Burnt.

Further to my post yesterday, I haven’t had any extended time off from my practice since July, 2014. When my receptionist pointed that out to me, I was kind of surprised. I’ve taken a few long weekends here and there but yeah, I haven’t really had a break from my job in well over a year.

It’s no wonder I’m a little cranky.

My older colleagues regularly take a month off every summer and at least a week or two in the winter. They can afford to do so as their children are now all grown up and out of the house. I am not in that position yet. I still have a mortgage and other debt to pay off and I wonder sometimes if I ever will?

I love my job but it’s hard to listen to other people’s problems day in and day out. Most of the time I can help solve the problem; here’s an antibiotic for tonsillitis; here’s a pill for your awful irregular periods, or here’s a great physiotherapist for your chronic ankle sprain.  If that was the extent of the problems I would be fine without a regular holiday.  But it’s not like that in family medicine.  In family medicine I see the wife who found out her husband is having an affair; I see the schizoaffective patient off their meds; I see the teenager with anger management issues displaying cluster B traits (borderline personality disorder) who bounces from one psych unit t to the next;  I see the elderly woman with memory problems who doesn’t remember she has memory problems.

I am privy to the knowledge that a wife plans to leave her husband, who is also my patient and is about to be blindsided. I am privy to the knowledge of a history of horrific childhood abuse and the subsequent psychological damage that does to a person. I am privy to the knowledge that a 40-something year old man really wants to be a woman.

It is a privilege to be these people’s family physician, it really is.

But even the doctor needs a break.

Oblivion.

What’s worse than one kid being sick?
How about three? Each one on the tail of the previous. Just as the eldest turns a corner towards the healthy side of the force, her baby brother spikes a fever and her other brother’s cough takes a turn towards the dark side.

FML.

I am curled up in bed waiting for the 1/2 tab of Gravol I just took to kick in. I am beyond exhausted and still feeling the remnants from last nights’ gingerbread festivities (hence the Gravol).

If I prayed to God I would wish for an uninterrupted nights’ blissful sleepy oblivion. That’s not too much to ask for, is it?

Recovery.

Last week, I ran 5 days out of 7.

You can probably guess that my knee has been feeling a lot better.  Except for the little “click” I keep hearing on the opposite knee every time I walk down stairs. But it doesn’t hurt, so I’m going to ignore it. In fact I think it might be gone today.

Now that I have run my goal of 10 km (okay, so only once, but still, I did it!), I feel like I need to set another goal.  While I fully intend on running that 10 km again, I want to improve my endurance.  Before all the injuries set in, I was running 5 km at a steady pace, with no walking.  I know that running:walking is a common practice for even the long distance runners, but there is still a small part of me that thinks that if I call myself a runner, I should be able to run a distance, you know?  Must be that type-A personality coming through.

Last week, I drove to the waterfront and had a fabulous run on the boardwalk.  I don’t know if it was the scenery that helped, but I found some energy the last kilometer and had my fastest kilometer in quite some time!  I was so excited.  I even had my first negative split!

neg split

So, the last couple of runs, I have changed things up a bit (yet again!).  I ran the first kilometer straight, it was about 7.5 minutes. Then I walked for a minute.  Then I ran the next kilometer straight, then walked for a minute.  Repeat x 4 km.  I have no idea if this is even a thing, but there you have it. After two runs like that, my legs were feeling the strain.

Being the good girl that I am, I took the last 2 days off. My legs needed it. I was really tempted to run last night, but I didn’t.  Partly because I was so damn tired, but mostly because I was too busy eating these little guys.

cookies

So, of course after eating far too many of these cookies, I really felt like I needed a run, but instead I sat my butt down on the couch and cross stitched for the rest of the evening. I had every intention of waking up this morning and going for a run. I don’t work on Mondays and thought it would be good to get the run out of the way and before it got too hot.  Yeah, well, it didn’t happen.

I blame the cookies.

Happy News Bear.

Sometimes being a family doctor is amazing. It is a great privilege to care for an individual or an entire family. One of the best parts of my job is delivering good news.

The other day a young woman came to my office. I hadn’t seen her in quite some time. A lot had changed in her life. She’s gotten married last year,l and they bought a house. She is a busy woman, working long hours which was one of the reasons she has come to see me.

She was tired. More tired than she had ever been before. We talked for a bit, then I asked her a few questions. Some of my followers who are physicians will likely already guess the diagnosis.

