My Other Patient Population

Just a few weeks ago, I ran into another volunteer at our town’s animal shelter. We chatted and joked about how low the cat census was. There were only three cats up for adoption. Ha ha, he said. We joke now, but wouldn’t it be funny if there was an explosion of kittens and cats tomorrow? 

Well, Murphy’s Law. The following week I walked in for my Thursday morning shift in the cat room, and there were: a sleek and lovely mama cat nursing five adorable tiger kittens; several new cats, all sweet and friendly, crying for food; and one tiny, lonely, desperately mewing kitten alone in a small cage.

Of course, I had had my whole day off planned out to the last five minutes. But as soon as I saw all those new kittens and cats, I knew my plan was shot. Never mind spinning at the gym, forget the Target run. Regardless, I was kind of excited.

Let’s face it, kittens are cute. And the tiny runty one, crying so loudly (amazingly loudly, considering the poor cutie was the size and heft of a little bird), I just wanted to HELP.

Now, I may be a passable physician, but I am a crappy nurse. All through training,  moonlighting as a hospitalist, or even in the office, when a patient has needed physical help getting to the bathroom or onto a bedpan, a glass of water or a straw, or whatever basic bodily-needs issue, I have tried, but I am so painfully clumsy. We don’t get any training in the proper patient-maneuvering techniques in med school; we don’t now where anything on the floors is kept; and this kind of thing is generally discouraged.

Well I remember being on patient rounds with the “team” as we residents did our self-concious presentations, the attendings asked probing questions, and we all pretended to meaningfully auscultate the patient’s heart and lungs. As soon as the patient would ask for help- Please can you move this tray, or Please can someone hand me the urinal, or Please I’d like a cup of water, the whole team would evaporate, ostensibly to “get the nurse”. This always bothered me, as we were all capable of making the effort, of taking the small amount of time to concretely help a patient with a basic need. I knew it could take ages and ages for the “right” person to come to the room. And it was obvious that the patient could care less about the differential diagnosis of elevated liver enzymes. They just needed to pee, dammit.

One of these times, when a weak and elderly patient asked for help to sit up, I stepped forward, and then fell behind on rounds as I (clumsily) boosted her up in bed, adjusted the bed, and strategically placed some pillows. Afterwards,  the attending took me aside, and said, not unkindly: You paid a ton of money and endured a hell of alot of training to be a physician. You should not be doing nurses’ work. If you keep doing that type of thing, that’s all anyone will expect you to do.

So I was never quite sure what was the right thing to do.

Whereas, at the animal shelter, that’s all I have to do. It’s my job one measly morning a week to take care of the very basic needs of these deserving kitties. I am not a vet and have no clinical responsibility, or clue. I do not make decisions and am never on call.

It’s so wonderful!

I let them out of their cages, one by one, and sweep, change the litter, plump the cat beds. I dutifully cut and crush pills and hide them in food (there are a couple of animals on Methimazole for hyperthyroidism, and one on Buspar for aggressive behavior). I pet them and, time permitting, wiggle a string or cat toy so they get some exercise. When my kids accompany me, that’s their job.

When there’s kittens, they need to be socialized. So it is part of the job description to pick them up, cuddle them, pet them, talk to them, love on them. So cute!

But this runty little kitten was extra concerning. I tried to give him a bit of kitten chow, and he promptly stuck his face in it and tried to suckle at the mound of mashed tuna, confused. Hmm. I called the animal control officer who is in charge, and she told me he needs kitten formula. Huh? New one for me. She mixed it up and showed me how to bottle-feed a kitten. You hold them on your chest upright and stick the bottle nipple in their mouth. She showed me how this little guy has some issue with his hind legs- “Swimmer’s syndrome”, splayed hind legs that don’t work very well. That may be why he was found all alone, possibly abandoned by his mama. After she left, I spent extra time holding him, and he purred and purred, kneading at my chest, warm and well-fed.

This week, I came in and found the little runt in the big cage with mama and her five kittens. Though her own kittens are a few weeks older than the little guy, she seems to have adopted him. Still, I held him and offered him some formula, and he took it, happily, his mouth and whiskers all milky, purring and purring.

