When Did I Become Evil?

I think for my sanity I may have to stop reading the New York Times. Ok, so I know sticking my head in the sand isn't the answer, but an article I read this morning has my blood pressure up again. A few weeks ago I wrote an angry response to Dr. Karen Sibert's op-ed on women doctors. I have since read many other responses, some calmer and more thought out than mine. It is nice to know I am not alone in my belief that women can work part-time and still be good doctors.

This morning there was an article in the Times about government "mystery shoppers" who will be calling primary care physicians (pediatricians and ob/gyns included) to see if they are accepting new patients, if so how long it will take to get an appointment and if there are different answers depending on the type of insurance (private or medicare/medicaid) the patient has. If you would like to read the article you can find it here.

http://www.nytimes.com/2011/06/27/health/policy/27docs.html?nl=todaysheadlines&emc=tha24

I object to this on many levels.

The stated purpose of this survey is to see if there is a doctor shortage. Really? I'm pretty sure this is already known. It seems to me we can compare the number of doctors trained with the number of people in the US and figure this one out. It has nothing to do with how long it takes to get an appointment and if a doctor takes medicare.

They also say that all of the information will be kept confidential. Again, really? I don't trust the government to do this, do you? There will be leaks and some doctors will be penalized for not being able to book a patient in the window that some bureaucrat set.

What really bothers me though is the need the government feels to spy on doctors. Do they think that if we get a call from a new patient vs a call from someone who identifies themselves as a government survey taker we will change our answers?

I am tired of being maligned by my own government. Clearly, they think I will lie if asked directly so they feel a need to lie to me. They also think that I only order diagnostic tests for the money (even when I get none) and that I am quick to order or perform procedures, again for the money.

Most doctors in this country get paid based on the number of patients we see. It doesn't matter if we spend 10 minutes or 10 hours with that patient, we get the same amount of money. Because of this it is to our benefit to squeeze in as many patients as possible. I'll be surprised if any doctors on this production model have long waits. Salaried doctors may be another story, but...

Most doctors in this country and beyond went into medicine because they are genuinely caring people who want to serve their communities. Because of this, I'll be surprised if the patient mentioned in the above article who complains of coughing up blood and trouble breathing will be made to wait anywhere.

Doctors are not the problem in this system. Our rates are set by private insurance companies who take their cues from Medicare. We work hard to provide the best care we can within the limits we are given. We are not allowed to unionize or strike. When I contacted my government representatives and offered to help craft the new healthcare initiative I was given a thank you and a request for money.

I have many patients that I see who cannot afford to pay me and I see them anyway, because they need me. I am in a sub-specialty where it takes a long time to see a patient. It can take an hour or more for me to do a new patient consultation. And yet the government decided last year that I shouldn't get paid any more for that than I get for a ten minute patient exam.

I have three children and a mortgage. Somehow I need to earn a living.

There are bad apples in every profession. I am tired of my profession being vilified because of them and the misinformation that is out there. This attitude will keep people from going into medicine and drive others out. Surveys like this will only exacerbate the doctor shortage that it is supposedly trying to find.

No one goes into medicine for the money. It makes no sense. You spend the first four years paying or going into debt for medical school. You spend the next 3-7 or more years earning miminal salaries and working non-stop as residents. You then make it to attending status and have to see as many patients as possible to try and make enough money to pay your overhead, live, and eventually retire someday.

Doctors may make higher salaries than some professions, but we don't make as much as some others.

Since when did earning a salary become a crime?

Birthday Bliss

Yesterday was my birthday and it was great. The day started off when I woke, on my own, at 7:00 and groggily realized that I hadn't gotten up in the middle of the night to feed the baby. Thank you Drew for a great birthday present.

He woke up soon after I did and I fed him and then went on a walk all by myself. Thank you to my husband for that present.

After I walked I took the older boys to camp and they laughed and were happy the whole way. There was no aggravation, no fighting, it was totally smooth sailing. Thank you Sam and Toby for that present.

At this point it was 9:15 and I was already having an amazing day.

I got to go out to lunch with my husband (and the baby), get my nails done (fingers and toes) and get a facial (half price!). My sitter gave all of the boys baths and I got to hang out with them through and after dinner with minimal fussing and fighting.

