the other animals' food.  Julia has asthma which comes with the need for inhalers and a weakened immune system so she's now requiring regular ear drops and washings.  And because it's not safe for her to go under anesthesia, I'm having to learn how to brush her teeth.  Alex, the newest kitten has the same amount of energy as Hammy the squirrel from "Over the Hedge".  He requires at least two 30-minute play sessions per day.  He has to be fed three times per day, and is also super food-motivated so we're constantly having to distract him while the other animals eat.  When he misbehaves, he has to go into time-out.  He tries to get in the shower with us.  And unfortunately for our Charlie Brown Christmas Tree, he occasionally goes back to his original roots as a "tree cat" and tries to play with it.  He is an adorable, and sometimes mildly frustrating, ball of energy.  Then there is Odie, the lone dog in the pack who is not thrilled to be out-numbered by cats like this.  When it was him, Julia, and Boris, it was fine because Julia and Boris tend to leave him alone.  They each have their spot and no one bothered the others.  Now, Alex has completely flipped the routine.  He is into everything, and this lack of reserve bothers poor Odie.  It also upsets the other animals that they spend so much time vying for my attention.  When I get into bed, I tend to wake up with Odie under the covers on one side of my feet, Boris above the covers on the other side, and Alex up by my face.  I can't roll over or move because they all want to be near me.  I have no privacy or personal space anymore.  While sometimes I wish I could hide away, I am glad to have all of them.  I hope Alex slows down sometime soon.  And I hope Julia learns that the toothbrushing and the ear cleaning make her feel better.  She doesn't have to like it, just reach the point, like the inhaler, where she tolerates it.

Days 140-145: Self Criticism

I am always overly critical of myself.  I had my quarterly review this past week, and I'm apparently right on track.  I have some areas to work on for chart reviews for clinic, and improvements in advancing my communication.  However, I feel like I am so far behind the curve ball.  I feel like I am incompetent.  I feel like there is no way I will be a good faculty member or assistant program director.  I feel like I have fooled people into thinking I can meet expectations.  I seriously have an issue with believing in myself.  It makes it really hard to see myself excelling in any role, even when others can.  I still try my hardest to be the best I can, but I set my goals for myself way higher than is sometimes attainable.  I haven't figured out how to get rid of my perfectionist ways and be content with where I am in the now.  I need to work on some of the self-care activities I'm supposed to be doing (ie. the mindfulness and yoga I'm supposed to have done last month and this month, respectively).  I have a million ideas for some of the things I could do for the narrative medicine/wellness curriculum as faculty.  I have to get myself to believe that I can actually do these things I have ideas to do.  I am thankful to have a support team behind me.  I need to believe the things they say about me.

Days 137-139: Moonlighting

I occasionally spend a weekend here and there working with the palliative care group at the other local hospital in the area.  During geriatrics fellowship, it was a nice way to spend more time in the field I love.  I spent what may become my last weekend of moonlighting this past weekend.  While I will get to spend more time with the team during the month of April, it is, in some ways, different being autonomous versus being a learner.  At any rate, this weekend wasn't too bad other than a rather bizarre encounter.  I usually try to use my communication education when running family meetings.  I still have a lot of room for improvement, but feel like overall I do a decent job.  This past weekend, I had a situation where I felt like my empathy actually made the situation worse rather than better.  I can't say I've had that happen before.  Every time I used an empathetic statement, it made the patient and family more irate.  It finally came down to me be blunt and borderline rude to be told I was making more sense.  I was told I was clearly several steps behind everyone else there.  I was told I was talking down to them.  I was told I was trying to hide something.  It was almost to the point that I wish I had another provider in the room to make sure I wasn't being any of those things.  The only consolation were the few family members who understood that what I was saying was what everyone else in the room was also saying.  I can't say that I've had an experience like that before.  Had my initial encounters been during the week, I would have had the supportive care nurse or palliative counselor with me to help make sure I was communicating as best I could.  I realized several times I became defensive, and I probably should have taken a breath and calmed down before continuing.  I supposed now I will hopefully know better when something similar happens in the future.  Until then, I keep reminding myself that I used the communication tools I was taught and conveyed the information to the best of my ability. 

Days 129-136: A Week of Silence

It has been busy since my last post.  I picked out the new dress for my matron of honor, saw a musical (Company), sat for the geriatric boards, set up another interview (at Wake!), and became a psych resident (unintentionally).  Oh, and ordered tickets for the Nutcracker!