I didn’t have time to hold and play with all the older kittens, but I petted them and scratched behind their ears. Mama too.

So nice to have this very different patient population, and a very different set of responsibilities!

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MiM post on the damage of physician training:

Some thoughtful comments for my last Mothers In Medicine post: Why Is Residency So Harmful, And What Can We Do About It?

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A Fall Saturday Morning With The Kids: Gardening 101

Hubby left town this morning for a Sunday game, and I wanted to get the kids outside. They had been inside all morning, alternating between arts n’ crafts (an assigned project for Babyboy’s class has morphed into a several days’ tornado of construction paper, glue sticks, markers and glitter pens for all) and Curious George. They had been fortified by a pancakes breakfast (from a mix, made in a large batch, stored in the fridge, and microwaved to order).

My workweek was sort of a downer, with many longer than usual clinic days and a few taxing cases. I had been planning to complete a long-overdue required training module my lightly scheduled Friday; but the afternoon was engulfed by clinical mass. Four p.m. rolled around, and I was still making phone calls on abnormal results, still writing notes, still emailing specialists. Come this morning, I needed fresh air as much as the kids did.

I had bought bulbs on sale last week, and the bag sat on a kitchen shelf. Tulips, daffodils, more tulips, more daffodils. I bought them, thinking of the bare mulchy patches of garden around our house. While the previous owners of this property had done a wonderful job with landscaping, thank goodness, it was all large bushes, with big spaces in between. I imagined a colorful spring garden. But, I’d never planted bulbs.

Never mind, we could make it a fun project!

I announced this plan. Babyboy needs no excuse to begin digging holes. If he finds a live worm or grub, all the better. He was halfway out the door before I could grab the bag.

Babygirl, not so much. She was not excited to dig in the dirt. But the bright and colorful photographs on the bulb bags, scarlet and yellow and orange and pink, tempted her out the door.

As Babyboy started holes with the big shovel, and I dug deep with the trowel, it dawned on me that I should have found time to read up on how, exactly, to plant bulbs.

The only instruction I had was what I remembered from the store display: “The ideal time to plant your bulbs is in the fall before the ground freezes! Assorted bulbs $3.99 per bag!” But, how deep does one dig? The ground got pretty hard not too far down. Did you need to pad the soil with compost, or fresh soil? Our soil was kind of rocky and sandy.

Oh, well. Babyboy and Babygirl picked out the bags that most appealed to them. We dug down as far as was easy, plopped down two, three bulbs, and covered them over with the crappy soil and old mulch.

We did this in batches, and in rather short order, had planted all the bare spots in the front and side garden beds. We got out the hose and watered them down. I imagined that one needed to saturate the ground well, as with planting mature plants.

Once the task was done, the kids ran around, until Babygirl, on a downhill race, face-planted. tears, hugs, cuddles, and we all tramped up the stairs for a snack break.

It’s only now, as the kids munch pretzels in front of Curious George, that I have a chance to read up on planting bulbs.

“Large bulbs should be planted 8 inches deep, small ones at least 4 inches deep.” Oops. All of our bulbs were pretty large, and we maybe made it 4 inches deep.

“Fortify and fertilize the soil if it’s dry and rocky.” Oops.

“Bulbs don’t like wet soil. Don’t over-water.” Oops.

Sigh. I may have gone to medical school, but I’m a pitiful gardener. Our bulbs may rot or end up as squirrel food, but, at least they were cheap, and at least we got out of the house for awhile.

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When Work and Home Collide (Episode 1247)

As many times as this has happened, I have no graceful coping strategy.

Last evening, just as Hubby and I were herding our two wound-up kids upstairs towards bathtime, my pager went off. Hubby said he could handle things, and I went to the dining room to call the patient.

It sounded like a simple upper respiratory infection that had triggered an asthma exacerbation, but I was asking a lot of questions to make sure it wasn’t a really bad asthma attack, and that there wasn’t a high liklihood of pneumonia, or some comorbidity to prompt urgent care.*

Then: “What are you doing, Mommy?” Babygirl wandered into the room.

Hubby was right behind her: “Come here, come back! Mommy has to make this phone call!”

