“Everything in life is only for now”

May 3, 2011 § Leave a comment

Everything in life is only for now – quote from Avenue Q imprinted on a pin that one of my patients wore on her hospital gown everyday
Residency

This post will focus on what I’ve gained, both with respect to my medical knowledge and my fitness.  It’s been an emotional and physical test of my ability to cope with loss, gains, and learning what is most important in medicine.  It’s been painfully humbling to say the very least.

This month has been a particularly challenging one, not in terms of the medicine, but in terms of the emotional connectedness and empathy I felt on a daily basis.  I spent four weeks on the Hematology/Oncology ward.  This means I was taking care of patients with blood disorders such as obscure anemias, bleeding disorders, leukemia, lymphoma, and specific cancers such as lung and melanoma.  There is no other service that teaches you how to connect with your patient or fosters an environment where bedside manner can make or break your relationship with the ill patient.  This was, in all respects, my favorite rotation of intern year.

Human connectedness

Those two words describe the essence of the service.  I have never developed connections with my patients as I did this month.  Yes, of course I care for all of my patients and am generally interested in their well being, but let me assure you then when you have a patient who is experiencing end of life, the relationship beckons deeper love.  I think this was, by and large, a month where I learned more from my patients and was “helped” by them more than I could ever have done for them.  I found myself going the extra mile, staying many hours beyond my duty hours just to spend time with the families, ensure that crashing patients were safe, all loose ends were neatly tied, and, foremost discuss end-of-life decisions- the latter being the most emotionally moving aspect of my training to date.   It become my job to initiate a natural path to death with my beloved, terminally ill patients.  No other profession is honored with the rights to discuss DEATH with another being, to tell a true fighter that it’s ok to let go. I would do absolutely ANYTHING to allow them the most comfortable and peaceful path towards death. I grew intensely attached to my patients, regardless of age, stage of disease, or stage of grief.  I found myself calling the nurses long after I left to make sure the dying had enough pain meds, were comfortable, and that their families could call my cell if they needed. Humbling, terrifying, mystifying.  While the families we cared for were losing a loved one to sinister disease process, I was gaining insight into the depths of family values, the human experience, family dynamic and the meaning of love.

Losing patients to disease hit me so much harder and signing a patient’s DNR/DNI form would bring me to tears at times.  One patient’s decision to become DNR/DNI (meaning that they did  not wish to have CPR or any life support) led me to the closest bathroom where I spent a solid 30 minutes sobbing.  Of course I didn’t do this in front of the family during decisions of that magnitude, but I can assure you that I broke down into tears while holding the hand of several of several patients while  listening to their life story.  Beautiful.

Also, something that I saw on this service that I didn’t see an ounce of on my other rotations was POSITIVITY.  I was astounded at the positive attitude and zest for life that my patients had.  Considering the grave prognoses I wrote in charts daily, I was inspired that each patient was living for THIS day.  They focused only on THAT days’ total blood count, THAT days’ pain control, THAT days’ time with family, and some days even shared the travel plans they had for their last days.  There was only one time where I saw a patient cry over their disease, otherwise these patients were the embodiment of stoicism.  Again, they taught me lessons that a medical text book or attending could never teach me.  The quote in this post’s title was on a pin adorned by one of my myelodysplastic patients everyday.  She was preparing herself for a bone marrow transplant but was developing complicating infections because her immune system was being ravaged by the disease process.  Every morning I walked into her room she was playing vivaldi on her iPad, had her hair and make-up done, and would smile at me and say, “Good morning Miss Thing, I’ve missed you! How are we gonna start this day?”…and all the while all I could see was her rouge smile, while in the back of my mind knowing how ill she was, yet she saw past the disease and chose to live her life.  Her’s, as well as the experience from others, made me re-think those little things that I get worked up about, that we all stress about, and that we allow to ruin our day.  I thanked all of my patients at the end of the month, wished them well, sat in my car and and just cried, not wanting the month to end and not wanting to lose these patients.

Who would have thought that dying patients would teach me how to live. One day at a time.

