Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “doctor”

Why Is It…

I have been accused by many of being a cynic.  I can’t imagine why this is.  My question for you is:  Is it cynicism if it’s true?  I have heard cynics described as “failed romantics”, and if that is the case, I guess I am a cynic.  I tried to deny it during a visit to my shrink, and he reminded me of a statement I made on one of my worst days.  When asked if the glass were half full or half empty, I replied that someone had stolen my damn glass.  Now that I would refer to as bitterness, but who am I to argue?

My cynicism, if it exists, began in junior high, but was firmly seeded when I started medical school.  The summer before I went to med school, several people told me that I needed to read Samuel Shem’s “The House of God”, which everyone agreed “told it like it is” and I would know what to expect when I started that July.  Let me say that it is an excellent book, but you should not read it prior to starting medical school.   It will set the stage for bitterness beyond repair, because all of the things in that book ARE true, and they are a horrible sad reality.  My husband has questioned the source of my somewhat bitter outlook, and among those sources are that book.  I have urged him to read it, so that he may better understand, but he has not read it yet.  He will probably not, unless I maybe read it to him.  He is very busy, and mostly reads technical journals.

I have made many observations, which I insist are realism and not cynicism.  Maybe you will agree with me, or maybe you won’t.  I suspect these random thoughts may ring some very familiar bells, which likely cannot be unrung.

Why is it that when you are terribly late, that you will hit every light on the way to your destination, but if you are early and hoping to delay your arrival, all your lights will be green and there is smooth sailing?  This also happens when you really need a stop light to quickly check a text, which may be crucial to your outings that day.  My husband would claim (I sometimes refer to him as Mr. Spock) that these occurrences are mere coincidence, and that our mind only registers the outcomes that we (bitterly) expect.  I don’t know.

Why is it that my husband always calls me when I am running between airplane terminals, on the toilet, sleeping, or otherwise engaged in an activity that makes it virtually impossible to answer the phone with any convenience at all? He indignantly denies this, and tells me if I don’t stop complaining, he won’t call me at all.  It would be churlish and counterproductive to suggest that this is a desirable suggestion.  It certainly would not make for good marriage relations.

This may not be a problem for most of you, but why is it that when you have been up all night delivering a baby, and desperately need to go home and shower and rest, that just as you walk triumphantly out of the delivery room, there is another woman sitting there in a wheelchair who has just come up in labor?  This seems unnaturally cruel.  It is a lot more unlikely to happen if you are well rested.  It is most likely to happen at 4 in the morning.  Studies actually bear this out.  Human cortisol cycles dictate that more deaths and births occur around 4 in the morning than at any other time.  The baby I delivered this morning came at 4:17 AM.  I rest my case.  When I got the delivery done, there was another woman being admitted in labor.  Really?  Uncool, universe, uncool.

Why is it that when you are in a rush to pick your daughter up from school, she will be covered in paint, in the middle of a project, and her backpack completely unpacked?  If you have plenty of time, she is packed, homework done, and ready to go home.

Why is it that the hotel WiFi always cuts out when I am actively doing something, like Skyping with my family?  It never does it while I am asleep.  Then I get accused of deliberately cutting off the connection.

Why is it that when I am finally getting some sleep, (and of course have not put up the Do Not Disturb sign at the hotel, because I think that there is no possible way that housekeeping will come around that early) that they come banging at my fricking door at 8:45 in the morning?  However, when I am at work at the hospital, and hoping that they will have come already, when I return at noon, they still haven’t come and start banging at my door wanting to know if I want service?  Why is it then, after they have already come and gone (and tried to weasel out of various services because I am sitting there, and they can ask me if I “really need my bed made”) that just after I have gotten rid of them and locked up the door, the head of housekeeping will show up, bang on the door yet again, just to ask if I have gotten my room cleaned.  Why is it that no matter how loud I yell, “COMING” in a tiny hotel room, that they NEVER hear me, even though I yell it twice, they still jam their keys in and pull at the door?  It’s one room.  I have a loud voice.  Have they all been deafened by their vacuum cleaners?

Why is it that there is always massive, dense frost that must be scraped if I am in a hurry or running late, but the windows are always pristine if I have plenty of time?

Why does the damn hospital always call when I am in the shower?

Why is it that they only show the episodes of Law and Order, NCIS and SVU that I have never seen RIGHT when my husband calls and wants to Skype.  Why does he blather on until the whole show is over?  Why can’t he ever call in the middle of the multitude of episodes that I could recite verbatim and am sick to death of?

Why is it that the patients that wake you up in the middle of the night are always the ones that you don’t know, that belong to another doctor or hospital, that have no prenatal care, and who are unbelievable pains in the butt? 

Why is it that after many days of clear skin, on the one day you will see someone whose opinion of your appearance matters to you, will you wake up with an enormous zit?  Why is it always the one that has roots in your damn tonsils, the kind that you can’t hide no matter what, and the kind that takes days (if not weeks) to clear up?

Why is it that if you are late for your plane, the parking lot will always be super full and you will have to park 8 miles away and run? Why, when you are early, will it be totally empty and you have your choice of spots?

Why is it that when you are about to miss your flight connection, your gate will be 6 concourses away, always in the Minneapolis-St. Paul airport, where you have to run most of the way and the tram will take you about 5 inches.  When you are early, your gate will be directly next to the one where you have disembarked.

Why is it that if you decide to go home because a patient’s labor may be awhile, that they will either develop conditions that necessitate multiple phone calls and the need to go back in to the hospital, or they will dump the baby out in the bed before you can get there, but if you decide to wait at the hospital, everything will go smoothly and will take forever, while you are trapped there with nothing to do?

Why is it that in winter, the beautiful sunny days are always horribly cold, and the ones at a temperature where you might actually want to venture out, are always gray, depressing, and raining.  Actually, there is a known reason for this, having to do with weather patterns.  I disapprove.

Why is it that when your call ends at 7 AM, you will get called in for an emergency delivery at 6 AM, which will necessitate you working over your call time, especially on the day that you have to be returning to the airport?  Why is your call replacement always late getting into town?

Why does Walmart never have enough fricking lines open, even during times that are known to be busy? 

Why is it that yogurt, toothpaste, coffee, and other staining items always splorp out on your work or travel clothes, but never on your t-shirt and yoga pants, even if you are being very careful?

Why, when you drop something small, expensive and important, will it always take a bounce that defies the laws of physics, and land in the one place that you believe it was physically impossible for it to go?  Why, if it is unimportant or messy, will it always land right in front of you, or splat on your clothes?

Why is it that the piece of luggage you drop always contains your computer?

Why, within months of the time that my GI doctor told me that I should not drink coffee, were not 1, not 2, but 3 Starbucks erected in my previously Starbucks-less town? 

