Saturday, January 30, 2010

New Sensation

In my previous job, I essentially functioned as a solo practitioner, so I could be fairly certain that (like it or not) I would deliver nearly all of my OB patients. Not that I didn't wish sometimes that a few of them would happen to deliver on one of the 4 days that I was freed from the hospital. In many ways, knowing all my patients from beginning to end was really wonderful. I knew who was stoic and who was, er, well....not stoic. I knew who was a worry-wart, who never had a single complaint, who had a birth plan, and who wanted an epidural when they hit the front door. I knew who was having complications, how far along (ball park) they were, and sometimes could even remember how dilated they were at their previous checks (should they arrive in triage thinking they were in labor).

The very best part, however, was the relationships I developed with the patients during the span of their pregnancies. We got to know one another, build trust, and when the time finally came for delivery, the rapport was usually strong enough for us to communicate well during the process, and to celebrate together when the delivery was complete. Sometimes this could actually be somewhat detrimental, as getting "emotionally attached" to patients can be a hindrance to good medical care, but mostly, while I cared for women on a personal level, I was still able to objectively direct their care. Of course, I didn't "click" with every single patient (that is impossible) but I did feel like a level of trust and mutual respect was able to be fostered with many.

Now, in a much larger practice where there can be anywhere from 60-80 patients due in a single month, it is much harder to develop the same rapport. There are times when I haven't even had a chance to *meet* a patient before attending her delivery. We try to have the patients see every physician at least once, but sometimes it just doesn't happen. This makes it much harder to develop trust in one another, during a very crucial time. So far I have overcome this by taking some time when admitting the patient to review all the records (sometimes helpful, sometimes not, depending on who was doing the documentation) and to discuss the plan of care with the patient and their family members. It is strange to deliver someone that you don't know well, and though I did experience this with some of OtherDoc's patients back in Whooville, it was not on the same scale.

Another adjustment I have had to make, and I think I may have mentioned this before, is adjusting to the "way of the group." Before, the medical decisions I made about patient care were mine alone, now I have 4 other physicians that have to be somewhat on board with a plan of care. Not to mention the way that they handle gestational diabetics and inductions is very different than to what I had become accustomed in the prior four years. Plus, when I order certain tests, sometimes another physician is the one that gets the results and then makes the decision on how to proceed. Scheduling inductions is also tricky, sometimes I can't schedule them for myself, and worry that I may tick someone off by scheduling someone on their call day.

Through all of this, I have noticed a strange new phenomenon. It isn't consistent, but I am starting to be able to "feel" who I am going to deliver. I know, it sounds completely bat shit crazy, but it is the strangest sensation. I just get this little gut feeling with certain patients that I am going to be the one that does their delivery. It matters not if I happen to personally like the patient or if the patient is one with whom there is not a strong connection. There is no basis in anything concrete, and it sounds so new-agey and non-scientific when I write it out like that, but, so far, each time I have "gotten that feeling" it has been correct. Verrrrry interesting. I will continue to observe as time goes on. Has anyone else, patient or physician, experienced anything like that before?

The really nice thing about getting my bearings and settling in to the new job is how well I am clicking overall with the patients and the nursing staff at the hospital. It is so great to hear the nurses tell me that they like the way I manage patients, or to have a patient tell me "You were my favorite, I hoped it would be you delivering my baby!" Very satisfying, indeed. Happy weekend, all!

Saturday, January 23, 2010

Workin' on the Weekend

Ah, weekend call. When I was in residency, the nurses would refer to it as the "3-day hostage crisis." I find this hilarious. And, in many aspects, true. In my former job, weekend call just seemed like a continuation of a long parade of call days that flowed seamlessly, one into another. I resented being held from my life on the weekends just as much as I resented the weekdays. Now, weekend call is a distinct, and separate being.

Weekend call for me consists of Friday, Saturday, and Sunday, starting at 7 am on Friday morning and ending at 7 am on Monday morning. Definitely a long, lonely stretch. Blissfully, the Monday after weekend call is mine, all mine. So there is always a break on the horizon, which, sometimes, is the only thing that keeps me going! Hospitals have a different overall feeling on the weekends. The pace is slower (usually) and generally, not a lot gets done. This even extends to Labor and Delivery. While it is true, babies have no concept of weekends or evenings and tend to come whenever they damn well please, but there are no elective inductions, no scheduled C-sections, and most patients are eager to leave the hospital.