It was wonderful. If you have to have a birthday and get older, this was the way to do it. And notice I haven't even mentioned any gifts or cake yet!!

I did get some great things, but the best thing of all was my day.

I'm going to try to hang on to that feeling when the baby wakes up at 1:30 and screams for an hour before going back to sleep (like he did this morning) or when I have to work or when the older boys are bickering and driving me nuts. It's nice to just know it's possible to have a lovely day and even better to have had one.

You Can't Stop Time

In two days I’ll officially be another year older.  Another year farther from my youth and closer to old age.  Birthdays are traditionally a time for celebration and reflection.  A time to look back at what you have accomplished and to look forward to what you have yet to do.  I remember when I looked forward to my birthday.  I was younger then.

This morning in the shower I felt slow and achy and I wondered if this is what it’s like to be getting old.  Or if it was because I had gotten up two hours earlier to feed the baby and spent the interim in that no-man’s land between awake and asleep.  Or both. 

I have accomplished a lot in the past year.  Most notably, I’ve had a baby.  I’ve also continued to raise my other two children, work, write a blog that I’m hoping to turn into a book and start this blog.  I’ve nurtured relationships with my husband, my family and my friends.  I’ve lost my grandmother and continued to mourn my brother.  I’ve continued to ride this roller coaster we call life.

I feel like my preface is over.  I’ve gone to school, earned my degrees, gotten married, started my career and my family.  I’m in the less rewarding stage of just keeping it all going now.  No graduation every four years, no pat on the back for a job well done.  Just the self satisfaction of going to sleep with the dishes done, the backpacks loaded and ready for the next day, the house relatively clean.  This is real life; making it through everyday just to face the next one; hoping that eventually we’ll save up enough, early enough to enjoy our old age before the end.  Hoping that we get to old age.

Life is not without its perks.  Seeing the baby smile makes everything better.  Listening to my older children have an actual conversation is a wonder to me.  Seeing the joy on their faces as they make a joke that is actually funny, or learn something new, or lose a tooth is amazing. 

This year my birthday wish is for time.  I wish for time to spend alone with my husband.  I wish for time to just hang out with my kids, with no place to be and no homework to get done.  I wish for time to slow down so the baby stays a baby as long as he can. 

I’m not going to be rich and famous.  I’m not going to change the whole world.  But I can have great influence on my little world and I wish for the time and energy and fortitude to do so.

Addendum to Yesterday's Open Letter

To the dad I saw this morning without shirt but with jogging stroller, bronze pecs and washboard abs exposed to the world, you and you alone, may continue running shirtless. 

But please wear plenty of sunscreen.

An Open Letter to Men Who Should Know Better

I am an unapologetic people watcher.  One of the best times to observe my fellow humans is when I am out walking in the neighborhood.  I find very little of which to disapprove, mostly I admire the variety and quantity of the species.  For the most part, if you are out there walking, jogging, biking, moving; I applaud you.  You can be with a single, double or triple stroller or infant in front carrier, with dog or dogs, in a gaggle or strutting solo and I am your fan.  Whether you are a young college student, young mother, young empty nester or young senior, we are all young when we are out there making the effort.  You can listen to music or listen to the birds.  You can wear the latest in trendy running fashions, or like me, be clad in old shorts and faded t-shirts left over from years ago and I am proud to be among you.  Whether your calves are hard as rocks or just a little (or a lot) softer, I welcome you.  There is however one member of our clan who should know better.

To the men who jog shirtless I ask, beg, plead with you to please put a shirt on.  Very few of you can carry this off in a way that is pleasing to the eye and even you shouldn’t be doing it with all that we know about skin cancer.  And to the 99.9% of men out there who can’t carry it off; we don’t want to see it.  I don’t want to see your pale skin reflecting the sun into my eyes.  I don’t want to see the rolls jiggling, the sweat dripping down from one to the other and finally to the sidewalk.  It’s hot, I get it, but the cotton of my old college t-shirt absorbs my sweat.  Or better yet get a moisture wicking shirt that promises to keep you cool and refreshed. 