Weight

Two weeks ago I reviewed my previous work-outs and saw that P90x (lean) made me put weight on and it was by no means only muscle weight. I went up a dress size and felt uncomfortable.   This gain did not make me happy but, like I said above, I have chosen to focus only on my activities and wise food choices I make THAT day.   I have several goal dates in mind (long term) but refocused on the short term goals by staying in the now.  With this mindset, a change in my exercise routine, a new exercise partner (mini-me, baby sis), discontinuing P90x (because there is not nearly enough cardio), I have lost two pounds this week.  This loss occurred despite going out to dinner and enjoying a few fantabulous vanilla bean cupcakes with Nutella frosting that I made for  my heme/onc nurses & attendings.

Recipe

I’ve chosen my French Onion soup because, like the experiences I’ve had this month, it’s simple, full of flavor, and the simplicity gives it it’s divine savory flavor. How fab does this look!?


French Onion Soup
As adapted from Gourmet, 2006

Ingredients

  • 2 lb medium onions, halved lengthwise, then thinly sliced lengthwise – **I actually used sweet onions**
  • 3 sprigs fresh thyme
  • 2 Turkish bay leaves
  • 3/4 teaspoon salt
  • 1/2 stick (1/4 cup) unsalted butter
  • 2 teaspoons all-purpose flour
  • 3/4 cup dry white wine – **I used equal amounts of Gewurtztraminer for the sweetness and acidity to offset the savory croutons and broth**
  • 4 cups reduced-sodium beef broth (32 fl oz) – **I used fat free, reduced sodium, minimal loss in flavor**
  • 1 1/2 cups water
  • 1/2 teaspoon black pepper
  • 6 (1/2-inch-thick) diagonal slices of baguette **I used freshly made, large cut Butter- garlic croutons** from the Fresh Market
  • 1 (1/2-lb) piece Gruyère
  • 2 tablespoons finely grated Parmigiano-Reggiano to sprinkle atop just before broiling
Prep

Cook onions, thyme, bay leaves, and salt in butter in a 4- to 5-quart heavy pot over moderate heat, uncovered, stirring frequently, until onions are very soft and deep golden brown, about 45 minutes. Add flour and cook, stirring, 1 minute. Stir in wine and cook, stirring, 2 minutes. Stir in broth, water, and pepper and simmer, uncovered, stirring occasionally, 30 minutes.

While soup simmers, put oven rack in middle position and preheat oven to 350°F.

Arrange bread in 1 layer on a large baking sheet and toast, turning over once, until completely dry, about 15 minutes.

Remove croûtes from oven and preheat broiler. Put crocks in a shallow baking pan.

Discard bay leaves and thyme from soup and divide soup among crocks, then float a croûte in each. Slice enough Gruyère (about 6 ounces total) with cheese plane to cover tops of crocks, allowing ends of cheese to hang over rims of crocks, then sprinkle with Parmigiano-Reggiano.

Broil 4 to 5 inches from heat until cheese is melted and bubbly, 1 to 2 minutes.

What experiences have reshaped you recently?

A pinch of success along the way

March 21, 2011 § Leave a comment

It was a refreshing week for several reasons, allow me to share what I’m proud of. I feel in control of my weight, I feel better control over my clinical decisions and am developing some incredible confidence, and I’m totes proud of myself for finding time to work out regardless of the hell that is bestowed upon me at work daily. I also made time to get together with co-interns not once, but TWICE…a rare occurrence for us girls.  I always like to make sure that my topics intra-post are related, so I should explain that my post this week integrates my weight loss, my time spent working off a few calories, and a recipe I concocted while taking some much needed MSFitMint time with my dear friends.  Yay me!

My Calm in the midst of a torrential storm

Here’s one of the ways I’ve maintained my peace in the chaos at work – my co-intern and I slip away almost daily for a skinny latte with one of Starbucks’ new Mini’s.  Crap, I just realized I was grossly underestimating the punch in WW points of the caramel squares….whoops!

Weightloss:

Weight watcher’s update: LOST 1.2 lbs this week!

I thought I’d review what I did, logged my workouts on paper AND eTools.  Writing my work outs on paper allows me to visualize how much effort I’ve been putting in, notice patterns (which I love, b/c I’m a compulsive ‘trender’…I like to see progress and crave a positive trend) and forces me to work out so I have something to write down.  I’ve been logging on my P90x work out sheet which I never really found useful…pretty useful now!  Not only did I log workouts, I also noted whether I was on, over or under WW points….and of course if I was on call.  Four to five days of work outs per week ain’t too shabby for a crazy intern!

