A Day in the Life

If you've noticed, dear reader, that I haven't posted in over a month it's because my schedule has been crazy since February started. I was so busy, I hardly even realized that my birthday had come and gone (alas, there was no 29th anyway...) I was on general medicine wards at Grady with only 4 days off for the entire month and 30 hours shifts every 8 days. That schedule is generally not so bad, certainly compared to others, but with having to wake up 1-2 times a night to feed Sam, the sleep deprivation added up.

Today's my first day off in 12 days and with a couple extra hours of sleep this morning, I almost feel anew...

I get a lot of questions about how I manage internship with having a baby at home. The answer always boils down to having amazing family support (the "it-takes-a-village" approach, i.e. what would we do without Beth and Steve??) and not trying to be super-mom. There are compromises involved on both sides, but when in balance, I feel lucky to be both a doctor and a mom. It's like having your cake and eating it, too.

Even before I had Sam, it always seemed to be difficult to get out the door at the right time. When I was pregnant, I had a hard time imaging what daily life would look like once a baby was in the picture. The answer seems to be to allow enough time for things to come up, and to be flexible about the order in which you do things... and keep a detailed calendar plastered to the refrigerator.

...and learn to function on less sleep...

Here's how it works on a typical day:
5:30-5:545  wake up
5:45-6:30  shower, pump while eating breakfast (or nurse if the timing works out), pack food, leave house
6:15 Kyle wakes up Sam, packs up the milk and drives him to Beth and Steve's house. Steve now goes into work a little later to cover Sam in the early morning while Beth gets her daily walk and yoga routine in.
7:00 Sara and Kyle both arrive at work
7:00-12:00 Various medical duties
11:30-1:00 Run to a call room to pump, eat lunch at lecture
1:00-6:00 More medical duties and +/- get to pump for the 3rd time that day
3:30-6:00 Kyle leaves work and coaches the Paideia girls' Ultimate team
5:00-8:00 I leave work and pick Sam up. Depending on the day, this time varies. Usually 15-30 min to get to Beth and Steve's house. Spend 15-30 min with them, recapping the day, +/- pumping if Sam just ate and I didn't get to do it earlier in the afternoon. Then 20-30 min back home. Sometimes takes me 90-120 min to get from work back to home.
6:00-8:00 Depending on the time, I may prepare dinner/heat up leftovers/call Kyle for take-out. Sam may or may not get a bath depending on how sleepy he is/how late I got him home. I nurse him and he's usually asleep by 730/8.
8:00-9:30 Eat dinner, organize my plan for patients for the following day/ read part of an article, or watch a little tv. Drink some wine.
9:00-10:00 Pump one last time, go to bed
3:30 Sam usually wakes up around now. Kyle changes him and brings him back to bed so I can nurse him.
4:30 I wake up realizing Sam's done nursing and has been asleep next to me for who-knows how long, so I get up and put him back in his crib. On a rough night, we do this twice, but most of the time, just once.
5:30-5:45 wake up and do it all over again

I feel tired just reading over this schedule! It certainly isn't sustainable, but it's do-able for the time being. Luckily, each month my rotation and schedule changes (April's looking good!) and Kyle's particularly busy Feb-May balancing work and coaching. Sometimes I worry that we're packing in too much; is it irresponsible of us to be trying to parent at the same time? How about the days when I only see Sam for 5 min in the morning and 30 min at night? Or the nights I'm on call and don't see him for 30+ hours?


I have to remind myself that I'm investing in my future career, a livelihood for my family. I'd rather be busy now when Sam doesn't realize that I'm away than when he's older. I also take comfort knowing that we are a true multi-generational household. When I arrive to pick him up and find Steve playing peek-a-boo or Beth rocking him to meditation chant music, I realize that I'm the only one who's stressed about being away from Sam. He, on the other hand, is thriving and adapting to the diversity of care he's receiving from all of us.

Thanks to Abba and Chief for all of your love and support!

Week 16! Big Times

So, February brings madness. Sara started a medicine rotation on Tuesday and I start coaching tomorrow. Sara's month started with overnight call on Tuesday and she has been working all day today (Sunday) so I've gotten my small taste of single fatherhood (and cannot wait for Sara to get home).

Sam purportedly got some back to front rolls in at Abba's house this week. He's had 5(while I was writing this he nailed his 6th! and is now working on his 7th) here today. Below is the end of the 4th roll (yes, he's cheating a little using the mirror but a few of them were without any outside assistance. The funny part is that he's not a big fan of being on his belly - so he gets over and then starts grunting.

He's also be dealing with his first tooth coming in. His left front bottom incisor is showing through his gums. He was a bit fussy on yesterday and Friday but has been in a pretty good mood today, just super drooly.

October 17, 2010

Just got these photos from our wonderful doula, Alicia.

 

On Staying Present

It's hard these days not to be thinking steps ahead of where I currently am.  It occurs on both a large and small scale.  We're here in Atlanta for 5 more months, but already I'm planning for life in Seattle. I'm currently on an ambulatory rotation this month and I'm already thinking ahead to the next two months of ward medicine. When I drop off Sam, I rush because I'm often late to work and when I'm leaving work, I wish I was already with Sam. While eating dinner tonight, I was thinking about what I've planned for tomorrow night's dinner.