Great.

“Who are you talking to, Mommy? Can I sit on your lap?” She started climbing up into my lap.

Meantime, I’m trying to continue: “Have you had any high fevers or chills?”

“MOMMY! Can I talk on the phone too? Can I have the phone?”

Babyboy ran into the room. “What is everybody doing? HEY get away from my Legos! Those are mine!” Babygirl had grabbed Babyboy’s police station Lego setup that we had placed on the dining room table for safekeeping. A tussle ensued. On my lap.

“That’s MY policeman and police car! You can NOT play with that! I did not say you could play with that! MOMMY she is playing with MY LEGOS!”

“But I WANT to play with them. I WANT TO!”

Screeching and wailing, grabbing, flailing, and some hitting. Hubby tried to intervene, and finally picked Babygirl off my lap and carried her and the Legos in question to the living room.

Me, to the patient: “I am so sorry, please excuse the chaos over here…”

She, chuckling: “I raised four of my own. It’s no problem at all.”

We had almost got through the call when Babyboy came dancing through the room, holding his crotch.

Me: “Oh! Oh, excuse me-”  I put my hand over the receiver and yelled: “HONEY he has to pee! Can you help him? HONEY!” Then, back to the patient: “I am so sorry, I just need to get my husband, our boy is potty training…” Hand over the receiver again. “HONEY! I don’t think he can get his pants down!”

Hubby came running, clothing was sorted, pee happened, and in the right place.

The patient, again, was understanding: “I’ve been through that a few times. When they gotta go, they gotta go!”

We wrapped it up with a plan, and I hung up. She had all the medications she needed at home, so I didn’t need to then also call in a bunch of prescriptions. Bathtime went fine, but bedtime was dragged out. By the time both kids were down, I was down too. Literally, I had fallen asleep on Babygirl’s new pick shag rug. And she had too. (Lately, this is how she prefers to fall asleep. On a pink shag rug.) I hadn’t charted the call, and I needed to send the note to a nurse, so they could call her in the morning… I knew I had today off, so I decided to chart when I got up.

This morning, I was up fairly early. I came downstairs, got my coffee, and was just opening my computer to log into work, when…

“Hi Mommy!” Babyboy came padding downstairs. “What are you doing Mommy?”

“Oh, honey,” I just couldn’t not feel frustrated. They hate it when I’m on the computer. “I just have to do a little bit of work, honey.”

He came up and pulled at my hand. “Can you read me a story, Mommy? Can you read me the story about the trains? It’s right over here. Come sit on the couch with me, Mommy.”

Ooooough. I hate this. I kicked myself for not forcing myself to log in and chart last night. Why did I go to bed without taking care of this?

I sat on the couch and read Babyboy the train story. We cuddled a bit, and then I tried to make my exit. “Ok honey, I just need to go in the other room for a minute…”

“Can I watch a Curious George, Mommy?”

Now, a TV show would get me the distraction I needed to log into work and write my note. But, it was a school day, and he had to eat and get ready for school. We don’t usually do cartoons in the morning on a school day. It’s setting a dangerous precedent.

“No, hon, you can play with your toys for a few minutes, then you have to eat and get read for school.” 

“Naoooooh!” Dramatic flourish.  “I want to watch Curious George! Please, Mommy, just one Curious George?”

Hubby came downstairs and tried to step in. “I’ll read you another story, honey.”

“Noooooh! I WANT MOMMY to read me a story!”

I had gone into the other room and was logging in to work, clenching my jaw. I just needed to type one damn short note and hit send. This would just take a minute. Just needed to get it done.

“No Mommy! Don’t do work! Don’t turn on the computer! I want you to read me a story!”

“I’ll read you another book as soon as I’m done. If you’re good.”

Babyboy thought for a moment, then rolled onto his side on the couch. “Oh- kaaaay Mommy. ” The past few months, he’s been the easygoing one. When we  set limits, he protests, but then, usually, he concedes, and admits defeat, with this hangdog “Oh-kaaaaay. ” It’s both adorable and heartbreaking at the same time.

And he was Okay. He lay on the couch and waited, quietly. When I shut the laptop, he perked up. “Are you done working Mommy? Can you read me a book now?”