Recipe

For over one week now I’ve been craving pizza – crispy crust with an oozing topcoat of fresh whole mozzarella…

Had a girls’ night with a few of my darling co-interns, one of whom (the hostess) made a mouthwatering white pizza which really got my recipe creating mind in a swing.  I thought I’d make a lighter version, add more veggies, and add a sweet tanginess with sundried tomato pesto instead of generic tomato sauce, keeping with the “white pizza” requisite.  OH! And while I made this gooey/healthy piece of perfection, I was drinking a STRAWBERRY ABITA, which is the bees knees. Light and fruity beer, one of my new favorites, and better yet, with only 11 carbs per 12 oz. serving it’s only ONE POINTPlus!

Flatout White Pizette 

PointsPlus™ Value:  12 (one serving is 1/2, so SIX points plus). Note* if you use recipe builder and add the veggies this turns out to be 8 points per serving….go figure.
Servings:  2

Ingredients

1 item(s) Flatout Carbdown Italian Herb Bread
2 Tbsp alfredo sauce, light
1/2 breast of garlic Rotisserie Chicken, torn to pieces
2 Tbsp crumbled feta cheese
1/2 cup(s) whole milk mozzarella cheese (of course you could sub part skim for a fraction of the points) 

handful of baby spinach leaves

4 grape tomatoes, sliced in half, lengthwise

2 button mushrooms, cleaned and sliced thin

1 tbsp sundried tomato pesto (I splurged and bought a fancy brand but classico works just as well)

Instructions

  • spray a nonstick baking sheet with cooking spray
  • spread pesto and alfredo sauce on flatbread
  • arrange torn chicken
  • layer veggies and feta
  • pinch of black pepper
  • add mozzarella and add a few light touches of the sundried tomato paste on the cheese
  • Bake for approx 10 min

Reason I’m showing off all of this unhealthy food?  B/c I ate like this and still managed to lose weight.  I have a strong suspicion it was b/c of the work-outs.  Glad I’m tracking.

What are you proud of this week?

Missing in Action

February 27, 2011 § 1 Comment

(a beautiful platter I made for a visiting friend…pieced together some medjool dates, brie, manchego, smoked gouda, marinated and roasted garlic, and olives)

I can’t even remember the last time I posted, but I can almost guarantee that I was closer to my weightloss goal than I am right now.

Residency –

Residency has been pretty hectic/bizarre.  I’ve been at the VA for the past two months so it’s been relatively easy going, but if you’ve ever worked at a VA medical center (God help you if you have or currently work there) you’ll understand why I’m having a hard time describing it.  It’s the most inefficient medical system, hires rather inadequate performers (at least this one does) and stresses DOCUMENTATION rather than sound patient care.  There are hazing rituals that occur here which would never occur at my home-base training site, namely abusive M&M’s (morbidity and mortalities – where you talk about flaws in patient  care), VA CPRS documentation “police”, and harassment (luckily I haven’t been the abusee of any of these wretched people yet but my time is coming shortly as I advance to second-year) by completely incompetent attending physicians.

Monday afternoons are likely the most stressful periods for my senior residents who have to present our morbidity and mortality cases; luckily in the ICU we’re pretty damn strong, but some of the other residents REALLY get the mental pummeling of a lifetime for their so-called “piss poor care”.  It’s a hairy and malignant system, abusive, abrasive and quite frankly I can’t stand it.  It really wears you down to hear your seniors get beaten down for simple oversights made by their supervisors but such is malignant medicine – if your supervisor practices poor medicine, you’re bound to be treated and trained  poorly, taking the brunt of the consequences from both the families and peers.  Because of the intense nature (and unfortunately minimal patient care superseded by endless hours spent SITTING and DOCUMENTING your “patient care” at a computer all day) I haven’t left work on time for the past few weeks…leaving very little time for me-time, and most importantly…catching my much needed sleep.

All of that being said, I’ve been doing my best to maintain a sense of calm and the only ways I know how are to

1) partake in as much outdoor activity as I can; i.e. snow-shoe-ing with my very out-doorsy amiga, Laura

2) dancing around my kitchen with my itunes and a wooden spoon, revamping some of my favorite recipes, and

3) working out when i have the time which has been hard as HELL this month.

