Baby boy!

Baby G is now 5 weeks old! I'm typing this one handed as he completes his absolute favorite past-time: eating. The child has gained a pound a week for the last five weeks. I'd worry if he was formula fed, but amazingly he has gained it all from breastmilk. Every 2-3 hours. 3.5 if I'm really, really lucky at night. Since he's over10 pounds now, I'm hoping this will slow down soon...but no luck yet.

I fell in love so much faster the second time. I wonder if this is typical. He looks more like me - red hair, blue eyes (though they are starting to turn brown like daddy's). He's also a lot calmer than Little Girl; but maybe this is just my perception as a more relaxed second-time mom?

Lately I've been feeling much more Mom than MD. Don't know if it's being mom of two or being on maternity leave. I'm not sure I'd go back if not for the large chunk of studen loans I need to pay off eventually. Then again, I've been reading the AFP Journal and The Vaccine Book (very interesting) in my "free" time (while Baby G is eating). I really do think that anyone who has a child should get credit in residency. There's nothing like learning by doing - you've been that Mom with a squalling child at 4 am when you'd give your left arm for just a half-hour of sleep, you know all about breastfeeding (positions, engorement, how tempting it is to quit sometimes, Fenugreek and reglan etc.), and you have the developmental milestones imprinted on your brain. Don't think they'll go for it though.

Eating is done. Must go change diaper.

The pregnant resident

I am sooo grouchy. Just like all my ob patients at the end I hate being pregnant and want to get this child OUT of me. I look like a battleship (bullous belly on skinny little legs), walk like a turtle, and am trying desperatly hard not to snarl like a badger. I had to take time off. The last three times I worked - including one 30 hour shift - I went into contractions every 2-3 minutes. Damn things hurt. Cervix changed only a little, not enough. Had one hit yesterday in clinic while I was trying to inject a shoulder...I am not safe for patient care anymore. So here I am at home. Where I was longing to be just last week. And I'm sooo bored and sooo grouchy. I'm taking care of Beautiful Little Girl at home and am so proud that I haven't been grouchy to her at all yet. I've had 5 tea parties in the last 2 days and am not sure how much more I can take though. My pelvis hurts every step I take. *whine whine whine* I'm tearful, hubby has to work late the next few nights. If I could put pitocin in my veins right now I could...but there's no medical reason. blah!!

Read the articles on pregnancy during residency. Studies show that we enjoy our pregnancy a lot less. Go into preterm contractions but not preterm labor. Yup. Why didn't I become a nurse? Or a pastry chef?

The Inhumane Code

Working the ER this month. Yesterday I got a heartbreaker.

87 yo F dementia, CAD, CHF, CRF, etc. 1 week AMS per her nursing home. Before I even walked into the room, one of my favorite hospice nurses pulled me aside and told me that the woman had been considering hospice last week, the day before she became altered. Had almost signed on. Has no family. Here's her guardian's number - talk to him.

Turns out lady is SICK - CXR white out, STEMI, LFTs of ungodly number, etc. Medical opinion is: it is not appropriate to code her but we need the okay from guardian. Guardian says he thinks that sounds appropriate but need to talk to his supervision (you are the $$*(*#@$ guardian on the legal document, make a #*$* decision). TAlk to supervisior. By her notes, two years ago, 87 year old wanted to be full code, so we want full code. $*(#@$* If she wanted a piece of paper to make her decision for her, she could have signed it, but no, she asked a human being with a concious who is capable to judgement to make that decision. That's you. Step up to the plate.

Codes are ugly. They are not the heroics on all those television shows. They are ugly, ugly, ugly. Ribs are broken, flail chests, crunch, crunch. Sheets, gowns, covers are all over the bed - breasts, pannuses, legs are all spread open. There is no dignity. Why can't people just die because they are supposed to die? Legally, when I'm on the code team or that doctor I have no choice - I have to hurt these people in their last hours when I know I'm doing nothing, NOTHING for them. YEs, I'm happy to try when they are 32 or otherwise healthy but so many times we beat dead bodies.

And it makes us inhuman. I feel bad not only for the body we are hurting but for every health care person in that room. You always have to store part of yourself on a shelf when walking into death but when its beyond futile, it kills the Human in you a little bit.

I stayed 2 hours past my shift with the lady. Of course she didn't make it. Cried the whole dang drive home and then put on a smile for Fairy Princess. Some people wonder how I can make it through residency with a child, I can't imagine not being able to heal without hugs from a Fairy Princess.

Who gets to sleep?

I had a bad call night on Saturday night. Though I am now an esteemed "upper level" and don't get all the floor calls, I get all the outside pages from patients who want an antibiotic over the phone (no), a refill on their narcotics (absolutely not), or want to know how much Tyleonl to give their three year old with a fever (happy to help). I also get to carry the code pager (insert drums of doom here.)

Before noon, my intern and I ran a code on a 32 year old schizophrenic with diabetes - a terrible combination if there ever was any. He took too much Seroquel and and was in DKA. We pulled out most everything in our arsenal but he died. The primary doctor came along just in time to tell the family...we were saved that horrible task. As we wrote our code note though we heard his mother sobbing. There is nothing, that tears me up more than hearing Mommies cry over their dead child - be they 32 weeks or 32 years.

And things never went uphill from there. We got less than two hours sleep. I'm not sure exactly how much as my rule is that if I get less than two hours, I'm not allowed to calculate exactly how much. It doesn't really matter because you are exhausted anyways and the numbers only depress you. Both the intern and I are pregnant - she in her first trimester, me in my second - so the night was a little harder than usual on both of us.

When I got home, I immediatly went to play with my daughter, now two, for a bit. Daddy went upstairs for a moment while we played princess-dress-up and made pretend muffins. After a half hour, I was getting pretty tired so I went up to find Daddy so that he could take over. He was lying in bed and said, "I'm going to take a nap; I didn't sleep much last night." And the bum feel asleep. Four hours later, I got my nap.

This is not the first time this has happened. Is this because I'm a sucker Mommy? Is this because I'm a woman MD? I was going to get all up in arms but then I talked to my male colleage who is a Daddy of an almost two year old and apparently the same thing happens to him. He gets home exhausted after call to have the child placed into his arms and Wife disappears for awhile. It tough work being a single parent for over 24 hours and, yes, we do desperatly want to spend time with our child...but sometimes we just get tired. I knew if I pressed the issue if I ever was so tired that I wasn't a safe mommy, Hubby would take over...but it would be nice to be tucked into bed by Hubby and Beautiful Daughter soon after getting home with both their blessings.

Then again, I am an awfully lucky mommy to have healthy child.