“Yes honey, I’m all yours. One book and then you need to get ready for school.”

I thought about this episode all day. Would some kind of shift work be better for my family? Would it be less stressful to have complete separation of work and home life?

Once, a few years back, I was rounding on our inpatients (back when we still did that) and a lovely hospitalist struck up a conversation with me at the nurses’ station. She wanted to know what my work hours were, how many calls we got after-hours. I told her, that usually I was at work 7 am to about 4 pm, sometimes leaving earlier, sometimes later, and calls were few. “Gosh,” she marveled, “It would be so nice to have normal working hours, with some flexibility on when you can leave for the day. I’m stuck here for twelve hours, whether I’m done or not. And the shifts can vary. It’s so hard to have that unpredictablity. My kids get so confused, and it messes up their routines when I’m not there for dinner and bedtime.”

Recently, I saw a healthcare provider as a patient. In the course of the visit, it came up that she had left clinical work to work in industry. What she did, exactly, was not entirely clear to me, but sounded like consulting of some sort. I asked her if she missed clinical work. “Oh, sure,” she said. “The-nine-to-five cubicle world isn’t for everyone. I know my clinical skills have rusted away. I can’t go back now. I wonder sometimes, but, I had to do what I had to do.”

So, maybe it’s true that the grass is always greener on the other side. And that the devil you know is better than the devil you don’t.

And so, I’ll stick with outpatient primary care and the after-hours pager, and work on my coping skills….

 

*As always, case details have been altered, and no real identifying information has been divulged.

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It’s 11 p.m. And I’m Up With My Toddler… Again

Ah, child sleep issues. If you go to Amazon.com and run a book search on “child sleep” you get 39,000 titles, ranging from Richard Ferber’s Solve Your Child’s Sleep Problems (the classic on the cry-it-out method) to children’s books like Adam Mansbach’s Go The F**K To Sleep (a runaway bestseller intended to amuse children and adults alike).

I myself have written something like ten pieces on child sleep issues… and yet I can write more.

Last year, with a bedtime-resistant and multiple-nighttime awakening toddler, and hubby and I losing our minds, like two bipolar zombies, we employed the cry-it-out method. It was painful. It worked. We achieved bedtime order and full night sleeps, and it felt better than drugs. I extolled the virtues of cry-it-out to anyone and everyone.

It lasted maybe a few months.

Then, we had a ten-day trip out of the country, followed by The Winter of Endless Illness, and we fell back into bedtime disorder and nighttime awakenings. By spring, Babygirl was up usually once, sometimes twice a night. Not nearly as bad as it was last year, but it wasn’t ideal. So at the beginning of this summer, we tried cry-it-out again.

Now, it’s different with a two-and-a half-year old than it is with a one-and-a-half-year old child. Babygirl can talk. Really talk. And, she still vomits when she gets upset. So, cry-it-out meant enduring forty-five minutes to an hour of Mommy! Daddy! Where are you? I need you! I need a hug! From you! Now! WHERE ARE YOU MOMMY????? I NEED YOU!!!! AAAAAGH! I puked! It’s all over my crib! Yucky pukey! Mommy! Daddy! Come clean me up! I puked! I have puke on me! It’s all over me! AAAAAAGH!

And then we went in there and had to scrub the rug, mop the floor, change the entire crib, and run another bath for her. Just not worth it anymore. Done with that.

Then, there’s the loosey-goosey summer schedule. We’ve had a few trips, many late evenings, more missed or late naps… Our schedules are all over the place. Hence, her schedule is all over the place.

So, today. It was Thursday, my day off. Hubby is traveling. As usual, we crammed an unbelievable amount of commitments, appointments, and errands into the day. Babygirl fell asleep in the car at 5 p.m., while we drove to Babyboy’s speech therapy appointment, and slept for an hour or so. Of course, I knew that would mean a later bedtime. But this late???

Thanks goodness Babyboy is, and always has been, a good sleeper. After tubby time and books, he’s pretty cheerful about lights-out. He cuddles with his lovey and murmurs to himself for awhile. That’s it.