It's hard to just stay in the moment. Or within 10 minutes of the moment. But a patient today reminded me of the importance of staying present.

He was a 67 year old veteran, walking into the primary care clinic today complaining of 3 months of intermittent cough and cold symptoms. (In medical speak that's: 67 yo AAM bib self to clinic c/o URI sx x 3 mo.) I don't remember how it came up, but he mentioned he was getting divorced and I asked, "Is that a good thing or a bad thing?" My question seemed to open him up and soon he was talking about moving out of his house of 15 years and how he didn't want to return to work anymore. Finally he said, "I just feel like I need a vacation from people. I need to get away from everyone."

I was just about to examine his lungs, the source of his complaint. I had my mental list of possible diagnoses shuffling around in my head and I was eager to listen to his lungs (Will I hear the wet crackling sound of heart failure? Or the dry crackles of pneumonia? Will I hear the wheeze of asthma or possibly the silence of an upper respiratory tract infection?) but something made me put my hand on his shoulder and ask, "Are you thinking about hurting yourself?"

"Well, I do have guns in my house and I know how to use them. First I was in Vietnam, then I was a cop. They've made a monster out of me. I've seen things that you'd never want to see. But no... I wouldn't be a coward and use a gun... I'd probably take a bunch of pills or jump off a bridge."

Suicidal Ideation (SI) is a term used frequently in medicine to indicate thoughts of suicide without attempt. It can range from thinking about it to having a detailed plan.  When a patient shows signs of depression, we HAVE to ask about suicidal and even homicidal ideation and then we assess their level of planning.

It turns out this patient said he was less likely to harm himself than someone else.
He again begs me to give him a work excuse because "I just can't go back there. I might snap."
His job?
A school bus driver.

So I end up walking him over to the psychiatric emergency department. He was willing to go-- even a bit relieved it seemed, though I would have called security if he had resisted. I wonder if he will be admitted to the psych unit tonight. I wonder if he really would have harmed anyone... or if he ever will. He seemed like a nice enough guy.

In the clinic there's a lot of pressure to see as many patients as possible and to see them all in a timely manner. Many of the docs there arrive at 7 or 8 and want to be out the door with their coat on by 4. At my level of training, I can evaluate a patient for one problem in 15 minutes, but I have to ignore everything else that's wrong with them. How can I do that without worrying that I've missed something?

This gentleman was my last patient of the day and yes, I was already thinking about getting out the door and picking up Sam. But in the exam room, I stayed focused on him, on his case and I picked up on something that I might otherwise have missed. I may have been a little later getting home than usual because of it, but at least I'll sleep better tonight knowing that staying thoroughly in the moment made me a better doctor.

3 Months Old

This month we attended our 7th annual "Triple Date" in Colorado. Historically, it has been a long weekend spent with two of Kyle's close friends and their significant others in some location central to all of us. What used to be 6 adults cooking, drinking wine, reading in our pajamas, and playing games has now turned into... well, let's be honest, we pretty much did the same thing, but added 3 children and a dog.  Needless to say, there was a little less wine drinking and a little more diaper changing. Despite the change in dynamic, we enjoyed getting to know one another's kids and watching them get to know each other. 

Video of Sam (3mo) and Olivia (6 mo) meeting.

Here's Olivia, Sam, and Flopsie-Mopsie (Ailee's doll):

All bundled up to go for a walk:

Trying out the Baby Bjorn:

Olivia and Sam sport their matching cup-cake onsies:

Sam's Development at 3 months:

-- Hands are open and purposefully grasping for things

-- Brings hands to mouth

-- Eyes follow objects and people in room

-- Head erect when on tummy, propped up on elbows

-- Smiling and laughing socially

-- Has rolled front to back a couple times

My development at 3 months:

-- Kyle was away last week and I felt more capable than ever caring for Sam

-- Back to my pre-baby weight!!

-- But, still needing to work on my post-cesarean abs...

-- Doing the best I can to increase milk production for pumping

-- Enjoying the predictability of routine, but excited to see new development!

Snow Day(s)!

We've had a major winter storm here, pretty big even for northern standards. Atlanta can shut down with just an inch of snow, but we've had 4-6 inches, freezing rain and freezing temps for days. With few snow plows and little salt and gravel, the city's been on stand-still. Kyle's working from home and I've been enjoying my extra time with Sam. Fortunately, I'm assigned to an out-patient clinic this month which is closed due to the snow= no responsibilities for me! I feel like a school-aged child!

Here Steve was watching Sam while I braved the crowds on Sunday to grocery shop. Everyone in Atlanta was out stocking up before the storm.

Sam's helping Kyle work:

Playing with Sam

He's holding rattles and rings now:

Outdoor adventure! Trekking out to our neighborhood coffee shop.

Here's hoping for another clinic cancelation tomorrow!

Sam Stats

Kyle brought Sam to his pediatric check-up. He got his first round of shots (a little crying, but not too bad) and had his stats recorded:

Height: 26.4in (99th %ile)- That's my boy!

Weight: 14.6lb (87%ile)

Head circ: 16.1in (55 %ile)