My first question was about her period. I asked her when her last menstrual cycle was. Her face went blank.

“Um … I … maybe … oh, geez, I have no idea.”

“Have you been using contraception?” I ask.

“Not really, no.”

“Well, let’s do a pregnancy test. And while you are in the bathroom, think back and see if you can remember when that last period was.” Is she a few weeks pregnant, or a few months?!

Upon her return from the bathroom, she reports that she thinks her last period was in February.  (As an aside, how did three months go by and she didn’t notice she wasn’t getting her monthly cycle??!).

Of course, her pregnancy test was positive.

I suspected she was probably close to 11 to 12 weeks pregnant.  She is a fairly thin woman and upon further questioning, she admitted noticing that her clothes were fitting a bit tighter.  Uh huh.  I had her lie down on my exam room table and took out the doppler.  It took a few minutes, but there it was.  The sound of very fast hoofs.  A gentle gallop, about double the patient’s heart beat.  The distinct sound of a new life growing.

“Do you hear that?”  I asked her.

Her face told me she did.  Tears welled up in her eyes.  “Is that… is that a baby?”

“It is indeed,” I said.  “If I had to guess, I’d say you were about 3 months pregnant, and probably due around the end of November, maybe early December.”

“Wow.”

She left my office stunned, but happy.  Suddenly it all made sense to her, why she was so tired, why she was gaining weight.

It never ceases to amaze me how some patients can get so wrapped up in their lives that they miss something so obvious when it comes to their health.  In this instance it was good news.  The best news, really.

On this Mother’s Day, I am reminded how lucky I am to love my job.

Back On Duty.

Final weekend of maternity leave.

Last night I had a lovely dinner meeting with the doctor who’s been taking care of my patients.  We had a “handover” of sorts.

Handover – A handover is the transfer of responsibility and accountability for some or all aspects of care for a patient or group of patients, on a temporary or permanent basis. It entails appropriately transferring information to help deliver safe care. (CMPA)

I had been keeping up-to-date on a few patients since I was off, but not many.  Our three-hour meeting was informative and extremely useful.  This physician has done an excellent job and a quick peek at some of her clinical notes on the EMR confirmed it. I am officially back on duty as of, well, now.

I have to admit, I feel a little apprehensive.  I am used to this feeling – I’ve had it every single time I returned to work after an extended leave like this.  Am I going to remember how to write a clinical note?  Will I remember how to take an appropriate, concise but detailed history?  Thankfully in the past, after the first few hours back, it generally feels like I never left.  I certainly hope this is the case next week.

Another variable thrown into the mix is my 6 month old son. When I returned to work after the previous two maternity leaves, the kids had been sleeping through the night for at least a month.  (How did I get so lucky?  Third time’s the charm, right?  Right?!) Sadly, no.  He’s not quite sleeping through the night yet.  He still wakes at least once, usually between 11pm – 2 am.  Husband has been wonderful and doing these feeds more often, but I still wake up.  I am still tired during the day.  I worry how I’m going to function now that I have to actually use my brain again.

Despite the fatigue and the apprehension, I am ready to get back to my work.

I love my job.

I love medicine.

A Note On Sleep Training.

Day 20 – January Daily Blog Posting Month

So, I’ve started sleep training baby J.  The reason?  This:

And this:

Both are amazing and needed in the immediate newborn period; the soother because babies need to suck and it’s just not practical to be a human soother all of the time; the swaddle because the moro reflex interrupts sleep and newborns/infants need to feel tight and secure when they sleep.

But there comes a time when both become a) a hassle, and b) a crutch.

Let me explain.

The soother becomes a crutch because once baby falls asleep, if the soother falls out of the mouth, the baby wakes up and starts crying.  Mom and dad have to go back into the room, re-position the soother and baby falls asleep.  This becomes a hassle when it occurs a bajillion times a night.

The swaddle becomes a hassle when baby starts moving around and pulls the Houdini routine and you walk into the room when baby is screaming only to find the soother still in the mouth but the baby’s arms are out of the swaddle and the kid doesn’t know what to do with them.

Both of what I described above started happening on a regular basis with baby J and one exhausted morning last week, I decided it was time to stop swaddling. The soother remained, but after two return trips to the crib to replace said soother in the span of ten minutes, another decision was made.  Bye-bye soother.

What ensued next?