But Babygirl? I tried. I stuck to the routine: we tucked Babyboy in, then went to her room, turned her lights out and dream lights on, and rocked in the rocking chair. And rocked. And rocked. And sang. And then took her to use the potty because she insisted she wanted to pee in the potty (she didn’t). And then tried to put her in her crib and she kicked and screamed and I didn’t feel like cleaning up puke. And then let her cuddle with her lovey on the floor because she insisted that’s where she wanted to sleep. And then chased her in the hallway and tried to get her to lie down again. Laid down on the floor with her and rubbed her back and sang to her… She’d been up for so long, she got hungry, started begging me for food.  I gave up.

So here we are now, she and I, at 11:30 p.m., sitting on the living room couch. She got her cheddar bunnies with sun butter and jelly, and a Caillou marathon (really annoying cartoon on WBGH Sprout). I got the kitchen cleaned, the kitty litter scooped, the cats fed and brushed, the dishwasher running, the toys all picked up, the clothes folded, and a blog post written.

Productive? Of course. I may be mentally fried and physically finished, but I can still do housework, and write.

But I’d really like to f*****ing go to sleep.

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My Weekday “Off” With The Kids…

Thursdays are my days off. “Off” makes it sound as if I  can spend the day lollygagging in playgrounds and on playdates. Other working parents know that a weekday not at work is crammed with errands and housework. For doctor-parents, the weekday not in clinic is crammed with errands, housework, and clinical responsibilities.

Huh?

Because if you’re not at work… you’re logged in to work.

Someone once suggested that I “choose” to log in to work on my day “off”. Well, like I tell my kids very often, it’s not a choice. Clinical decisions need to be made, and unless I’m completely signed out and on vacation, I better not leave my patients hanging, and make my colleagues resentful.

And, for the most part, I don’t mind. It’s a heck of a lot easier for me to address a problem, refill a prescription, or act on a lab result on a patient of mine, who I know, than it is for someone else, who would have to look into the chart and figure it all out from scratch.

And, for the most part, it doesn’t take up that much of the day. I try to log in to work at least twice on Thursdays: late morning, and midafternoon. Believe me, I much prefer this arrangement over going into work five days a week. It’s a good thing.

Today was tough, however. The kids are both off: Babyboy’s summertime Special Ed program is over, and there’s a two-week break before his Pre-K classes start. Babygirl isn’t in daycare on Thursdays. Hubby needs to prep for a big sporting event tomorrow (Sports broadcaster/ writer. Football. NFL Preseason game. Lots to do!).

I structured the day. Thursday mornings, I volunteer at the local animal shelter. This is sacred. This is something I do that makes me happy. It also makes seven or eight shelter kitties happy. Babygirl comes with me most Thursdays, and Babyboy cries about it, because he usually has to go to school. Today, he was up first, so I whispered, Hey! Do you want to come to the animal shelter with me today? And he popped right up from his Legos and ran upstairs to get dressed.

We flew through the kitty routine. He was very good: he picked out catnip mice and jingle balls for each cage, and stayed away from the mean kitties on my warning. We flew home. Babygirl was up. My plan was to get some housework done, log into work, get Babygirl dressed, and then take both kids to the gym, where I had booked an hour of child care (it’s an awesome gym that has a daycare on-site! Just need to book time in advance).

But there was alot more clinical work than I had anticipated. And, an urgent case that needed some thought, and likely a specialist referral, on short notice. There was alot of back-and-forth with my staff who were handling it on the ground. I got bogged down in it, totally absorbed. Hubby managed the kids: monitoring Babyboy up on the chair at the kitchen counter, cutting tomatoes with a plastic knife, salting and peppering them in a pot, to make ‘vegetable soup'; and chasing Babygirl around with her clothes. I ended up being stressed, and late out the door.

The kids were happy to play in the gym daycare, but I was distracted throughout my whole workout, fretting about my patient. Would the staff be able to carry out the action plan we had settled on? My heart rate was up, and not just from the spin bike.

By the time I picked up the kids, they were several hours away from breakfast, and headed towards hunger meltdowns. I wanted to give hubby more protected time, and the kids love the casual neighborhood blunch place (breakfast food served until 4 pm), so we walked over.