4) meeting up with my tight knit group of incredible co-interns (which, surprise – none of them are internal medicine interns…if that tells you anything about my personality. PS – this will also be the focus of a future post – how I’m itching and scratching to switch residency programs because i’ve grown very weary towards internal medicine)

5) shopping – as pathetic as it sounds, I’ve been meeting my sister for many-a-shopping sprees lately b/c it’s been such a wonderful release.  Mind you, I haven’t purchased much and most of these meet-ups are at the local Fresh Market, but the thought of buying FRESH produce to cook with or a brand new cast iron is very exciting and brings me peace.

Residency and my Gut –

I haven’t been to a weightwatchers meeting in months or a weigh-in for a few weeks. my weight has increased by about six lbs and it’s not muscle and I’ve been pretty down about this. Just last month I was about five pounds from meeting goal and thats when my second VA month started and that’s when the real fatigue set in.  I had been incredibly successful combining P90x LEAN with a few classes at the gym (body pump and Spin), as well as cross training – but lately I’m just dead by the time I leave work at 10pm  and barely even have the energy to throw my gym clothes on.

My appetite has also been CRAZY.  I know that the new PointsPlus system allows you to eat most fruits without the weight of extra daily points, but I’ve been eating fruit galore (waaaay more than I had been on the old plan) and my weight is just compounding.  On the average day I’ll have 1-2 bananas, 1 pack of raspberries or blueberries, and at least one cup of grapes in between meals.  My meals, on the other hand, have been upsetting as I’ve been craving salts and of all things, pulled pork.  Being that I can’t have pulled pork for every meal I’ve been gorging on other salty and usually fattening meals, such as frozen lean cuisine and SmartOnes – check out the sodium in those bad boys!  They’re quick and fuss-less so they work well for the VA.  If I don’t take a frozen brick, I typically take some left over small portion of the previous night’s dinner which usually consists of bulgar or soup.  The weekends can be messy though – I typically use my weekly points here or I even go overboard and have EXTRA points, which make way into my exercise points. Hence, I’ve been over points each week for the past month, thus making my weekly at-home weigh-in very stressful.

Luckily I recently found out that a fellow local foodie also goes to the same location for weekly WW meetings so this has been a motivator.  Food PLUS weightloss PLUS friends is usually a win-win game.  I’m hoping to get to more meetings for some real motivation, and get back on my exercise regimen….wish me luck!!

How does you all deal with a period of weight gain and legitimate lack of exercise time?

Imaginary Obstacles

August 28, 2010 § Leave a comment

A few months ago I was told that it would be impossible for me to be an interventional cardiologist AND a wife/mother.  What I was really hearing was that it’s impossible to be a woman and live my personal dreams.  Unfortunately I admired the neurologist who told me this far too much otherwise I would have printed this article and stapled it to his forehead….or somewhere else.

NEJM article-

Women in Medicine Force Change in Workforce Dynamics

April 2005

By Bonnie Darves, a Seattle-based freelance health care writer.

Career Resources Editor’s Note: Women are finally gaining equality with their male colleagues in terms of admission to medical school and representation in non-surgical sub-specialties. However, significant disparities remain in surgical sub-specialties, senior academic and leadership positions, as well as in salary. Crucial to the advancement of women in medicine is positive role modeling and mentoring from those who have overcome obstacles and achieved success. The outlook remains bright for women entering medicine and choosing a career path that will bring personal and professional satisfaction.

John A. Fromson, M.D., Vice President for Medical Affairs, Massachusetts Medical Society

In July 2003, when Nancy Nielsen, M.D., Ph.D., was elected speaker of the House of Delegates at the American Medical Association, the Buffalo, New York internist was presented with a box containing glass shards. With becoming the AMA’s first female HOD speaker, Dr. Neilsen had truly broken the glass ceiling.

That story contrasts sharply with what happened 70 years earlier in Dallas, Texas. A year after the country’s first female orthopedic surgeon, Ruth Jackson, M.D., started her practice, the newly founded American Academy of Orthopedic Surgeons (AAOS) opened its membership to all practicing orthopedic surgeons — except Dr. Jackson. It wasn’t until four years later, when Dr. Jackson passed the American Board of Orthopedic Surgery’s newly instituted exam, that she was admitted to the AAOS.

Dr. Jackson’s struggle paled in comparison to the discrimination and ostracism the country’s first female physician, Elizabeth Blackwell, M.D., faced en route to receiving her medical degree in 1849 from Geneva Medical College. Yet it illustrates how little the acceptance environment had changed by the early 20th century.