I revel in the beauty of nature when I walk.  I watch the birds, the squirrels, the houses, the flowers, the trees and the people.  For the most part all of the people are beautiful because we’re all part of this neighborhood.  We make it what it is.  You are not beautiful.  You are unpleasant, but not unfixable.  Don’t stop running; don’t stop participating in the flow of this lovely community.  But please do it fully clothed.

Thank you.

My Job, My Choice

There is an op-ed piece in the New York Times this week that has me and many of my female doctor friends up in arms.  The article, “Don’t Quit this Day Job” is written by anesthesiologist and mother of four, Karen Sibert.  You can find it here.

http://www.nytimes.com/2011/06/12/opinion/12sibert.html?_r=1

She writes of the doctor shortage and of the propensity for women in medicine to work part time, or not at all.  She urges women not to do this citing herself as an example.  She acknowledges that you can’t do it all, but feels that you can do enough.  She has some good points and on first reading it made me feel incredibly guilty for working part time and wanting to work even less. 

It’s true that there is a doctor shortage and that this will only get worse as an aging population that needs more and more medical care continues to overwhelm the number of practicing and training doctors.  It’s also true that resident salaries are paid for by the government, so therefore by you and me, the taxpayer.  It’s also true that there are a lot of women going into medicine and that many more women than men later choose to work part time or not at all.

However, there are other truths. 

Dr. Sibert writes,

“Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.”

When I decided to go to medical school I was foot loose and fancy free.  I was 22, single, and had no idea that any of my education would be government funded.  It was a choice I made freely and willingly with the best of intentions.  It never occurred to me that I would want to do anything other than work full time at this chosen profession.  If you had asked me then if I would work part time I would have said absolutely no.  Even 5 years later, married and starting my ophthalmology residency I would have said absolutely no.  I can remember hearing about a woman who had finished training before I started who was slowing down and thinking of quitting and I was incredulous at that choice after she worked so hard and so long to get where she was.  Priorities change, life circumstances change, and I don’t think it’s fair to hold anyone to a decision made at age 22 for life. 

As far as medical education being a privilege and not an entitlement, she’s right and she’s wrong.  No, you’re not entitled to a medical education.  You have to work damn hard to get one.  You have to take (at least for me) incredibly difficult science courses and do well in them.  You have to, at your own expense, take the MCAT; apply to medical schools (each with their own application fee) and travel, again on your own dime, to interview at these schools if you are lucky enough to be granted one.  You have to apply to a lot of schools because it is difficult to get in.  There are no loans or government help at this stage.  It’s expensive.  I once had to spend more than $700 to fly from Philadelphia to Chicago for an interview.  Now, that’s nothing in the grand scheme of medical school tuition, but for an unemployed student, it was huge.

Then you get into medical school and you have to work damn hard to stay in, all the while sacrificing time and money.  When my other friends were enjoying their 20s, going out with friends, travelling, socking away savings for retirement, I was studying.  Again, it was a choice I made, and my husband understood and supported it.  I was lucky enough to have grandparents who paid my tuition, so I don’t have medical school loans.  They paid in full for my privilege to go to school full time and then spend most of my nights and weekends studying for two years.  My husband had to do the laundry and the grocery shopping so he could eat and wear clean clothes.

Then for the next two years they paid so I could spend all of that time and more working in various hospitals learning my trade.  Although they paid my tuition, I paid for living expenses and books.  We paid with money and time. 

Then came internship, residency and fellowship.  I worked even harder.  I spent 5 years more away from my home than in it.  I had two children and went back to work 6 weeks after my c-sections and counted myself lucky to be able to take that much time off.  I cried with frustration at not feeling like I was doing anything right.  I felt like an inadequate doctor, mother and wife.  But still I soldiered on.  It was my “privilege”.

By the time I hit fellowship, lifestyle considerations were weighing heavily on me.  This is not popular to admit.  Medicine is supposed to be a calling, not a job.  Doctors aren’t supposed to expect a life outside of medicine.  It doesn’t have to be that way though. 

Dr. Sibert writes:

“You can’t have it all. I never took cupcakes to my children’s homerooms or drove carpool, but I read a lot of bedtime stories and made it to soccer games and school plays. I’ve ridden roller coasters with my son, danced at my oldest daughter’s wedding and rocked my first grandson to sleep. Along the way, I’ve worked full days and many nights, and brought a lot of very sick patients through long, difficult operations.”