Why do you always miss the flight when you are headed somewhere of tantamount importance or great desire, but never when you are going somewhere where you couldn’t give a shit if you get there?

Why are the totally cutest clothes and shoes marked down to a totally awesome price only available in someone else’s size?

Why is it that you always have some weird muscular spasm and ram your freshly manicured toenail smack into the underside of the drying table when you are getting up to leave from your pedicure?

Why does your car wait to go off waranty before it totally falls apart?  Why does this happen one day after it expires?

Why is it that the drier always beeps when you are in the middle of dinner, or a shower, and it is always the load that must be hung up immediately?  It is never towels.

Why is it only the glass ornaments that fall off the tree?

Why do you always have to poop right after your shower?

Why is it that you always get horribly sick on vacation, and not when you could totally use a break from work?  Why does your kid only get sick when you are about to leave on vacation?

Why is it that packages that must be signed for only come when you are not home?  Why does the mailman come at 2 PM when it doesn’t matter, and at 9:30 AM when you are struggling to get bills out on time?

Why does your phone lock up while you are trying to pull up your boarding pass to get on a plane?

Why is your plane seatmate always the last to board?

Why is it something different that sets off the TSA metal detector every time, when you always pack the exact same things in the exact same way?

Why is the person ahead of you in line at the grocery store always trying to pay in Euros, or trying to use their debit card to bring down the entire US banking system as we know it?  Why must their items always be price checked?  Why do they have 80 coupons?  Why is their credit card always denied?  Why is it that the line you pick is always the one that comes to a smack halt, when all the other ones are moving smoothly?

Why do travel opportunites, parties and visits with friends only come available when you have already made other, unbreakable commitments?

Why do your coat, backpack straps, purse straps and other items always get hung up on doors and handles so intensely that you must back up and untangle them?  Would this ever happen if you needed this to to save you from falling off a cliff?  Hell no.

How can an enormous ice scraper disappear out of a rental car that only you use, that you always keep locked, and that is so big that if it fell out, you would totally hear and feel it falling on the ground?  Why does this only happen on the day that the most ice forms all over your windows?

Why is it always someone else that wins the damn lottery?

Why is there always a crisis when you desperately need to be doing something else?

Why, if a cabinet door is opened for a minute, will you smash your head into the corner of it so hard that your ears ring and there is a bloody flap on your scalp?

Why does one earring always come out and get thrown away with the scrub cap?

Why, when you have to do a delivery so fast that you don’t have time to change out of your street clothes, or put on your tall hipwader boots, does the amniotic fluid explode all over you, the blood sprays all over and out of the cord, and the placenta flies out with a plop and a splat on to your feet, but when you have on your protective gear, the delivery is unbelievably tidy, and nothing gets on anything?

Why do you always get a paper cut right before you have to cover your hands with alcohol solution to do surgery?  Owwww.

I could go on.  Really.  Endlessly.  This is but a random smattering of my questions for the universe.  My husband would state that all of these occurences are random, and have nothing to do with the circumstances at hand, but I just don’t agree.  Somebody stole my damn glass.







Things That Men Say

Let me preface this for those who do not know my by saying that I am an OB/Gyn – a doctor that takes care of women, doing, you know, women stuff like baby birthing, hysterectomies, icky periods… yeah, that stuff. Because I care for women for a living, I get to spend a lot of time with their men, frequently under bizarre circumstances like childbirth, or a really icky pubic rash. Shhhh… I’ll tell you a secret. OB/Gyns have a saying: “All women are different, but all husbands look alike.” Their men are a constant source of amazement, embarassment, stereotypical behavior, sweetness, and hilarity, planned or not.

I made a previous post about things that patients say that amuse me. This one’s just for the guys! Here’s to you and thanks for all the laughs (and muffled sobs)!