Perhaps the most telling story about how things have changed in the intervening years for women in medicine — and what the future holds — lies in two statistics that made headlines last November. The Association of American Medical Colleges (AAMC) reported that for the first time in history, women made up the majority of medical school applicants, and that the number of black women applicants exceeded 1,900 — a 10 percent increase over the previous year. And in 2002, 40 percent of all residents were women, a statistic that clearly supports the prediction that by 2010, approximately 40 percent of U.S. physicians will be women.

In certain specialties, especially primary care, women have made large strides. Women comprised only 20 percent of pediatricians in 1970, for example, but accounted for 49 percent in 2002. In obstetrics and gynecology, the growth of women in the field is even more dramatic: from 5 percent in 1970 to more than 70 percent three decades later.

Despite how the overall numbers picture is changing, women in specialties such as orthopedics are still relative rarities — in 2001, less than 9 percent of orthopedic surgery residents were female. Yet times are changing, if slowly, even in this traditionally male-dominated specialty. Sybil Biermann, M.D., associate professor of orthopedics at the University of Michigan in Ann Arbor, who has conducted research on orthopedics work force trends, is buoyed by the changes she has witnessed in the field since she completed her residency in the early 1990s. She is also well aware that much work is needed to increase recruitment in orthopedics and other surgical specialties.

“In my field there is tremendous opportunity for women, and there really are no obstacles in terms of gender bias when you are at the level of being considered for a residency program,” says Dr. Biermann. “The issue is that we’re not recruiting women into the field early enough.”

Dr. Biermann, who joined the University of Michigan faculty 11 years ago, credits the tremendous support she received from the department chair at the University of Iowa as one of the chief factors in her decision to pursue orthopedics. “I was fortunate to be in a program that had trained more women than perhaps any other program at the time, and that really helped to create a supportive environment,” Dr. Biermann recalls.

Orthopedics has been considered one of the last “holdouts” in the surgical specialties, as regards the presence of women in the field. In general surgery, for example, nearly one-fourth of residents are women; and even in neurosurgery, another traditionally male-dominated field, women account for approximately 10 percent of residents, according to the most recent data from the American Medical Association and research conducted by Dr. Biermann for her article published in the December 2003 issue of the Journal of Bone and Joint Surgery. Changes are also occurring in thoracic surgery, where women residents made up nearly 7 percent of the total in 2001, compared to only 0.61 percent in 1970; and in urology, which saw the percentage of female residents increase from 0.27 percent to 12.6 percent over that three-decade period. The most dramatic increase is seen in ophthalmology, in which there has been a tenfold increase — from 3.6 percent in 1970 to 32.4 percent in 2001 — in women in training programs.

The career path of Ellen Raney, M.D., a pediatric orthopedic surgeon in Honolulu, exemplifies the changes that are occurring in the surgical field as a whole and orthopedics in particular. Now chief of staff at Shriners Hospital for Children in Honolulu, Dr. Raney might not have imagined that eventuality when she was the sole woman in her training program 12 years ago. “I was fairly naive to the obstacles in the beginning, and it was hard to be in a program where I had no role model,” Dr. Raney says. “But I loved orthopedics — and I found I had an aptitude for and special love of pediatric orthopedics, so I was determined not to lose sight of my goals. Today, I like to think that my success is making it easier for the next woman.”

Illinois neurosurgeon Gail Rousseau, M.D., a past president of the organization Women in Neurosurgery, was also a “solo act” as a woman in her training program at George Washington University, which she completed in 1992. “I think the environment was fair. I got no breaks for being a woman, but encountered no special difficulties because I was a woman, either,” says Dr. Rousseau. “Neurosurgery is an exacting science and a rigorous residency for anyone who undertakes it — as it should be.” She notes that then department chair, Edward R. Laws Jr., M.D., was supportive during that time, as were her male counterparts in training and the attending physicians. “They were all very supportive and I’ve felt that way, almost without exception, throughout my career,” says Dr. Rousseau, who has held leadership positions for both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Despite the increasing numbers of women in the field — only eight women composed the founding membership of Women in Neurosurgery in 1989, but there are approximately 250 practicing women neurosurgeons in the United States today and 550 internationally — women remain a small minority in the field.