The best thing about weekend call, for me, is the ability to spend as much time as I need to on Labor and Delivery, without feeling rushed. Weekdays usually will have scheduled C-sections at 7 am or 12 noon (sometimes both) and inductions can range from 1 to 3 for our group, there are circumcisions to be done, patients to be rounded on, not to mention a full slate of office patients for the day. Getting it all done can feel impossible, even when there are other partners there to divide the work. Splitting work can also be stressful, wondering if all the patients were seen, or if someone got missed in the shuffle. On the weekends, there is something peaceful (or is it merely resignation?) about knowing that, come what may, *you* are the one responsible. Sometimes it makes me wonder if I would prefer being a "laborist," because I really love the ability to stay on L & D, close to the action.

Some mornings there are just a few patients to see, and I can sleep a little later, and spend a lot of time with each person. Other mornings, there are many patients to see, but the pace doesn't necessarily have to change. Following the cardinal rules of deference to the call gods, I never make a single plan for my call weekends. If it happens to be slow, we spend some lazy time as a family together at the house. If it is busy, then I can take up residence in one of the (really, way too nice) call rooms where I can read, flip channels, and watch laboring patients simultaneously, or I can hang out at the nurses' station, chatting and getting to know my co-workers (and usually get access to some really great food, the staff definitely eats well on the weekends!)

So, while I still get a little wistful when I hear of others' fun weekend plans on the weekend that I have to work, I am bolstered by the knowledge that my "day off" lies just on the other side of the weekend. I am further heartened to know that weekend call is only once a month, leaving 3 other weekends wide open for fun plans of my very own, without fear of the dreaded page from L&D. WTF is wrong with me? I never thought I'd see the day when I appreciated weekend call; I must be getting mellow in my old age! Working or not, I hope you all have a wonderful weekend.

Saturday, January 09, 2010

New Year, New Me

Year after year, I have seen resolution after resolution fall by the wayside. We always start the new year with the best of intentions, but, more often than not, our perfectionism gets the best of us. We inevitably fall off the wagon, then, once off, tend to wallow in the mud. I will say that I have not been perfect, but instead of wallowing, I have picked myself up and tried to be better. Since starting my new regimen, I have lost 15 pounds, 6 inches from my waist, and 4 inches from my hips. I also ran in my very first 5K (boy, is my body pissed off about that one!) So my resolution for 2010, is much the same as every other year. To be a better mother, doctor, friend, and person. But this time, when I inevitably fail, I won't give up on myself as a lost cause. I will dust off and persevere. I know I can do this, and so can you. 2010 is going to be a great year, and I hope to be able to share more stories with all of you.

I am six months into my new position, and I cannot believe the difference. I am still working very hard when I am at work, but when I come home, I am home! I see my kids, we do normal family-type things. We have *plans* each weekend! The days that I am on call, I expect to stay in the hospital, but luckily, those days only come one week day per week and one weekend per month. The past four years are becoming more of a dim and distant memory. I have no idea how I did it, besides sheer adrenaline. I remembered that when I thought that I might die in the last mile of the 5K that Mr. Whoo and I ran together. If I can survive those 4 years of stress, I can survive a measly 3.1 miles.

Recently, I discovered that a woman that I know from college is a patient of our Ob/Gyn practice. This is a bit of a sticky-wicket for me ethically. We weren't the closest of friends in college, but we knew one another well, she is my friend, etc. I find myself worried to death that something will go wrong with her pregnancy, and that she will feel like it is my fault. So far all is going well, and she is excited that I am part of the group taking care of her. I, however, am petrified. The closest thing I have come to before was being a physician for the nurses with whom I worked in the hospital. At least they knew me as a professional *before* becoming my patient! Anyone else out there with advice on how to handle being a physician for someone who knew you before you became a doctor?

P.S. Whoever keeps commenting with Asian characters/links/advertisments, would you please CUT IT OUT? I will not publish these comments, and they are cluttering up my message feed. Ugh.