1. When you do her hysterectomy, can you get the mean out of her too, doc?

2. Hey doc, while you’re sewin’ that up, can you throw in a couple extra stitches, just for me?

3. You mean that thing’s an extra nipple? Babe, you’re a FREAK!!!

4. Only YOU would ask the doctor for something like that, Princess.

5. I thought she’d go back to normal after the baby came out.

6. We both dug around and looked for it, doc. Just can’t figure out where the damn thing went!

7. Are you gonna stick that duck thing in ‘er?

8. I’m leavin’ the room. I don’t wanna see this.

9. Oh, my God, what’s THAT?

10. What’s that brown stripe in the middle of her belly for?

11. Hey, if you’re gonna do that to her, you oughta at least buy her dinner first!

12. I dunno, doc. She got off your scale and just started cryin’.

13. What do you mean, she got pregnant in April? I wasn’t here in April!

14. What’s THIS for?

15. Is it OK if we keep the litter box in the kitchen?

16. Don’t worry, doc. I ain’t gonna pass out. It’s just like guttin’ a deer, right?

17. If it’s a girl can you put it back?

18. If it’s a boy, you only got one dick you gotta worry about. If it’s a girl, you’ve gotta worry about ’em ALL!

19. She caught that somewhere else.

20. I AM payin’ attention, hon. You just keep pushin’!

21. I’m just gonna sit over here.

22. I feel a little…. THUNK!

23. There ain’t another un in there, is it?

24. You swear it ain’t twins?

25. Does that hurt, babe? That looks like it hurts! What do you mean, shut up??

26. OW! You’re gonna rip my fingers off!

27. What do you mean, this is all my fault? You was there too!

28. My wife is hurtin’! Fix that Goddamn epidural thing, NOW!

29. She done broke her water all over my truck upholstery!

30. What do I do? What do I do?

31. Damn, Babe! You’re big as a frickin’ HOUSE!

32. Is she gonna be OK?

33. I am NOT drunk!

34. Can’t you just grab its ears and pull?

35. Why’s his head all pointy? Is that gonna go away?

36. What do you mean, you don’t want my mom in here?

37. Some things a man just shouldn’t have to see.

38. What do you mean, she can’t just have it now?

39. Can you just spay her?

40. Damn, I can’t even look at her but she gets knocked up with another one!

41. What do you mean, we can’t have sex til the baby comes?

42. Seriously, what do you mean, we can’t have sex until the baby comes?

43. How long do we have to wait to have sex?

44. Tie her tubes? Cut ’em the hell out, set fire to ’em and STOMP ’em!

45. Semen analysis? Hell no, doc, I know it ain’t ME! Ain’t nothin’ wrong with ME!

46. How soon can you do a paternity test?

47. Where’d the red hair come from?

48. She said it was a alien probe! That’s funny Babe! Ain’t that funny?

49. I can’t wear one ‘a them things! Like taking a shower with a raincoat on!

50. It can’t just get lost up in there, can it?

51. Damn, looks like you’re stickin’ your whole HAND up in there!

52. Oh my God! I shouldn’t’a looked down there! Oh, CRAP!

53. What’s that stuff comin’ out of her now?

54. That is just so GROSS!

55. Gawd, doc! How’m I gonna compete with THAT thing?

56. She told me she couldn’t get pregnant.

57. Can you give her somethin’ to make her wanna, well, you know… ?

58. Why’s she squallin’ like that?

59. Damn, her boobs got BIG!

60. Her nipples look like dinner plates!

61. Her boobs are bigger than my kid’s HEAD!

62. That thing makes her look like she’s on a milkin’ machine! OW, Babe!

63. I can’t pick him up. I don’t know how to hold his head.

64. COOL! He blew poop out his diaper right up his back! THAT’S my boy!

65. What do you mean, I get to have the next one?

66. I swear I didn’t think that thing’d get stuck up there.

67. Oh my God! Why’s that woman next door SCREAMIN’?

68. Did you really have to go into labor right in the middle of the Iron Bowl?

69. Do some jumping jacks, Babe. We need to have that thing this year – we need the deduction.

70. Can’t tell if she’s walkin’ or rollin’.

71. Why does she still look pregnant?

72. She can’t have the baby Thursday. I can’t get off work then.

73. She cain’t have the baby on Halloween – he might be a WITCH!

74. What the hell’s a onesie?

75. If her mom don’t leave I’m gonna go nuts.

76. No, you can’t buy all new shoes if your feet spread.

77. How come you need your toenails painted? You can’t even SEE ’em!

78. Stirrups? You mean like on a horse?

79. Why’s she so grouchy when she’s on the rag?

80. Oh my God! That needle is huge!

81. Don’t worry. I’ll make her take her pills.

82. Damn, girl! Your Tweety Bird tattoo’s done turned into Big Bird!

83. Is she gonna have to take that piercing out?

84. Looks like he’s a little alien tryin’ to crawl out your belly.

85. What’s that cut for her c-section gonna look like?

86. She doesn’t want an epidural. You don’t want an epidural, hon. We want an all natural birth.

87. Just breathe, hon. You’re not breathing the way we practiced. What do you mean, shut the hell up?

88. What the hell do you want me to do??

89. Why are all the magazines in here for women?

90. She’s a MILF in training.

91. I forgot the camera.

92. This wasn’t in the birth plan.

93. You’re not the doctor we’ve been seeing.

94. How can you stand looking at this stuff all day? Why’d you decide to do this?

95. Don’t you feel weird looking at women’s crotches all day?

96. Will she still be a woman if she has a hysterectomy?

97. Will she still be mean when her periods go away?

98. You gotta do something, doc. She’s rippin’ the covers off and freezin’ my ass off every night.

99. I told her I was coming in with her to make sure she addresses this issue.

100.Thank God I’m a man. That’s all I’m gonna say.

Come Ride The Rollercoaster

I am an OB/Gyn. For some, the first thought that comes to mind is, what is that? In this case, you are probably a single male. For those of you who are single men, the answer is, I take care of women.

I do pelvic exams. I do pap smears. I hand out birth control. I catch babies. I do c-sections. I do hysterectomies. It sounds straightforward. It almost sounds easy.

I deal with pain, physical and mental. I deal with disease, physical and mental. I deal with disasters. I deal with miracles. I deal with women. I deal with women and all their world around them. All of it.

An OB/Gyn gets to know their patients, unlike surgeons. Surgeons meet a patient because there is a sick organ, they remove the organ, they take care of the patient for the required six week recovery, and say goodbye, unless they find another broken organ to remove. We also remove sick organs. But we remove them from people we have known for thirty years.

An OB/Gyn begans their journey with a woman when she is still a girl. Girls have cramps, they bleed until they soak their clothes, they start thinking about sex, they have sex. Girls get pregnant.

We talk about sex, we talk about pregnancy, we talk about diseases. We try to prevent them and we look for them.

The girls become women. They come to you because they are getting married. They don’t want to get pregnant. They do want to get pregnant. They have never been examined before. They have been examined a million times.

The women have their babies. We deliver them. We deliver delight, we deliver pain, we deliver reality, and sometimes death comes when it shouldn’t.

The women get older. Their marriages get longer, or shorter. The sexual partners increase, or they go away altogether. Things start bleeding weirdly, and hurting. Things start growing where they don’t belong. Things start falling out.

Then things shut down entirely. Here come the hot flashes, the wrinkles, the dead sex drive, the dissolutionment, and the next generation starts making them crazy.

They lose their husbands, when they weren’t ready to. They lose their children, when they shouldn’t have. They spend a decade of their life caring for invalids. They forget who they are; who they were. If they are lucky, their children start driving them around.

Come ride the rollercoaster with me. Spend a day with me.

C-section, early morning. There is blood. You are tired, from lack of sleep. The day is just starting. You have to explain to a woman that you have to cut her open. She doesn’t want to be. Her husband doesn’t want her to be. There is no choice. There is nothing worse than explaining to someone that they don’t get a choice, that any different choice they make may result in death. The baby is born. The mom is OK. There is relief. Life is good.

Late for clinic. All doors closed, with charts in them. Lights are blinking. Phones are ringing. Your nurse is looking at her watch. You are looking at your watch. You start running. You must be terribly efficient.

There is something in humanity that abhors efficiency. The further behind you are, the more complicated the patients become. When someone bursts into tears, you just can’t rush out their door.

Here is my day.

Room 1. There is a little girl in there, a scared, skinny little girl. In the nurse’s hand is a positive pregnancy test. She knew, but she didn’t know. Her mom is in the waiting room. She doesn’t know. Skinny Girl doesn’t know what to do. She is crying, and twisting the friendship bracelets on her arm. How does she tell mom? How can she have a baby? How CAN’T she have a baby? These issues have to be discussed. NOW. You are scared for the girl. You are sad for the mom. You are sad that another kid isn’t going to finish high school.

Room 2. Elation! You have been taking care of her for almost 10 years. She just got pregnant! She has been trying so hard, so long! You can’t help it, you’re ecstatic for her. You’re ecstatic with her. You hug her and whoop.

Room 3. A lonely tiny bedraggled little lady slumps on the table. This is her first exam in 8 years, because she has been home taking care of her sick husband for that long. Now he has died. She is trying to remember how to take care of herself. She doesn’t remember, it has been so long. She hasn’t seen her friends in years. You leave the room, and feel profoundly lonely for her. You feel her loss. You see her emptiness.

Room 4. A black eye. Where did she get the black eye? She fell. You give her the shelter number, tell her to sneak it in her shoe. You document. You pray.

Room 5. One of your favorite pregnant patients. She’s brought her mom to meet you. You’re flattered, and tickled, and happy to meet her! You joke, you laugh, you enjoy each other’s company. You hate to leave this room.