The kids were so, so good. A four-year-old and a two-and-a-half-year-old sitting eating a hot dog and french fries and a pancake, respectively, their little hands managing big-people forks. Nicely asking for more ketchup, more butter, more syrup, please. An elderly woman came over at one point and gushed, Your children are beautiful, as good as gold! So mannerful. I smiled, because I knew it was because they were starving and couldn’t shove the food in fast enough. But hey, positive public praise, I’ll take it.

[An aside- Babyboy, who started potty training last month, successfully used the toilet in the gym and the restaurant! No accidents for one week!]

We strolled from the restaurant to the local grocery, and the kids picked out fruit. Babyboy insisted on carrying the basket, and when it became too heavy, he pushed it on the floor in front of him, slid it all the way down the aisle to the checkout. I let him. No positive public praise on that.

Through the parking lot, to the car. Drove to a playground, let the kids run. Hubby called. I had forgotten all about Babyboy’s speech therapy! Babyboy is difficult to understand sometimes; he’s picked up his own way of saying things. The speech work is important. Hubby drove to the playground and picked up Babyboy, promised balloons (they use balloons, hard to explain) and brought him to the speech appointment.

I brought Babygirl home and logged back in to work. Held my breath to see what had happened with that acute case. Our admin had worked minor miracles to get this patient a tomorrow appointment. Our nurse had spent a good chunk of time on the phone with the patient. But there was still an issue, some questions, not clear if it was better to wait to a different specialist next week. I had to think about this. I thought about calling the patient directly. But Babygirl had not napped, and was especially needy. Plant her in front of the TV and make a phone call? Hmmmm… Babygirl held on to my leg, Mommy, pick me up! Pick me up! Nope.

I looked up a couple things, researched, typed out explicit instructions to the nurse, several options for the patient, and let the nurse make the phone call, from the office. I held Babygirl in my lap, read her a bunch of books, fretted more about the case.

Hubby and Babyboy came home, with balloons. Babygirl immediately popped one and everyone started crying. Hubby and I decided to aim for a six p.m. bedtime. Dinners were prepped, theirs (sunflower butter sandwich, milk, strawberries and whipped cream) and ours (grilled chicken, salad made from Babyboy’s earlier ‘vegetable soup’ experiment, ice water, not wine).

I logged in one more time. A plan had been made. But then, the patient emailed me with concerns. I was almost relieved; I felt bad about not being able to call them myself earlier. I emailed back. I think we’ve got a good plan. Shut the laptop.

Upstairs. Everyone got a bath, a warm milkie, and into pajamas. We read a gazillion books. Babygirl melted down. I did one-on-one, this-is-not-a-choice bedtime with her. She fell asleep in my lap after twenty minutes of rocking and shushing. Meantime, Babyboy was bouncing off the walls with Hubby. We did a mellow bedtime with him; Hubby told him stories about skunks (Babyboy’ strident request; skunks are a current fascination), and we ended up reading more books. He finally fell quietly into sleep, snuggling with his stuffed kitty, murmuring about skunks, 8 p.m.

Somewhere in there, several loads laundry got done and folded; the dishwasher was emptied and then filled; the grill was cleaned and put away; the birdfeeders were topped off with seed and sunflower butter sandwich crusts; the mail was opened; the junk mail was shredded; the bills were paid; and we ordered 75$ worth of new kids’ books from Amazon, including two about skunks. (Yes, we belong to a wonderful library, and yes, we buy new books, and if they’re not destroyed, they’ll be handed down or donated. I can’t stress about keeping library books in good condition.)

Hubby didn’t get as much protected time as we had planned, and he’s looking at a late night. I feel kind if bad about that, but good about the day.

I will gladly take a day like this, over going in to work. It’s hectic, and work overlaps with life not infrequently; but it’s also a break in the routine, and a chance to spend more time with my kids. It’s flexible, and I almost always get some good recharge activity in: the shelter, the gym. Yes, it’s a day “off”, but hey, it’s a day off.

 

 

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Latest Mothers In Medicine Post

My latest post on the group blog Mothers in Medicine: “Taking Care Of Ourselves”.

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