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...