15 minutes. You were alotted 15 minutes for each.

Back in room 1. Tragedy. Your patient has been going through infertility treatments for two years. She finally got pregnant. The ultrasound shows that the little heartbeat is gone today. You are the one who has to tell her. You watch her eager face go to apprehension, to dread, and watch it crumple. The sobs are gut wrenching. Her husband is sobbing too. It is so hard to watch a man so bare, so crushed. They are destroyed.

Back in room 2. She has a rash. It hurts, it hurts so so bad. It hurts to pee. Her glands are swollen. What is it? She is a sweet girl. This has been her first sexual partner since a long relationship. She gambled. She lost. She has herpes. To do the test, the swab, you have to hurt her, scrub the spot with the sore. You have to tell her, she has an incurable disease. You have to try to figure out how to help her live with it. She cries and cries.

Back in room 3. Your patient has brought in her beautiful new baby! You pass the baby around, hold the baby, hold back sentimental tears at his silly little hat. You have your picture taken. You are the hero. You feel great!

Back in room 4. You discuss birth control. Your patient wants to know options. ALL the options. Now. She wants you to help her decide. Now. You struggle not to look at your watch. She wants you to explain how the IUD works again. She might want that. She might not. She doesn’t know. You feel impatient, and rushed, and put upon. So tell me about the IUD again?

Room 5. Again. The woman there doesn’t want to have sex with her husband. She wants to know why not. Is there a pill? A magic cure? You try to explain how complicated female sexuality is, how many dozens of factors that can affect it. Is there a pill? A magic cure? You can’t fix her. There is no pill, no magic cure. Frustration. Sympathy.

15 minutes.

By the end of the day, you are wrung out. Destroyed. And you may likely be on call for the night. All those feelings; you’ve been tumbled around in them all day. You felt them. You felt them all. You couldn’t NOT feel them. You know these people. How could you not feel joy for them, fear, anger and pride? Not to feel is to die. You can die, or you can ride the rollercoaster.

Up. Down. Up. Down. Down again, just to break the pattern.

When you drive home, it is dark. There is no dinner. You don’t want any. You don’t have time to make any.

Your husband wants to know, why don’t you want to go out to dinner with friends? You need friends, you never see your friends, we don’t have any friends. You try to explain your job.

You tell him, honey, this is my job. All day, I enter rooms containing people who are scared, broken, overjoyed, sick, hurting, elated. I have 15 minutes to see them, get to know them, persuade them to take their clothes off in front of me, and tell me their darkest secrets. Small talk. You are the world’s leading expert. Small talk is what gets you through their embarassment, their discomfort, their fear. You are so good at it that sometimes they ask you when you are going to do their pap smear. It is done. You did it while you were chatting, distracting them, making them laugh.

Now he wants you to leave your house, go to a party. A party filled with people. The small talk. You just can’t handle it. You’re small talked right out. You never want to talk to anybody again. You are so tired. Your husband looks at you. He doesn’t understand. He thinks you are introverted, and disinterested, and no fun. What you are is out. Out of emotion. Out of love. Out of hate. Out of caring. Out of conversation. Out.

If you are lucky, you get to go to bed. If you are not, you get called back into work. More joy, more fear, more elation, more sadness, more blood, more babies. Now you are doing all this in the dark, all night. You mustn’t drop your guard. You must be ON for everyone, to explain, to persuade, to rescue them from ignorance and fear, and choose the right thing for them, the good thing. Sometimes there is no good thing. Forget your own issues; you are being paid to maintain their energy, keep them compliant, keep their spirits up.

If you are lucky, you get to go to bed.

The alarm goes off at 5, and you are up again. Another whole day. And another. And another.

Room 1. Room 2. Room 3. 15 minutes.

Come ride the rollercoaster. Come ride it with me. Today, and tomorrow, and tomorrow, and tomorrow…

Sliding Downhill

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Orientation Fun


Rapid City Regional Hospital Credit: Flickr Creative Commons – Emilio


I started a new locums travel doc adventure in Rapid City, South Dakota yesterday.  I was to report to the hospital for my “orientation”, a word to those in the know as “soul shattering meaningless tedium”.  My schedule was as follows:

0645 – 0701:  Lean up against the wall opposite the Medical Staff Office where I was supposed to report at 0700.  Watched 3 (count them, 3) employees come up, unlock the office and ignore me totally, despite the fact that I was obviously the new doctor who was getting processed (much like the beaks and assholes that go into luncheon meat) and that I was holding up a wall in the hall out of sheer sleepiness and boredom.  I did manage to get a picture of Traveling Guck sitting under the Med Staff Office sign, post it on Facebook, and email it to my daughter.

0701:  They actually stick their heads out and open the door for me.  Apparently they take the 0700 start time very seriously.

0701 – 0707:  Introduction to the 3 dickheads who left me standing in the hall.

0707 – 0720:  Taken to get a photo badge processed.  When I asked them if they needed ID verifying my identity, they said no.  Apparently they don’t mind issuing medical staff badges to random strangers.  I was of course lined up against a blue wall without opportunity to inspect my hair, and allowed one deer-in-the-headlights shot with no Mulligan.  I was told to go do something else; the badge was processing.

0720 – 0735:  Taken to IT to get computer passwords and immediately change them.  Since they wouldn’t tell me the criteria for the passwords (I swear, they didn’t know whether I needed capitals, lower case, special characters or numbers), I had several do-overs until I found a password that the freaking computer would accept.

0735 – 0740:  Back to pick up ugly badge. Future spoiler:  they set it up wrong and it didn’t open any of the doors that I needed it to.

0740 – 0815:  The ultimate in mind boggling tedium.  This is the same standardized spiel you are given at every single hospital that you work in:  it is dictated by OSHA and JCAHO and a few other acronyms.  Therefore I have heard this 3 times in the past 3 months.  It involves:  Hospital Mission – a retch-inducing phrase or two about Service, Teaching, Health Promotion and Other Grandiose Bullshit, Fire Procedures – seriously, who doesn’t know about RACE and PASS?, Infection Control – a list of all the nasty bugs floating around in the hospital and the special antibiotics used to treat them, if you are lucky and they can be treated at all  (Flesh-eating bacteria included), HIPAA – letters stand for “you’d better not give anyone any information about any of your patients and it we find out you did, we will fine you, fire you and set fire to you”, Code of Conduct – they now must produce a written list about how not to be an asshole (official name:  disruptive physician) because people apparently don’t have the sense not to be assholes and must be given a specific list of asshole things not to do,  Peer Review – we will be watching you, new doctor, and auditing your charts because you are probably incompetent, and Software Use and Access – the passwords never work.

