Sleep, Loss, 5 Days Until Vacation

Well, I tried to crank out a quickie blog entry before my last call. Didn't work so well. Here I am post-post-call about to go back to work to round on all the c-sections I did on my last call (yep - every delivery was by c-section, half of them emergent under general anesthetic - just a typical call for this black cloud). I am very drowsy so I apologize in advance for the typos. Pre-call I didn't get much sleep as I kept hallucinating my pager going off all night and had to answer all the non-pages. Last night I think I did sleep most the night, but now the days are shorter and I wake up in the dark again, groggy and disoriented.

I am so excited that my last week of the massive marathon twelve-week Q4 call is upon me. One more day as rover (i.e. secretary, ultrasonographer, referral nurse and slave to the OB clinic), one more crammed packed high-risk OB clinic, two more of my own nutsy clinics and ONE more call. That's it. Then I start vacation. Thank GOD!

Speaking of vacation... On the way back from riding the other day I saw a car drive by with a Yale sticker and felt a longing for Connecticut. I still haven't heard about my May rotation swap. For all I know it's circling around some committee somewhere. I'm anxious to submit it back to my own people so I hope I get approval soon so I can move on to step 11 of 23.

In my initial attempt on this blog entry I was reflecting on last Friday. It was a particularly hard day for me at work. Sure, I had to get up extra early round on the bazillion patients I delivered (plus pre-termers trying to keep their buns in the oven a little longer). But then I find out one of my favorite panel patients is losing her one-day old baby to child protective services for some vague unspecified reason. The patient, me, her nurse, and even the social worker were all shocked. How come they don't take babies away from totally unfit mothers but then take them away from rehabilitated mom's? I don't get it.

Then, I had my "One on One" in clinic. That means that a faculty doc shadows me all clinic, sits in the room while I interview and examine my patients that day and gives me instantaneous feedback. Sounds fun, eh? It's kinda like being a medical student all over again. Then, after she didn't show for her appointment, I find out one of my patients died. She was one of the hardest (I've blogged about her before) and one of the crotchety-est patients on my panel. But she really liked me, trusted me, and we had a great time together. I looked forward to seeing her each clinic even if I knew she would whip out some health-threatening surprise each time. I easily spent more time with her than any other patient. I rounded on her in the hospital, in the ICU, saw her each month in my clinic, talked to her while she was ventilated, even watched the snow fall at 5 am on Christmas morning post-call and she gave me root beer as a gift (and because it didn't jive with her diabetic diet). Funny, I always talked to her about her end of life plans but she was so resilient I think everyone thought she would never die, even though we all knew better. I also imagined myself being able to say goodbye at her funeral instead of finding out days later from a "why did you miss your appointment" phone call from my nurse. SG, I hope your passing was peaceful and you are breathing easier wherever you are...

Thankfully I had a Saturday off to try and process all of this and catch up on a little sleep before hitting up another week of everything and my Sunday call was too busy to think about anything other than work.

Twenty-Three Steps to Get a Vacation

They say time flies when you are having fun, so is the opposite true? Is it like that last scene in that X-Files episode where the former speed-addicted teenager watches the second hand creep, creep, creep and then skip back a beat and creep another second forward? The agonizing passage of time...

I bought my ticket for vacation in Colorado. I hope to be there for the birth of my new little cousin and I hope its warm and pleasant. Not surprisingly, given my incredibly regimented schedule, I have most of my vacations planned through the next 12 months. All except the last. My last vacation of the year has been exceedingly hard to manage. See, the residency gives us our schedule for the next full year at one time. Then it's on us to try and find a time during one of the few rotations where its allowed to vacation to find coverage for our work and maybe get it approved to go.

I want to go to my 10-year college reunion very badly. I miss my college friends and they think they might be able to make it. This could potentially be a very fun reunion and I could get some QT with Boston and my friends that live there. (Picture of Obama speaking at this year's May Commencement and Reunion - will be hard to top next year).




So here are the hoops I have to jump through to make it happen:

1. I have to swap my rotation week. I need to find a person to be willing to take on a week of in-patient pediatrics that week in exchange for their out-patient rotation. DONE
2. I have to make that week as equivalent as possible in call days, call points and days off. DONE.
3. I have to make sure that our swapped out-patient weeks are also as equal so we don't end up taking unequal back-up or hospital call. DONE
4. I have to get a signature from said person. DONE
5. I have to submit it to the Chief Resident for approval. DONE
6. It has to then be submitted to the scheduler for approval. FAILED - now onto #7
7. It has to be documented that the during said swap we are actually covering for each other - me covering for her out-patient duties and her for me (The whole idea of a "swap" apparently not obvious enough to get authorization). DONE.
   
8. I have to get my faculty advisor to sign the swap request. DONE.
9. I have to get the other resident's advisor to sign it. KINDA - he signed conditionally, adding step #10 to the mix.
   
10. I need approval from the in-patient hospital service involved in the switch. This is now going to be discussed in the meeting for the service faculty, if it is appropriate for the switch to occur. PENDING.
    
11. I have to resubmit to the chief resident.
12. Then back to the scheduler.
13. Then to the clinic director. - if this is approved then the swap is for sure and I will have an out-patient week the week of reunion.
14. Then I have to request the week off.
15. Find coverage for my colposcopy clinic
16. Find coverage for my procedure clinic.
17. Find coverage for my obstetrical patients.
18. Find coverage for my patients that may be admitted to the hospital while I am gone.
19. Find coverage for my in-basket and mailbox and any patient calls or concerns while I am gone.
20. Get signatures on the request from each person covering 15-19.
21. Submit this signed request to the chief resident.
22. Then on to the scheduler for approval.
23. Then to the clinic director for approval...

And then, after step 23, the vacation might be approved and I can attend my 10-year college reunion.

All this for 7 days off in May 2009. I wasn't kidding when I told my college friends that I may have to move mountains to go to attend.

On a positive note, only three weeks left of OB. That means only three weeks left of this endless 16 weeks of inpatient life - on call every 4 days, only 4 days off a month, living by my pager, sleeping little, eating crap and falling out of touch with everyone that matters. Then I get one week vacation, one week of a more relaxing rotation and then right back to in-patient life.

689 days left of residency...