In traditionally male-dominated non-surgical specialties, relative representation of men and women is changing far more rapidly. According to the most recent data published by the AMA, in the September 3, 2003 issue of JAMA, women physicians, in growing numbers, are choosing to go into a broad range of non-primary care specialties. For example, 27 percent of anesthesiology residents are female, 25.7 percent of radiology residents are women, and 49.4 percent of pathologists in training are women.

The successes of pioneers such as Drs. Raney, Biermann, Rousseau, and others who have ventured into surgical specialties are, in fact, figuring in the career decisions medical students are making these days. Catherine Mohr, a California medical student who is in her fourth year of Stanford University’s five-year program, credits several mentors — both men and women — with her decision to go into general surgery. A female friend who is a surgeon has given Mohr an honest picture, she says, of “the pluses and minuses of the field, so I’ve been able to watch her career develop. But one of my strongest supporters is a male surgeon,” says Mohr, referring to Stanford’s chair of surgery, Thomas Krummel, M.D., with whom Mohr consulted even before she decided to go to medical school.

At the time, Mohr already had an established career in engineering, but was wrestling with the growing personal recognition that she had shied away from her true calling. “I shared my interests with him, and he simply said, ‘what will it take to get you to come to Stanford?’ ” she says.

Women figure prominently in medicine’s wave of the future, but challenges remain

Although women physicians are far more common in the OR and the ER than they once were, they are still a minority — if a visible one — in the boardroom, the executive suite, and the upper echelons of academia. Diane Magrane, M.D., associate vice president for faculty development and leadership programs at the American Association of Medical Colleges, notes that there has been a stagnation of sorts in academia, in particular. “Women have been about 30 percent of [medical school] faculty since the 1970s, but what we know is that women are less likely to advance past assistant professor than men are,” Dr. Magrane says.

Further, women physicians continue to earn less than their male counterparts — an estimated 25 percent to 35 percent less, depending on the field. While part-time employment status and the predominance of women in primary care surely contribute to the earning disparity, those likely aren’t the only factors, according to the AMA office of Women and Minorities Services.

Dr. Magrane agrees. “There is still a disparity that can only be attributed to gender. How much that is, we don’t know, but it has been consistent,” she says.

In 2002, for example, only 12 percent of full professors were women, compared to approximately 1 percent 30 years ago, and women comprised only 14 percent of tenured professors, according to the AAMC report “Advancing Women’s Leadership.” “That’s not that much of a shift, considering the number of women in the [academic] field now,” Dr. Magrane says. And while there are now 11 female medical school deans, women clearly remain a small minority given the fact that there are 126 teaching institutions, Dr. Magrane adds.

Responses to a survey regularly conducted by AMA’s Women Physicians Congress support Dr. Magrane’s contention, but indicate that advancement opportunities are improving for female physicians. In 1998, respondents cited “leadership development, education, and training” opportunities as their No. 1 priority, but by the 2003 survey that issue had dropped down the scale considerably. And when asked whether the professional climate, as regards disparities or discrimination, had improved for women since they entered medical school, 44 percent of respondents said “somewhat” and 27 percent said “very much” — and only 6 percent said “not at all.”

Despite the statistics on women in leadership positions, which may be attributable more to women physicians’ lifestyle choices than to actual obstacles in academia or the business side of medicine, the environment is far more “women-welcoming” than it once was, recalls one pioneer, Barbara LeTourneau, M.D., M.B.A., vice president for medical affairs at Regions Hospital in St. Paul, Minnesota. “When I received my MBA in 1987, there weren’t very many women in medicine — and there definitely weren’t any women in management positions,” says Dr. LeTourneau, an emergency medicine physician. “When I was 35, I almost never saw a woman in the role of an elected medical staff position, but that’s changed now.”

For Dr. LeTourneau, the move into management was gradual and, as was the case with many of her female colleagues at the time, the first leadership position came about almost by way of default. After she had been in practice for a few years, the physician group with which she was affiliated discovered that although the number of women in the group was increasing, the board of directors was composed entirely of men.

“I think I was recruited because I was the only female full-time ER physician. But then I discovered that I liked management and had a flair for it,” she says. Even though she experienced occasional roadblocks in the management side of her career, mostly because she was a rare sight at the time, Dr. LeTourneau thinks that opportunities for female physician executives are abundant now, for those who are willing to deal with the minority factor that persists in the business arena.

