Scenes From the Hospital

Evacuation chair. To wheel people down the stairs, presumably when the elevator is out.

There is one of these in the stairwell on the west wing. One. Not even one per floor. Just one. I'm really not certain how efficient an evacuation will be with just one evacuation chair for the entire west wing of our hospital.

But never fear, because if we need to evacuate the NICU, there is this:

You just shove a baby in each pocket and run.

A lot more efficient than a single evacuation chair.

And, not gonna lie, I could have used one of these a few times when the boys were itty bitty. Would have made folding the laundry and other household tasks a bit easier!

DILMOT: Part 2.

Please see Part 1 for the first part of the day. If you want to. If you randomly showed up at this post, and it is a Part 2 post and you really want to know about Part 1, then go read Part 1. If you just want to read Part 2, feel free. Or, you know, don't. My kids don't listen to me, why should you!

We left off at lunch time.

Peanut butter and honey (crusts cut off), gold fish crackers and berries all around!

For your own lunch, you prepare a salad, and toast the crusts of the kids' sandwiches. Toasted crusts make good croutons!

After lunch, do you:
a) Help the kids with a craft project
b) Clean up breakfast and lunch mess while the kids play
c) Take out the garbage since garbage day is tomorrow

You chose a. Some days you choose b, but you're feeling parental today and want to do something fun! Also, you bought a craft project at the dollar section in Target and if you don't do it today, it will just become another project stashed on the shelf that you will do 'someday.'

You manage to keep your calm while the kids paint, and the paint stays relatively contained. You even let them go outside and pick a couple of rocks to paint, because painting things is fun!

Then Child B tries to paint Child A's rock.

So much loudness. And painting time is done.

1:30: You clean up from painting and decide to try to get started on the garbage. You go outside to drag the big bins to the front of the house.

1:32: You come back inside to this:

They want to keep playing. Child B insists that you play, too. Do you:
a) Make them clean it up, and proceed to nap time.
b) Let them play for a bit while you clean up breakfast and lunch dishes and take out the garbage.
c) Join them in the chaos.

You choose c.

If you can't beat 'em, join 'em! After a rousing game of pretend restaurant/doctor's office, you finally convince Child B and Child C to head upstairs for nap time. Child A joins you and makes every effort to undermine the process because she wants to keep playing with them. After some tears, a time out or two, a couple of books and some big hugs, Child B and C are down for their nap.

2:30: Child A wants to keep playing with you, so you give her some undiluted Mommy time. Part of you feels like a wonderful mother for focusing all of your attention on her when she wants it. The other part of you realizes that you are doing it just to stave off another argument.

3:00: Child A gets 30 minutes of screen time before her own rest time.

During that 30 minutes, do you:
a) Clean up those darned breakfast and lunch dishes, as well as the mess the kids made
b) Go take care of busy work in the office
c) Take out the garbage
d) Work out

You choose b. 30 minutes of screen time for yourself to pay some bills and check Facebook, etc.

3:30-3:45: Get Child A upstairs and into her room for 'Quiet Time.' She believes the quiet part is optional.

3:45: You have reached your one and only uninterrupted hour of the day. Do you:
a) Clean up the stupid breakfast and lunch dishes
b) Clean up the messes the kids made during craft and play time
c) Take out the garbage
d) Clean the front window that you noticed is getting mildewy around the trim after all the rainy weather
e) Sit back in the office to start writing a blog post
f) Take a shower
g) Work out
h) Start working on dinner

You want to do all of the above, but only manage to squeeze in a haphazard mix of a-e.

4:45 (on the dot): Child A shows up at your office door, in a princess costume and wants a snack. Immediately.

5:00: Child B and Child C are still sleeping. Do you:
a) Wake them up so that they will go to bed at a decent hour
b) Let them keep sleeping

You choose a. You have to choose a every day. You've tried shifting their nap earlier, but they just stay awake until the normal nap time and still try to sleep past 5. You are thankful that they still nap, but a big part of you is ready to be done with naps so you aren't tied to the house for 2-3 hours every afternoon.