0815 – 0830:  Ridiculously long-winded talk from the head pharmacist, who has a way overdeveloped sense of importance, and who gave me 8 (yes, 8) business cards of pharmacists who I would probably not encounter were I to work at the hospital for 10 years.

0830 – 0930:  Computer training.  This seems to follow a basic pattern – taken to a dark room where a pasty antisocial individual is hunkered down,  sat in front of a computer and given a mouse to click on various things without explanation.  This is all punctuated by, “oh, I don’t know why that’s not working – it usually works”, from the IT person who seems to have no idea about real-life applications of the material they are teaching.  An hour of, “Oh, let’s back up, oh, no, no, no, we didn’t want to go there, OK, try clicking on that” where really, I would have done just as well playing with the damn program myself.

0930 – 1000:  “Do we have anything else for her to do?  I’m not sure, do we?  Did she see the pharmacist?  Oh, I guess we should try to show you the hospital.”  Remember that I must see Medical Records for instructions for record dictation.  Meet with sourpuss from Medical Records.  Receive incomprehensible instructions and dictation cards.

1000:  Phone call from the doctor who is already turning call over to you, explaining that you already have a labor patient to take care of, despite the fact that you haven’t even seen Labor and Delivery yet.

1000 – 1020:  Taken at a gallop past the OR, doctor’s lounge, ER, radiology, and finally, Labor and Delivery where you are kindly intercepted by the chief MD of the Ob/Gyn department, who gives you an actually civivlized and useful tour of the area.  You are introduced to at least 25 people, none of whose names you will remember.

1020 – 1030:  Shown where the locker rooms, scrubs and break rooms are.  Both the MD call rooms are occupied, so no place to sit there.  Insructed to throw backpack on the floor in the nurse’s lounge.

1030 – 1040:  Locate and change your scrubs to their scrubs, because the ones you have on (although perfectly functional) do not belong to this hospital and are thus assumed to harbor awful bacteria.

1040 – 1500:  Sit around on Labor and Delivery because the patient in labor is having her third baby and it should come fast.  It does not come fast.  Chat with nurses (who are too busy to chat) and a Family Practice resident who is waiting to do a delivery and who is hoping you will let him do yours.  You don’t want to let him do your delivery, because you don’t like how anyone does deliveries except for the way you do them, but you have to be a good sport, because that was how you learned back in the day, and people have to learn, don’t they?

1500 – 1530;  Actual delivery of the baby.  You let the resident do it.  He does OK except for the suturing part, which is so slow and fumbling and incompetent that you want to kill yourself.  You would have finished 20 minutes ago.  The nurse is uncertain whether the stitching job is adequate.  It is adequate and you politely tell her to bugger off.

1530 – 1600:  Attempt to take care of strange paperwork and computer work, none of which functions the way you were shown by the creepy IT person in the basement.  Swear under breath.  Repeat.

1600 – 1615:  Use Google Maps (which totally rocks, by the way, and it’s free) to find your way out to Bumfuck where the Ob/Gyn clinic is located.

1615 – 1700:  Meet the doc you are working for and her office manager husband, who regale you with how awful and unfair the politics at the hospital are, and how they hope they will not make you suffer too much.  Yippee.

1700-1715:  Find way back from Bumfuck to the hotel using Google Maps, which by now has used up the battery on your phone.  Pray that you get to the hotel before the phone dies and you are stranded forever.

1715:  Collapse on the bed with the stuffed duck and eat an Atkins bar.  Plan TV watching.  Sulk because tomorrow the patient that delivered wants her tubes tied, a procedure you hate doing and you will have to get up early to do it.

The Doctor Is The Patient

CT scanner, from aestheticdoctorsingapore

I became a patient instead of a doctor last night.  The day before yesterday, I flew home from North Dakota for a few days at home before going on a trip to South Dakota.  Yesterday, I experienced sudden left calf pain for no reason at all.  I hadn’t had a cramp, nor had I injured the leg in any way.  Sudden unexplained calf pain can be a sign of a DVT, or a deep venous thrombosis, which is quite dangerous as that blood clot can be thrown into the lung, which in severe cases can result in instant death.  Travelers are at high risk for a DVT because sitting for long periods of time can impede blood return from the legs to the heart, and with the blood pooling in dependent areas, it can set up as a clot.  I am also over forty years old and am on estrogen in the form of birth control, which increases my risk for DVT even more.

I considered the pain for a while, and I could think of no plausible reason for it to be there.  And knowing I had another plane trip in two days, it would seem very foolhardy to hop back on a plane and risk throwing a clot at 30,000 feet up, where there is no medical care available.  So I made the decision to take myself to the ER, as they would need to perform a number of tests, most of which are not available at an outpatient clinic.

I arrived at the ER, in my own hospital where I have worked for ten years, and signed in.  I was recognized immediately and was signed in.  Membership does have its privileges.  They instantly brought me back to triage, before an entire waiting crowd of people, had my vitals done and they whisked me directly to a bed.

They immediately drew bloodwork pertinent to the diagnosis of a DVT.  Everyone who came into the room recognized me and chatted with me.  The lab tech came in and said she’d drawn bloodwork a million times with my name on the order slip, but had never drawn blood on me.  She confessed she was a little intimidated.  I told her not to be; I have amazingly beautiful veins and I told her she would have no trouble accessing one.  Indeed, I was an easy stick.  While we were chatting, she told me she was pregnant, and that her doctor was my former partner, who is a great person, so I told her I was happy for her.

Next the ER doctor came in, and he is one of my friends, which was great.  He’s also brilliant, by any standards, which is also great.  He’s also qute eccentric, which I enjoy.  He was always calling me when I was on call, and he always starts his explanation with “I’ve got this girl here…”.  Doesn’t matter if the girl is twenty or eighty.  So he came in and chatted with me about what the problem was, and he checked out my leg and checked pulses and all that good stuff.  Then he ordered leg dopplers and headed back out.

The doppler tech came in, and I know her too, so we started chatting about all the crazy things going on in the hospital, and about how everyone is so scared for their jobs, because they are slowly shutting the hospital down.  She scanned the leg, and everything turned out OK.  Several years ago, I had contacted the CEO regarding equipment that they needed for the vascular lab and weren’t getting.  I asked if she ever got the equipment.  She smiled and said she got it the next day.  It was good to see her.

The RN came in to see if I needed anything.  We chatted too, about the job situation.  She’s a former EMT and firefighter, and she has maintained her certification in both so she may have more options than some.  She adjusted the thermostat for me and got me tucked in to wait on lab results.