“Women who are entering the physician executive field now will find the playing field level at the entry level. But I still think that where women have to work harder and outperform men is at the upper levels — because even though you’re not excluded, you have to overcome the difficulty of not being part of the male ‘club,’ ” Dr. LeTourneau says.

For the Birds

July 30, 2010 § 2 Comments

This month of night float is almost over…THANK GOD!

That lifestyle is for the birds

The things that this schedule has done to my metabolism, mood, waistline, circadian rhythm, personal relationships, work ethic are catastrophic.  I have never felt more out of touch with the world, even while I made my monthly cross country treks during my last two years of school.

It’s such a struggle for me to look on the bright side of things right now.  I hate seeing these changes in my life.  I have been venting non stop to one of my favorite people how my life feels so out of whack right now and how I’m not sure how much more of it I can take – having second thoughts on a daily basis and wishing I had chosen surgery or ER over internal medicine.  Dammit, I had the scores (I think).  Why did I choose internal medicine out of the fear that I wasn’t cut throat enough to survive a surgical residency or fear that I wouldn’t get interviews? Why didn’t I tell the program director at my ER rotation that I would do anything to switch to his program because it was so strong in both didactic and clinical areas? I’m so damn sensitive.  Why the hell did I settle? Maybe these ridiculous questions are just part of this treacherous territory. It’ll most likely all work out in the end…only if I get that cardio fellowship (fingers crossed).

The main goal of this post was to highlight how my body and mind have changed drastically this month.  I have to look on the bright side and congratulate myself for the strides I know I’ve made.  I started spin class when I knew my stress level was a bit high, fell in love with it and now I can’t get enough.  I  spin about 3 times a week and I’ve continued my C25K on days opposite spinning, almost right on schedule. That’s pretty stinking good, right?  I typically only leave one day out of the week to rest my muscles one weekly.  I’m so f^&*ng proud of myself for the determination that takes.

There’s a but….

Despite how much more exercise Im getting and how the scale reassures me that things are going well overall, I still look at my gut and overly large chest in the mirror and wonder why they won’t budge.  Aggravation!  I have attributed it to a few things, all related to night float (for the most part). I’m not doing nearly as much yoga/pilates as I was during my slightly flatter belly days, not eating on a normal diurnal cycle, and not eating the most of the healthy foods I used to crave – simply because night shift is such an abusive schedule on the body.  I used to eat once every three hours and barely ate carbs simply because I didn’t crave them.  I would have one of the major meals of the day and creaking it up with a Kind bar, fruit, little yogurt shakes, SOMETHING of substance.  I can’t eat on my normal schedule when I’m sleeping at odd times and eating when I can.  These days all I crave are bagles, Dunkin’ donuts grilled cheese flatbreads, chocolate, sweet breads, chips and salsa, chinese food, salty, and more chocolate.  What the F*** is that about?  I suppose my body is just in freak out mode because of the change in cycle – I think that’s why the carbs are being over desired.  This is no bueno.

so….

I’m going to attempt to take these changes in stride.  It’s OK that I put on pound on this week – after all, the nurses loved working with my co-intern and I so much that both the ICU and the ER had little parties for us. That meant pizza, wings, ice cream cake, garden fresh veggies, homemade brownies/choc chip cookies, and my favorite – cheese and crackers.  This, by the way, is an extremely rare thing for nurses to do for interns (so I’ve heard) so I’ll give myself (and my co-intern) a huge pat on the back for keeping the RNs happy. (Plus of the month) It’s OK that I ate that way.

I’ll also have to learn to forget the scale for the time being.  I didn’t go for my weigh in this week because I knew what the situation was and I didn’t want to be too much harder on myself.  I know what this night-style is doing to me so I’m letting it go. Along those lines, I’ll have to let go the negative feelings I have about my job right now.  I think the mental and emotional hardship is part of the game at this point and I have to remember that I’m still learning.  I think it’ll all be OK at the end.

My main goal of the week will be to add more of my Yoga or Pilates as my schedule changes to day team, finally.  I’ll see how that schedule works out and if I have time for the yoga, I’ll do it; if not, then so be it.