Good for her.  But the argument that “I did it so you have to also” doesn’t cut it with me.  It’s the same argument that was put forward when I was an intern and resident hours were cut to make up for sleep deprivation that can lead to medical errors.  You wouldn’t let a pilot fly after being awake for 36 hours, why would you let a person prescribe medicine or perform a procedure?  “Because that’s the way it’s always been done” isn’t the answer.  There are good concerns for continuity of care for the patient, but those can be addressed and still allow for more humane work hours that benefit both doctor and patient.

I’m glad that Dr. Sibert was able to work and parent her children in the manner she chose.  I’d like to do the same in the manner I choose.  The priesthood isn’t an irrevocable choice, so why should medicine be?  If entering medicine is a lifelong, irrevocable decision then make it so.  Make it like the military with commitments and penalties for leaving spelled out the moment you begin. 

But that’s not how it is.  I appreciate the money invested in me by the taxpayers.  I provided good care during those years to any and all comers.  I slept, when I could, at hospitals.  I left the house before my children’s daycare opened and came home after it closed.  I abandoned my husband on weekends and holidays.  When I came home I was asleep more than I was awake so I could continue to do it all.  I think I have, at least partially, paid the taxpayers back.  And it’s hard to feel grateful to a government who thinks I am overpaid and connivingly so.  A government who thinks that every diagnostic test I order is done with an eye on the bottom line and not in the interests of serving my patients even though I get nothing, yes, nothing, in the way of financial remuneration from most of these tests.  A government that champions a healthcare system that actually penalizes me for spending time with my patients, getting to know them and being able to provide the care they need and for which they come to me.  I am in a subspecialty whose numbers are dwindling precisely because it is getting harder and harder to make a living at it.

Dr. Sibert talks about my moral obligation to my patients.  Yes, that is real and that is there.  But what about my moral obligation to my husband and my children?

There are issues here that every physician, whether male or female, needs to work out for themselves.  If there’s anything I’ve learned in the last year and a half since my brother died, it’s that life is precious and regrets are the worst possessions.  I’m doing my best to figure it all out as I go along which is all any of us can do.

Stain Magnets

Have you ever had a piece of clothing that is a stain magnet?  I remember in middle school Benetton rugby shirts were all the rage.  The shirts were white with a bold strip of color across the center.  My mother declared they were too expensive (because they were) but I saved up my own money and got one with a bright green stripe across it.  Every time I wore it I got something on it.  Every time.  And of course I couldn’t bleach it because of that green stripe.  We didn’t have bleach pens back then.  I remember trying white out, that didn’t work very well. 

Since then I have had a variety of clothes that I just know I’ll be washing every time I wear them.  Right now I have one nursing top that the baby spits up on pretty much as soon as I put it on.  I don’t even know why I bother with it anymore.

My brother, Eric, has bought my children lots of clothes over the years.  It seemed like everywhere he went he sent back t-shirts.  Of course Drew will never get a new shirt from Eric, but he has lots of hand-me-downs.  I have a onesie from the New Zealand rugby team, the All Blacks, that is just his size right now.  Last weekend I put it on him with the plan of taking some pictures of him in it.  Before I could execute he blew out his diaper and the poop-soaked onesie needed to be changed.  This upset me more than it should have given that I have a washing machine right in my kitchen, but things from Eric do that to me.

This weekend I tried again.  I got some great pictures.  Then later, when I was feeding him, I noticed the front of the onesie was all wet.  When he was done eating I got up to change him and realized my front was all wet too.  He had peed all over us.  Apparently my diapering skills need an update.  Do they have continuing ed courses in diapering?

This time I wasn’t as emotional, after all, I’d already gotten the pictures.  But it cracks me up that the piece of clothing that is a dirt magnet is from Eric.  It just makes sense.  I can feel him laughing at me.

Sleep Training

It’s hard to complain when your infant sleeps for eight hours in a row, but I’m going to anyway.  The eight hours part was nice, yes, but does it have to be from 8:30 to 4:30??  No matter what I try, this little man’s internal clock always gets the best of me.