Yes.  Blood-curdling screaming.  Poor kid didn’t know what to do.  Arms were flailing all over the place, legs kicking up a storm and there is me, face to face with screaming and quietly doing this:

At some point though, one just has to leave the room and let the baby cry.  And cry he did.  But he stopped eventually and fell asleep, for about 20 minutes.

The the screaming started again.  I looked over at my cat who was sleeping on the couch next to me and she gave me this look:

Ah … sleep training.

Excuse me while I tend to the infant … in the time it took for me to write this post, about 20 minutes, he slept and is now awake.

 

Zzzz….

Kids get up really early.  Like, 6am, early.  Especially when the bedtime shenanigans mean they’re finally asleep by 8:30pm when the norm in this household is 7pm.

Last night was epic.  Husband usually does the bedtime routine as the baby usually starts cluster feeding at exactly the same time.  Last night he was getting ready to go to a concert, so I took over bedtime.  Baby was surprisingly asleep.  The kids were overtired so you can imagine the disaster that ensued.  (I say disaster, but husband just calls it routine.)  The kids are used to their dad putting them to bed, so they kept asking for him.

Bedtime took almost two hours!  Eventually, husband left with our friends and I was left with a cold pizza for dinner, one child (the eldest) asleep on the top bunk and the toddler playing quietly in the room with the lights on.

Oh, and did I mention I was just a teensy bit stressed that one child was still awake?  I was hungry, had a baby attached to my breast for well over an hour and emotions were running high.  I retreated to my basement cave, drank a glass of wine, had my cold pizza and started a Smallville marathon while listening to the toddler do God-knows-what in the bedroom.  I could hear him talking about stars on the floor and it was close to 8:45pm by now, so I decided it was time to put him back to bed.

By the time I got halfway up the stairs, he was coming down with a mischievous grin on his face.  “Back to bed, momma?” he said. As we went into his room, I saw that he had put a lot of little purple shiny flower stickers on the bedroom floor by the door. I tried to stifle a laugh.

What a toddler does when he's supposed to be sleeping.

What a toddler does when he’s supposed to be sleeping.

His big sister was sound asleep on the top bunk, bright lights on and all.  Quite the amusing sight.  I gently put the little guy back to bed on the bottom bunk and explained that his big sister was asleep, it was time for bed and he was not to turn on the light again or I would put him in the crib (which he now hates).  I left the room and waited at the top of the stairs.  No signs of movement (or mischief) after five minutes.

Ah … the pleasant sound of silence.  Finally.

I was soon fast asleep (so much for that marathon viewing of Smallville).  The baby woke up a few times which is pretty typical, then I was jolted awake at 6am by the sounds of the toddler falling out of the bottom bunk.  By the time I got up the stairs, husband was with them and all was fine.  Unfortunately, the kids were now awake and as husband had only been home for a few hours, he needed sleep, so the kids came to see me in the basement.  I’ve been watching Thomas the Tank Engine for the past hour and a half.

I need coffee, preferably via IV drip.  Anyone?

Epic fatigue.

I am 29 weeks pregnant.  Hard to believe how fast this pregnancy is going.  Baby is very active and so far this pregnancy has been very similar to the other two, except for the occasional brutal bouts of heartburn.

But can I just complain for a moment?

I am tired.  Bone tired.  Despite at least 8 hours of solid, uninterrupted sleep (except when I have to change sides w/ my body pillow), I am exhausted by 11am.  Like, I could fall asleep at my desk between seeing patients exhausted.  This makes me nervous because it’s just the beginning of the 3rd trimester – there is still a lot of time left and if I’m already this tired?  I don’t even want to think about it.

I am so tired that I can’t even work on my cross-stitching in the evenings.  After dinner, I recline on the couch, my cat comes for snuggles and an hour or two later I’m dozing and ready for bed.

Did I mention that the occasional nap doesn’t help either?  Oy.

I walk as much as I can, for as long as I can.  Inevitably, the lower back stiffness kicks in and I have to stop, or it’s a particularly hot and humid day and I just can’t physically muster the energy to keep going.  I miss running.  Oh, how I miss running.  Part of me wishes I hadn’t stopped but I had to listen to my body and at the time, during the peak of the fatigue of the first trimester, I just couldn’t.

Have I mentioned it’s taken me 5 days to write this post?!

No real point to this post.  Just needed to vent.

And … now I need another nap.