5:15: It starts raining out of no where! Rainbow weather! You rush the kids outside, Child B and Child C still barely awake.

They're not as excited as you are.

5:30: Time to start cooking dinner. Also, the kids are grumpy and all want snacks. Do you:
a) Attempt to cook dinner while dealing with each new crisis as it comes up
b) Order pizza
c) Turn on the TV to hypnotize them while you cook in relative calm

You choose c. You wonder every day how parents of the past got dinner cooked without TV to distract the kids.

You attempt to prepare a well balanced meal, while fully aware that they will eat approximately 0-10% of what you put in front of them.

All she ate was the roll and the tomatoes.

6:30-7:30: You clean up dinner, the kids run and play and fight. You may or may not yell.

At one point, you attempt to sneak back in to the office to keep working on your blog. During which time you have to tell Child B that you are not ordering pizza, you are writing a blog. No, not ordering a blog. ("No order blog. Me no like blog.") Writing a blog. Blog. No, it isn't food. It's a... blog.

7:30ish: You remember that it is your Dad's birthday! Do you:
a) Send a "Happy Birthday!" text
b) Skype with your parents

Of course you choose b! You try to have a grown up conversation with your parents while Child B insists that he has to man the tablet and only wants to talk to the dog. Child C shuts Child A's finger in the door causing both of them to completely lose it. You figure your parents wonder where they went wrong with you as they get to witness the night time craziness first hand! You manage to get all of the kids to allow you to sing Happy Birthday to your dad. Child B does not approve of singing.

After hanging up, Child A has a complete and utter melt down because "You care more about your parents than about me!" Clearly undiluted Mommy time earlier didn't help.

8:00: Time to head upstairs for the bedtime ritual! This starts at 7 on bath nights (thus waking the kids up from nap at 5!)

At this point, Child C, who has been the least demanding child all day long has some sort of breakdown caused by something completely unknown, but apparently tragic.

You try to calm him down, but your efforts are met with blood curdling screams, so you leave him alone to reset.

8:20: Your husband makes it home after a long day at work.

All the children are happy to see him. Child C breaks out of his funk, cause still unknown.

Bed time ritual continues:
- PJs
- Dance Party
- Books (oh so much drama about who reads what book, and who sits where, etc)
- Teeth (more drama about who gets brushed first and by whom)
- A trip to Child A's room to turn on her rainbow
- Back to Child B and C's room to turn on their moon
- Sing a song to Child B and Child C
- Do a special dance back to Child A's room
- Sing to Child A
- Tend to any child that needs fresh water, a new diaper, one last hug, etc

9:20: All kids finally in bed, you head back downstairs with your husband. With his help, you finally finish taking out the garbage, finish cleaning up from breakfast, lunch and dinner and all the other messes that accumulated through the day.

10:00: Crash on the couch to spend an hour or two talking about your respective days, politics and finally watching a bit of mindless television.

12:00: Bed. You set your alarm for 6:30 thinking that you will try to get up and go for a run in the morning!

Day in the Life: Mother of Three, part 1.

I've posted a lot about my professional job lately. Let's venture into a day in my other 'job' - my life as a mom. My Day in the Life as a Mom of Three (DILMOT, as opposed to DILPH)

We're going to do a "Choose Your Own Adventure" day. Except that you can't actually choose, since I already chose, and I have not yet mastered the skill of alteration of Time and Space, so cannot therefore go back and choose a different choice. So, let's call it a "Choose My Adventure" sort of a post, mmm-kay?

6:45: Alarm goes off. Do you:
a) Get up, as planned to go make a fresh pot of coffee, have a quick bite to eat and a few moments to yourself before the kids wake up
b) Hit the snooze button repeatedly until Child A hops exuberantly into your bed and starts talking non-stop.
c) Get up and work out

You choose b.

After addressing Child A's numerous questions about what was going to happen during the day, she declares that she can't possibly get out of (your) bed yet and getting dressed is beyond the last thing that she could possibly do. So, you run downstairs, start a pot of coffee, check back in with Child A (now feigning sleep) and go to wake up Child B and Child C.