For a long time, longer than with either of the older boys, I fed him on demand all through the night.  It was a combination of him being my last child, him sleeping in my bedroom and the fact that he was born a little smaller than the others and continued to lose weight for longer than the pediatrician wanted, that kept me waking up at all hours even after I started back to work.  Finally, over Memorial Day weekend I decided it was time to sleep train.

We moved the crib from our bedroom to the dining room (the other bedrooms are upstairs and I didn’t want him to wake the other boys, nor did I want to have to go upstairs to get him) and put him to bed after his 10:00 feeding.  He woke up for that 2:00 feeding and screamed for over an hour.  Exhibiting amazing willpower, my husband never even woke up.  I lay there and listened.  Eventually the baby went back to sleep and when he woke up at 6:00 I fed him.  We did this again the next night and the next with the periods of crying getting gradually shorter.  Then for three glorious days he went to bed at 10:00 and woke up at 6:00.  Halleluiah!  I was feeling pretty good.

Then he went to bed at 9:00 and woke up at 5:00.  Ok, that’s not so different from 6:00 so I went with it.  That lasted 2 days.

Then he woke up at 4:00.  What the hell?  This kid is going to nickel and dime me back to that 2:00 feeding!!

So I started trying to keep him up later and later.  I would try and stretch each interval between feedings so that his last feeding was at least 10:00 or later.  He likes to fall asleep after his 8:00 feeding, which doesn’t work so well for me.

Two nights ago I fed him at 8:30 then stayed up and made him wake up at 11:30 so he could eat again.  He woke up at 2:50.  I let him scream.  It lasted over an hour again.

Last night I fed him at 8:30 and put him bed and he stayed there quiet until 4:30 at which  point I got up to feed him.  I guess I’ll take what I can get.

It makes me wonder though, who’s training whom???

Mixed Emotions

My husband is taking the two older boys to visit his parents for a week.  By the time I get home from work tonight it will be just me and the baby and the cosmopolitan he’s already mixed and put in the refrigerator for me.  Yea!  Right?

I’m already missing my boys.

For all of my frustrations and aggravations I truly do love my children.  I know you know that, but I had to say it anyway.  I hugged my 7 year old before he got on the school bus to go to his last day of first grade this morning and was sad that I won’t get to hear about it in person.  I dropped the 4 year old off at his school and he was ready to start his day without even saying goodbye until I reminded him.  I love that he loves school, but today I needed him to miss me just a little.

I will also miss my husband.  Who will I hang out with and decompress with at night?  The house is going to seem so empty and quiet. 

Sure I’ll get a little more sleep this weekend (maybe), and I’ll have some more freedom and flexibility during the week, and I’m really looking forward to the Girls’ Night I’ve got planned, but I’m really going to miss them all.

Drew and I will be on our own (with babysitting for when I’m at work) until next Sunday, which happens to be Father’s day.  Kudos to my husband for flying on Father’s Day with a 7 year old and a 4 year old to bring my family back to me.

Calgon, take me away!

I don’t know what to write about today.  So many things are happening; it’s hard to keep up with them all.  My oldest son is finishing his last week of first grade.  How did that happen??  He has been bringing home all of the work that has been kept at school all year which is now cluttering my kitchen counters because who has time to go through it all??  And of course I want to go through it all.  He also has had field day and a pizza party and other activities designed to make the 4 year old jealous and completely wear out the 7 year old.  This makes for lovely dinner time fights.

The four year old has two days off from his preschool this week for Shavuot (the Jewish holiday commemorating when God gave us the Torah).  Luckily, these days coincide with my days off this week so I don’t need to worry about extra child care.  Unluckily, I now have to figure out what to do with a bored 4 year old and the baby. 

Don’t tell my kids yet, but we are going to Disney in October in conjunction with a conference I have in Orlando so I’m trying to plan that also.  My head is spinning.  Anyone have any advice about planning Disney vacations?  Do we really need the meal plan???

And I’m still mourning.  For those of you who don’t know, my brother died about a year and a half ago and while I’m making progress, I’m not done and I may never be.  While my husband had the two older boys out Sunday afternoon I introduced the baby to the bobble head doll of Eric that we had made for him for what turned out to be his last Chanukah.  I really miss Eric and I hate so much that Drew will never know him and he will never know Drew.

