Thursday, April 23, 2009

To Get to the Other Side

There are times in life when everything seems to fall right in to place, and then, there are times like now. I can see the shimmering oasis of a new life, just on the horizon. A better call schedule, closer to family and friends, a chance to work in a collegial (not competitive) environment, more time with my precious kids and husband, and a chance to grow as a physician. Between the oasis and where I stand, however, is a treacherous, rock-filled, rapid river, swirling and threatening my ability to ever reach the opposite shore.

Obstacle #1 - Our house is on the market, and we have shown it at least a dozen times. Yet, despite positive overall feedback, not a single offer. I don't mean to boast, but our house is a beautiful house. I love it. I was ready to buy it the second I walked through the front door, and I can't believe that everyone else that sees it doesn't feel the same way. We never thought we would have to sell this house. Maybe we should have thought about selling it before we bought it. If we don't sell before we move, we'll have a hefty house payment, along with any rent payment we need to pay in Newville. This alone will be a financial strain.

Obstacle #2 - Mr. Whoo has yet to find a job, nor procure an interview in Newville. Granted, he has only starting looking in earnest recently. However, he is looking for work in the finance world, which isn't the best place to be seeking employment given the current state of our economy. We have been fortunate that he was able to quit his job last fall when our family really needed it, but now we worry that the employment gap may cause an impetus with new employers. Plus, without an additional income after the move, there will be more financial strain on our family. (See Obstacle #1)

Obstacle #3 - My current place of employment is not letting me go without a fight. There have been veiled and outright threats of lawsuits and damages and liabilities for me leaving earlier than my contract had mandated. There is also the matter of giving back a portion of student loans paid by the hospital. The fact that we would have to pay back was not unexpected, however, the amount that we calculated is about half of what the hospital estimates. We are procuring the services of a contract negotiator and a lawyer, who seem to believe we have a case for inducement, but I'm having angina just thinking of it. Not to mention the fact that, if the hospital's calculations are correct, they want us to pay up in less than 2 months. Add more financial liability to the swirly, cold, and fast water.

Obstacle #4 - Emotionally, I am wrung out. I am completely exhausted, and barely hanging on by my fingernails to make it to the date I indicated I was leaving. Being on call, continuously, with only 4 days off per month (plus vacation time), has left me completely burnt out. I find it hard to drag myself to work and muster compassion for my patients. They deserve better than the doctor I am right now. My health, mental and physical, is suffering. The remainder of my contract is a mere six months, and by finishing it out, I can alleviate much of the financial burden of the above obstacles...for the price of my very sanity. I want to cry just thinking of it.

So, I sit here on the bank, pining for the oasis, and unsure how to navigate the obstacles that lie before me. Oddly, I am reminded of the "old school" computer game, "The Oregon Trail." When faced with a river, you can try to ford the river, float the river, or hire someone else to help you across. Right now, I am pining desperately for someone to throw me a life line, or at the very least, a strategy for surviving these treacherous waters. The best advice I can relate to our readers is to know what you are getting in to before you sign a contract. There is no such thing as a perfect job, and if it seems too good to be true, it, in all likelihood, *is* too good to be true. Caveat emptor...and pass the caulk.

*cross posted at Mothers in Medicine

Sunday, April 19, 2009

Revenge of the Pregnant Women

Oooooweeeeeeooooo. Scary, huh? Well, to a poor, unsuspecting, newly-recovered from the flu Ob/Gyn, it is the scariest prospect around. You see, for the first time (and I do mean, the very first time) in 4 years, I was oh-so-fortunate to have an entire 3 weekends a ROW! The audacity! The outrage! Ohhhhh, and the payback. You see, 2 of those weekends were included on my vacation, which was less vacation, and more "how much activity can you cram into 10 days?" This was spent in the southerly regions and in Newville, the site of our pending relocation. The third weekend was Easter weekend, by some stroke of luck, I was able to convince OMFH to grant me the holiday off, to visit with Mr. Whoo's family in the Great White North. Easter weekend marked the beginning of the the Whoo Family's dalliance with "The Flu." It started with Bean, quickly moved to me, and took out CindyLou later on in the week. Mr. Whoo is the only one left standing, and he's starting to get that characteristic hacking cough. Surely, I thought in my fever-fogged brain, out of all that glorious time off, some of my patients would deliver in my absence. Much to their delight (and my relative dismay), they did not. Other Doc, throughout the whole of my vacation and time off, did not deliver a single patient of mine.