Child B only resists getting up a little bit. He has had copious diarrhea for the last 5 days and has woken up soaked in disgusting combination of urine and stool for the last several mornings. You are elated to find his bed only mildly damp this morning!

Do you:
a) Soak him in the bath to make sure he starts the day fresh and clean, not slightly smelling of urine.
b) Wipe him down with baby wipes.

You choose b.

Child C, who has been awake for about 45 minutes talking to himself and making bizarre noises gladly hops out of bed. You give him an extra squeeze, because... thank you.

Now, back to Child A. She has moved from your bed to her bedroom floor at the prompting of your husband (Who is amazing, and helps out where he can. I only gloss over his contributions for the sake of brevity)

She picked her clothes out last night, thank goodness. But she still insists that she is incapable of doffing or donning any clothes by herself (despite the multiple costume changes you have seen her execute sans assistance).

7:50: All kids (and yourself) finally clothed (but not bathed), you head downstairs. You try to convince all of them simultaneously that it doesn't matter who picks out their juice cup first. This may or may not involve yelling.

Child A wants yogurt and orange juice.
Child B wants "monkey" cereal and apple juice.
Child C wants "mama" cereal and apple juice.

All of them want it first. You try to convince them that it doesn't matter whose food is prepared first. This may or may not involve yelling.

You grab some coffee and a quick bite to eat while managing requests for seconds, thirds, or entirely different meals than what they were already served.

8:15: Everyone fed, dressed and shoed, you head to the car.

8:25: You drive away from home. You wonder again how it takes 10 minutes (on a good day) to get from the front door to driving away.

8:35: Drop Child A off at Pre school.

Now, left with two children, do you:
a) Go to Target.
b) Take them to the park, it is a nice sunny day after a lot of rainy days, and they need to get some energy out.
c) Go home and try to clean a little while the boys play.
d) Work out

You choose a.

Target with Child B and C is much easier than with all three. Heck, Target with Child B and C is easier than Target with Child A alone. Child A has discovered consumerism. Children B and C are (as of yet) happy to play with a toy, then put it back on the shelf.

You spend an inordinate amount of time at Target, seeing as you only went to pick up some birthday gifts for Child A (who is about to turn 5!) and a few groceries. A lot of that time is spent bribing Child B with food. And taking two separate trips to the bathroom to change two separate poopy diapers. Even though Child B insisted on sitting on the potty when you were changing Child C's diaper.

Time to check out. Do you:
a) Choose the longer line with the checker you recognize as being okay, but a talker.
b) Self check out
c) Choose the slightly shorter line with a checker you don't recognize.

You choose c.

You chose wrong. You always choose wrong.

Your friendly new Target checker is perhaps the slowest checker you've ever encountered in your life. And super chatty. And doesn't seem to understand that you need to attend to Child B who is more and more frantically insisting that "I push button!" on the ATM pad. So you spend the 10+ minutes in the checkout line holding Child B, trying to distract him, while making idle conversation with the checker. "Yes, yes, you will get to push the button, but not yet. Yes, that is a great deal. No, don't touch that. No, I haven't tried those before. Stop pulling on my purse! Oh, you don't need to bag the gallons of milk. Here, hold the card, but it isn't time yet. Or the two liters. Oops! You dropped the card. Yes I have a Red Card. Okay, put the card in. No cash back, thank you. No, don't pull the card out yet! You can push the button now!"

It finally ends, and has taken long enough, that it is already time to go get Child A from school. (It is early release day, so she's done a bit earlier.)

You get all the kids home, out of the car, manage to distract Child A enough that she doesn't catch on that the back of the car is filled with a myriad of birthday and Easter (and probably Christmas) presents. Child B wants to carry in all the groceries BY HIMSELF, and child C trips and falls while carrying a 6 pack of beer* (thankfully, child and beer survive unscathed). Also Child A is upset because I am paying attention to her brothers and not her. Lots of talking and soothing.