The doctor came back in the room.  My clotting labs had come back abnormal.  He wondered if I had already thrown a clot from my leg into my lung.  If it was a bad one, I would have died already, so I would likely be OK.  But the abnormal lab meant I needed a chest CT to make sure there was no clot in my lungs, because if there was, I was going to have to take blood thinning medication to get it to go away and prevent future ones from happening.  I knew the CT would be done with contrast.  I’ve had a CT before, so I knew how weird it feels when they push that stuff into your vein.  You get a massive hot flush from your head to your toes, and a cough reflex when it hits your lungs.  It’s not a lot of fun.

That means I needed an IV.  The RN came back into the room to start it.  She too confessed that it was a bit intimidating to start an IV on a doctor.  I told her number one, I am not at all intimidating, and number two, I have beautiful veins and she would have no trouble getting one.  As advertised, she nailed it on the first try.  I didn’t even feel it much.  She told me I would have to keep my arm straight as it was at the bend of my elbow.

They came to pick me up for my CT.  I was wheeled down the hall, and the CT tech informed me that this contrast would be twice and much, and pushed twice as fast as the contrast I had had for my previous abdominal CT.  Great.  He also told me that the chest CT was the equivalent of 300 chest x-rays.  Double great.  We laid me out on the table and he did one pass without the contrast dye.  Then he rolled me back in and BAM I felt that stuff hit my body, a mile a minute, head to toe.  I was in the breath holding phase of the scan and the urge to cough when the stuff hit my lungs was almost impossible to control.  But I made it through, and it wasn’t even as bad as I had remained.  It gave me a really weird afterglow feeling in my privates for a minute or two though.  Then I was wheeled back to my room to wait for results.

The results took about forty five minutes.  I laid on the bed and kept my left leg straight because it hurt, and the right arm straight because there was an IV in it.  Then the doctor came back into the room and told me there was no clot in the lung.  Thank God!  Now I could travel to my next assignment and not have to be stuck in the hospital.  There were some other weird findings on my chest film though.  There were some areas that looked like I might have had TB, which as far as I know I’ve never had, as I am tested for it every year since I started med school.  Another possibility was histoplasmosis, which is common in the South and many people carry it asymptomatically in their lungs.  It only reactivates if you are somehow immunosuppressed.  Hopefully that will not happen.  Also, my blood sugar was a little high, and my blood pressure was a lot high, which kind of worried me.  Now I will have to go see my primary care doctor and have all these things worked up.

I didn’t get home until after midnight.  Hubby and daughter were passed out in the bed.  I was very relieved I didn’t have a blood clot, as I leave for South Dakota for work tomorrow.  My husband wondered in the morning why I didn’t wake him to give him the news when I got home.  I reminded him that he has insomnia and if he was asleep, I wanted him to stay that way.  So when I get back, I’ll be following up with my regular doctor to explain all these adjunctive findings that we came up with while ruling out the DVT.

Saying Goodbye

I packed up my office yesterday.  I would like to say it was a bittersweet parting, but it was sweet, sweet, sweet.  This move was so different than the one last year.  Last year marked the end of eight years of ownership and administration of a private medical practice.  I was a partner.  The practice broke up because my other female partner left.  She had had enough of the trials of running a practice, and of the politics in this town and she found another job.  We had both been considering leaving.  We had discussed it.  We knew it was only a matter of time until somebody did.  So last year we folded up the corporation, because I was the only remaining partner.  I joined the hospital’s Ob/Gyn practice as an employee because I was tired of running a business too.

Last year’s move was different.  It felt like a sort of failure.  I had to leave my bright corner office and move into a windowless room.  I was joining two women with whom I had shared call, but they were the best of buddies and were used to working with each other.  I was an unwelcome intrusion.  I can truthfully say, that after a year, I still didn’t really fit in.  My nurse and I were stuck off to the side, an afterthought, while the two other doctors, their nurses and the ultrasound tech sat in the central area and chattered merrily away.  Sometimes we were briefly included in a conversation.  Mostly we just talked to each other.  I didnt even use the office I moved into.  With our computerized medical records system, we were chained to laptops just inside of the exam rooms.  My nurse actually had a bigger area than I did.

So moving the office last year then, was just that, moving an office.  I didn’t have any anticipation of happiness when I moved, although I had hoped.  I got rid of some stuff, and just moved the rest down the hall into the new office.  The office was much smaller than the old one.  I tried to make it a home; I covered the door and walls with drawings and notes from my daughter, and funny clippings I had saved over the years.  It was always cold in there.  My plants died because there was no sun, and because I didn’t think to water them much because I was never in there.

A lot of politics happened over the year.  A big hospital conglomerate came and bought both hospitals in town.  They completely shut down our sweet little labor and delivery unit and moved all the nurses and all the deliveries to the bigger, drabber hospital across town.  Then they put the three of us docs into the call rotation with the four-man group across town.  We didn’t like having to go all the way across town.  They didn’t like us.  We didn’t like them.  We had to learn an entirely new hospital system.  Call for seven Ob/Gyn doctors was very busy.

My husband and I had been discussing my getting part-time work for a while.  This year we decided to make it a reality.  It just seemed like the right time.  I was so unhappy, and things were just getting worse.  So we made it happen.  My husband sold our airplane because my part-time work would not allow us to pay for it comfortably.  I joined a locum tenens company to do travel doctoring, which had always been my dream.  I turned in my notice.  Everyone was shocked that I was leaving.  I enjoyed the biggest, most stable practice in town, because I had been practicing there for so long.  And I was letting it all go.

I happily counted down the days to the end of that miserable job.  As of this writing, my last day is February 14, 2013.  So this weekend, I cleaned out my office.  This time I really cleaned it out.  I got rid of tons of books and papers that I didn’t use.  I shredded pounds of confidential paperwork, because I had been Chief of Staff of the old hospital.  I went to the U-Haul place and bought boxes and boxed everything up.  As I packed boxes, I had memories of my time at the hospital.  I defrosted the mini refrigerator.  It had been a gift when I first arrived, in 2003.  One of the office staff said, “It’s for you, as long as you don’t ever leave us.”

I packed up an entire box of breakable collectibles.  I collect storks, and things related to pregnant women.  I packed up the Lladro storks I had bought on a trip to Jamaica.  I packed up a beautiful ceramic female Ob/Gyn in scrubs, holding up a  baby, that my mom had bought me.  I packed up ceramic babies, and an entire Willow family of pregnant women, and women and familes with babies.  I packed up gifts from my nurse and my patients.  And I packed stuffed animals.  Scooby Doo with scrubs on.  Little Beanie Baby doctors.  A “Histo”-potamus my friend the pathologist gave me as a joke.  Stuffed pregnant bears.  Stuffed storks with babies in blankets.

I packed files of letters and cards from my patients.  I read some of them, and thought about how I would miss those patients, and they would miss me.  I packed files of cartoons that my mom has clipped for me over the years, all about doctors and babies and Ob/Gyns.  I left the bulletin boards with the pictures of my babies on the walls.  Those belong to the practice now.  People like to find their baby pictures when they come to the office.  No point in taking them away from their families.