The musical, Company, was dark.  LOML referred to them as caricatures of married life.  The couple where the wife was on a diet and the husband sober but started fighting to show discourse.  Then there was the couple that seemed so happy but were getting divorced only to be more in love once divorced, literally staying in the same apartment "for the kids".  There was the bride who panicked, got mad at her fiance, told him she didn't want to marry him, had the best man propose to her, and she decided he was silly and she needed to go find her fiance who was a "good man".  There is the "loose man" and "uptight woman" couple where the typical gender roles are maintained right down to the wife's "purpose" being to make the husband a sandwich after smoking weed.  Finally, there was the woman who was on her third husband and only marrying for the money.  She is  truly the most cynical.  The girls the main character dates are also all stereotypical.  The good girl who ends up with a different guy, the ditsy flight attendant, the bad girl.  Each fits a typical mold.  The entire premise is that marriage is a trap that is a constant love-hate relationship with the person you are marrying.  While I realize that marriage is ugly and messy sometimes, it didn't come across that any of the couples in the show actually loved each other.  The main character, who was a single guy, only seemed to want to get married because it "seemed like the time to do it".  I usually enjoy musicals, but while the actual music was beautiful, the overarching story did not hit the mark for me.

As for the psychiatry thing, I am shadowing one of the geriatric psychiatrist who has me doing notes.  Fortunately, the physician I'm with does most of the orders and tells me what he wants me to write.  So really, I'm less of a psych resident and more of a note lackey.  Only a few more days and then a four day weekend for Thanksgiving.

Days 126-128: Admin Time

As sad as it sounds, I get really excited when I have a little admin time at work.  I feel productive when I get work done during the normal hours of the day.  It can get very tiring working all day then coming home and having to work until bedtime.  It gets a little old.  Having admin time is the breathing room to get work done in the office without distractions from three cats and a dog.  Once I have a to-do list, I am good to go.  There are a lot of little projects to do, and when I come home, I really don't want to do them.  I want to relax and read or write or paint or be with the animals.  I know that's not always possible, but my hope is to be able to find more time to spend with those in my life that mean the most.  There will always be a lean toward work, especially earlier on, but it will continue to improve.  Sometimes I like going full-tilt, but sometimes I want to be able to take a breath without constantly thinking about everything waiting for me to complete.

Days 122-125: Feline Leukemia

This weekend was marked by the good news that Alex, the new kitten, does not have feline leukemia which is the cat version of HIV/AIDS.  This is great news because, for the most part, indoor cats are not exposed to the feline leukemia virus, and therefore, are not vaccinated for it.  Indoor/outdoor cats are due to the higher likelihood of exposure.  Kittens are usually vaccinated for the first year due to their constant desire to escape to the outdoors to explore.  Once they are over a year and less likely to try to escape, they no longer need the vaccine if they will be 100% indoors.  Since all of our cats will be 100% indoors, they are not vaccinated.  Alex had to be kept separate from Julia and Boris until we knew he was feline leukemia negative.  Since false negatives almost never happen, a negative test is truly negative.  Therefore, we are assured he is not infected.  This has made things easier and more interesting since Alex does not have to be sequestered in the front room any longer.  Boris and Julia are not always enthusiastic about having a new sibling.  Though, cats aren't ever really excited about anything, except meals.  At any rate, they are tolerating the kitten being in the house.  He is behaved, for the most part.  We are working to train him to not use our hands as toys.  The scratches on my hands show how well we are succeeding.  I have clipped his nails once already.  He did pretty well.  Boris and Julia have hissed and growled and smacked him around, but his kitten energy levels and his obliviousness have made the situations relatively comical.  Boris will pop him on the head, and he'll turn around and bite Boris on the ear.  He tries to get Julia to play, and she'll sometimes play along.  Odie sometimes tolerates him.  Overall, I think we'll be in a better place in a couple weeks, but introductions are going well at this point.

Days 119-121: The Difference

There are a few families and patients through time that will forever shape a doctor.  While I have had many wonderful patients, there are two that stand out the most.  One was a little girl I took care of who had cancer.  She passed away from complications from her chemotherapy.  I still carry the picture she drew for me, and occasionally listen to the two voicemail messages she left for me to "check in".  She was special because when she felt her worst, I was the only "doctor" she wanted to see.  She would let me talk about the hard stuff with her because I knew she was always listening and absorbing what we were saying, even if the residents on the team didn't think so.  The second is the patient that I took care of on the palliative care unit last week.  He was such a sweet man, but his family, and especially his daughter that made medical decisions for him, grew to trust me like the little girl from 5 years ago.  I am not sure why they felt I was the one to trust.  I am completely humbled by the faith they had in me.  But it carried them through his death a few days ago.  To the point, that his daughter came to the palliative care unit to find and tell me of his passing.  I am thankful I kept an eye out for his obituary so I could go to the visitation.  There are only a few patients whom I have felt I needed to say goodbye to the patient and family.  He and his family are one of the them.  His daughter kept introducing me as her "daddy's doctor".  It is beyond humbling.  I never really know what to say in those situations.  Before I left, his daughter told me that she would never forget me.  I hope that she realizes that I will also never forget her, or her siblings or father.  It was one of those doctor-patient relationships that forever sticks to your spirit as a reminder of the gravity and importance of what I do.  I hold those moments dear to help act as a beacon when I start to lose faith in my abilities to care and support others.  They truly hold a special place in my heart.  I hope they know how much they mean to me.