*I did not hand said child a 6 pack of beer. He grabbed it from where I had briefly set it down to help Child B deal with a gallon of milk.

12:00 You made it to lunch!

... and the end of this particular blog post. I'll post more of your day tomorrow (honestly, it actually is tomorrow already).

You can head on to Part two here!

I [hate emoji] February.

I remember the winter of 2008 as a bad season. I was in my second year of residency, and I spent February in the PICU. In addition to working an ungodly amount of hours, we had, if I remember correctly, seven pediatric deaths. Most of those were due to influenza. That single four week period of my life is why I will always recommend the flu vaccine, even though it is only 48% effective, at least this year. Cause I can guarantee you that those parents of those seven children would have done anything to reduce their child's risk by 48%.

I digress.

The point is that I remember that February as probably one of the most stressful months in my life. It was stressful and depressing and demoralizing. The only saving grace was the presence of the rest of the PICU team, particularly the attendings. As much as I may have hated them at the time, they were a calming, seemingly all-knowing presence that mitigated my own stress. I may be clueless at the best way to treat a patient's VQ mismatch or the the finer points of extracorporeal membrane oxygenation, but the Attending would Make It Better. (And maybe only make me feel a little foolish at the same time...)

I hated that February.

As it turns out, though, when you graduate from residency and take on a Grown Up Job, YOU are the attending. YOU are the one that is supposed to be the calming, seemingly all-knowing presence that will Make It Better.

And it turns out, that I generally hate Februarys.

I am glad that February is the shortest month of the year because I HATE IT. Capitalized, bolded, italicized. HATE IT.

It is the peak of our 'respiratory season.' The month that kids get the sickest. Little babies and toddlers that struggle to breathe and cough so violently they throw up. Sometimes, all it takes is a little bit of oxygen and some TLC and the babies and toddlers do fine. They spend night or two in the hospital, then they look better and feel better, and everyone is happy and they get to go home, yay!

But this is a bad season again. The little babies and toddlers are coming in sicker, and they are staying sicker longer. We give them a little oxygen, but it isn't enough. So we give them a little more. And maybe some IV fluids. And maybe try some breathing treatments. And do they have a fever? Maybe it is the fever making them breathe like that. Or maybe we need to start antibiotics? And are they still breathing hard and fast? Maybe we should try some more support with a different kind of nasal canula? Another breathing treatment? Steroids? Did that help? Is their stomach too full from eating? Maybe we need to stop letting them eat while they are working that hard to breathe? Are they fussy because they're hungry or because they can't breathe? Did we try a breathing treatment? What else can we do? How long can we let them work this hard? Are they getting tired because it is nap time or because they are about to stop breathing entirely?

And you guys -- it is MY job to answer those questions. Obviously with the help of the nurses and respiratory therapists and the family. But, ultimately, it is my responsibility. I only see my fellow pediatricians once a day - at 8 am when one of us comes to relieve the other.

I have been doing my Grown Up Job for going on eight years now (!) And these questions have become HARDER to answer. I feel like I should just know what to do - oh, he needs albuterol, she needs antibiotics, and he just needs a hug and a bottle! Some days I do. Some days I totally rock it, and make good diagnoses and treatment plans, and patients get better and I feel Competent and Effective.

But not in February.

Ultimately, when I can't answer the questions, or my answers aren't making the patient get better, I have to transfer the patient to a Higher Level of Care - aka the PICU. We are super lucky to have two amazing PICUs to choose from within a 20 minute helicopter flight. It is absolutely the right decision to make for patient safety, but part of me feels like I failed in my job any time I have to transfer a patient out. Like I didn't find the correct combination of therapies to stabilize the patient with the resources I have available. In reality, that is completely irrational, as 95% of the time, they escalate care in the PICU above what we were doing. And we provide near-PICU level care here.

But it still feels like a failure.

This respiratory season (since late December), I've had seven transfers (likely eight before the night is done). Those I've transferred have spent from 2-9 days in the other hospital before going home, so again, demonstrably not a failure on my part.