Instead, they all waited for me. So this week, between popping Day.Quil, Ny.Quil, and Mot.rin, I have been exceedingly busy. The day that I returned from vacation, I had an induction for post-dates (41 weeks and 6 days). She had received cervical ripening overnight and actually was really contracting well. About 5 minutes after I hit the floor, she SROM'd the thickest meconium fluid I had ever seen, this was followed by a 10 minute trip to the 60s for the fetal heart rate. I checked for a cord, couldn't find one, tried everything possible to get the kiddo to recover, and eventually went down for an emergent cesarean. The baby was out in less than a minute, and needed a little transition time, but ended up doing very well. Not the best way to start the morning. After finishing up the paper work and talking to the family, I saw a familiar patient roll up to the nurse's obvious distress. She was supposed to have a repeat C-section later that week, but, she was in labor today. Back we went to the OR, where I delivered a 9.5 pound baby boy. I finally made it to the office that day around 3 o'clock.

The rest of the week continued in a similar fashion. There was a severe IUGR baby, born to a couple that struggled with fertility for a very long time. She was only 37 weeks, but the baby was measuring 32 weeks. We had watched the growth for the last few weeks, and it had steadily plateaued. The patient received only cerv.idil, but quickly labored and delivered a healthy, 5 pound baby girl. The placenta was incredibly calcified and quite small, so I felt confident the correct decision to deliver had been made. Unfortunately, there were a few inductions, one for preeclampsia and one for post dates that ended in late night cesarean sections. Both moms and babies did well, but I hate to have failed inductions. It makes me feel as if I have failed those patients.

Oh, and then the "weekend" came. My first weekend back since vacation, and, let's face it, I was already dragging from a busy week and a lingering illness, and OtherDoc had a similarly bad week. There were a million patients to round on, and about half a million circs (my favorite! Not.) I got the first call a little after midnight about patient at term with SROM. I had a little hope, as she did not want an epidural (score 1) and was only 2 cm when she was admitted (score 2!) Between my sick kids and being paged every hour from patients and from labor and delivery, very little rest was had between her admission and the call telling me that she was 8 cm at 4:00am. I arrived at the hospital right as she was beginning to push. Blessedly, it was a very nice, smooth delivery. No tears and a healthy baby. I'm sure my patients didn't appreciate being rounded on at 5 am, but I certainly wasn't coming back later! I did my umpteen circs, rounds, discharges, and spent the rest of the day trying, unsuccessfully to catch up on rest.

In the late afternoon, another "rule out labor" came in to triage. She had not changed her cervix, but she was post dates, and I decided to keep her for observation. I communicated several times with the nursing staff before I went to bed, and was assured she was "doing nothing." I took a Ny.Quil and was in bed no later than 10:30. Imagine my surprise when I received a page at 3:30 am telling me she was completely dilated. It was an all-too-familiar dash to the hospital in the middle of the night. I arrived, broke the bag of water, and she pushed out a beautiful 8.5 pound boy over an intact perineum. Once again, it was circs at 4:30 am, and rounds at 5 am. I have spent the rest of the day trying to recover. I am just now starting to feel human again. I really can't keep up this pace. I hope that I have done sufficient penance for my time off, and that the pregnant ladies are merciful tonight!

Wednesday, April 15, 2009


Whoa! I just blinked and a whole month was gone! Sorry to be MIA for so long. You have heard it all before. Get the house ready to sell, try (yes, I said try) to leave the old job, try to arrange things for the new job, take the family to the extremes of the North and South for back to back vacations, oh, and you know, work a full-time, 4 days off/month job. Makes it difficult to blog, ya know?

It isn't for lack of material, that is certain. I have a million ideas rattling around my skull, but no ability to focus in and write. Shall I write about how my current job in Whooville is giving me hell about trying to leave my contract early? Or shall I write about how difficult it is to tell my patients that I am leaving...especially the pregnant ones, due after I am supposed to leave? How about writing on how I managed to not eat pasta for the entire of season of Lent, and still managed not to lose a single pound? (Oink!) Or how we still haven't sold the house and I am freaking out? Maybe I should write about how big my kids are getting, almost 5 and almost 2, and how I feel like I've missed out on so much. It isn't anything you haven't heard me bitch/moan/whine or complain about before. I know I have to get back in the blogging "saddle" again, but I am unsure of how to start. What do *you* want to hear about?

Oh, and happy Tax day. Heh.