So I packed up boxes full of memories, most of them good.  They were all from a brighter time, before I came to the new practice.  And as I packed, I felt liberated.  And overjoyed.  I was leaving this town, which I never liked.  I was leaving this practice, which had completely failed to welcome me.  I was leaving the politics, and the ridiculous unwieldiness of the merging of two hospitals and two practices.  I was free!  Free to travel from state to state, meet new doctors and nurses and patients and different kinds of people!  Free to spend time with my family!  Free from the endless grind of working every day, in the same unhappy job.  Free from being shipped across town, to a hospital that I didn’t know.  I can’t remember the last time I felt so happy and free.  I am anxious, of course, about the changes to come, but they are my changes.  They are not being foisted upon me.  I am free to determine my own destiny.  For the first time in years, I feel real.  And whole.  And alive.

Come To The Land Of The Ice And Snow

So here is how I, a presumed redneck toothless Southerner, imagine that my upcoming trip to North Dakota will go:

I will undergo a full body cavity search when embarking on my journey out of Alabama because I send off some kind of weird vibe to the TSA that causes them to believe I am a Hijabi on a Jihad.  Don’t ask me why, because I am a little white German girl with blue eyes, but there is something about me that screams to the TSA:  TERRORIST!  I am the one chosen out of every line to be randomly searched, radiated and mauled.  Every single time.  They even did it once when I was travelling with my ten month old daughter – I literally had to hold her in one arm while I held the other one out so they could pat me down, and then switch her to the other arm so they could pat the other side.  She was screaming in terror of the strangers in their blue gloves.  I can’t say I blame her.

When I arrive in Denver, I will climb into a rickety prop plane that resembles the one full of goats and chickens in Romancing the Stone.  Yes, I am showing my age here.  The goats will actually be caribou, and the chickens will be those snow-shoes feathery footed birds that I can’t spell.  We will bounce wildly up and down in the frosty air, because the wings and prop will be freezing over.

We will land with a thud.  And a skid, because the runway will be covered with glacial ice.  We will have to climb down the stairs of the plane onto the icy tarmac, I in my puffy coat, and the cold will hit with a blinding force that will remind me exactly what a bad idea it was to go to North Dakota in the winter time.  There will be a blizzard.  And a whiteout.  I will not be able to see my hand in front of my face.

When I arrive at the Rent-A-Car place, half frozen, they will give me a Prius to attempt to drive on ice.  And it will not have snow chains or whatever thingies that I don’t know about to keep me from skidding off the road.  I will have to stagger out into the frozen tundra to find my car in the lot, which will be frozen shut with sheets of ice.  I will be unable to open the doors.  I will not have an ice scraper.  The GPS in the car will not work.

I will get lost trying to drive from the airport to the hotel.  I may slide into a ditch.  I may or may not be rescued by large Paul Bunyan-like men in red flannel coats and hats with earflaps who say, “Oh, yah” a lot.  I will finally find my hotel, and stagger, a frozen docsicle, weeping into the lobby.  I will have to go back outside and get my stuff and I may or may not get frostbite.

My first night there, I will listen to coyotes and wolves howling outside my room.  And the constant sound of fracking.  I may be going to a fracking boomtown.  I will learn everything I never wanted to know about fracking.  The room will probably be icy cold, and I will sleep in my coat.

Overnight, a massive blizzard will have descended on the town and covered the roads.  They will not be cleared and I will have no idea how to find the hospital.  Or how to drive there.  I will finally get there, and I will be late, and my nose will have the beginning stages of frostbite.  When I find the clinic and Labor and Delivery, the nurses will all have incredibly funny accents, right out of the movie Fargo.  There may or may not be murderous kidnapping psychopaths throwing people into wood chippers.  There may or may not be a pregnant cop whose husband designs postage stamps.  They will all say, “Oh, yah,” and then make tremendous fun of my Southern accent.  They will get me to talk just so they can hear how funny I sound.  They will ask me, “Say y’all,” and I will say YAWL with the biggest Southern drawl that you can imagine.  I will hit them with all my little Southern witticisms.  I will be an ambassador of Southerness!  I will show the world that just because I come from Alabama, I still have all my teeth!  And then we’ll sit down and have one of those incredibly gross bowls of french fries with gravy slopped all over them.  Cause that’s how they roll up there.

A Very Bad, No Good, Very Awful Day

This daily blog post thing is really hard when the bad days hit. I had the most unbelievably bad day today; I am so agitated I can barely sit still. I would talk about that except I really don’t want to talk or think about it any more. I wrote a blog post yesterday, but I had to publish it privately because the person I was discussing would be easily recognizable from my post, and I don’t need to get sued. Too bad. It was an interesting post. We talked about snuff films and stuff.

This morning I found out that my new job in North Dakota may be in jeopardy, due to some creative scheduling by the hiring hospital that involved them hiring four doctors instead of two.  So my two weeks work a month is cut at least in two.  I don’t know if we can get by on that money.  The locum company rep assigned to me made it sound like a sure thing that the two weeks at the end of the month was mine, and now I found out that it is all screwed up only because I CALLED HIM with some questions.  I have no idea when he had planned to let me know otherwise.

I had to go to a meeting of our two OB/Gyn practices that are being joined at lunch today.  I had to go despite the fact that my last day of work with them is in two weeks.  They made me go anyway.  The meeting was hideous.  The group across town that my group is joining spent the entire meeting bitching and moaning about problems in THEIR clinic, leaving those of us from across town wondering why we had to sit there for an hour and a half.  Eyes were rolled, names were called.  They clearly all HATE each other.   And now they hate us.  I would be so grateful because I’m leaving, but now my new job is in jeopardy.  I may have no job at all, or I may have to go crawling back to this awful old job.