But still.

I read articles about burn out in doctors, and think - oh, those traits don't apply to me. I have control over my life and work, I know what I'm supposed to do, my coworkers are great and supportive and I love what I do.

Except in February.

I feel like the clueless resident waiting for the all-knowing attending to come up with the clear solution and Make It Better. (And maybe make me feel only a little foolish...)

February is officially my Burn Out Month. Things should start to improve in mid-March. Fewer kids will get sick. They'll get better faster and will respond to treatments the way I think they should. I can and will push through until then. Then my job will be awesome again.

In the meantime, I'll vent a little (or a lot), and my house will get super messy because I used up all my Adult-ness at work and can't possibly Adult at home. And I will try to go for runs, and will definitely drink a lot of coffee and wine.

Now, if you'll excuse me, I have to tranfer a patient...

A Day in the Life

Have I ever done a "Day in the Life" post? I don't think so. Maybe? I know I've thought about it before, but can't remember if I have ever done it before.

And I'm too lazy to go back and look.

So.

A Day in the Life.

But, wait. Should I do a Day in the Life (henceforth known as DIL (I'm excluding the "T" for aesthetic reasons)) for my life as a Pediatric Hospitalist, or DIL for my life as a Mom of Three. Mom of Three must be capitalized if Pediatric Hospitalist is.

Seeing as today, my actual DIL was as the former*, I shall proceed with that.

*Interesting** aside. I love LM Montgomery books. Anne and Emily were my literary soul sisters growing up. Well, LM is fond of using "former" and "latter" in her writing. I am ashamed to admit how long it took me to actually figure out what those words meant. I was like 14 years old before I finally had to stop and use my Context Clues (also capitalized) to determine which was which.

And, as I come to the end of writing that paragraph, I am struck with the sudden realization that it was a lie. It was actually the word "fortnight" that Lucy Maud used a lot, and I didn't know what it meant until I was 14. I did, in fact, use my Context Clues to figure it out. Two weeks. I don't remember when I learned former vs. latter.

**And by "Interesting," I mean "Really, just a rambling paragraph about nothing."***

***And, as it turns out, a total lie.

All aboard, welcome back to my train of thought.

So. My DIL as a Pediatric Hospitalist. DILPH. Say it out loud. You know you wanna.

6:00: Alarm goes off

6:15-ish: I actually get up. Sorry, Marc, it is hard to break the Snooze addiction.

6:15-7: I attempt to get ready as quietly as possible so as not to mix up my DILPH with my DILMOT (got me?) by waking up the nearly-5 year old lightly sleeping in the other room.

7:00: Get accosted by said nearly-5 year old who wants me to 1)let her sleep; 2)carry her downstairs; 3)eat breakfast with her; 4)not go to work; and 5)talk WAY more than I want to in the morning. All at the same time.

7:15 - 7:45: Drive to work. The quietest part of my life. Some people hate commuting. I welcome the adult time that I have ALL TO MYSELF. I either listen to NPR, Hamilton, pop music or Pediatric lectures on tape, depending on how responsible I'm feeling.

8:00-8:30: Sign out. This is when the outgoing Pediatric Hospitalist tells me about the patients that I'm taking over for. Also a great time to confer with a colleague about how to best care for our patients. And to vent.

And, in continuing with my rambling post, I will now refer you back to the post I wrote nearly two years ago, wherein I outlined what I do during my day working at the hospital. One might be inclined to call it a DIL post. If one wanted. The only real difference from two years ago is that I no longer intubate babies that poop before they were born. We no longer punish them for that. Science.

Now I don't know what to write about.

I suppose I should get back to writing the ER consult note, discharge summary, transfer summary and 2 daily notes I have left to write. Or to go see the two newborns that need to be admitted. Hmm. Perhaps this blog post was all about procrastination? And you fell for it! Mwa hahaha!

Next, I will write my DILMOT post. Perhaps in a fortnight or so.

See you in two weeks.

CONTEXT CLUES.