Oh, and I’ve also been on call since last Friday and will continue to be until this Friday morning.

Thankfully, I have a sitter coming this afternoon and I’m going to go get my nails done.  I need some pampering time and the claws on my hands and feet need to go.  Hopefully I won’t think about any of this while I’m there and I’ll come back refreshed and ready to take it all on again.  Maybe. 

Maybe I just won’t come back.

Aggravation

I hate the drycleaners.

Running errands can be very difficult with kids.  I know, people do it all the time, and so do I, but it really makes me prioritize what needs to be done.  One of the things that has slipped low on the priority list is the dry cleaning.  Most of the stuff that needs to get cleaned is mine, and most of that is work clothes and since I haven’t been working for three months, there hasn’t been much call for it.  I do have some sweaters that I haven’t worn since January and a jacket that got a spot on it last month, but nothing really urgent.  Now that I’m back at work though, it’s really starting to pile up.

It hardly seems worth it to get three kids out of the car just to run in and drop off the clothes and get them back in the car though.  Even if I only have the baby, his carrier is really heavy and put that together with a huge load of dry cleaning and I might not be able to carry it all. 

I finally scheduled a good time to bring it in.  On Wednesdays I only work in the afternoons so I asked the sitter to come a few minutes early and planned to take in the dry cleaning before heading to work.  She got stuck in traffic.  I was pretty desperate for work pants though so I decided it would be worth it to possibly be a few minutes late for work to get it done.  When I got to the cleaners the door was locked and there was a sign that said this:

“Went to the bank.  Back in 15 minutes.”

ARRGGH!!!!

So I was a little late for work for nothing!

The next morning, a Thursday, I drove the preschool carpool and even though the baby was due to eat as soon as (or before) I got back, I made him wait and took the damn clothes in.  At least he was at home so I could run it in quickly.  The guy asked if Monday was ok to pick them up and I asked if we could do it Saturday.  He said it would have to be Friday because they don’t do pick ups or drop offs from the cleaning facility on Saturday.  I confirmed that the store front was open on Saturday so I could still pick up the clothes then and said ok.  Then I went home and fed the screaming baby.

I am on call this weekend so I worked Saturday morning.  On my way home I swung by the dry cleaners.  They were closed.

ARRGGH!!!!

So now most of my work pants are stuck at the dry cleaners.  I have a case in the OR at 7:30 Monday morning and then work a full day on the opposite side of town.  I work a half-day on Tuesday, but lately it’s been a struggle getting back in time to meet my 7 year old’s school bus on those days (it’s a long half-day).  After school he has a piano lesson and then it will be time to pick up the 4 year old from school.  I’m sure the baby will need to be fed and attended to in there at some point too.

That means that most likely the earliest time I can pick up the cleaning will be Wednesday when I’m off for the whole day but will have a sitter in the afternoon.

I know this is minor.  I have other clothes.  But oh the aggravation!!  And the thought that someday, fairly soon, I’ll have to do it all again.

Ah-choo! (sort-of)

Any mom worth her salt knows how to deal with a virus.  Lots of tissues, Tylenol, movies and love usually do the trick in my house.  This week, however, the virus got the best of me.  No, I wasn’t the one who got sick and it wasn’t any of my kids or my husband.  It was my computer. 

Anyone who has noticed my absence from the blogosphere now knows why.

I can (and do) check my email on my phone, but anything that requires a lengthy reply or pulls up a web page with small print I usually save for when I’m on the actual computer.  My dictation editing program for work requires the computer.  Blogging requires the computer.

It was actually an interesting exercise.  I thought I would be way more lost without my laptop for 5 days, but I did alright, mostly thanks to my iPhone.  Don’t get me wrong, I’m thrilled to have my computer back and grateful that none of my pictures or documents were lost, but I learned I can survive without it for longer than I thought.

So today I went through and picked out the pictures for the baby’s birth announcements (yes, I know he’s over three months old already, so sue me) and I’m blogging.  I’ve edited my dictations and checked facebook.  Next I’m going to look at some information I’ve been saving about a conference I want to go to in the fall. 

I’m back and it feels good.