I had the worst patient (with mother in tow) that I have had for MONTHS, if not years.  Put together ignorance, entitlement and sheer craziness, and you get something really awful.  The girl was complaining because her birth control was making her bleed.  She was on a form of birth control KNOWN to make people bleed – in fact – I notify patients of that when they want it put in.  We switched it out two weeks ago, and she hasn’t stopped bleeding yet (this stuff takes a while to work, people) so she demanded an appointment.  She had her mom call a few times too.  The girl postured, strutted, and burst into tears and attitude and informed me that she wanted a pill that would make her stop bleeding TODAY.  I told her if I had that pill, I would have given it to her already.  Her mom started with the major cray-cray.  “If we had done a D&C when she had her MISCARRIAGE like we SHOULD have she wouldn’t be bleeding now.  My FRIEND was bleeding and they looked and looked and then didn’t find anything and SHE had a TUMOR.  How do we know my daughter don’t have a tumor?  I want a SPECIALIST.  This girl been bleedin’ for SIX MONTHS and ain’t NOBODY should bleed six months,  And I don’t think it was them HORMONES.  There somethin’ WRONG with her.  You ain’t doin’ NOTHIN’ for us.”  I then honestly informed them that I was leaving the practice in two weeks and I would need to transfer their care elsewhere.  I also told her that the gynecologist IS the expert for this problem, and that we were doing the best we could.  They stormed out to the lobby and proceeded to throw a massive fit.  “The doctor LEAVIN’ and she don’t care NOTHIN’ about us and my daughter have a TUMOR and she won’t send us to see no SPECIALIST.”  She then started to demand an ultrasound TODAY (schedule full, sorry) and demanded to see one of my partners TODAY so THEY could send her girl to a specialist.  My partners refused to deal with the nut cases.  I got a phone call from the receptionist, who was freaking out.  What was I going to do about this scene in the lobby?  I told her to call security.  And of course, the patient is on Medicaid, which means that my tax dollars are going to support her, her pregnancies, her birth control, and her attitude.  So all afternoon, all I got to hear about was the scene in the lobby.

Now, this evening, my husband and I have to go through all the emails from the rep at the locums company so we can find things to yell at him about, because of my job getting all screwed up.  And tomorrow, I will start an entire weekend on call at a very busy hospital that is new to me, and I will probably not get to come home for days.  So I am having an awful day, and this is what I’m going to write about.  My apologies if my sense of humor seems to be lacking.

The Glass Is Half Empty (And There’s Cholera In The Water)

I am examining myself and trying to figure out why I am such a pessimistic person. The immediate answer would, of course, be that I have been a depressed person for most of my life, and we are quite prone to pessimism. The slightly less immediate answer would be that I am basically a born cynic, have been since a young age, and believe that some cynical thoughts don’t count as cynical if they are true.

The longer answer is, I am a physician, and physicians are by nature a VERY pessimistic bunch. It’s ground into us early. Before medical school, it’s all about the frantic studying, and a lot of people get culled out applying for medical schools. So you’re not ever sure that you’ll get to go at all, and you have to steel yourself for that possibility.

Before you even START medical school, the pessimists get ahold of you. You are told to read House of God, by Samuel Shem, and this book tells you more than you ever wanted to know about the attitude you’re going to have. I read that book the summer before med school and cried. It’s a must read if you want to understand what your doctor is truly probably thinking, and what they’ve been through.

Then the skull fuckers get a hold of you in med school. Sub-par students try to terrify you into believing you’ll fail. You’re not sure who’s sub-par and who’s not, but once you figure it out you realize that they are the skull fuckers. They approach you before tests, regaling you with tales of how much material they’ve studied and how much territory they’ve covered. This is to trick you and frighten you into believing that you are underprepared. And if they take a test a section ahead of you, they’ll tell you horror stories about how impossible the test was, how you’d might as well give up, so you’ll be so nervous going in that you’ll do much worse. Nothing increases your view of other human beings like these moronic pieces of shit. It goes on constantly.

Once you get into the hospital, as a third year med student, you realize you are the lowest of the low. You are given jobs that not even the nurses or the orderlies will touch. At the VA, if labs were ordered, WE had to go draw them. We had to do our own EKGs and read them. We had to clean out disgusting bedsores and shotgun wounds that nobody else wanted to touch. We were woken up to do a history and physical on a patient (after the residents and the attending had already done one) who was too batshit crazy to communicate orally, and too combative to touch. The residents just laughed when they woke us up.

About this time, you start with the pessimistic magical thinking. This is the polar opposite of magical thinking where you hope for a good outcome. Around this time, you’ve learned that the worst possible thing that can happen probably will. And you’re trained to think that way. You’re paid not to miss the bad things. So you have to look for them everywhere, and expect that the patient will have the worst possible disease, the worst possible complication so that you can quickly detect and treat it when it happens. When it doesn’t happen, so much the better, but you never unlearn that negative point of view. It persistes all the way into private practice.

When you’re on call, you expect the worst. You’re all alone in the middle of the night; it is just the right time for a five hundred pound woman to come in needing an emergency c-section, which you will have to do all by yourself. You lie there in the call room and stare at the ceiling, unable to sleep because you KNOW somewhere out there is that woman with her name on you. You NEVER make plans when you are on call; the simple purchase of a movie ticket will cause a ruptured ectopic pregnancy to show up in the ER before you even get in through the theater doors. Yes, it happened to me. Fortunately they gave us our money back on the tickets. As you get older and older, and less and less optomistic, and have seen some of the truly horrible disasters that can happen in your profession, you just become more and more nervous. Every woman who comes through the door in labor – will this be the baby that dies? That one in over a hundred thousand MOMS that die on you? Every one could be the one. This haunts you so much you begin to lose all perspective.

And things like today can happen to you. The person on call (who is NOT me today – I’m on some time next week) is in charge of all the delivered patients and all the laboring patients, and all the unattached Gyn patients that come through the door. If you’re not on call, you should be immune from having your day yanked out from under you by a wayward patient. But the group across town that we’ve just joined has a rule – we take care of our own Gyn patients EVEN IF WE’RE NOT ON CALL if we’ve operated on them or if they just show up in the ER and say that they are our patient. And that’s what happened to me this morning. My husband and I made dinner plans with friends, which I never ever have time to do (not to mention, I don’t have any friends since I’ve been on call all the time for years) and which I felt perfectly safe doing, because I am not on call. But at 8:15 this morning, the OB/Gyn on call from last night called me and announced that a patient had come in through the ER, with a possible cyst or pelvic infection, she might need surgery, and because she said I was her doctor, she was all mine for the day. WTF? I had to call the nurse taking care of her. I had to order things over the phone. And I had to spend my whole lunch hour over there seeing her. The worst part was, my morning was RUINED. I was CERTAIN that the patient would need surgery this afternoon, because that would be the worst possible outcome for my day. I was CERTAIN I would be missing my dinner fun. Of course, when I went over there to see her at lunch, she wasn’t sick at all and I was able to let her go home. But the morning was spent CERTAIN that my night was ruined. And I was furious. And I still didn’t get any lunch.

So that doctor pessimism has ruined me. It has permeated every aspect of my life. I don’t know how to turn it off. And the magical thinking persists. I feel like, if I don’t think of all the possible bad outcomes, one of them will happen. And if I don’t expect to get my plans ruined – well- that’s when they will be. So this is why I’m taking some time off. I’m going to work as a travel doctor two weeks out of every month, and be off two weeks out of every month, so I can spend some time with the family and break the cycle of constant terror that something awful is going to happen. Not to say I won’t feel that way the two weeks I’m working. But at least I get two weeks free of the terror. And maybe that will be enough for me to turn some things around.

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