Happy Reading 🙂

I am what I eat

July 11, 2010 § 5 Comments

Gross

I feel so gross.  Residency finally started and I’m working night float so that means I’m not really eating much because I’ve never been a night eater, right? I thought that when I shifted my sleep schedule that I’d also eat much less  and I’d be busy enough to stave off cravings.  I couldn’t have been further off.  The only accurate part is that I’m not, or at least I didn’t think I was, a nighttime snacker.   Working nights has made me soft, literally.  Some how I’m hungry every hour. I have been trying to stick within my WW points and pack little 4-point almond butter and banana sandwiches, apple, greek yogurt with granola and fruit, and by sticking to my all bran in the AM.  I have even stuck with my eating every three hours rule and have an eating schedule planned out in my head.  None of this is helping.  For some reason I’ve re-developed my love handles and my abdomen looks like something I’ve only come across on maternity units.  My measured weight is actually continuing to decrease while my image in the mirror is NOT what is was when I graduated last month.

I’ve been eating so much more…and not just when I’m at work, it’s mainly when I wake up in the afternoon. I’ve completely let myself go to the point I had TacoBell two times last week while hanging out with the little bad influence Runt-my sister.  I hadn’t touched bad-for-you-nutrient-deplete fast food in months. MONTHS.  Then she introduced me to the crunch wrap supreme. 12 fucking points.  12!!!!! Mind you, this was at 1 a.m. It’s been downhill from there.  I had tiramisu, went to a wedding and had cake and a cannoli, multiple sweet mixed drinks, I’ve even gone back for more TacoBell.

I miss my last few months of people making fun of me for eating so healthfully and for my self-control around desserts/junk at work.  I’ve never had control like that before.  As much as I say I want to get back where I was with my self control i feel like it won’t be as easy this time because i don’t have a particular goal.  Last time it was that I didn’t want my classmates seeing me as a fatty at graduation.  I haven’t been able to find a new short term fitness goal.  I know this is what works best for me.

The only thing I’ve go going for me lately is that I’ve been exercising A LOT lately.  I’ve been doubling up on spin and running; a little speed-junkie I guess.  The only thing I really miss is my hot yoga… and I guess pilates.  I’m pretty sure those were the two things that really helped me tighten up and tone…the only issue is that I can’t afford the Bikram anymore and I have no patience for pilates.  It’s just not what I need these days.  I’ve got to get back into it.

I need some tips and encouragement/motivation ASAP.

happy Eating…. 🙂

Day one, done.

July 1, 2010 § 2 Comments

Unofficial Day one as an intern is over.  Tonight’s the balls- to- the -wall-official night.  Not gonna lie, it wasn’t at all what I expected but it was a relatively chill night.  Still testing the waters.  Hoping I chose the right specialty…hoping I’m smart enough to get thru this….hoping I don’t screw up.  I’m afraid I won’t be hard working or diligent enough.  I still haven’t quite figured out what the model intern is but I hope to be as close to it as I can by an early point….don’t know how to get there tho.  I don’t even know what the generic “hard working” means…it’s so different in the real world vs the student world.   Responsibility and becoming an adult are not fun life transitions when you hit the ground running at full speed.  It’s like NASCAR meets Adderall.  maybe I am too tired and cranky to write.   I did learn a few things about myself tonight…

I seriously glaze over anything I read, regardless of the weight it carries – especially at 4 am

questioning how smart I really am….I feel like I’ve forgotten it ALL

all interns are created equal, especially during the first week.  We all feel so dumb.

snacking on small protein-laden, high omega 3, and/or fruits every three hours prevents my inner bitch from surfacing, especially if it is covered in dark chocolate

I’m going to relinquish my hatred for scrubs.  I felt like a jack ass in my little pink v-neck sweater and khakis that are now 2 sizes too big.

surprisingly it’s not as difficult to smile all night as I thought it would be.

I can sleep better knowing that I have very bright residents willing to take the time to make sure I am comfortable, accurate, and help me whenever I need. I’m really lucky in that respect.

I have a seriously kick-ass intern class

I don’t like new computer systems. Not at all.

I still feel awkward when I’m referred to as “doctor”.  That’s going to take some getting used to.  Basically, I don’t think I deserve the title considering how little I know and how dumb I feel.

That’s about it for now. I’m pretty beat.  Might head to the gym for my run, but we’ll see.

I’m not even sure if this made any sense. Sorry ’bout that.

Happy reading

🙂

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