Reality Shock

I've been looking forward to this, my first day of maternity leave, for what seems like eons. Like most working moms, I look at the stay at home moms (SAHMs) with jealousy and judgment. It looks so wonderful from the outside. How could their houses be anything but clean and organized? How could they ever need to order pizza for dinner? How wonderful it would be to just wake up and spend all of the day with your children and completing small home projects.

Reality shock.

I got home from the hospital at 8:30 last night and did the baby feeding at 10pm and 3:30 a.m.

Husband left at 5:30 for five days in Guatemala. He had warned Son that he was leaving, but when Son rolled out of bed at 8 a.m. he threw a significant tantrum involving the repetetive screaming of, "Daddy! I want my Daddy! Daddy daddy daddy!"

Every morning, Son eats a poptart and drinks a glass of carnation instant breakfast for some protein and vitamins. Today, after his tantrum and while I was changing the baby's diaper, he broke up the poptart and ground it into the cushions of the couch. I lost my temper when scolding him and threw my own little tantrum that went something like, "Husband! I want my Husband! Husband husband husband!"

Complicating all of our morning angst is that all three of us (me, Son and Daughter) have bad colds. We are all drippy and sneezing, and I'm sure their heads hurt as bad as mine does. This is daughter's first virus, and I'm worried that her 5 week old body might get very sick, very fast.

Meanwhile, my goal for today was to address 50 envelopes to send out our Christmas letters. After all, the Christmas season doesn't end until Epiphany on January 6th. There is still time if I get those letters postmarked today or tomorrow.

Maybe, just maybe, my defenses are down from the chaotic too-many-patients and too-few-doctors holiday week at work I just survived. Maybe being a SAHM this month won't be this bad all the time. But if this keeps up, I guarantee in a couple of weeks I'll be screaming, "Work! I want my work! Work work work!"

So, to all of you SAHMs out there, I'm sorry for envying and judging you. It ain't easy. Ain't easy at all.

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Code Blue

I've been thinking a lot about code status and whose right it is to determine it. Moreover, who can decide to go whole hog in an exhaustive workup and treatment when every medical professional agrees there is no hope?

Patient? Definitely. But when he/she is incapable or when futility is an issue, I'd like my vote to count as much, if not more, than the cousin from two states away who is calling the shots by phone.

I've been asking around, and most people do as I do...defer to the family. Why? Fear of messy litigation. Older physicians and nurses tell me that in the 60s and 70s, code status was up to the treating physician. Period.

Do I want that final responsibility? Not always. But sometimes, when we are pouring hundreds of thousands of dollars into a vegetative patient with no real hope of recovery, that responsibility seems appealing.

Just before Christmas, I helped a family decide to continue care for their critically ill loved one and yesterday he went to rehab. Today, I tried to convince a family that hospice is the best option for their very demented, 92-year-old grandmother who has inoperable severe aortic stenosis. You guessed it - they want everything done. Everything.

Someone told me that in Canada there are cutoffs - you can't have a CABG after a certain age, can't have a new liver if you drank away your first one, etc. That's how they contain health care costs and are able to provide care to more people. I'm not sure if this is true or not.

In a way, that makes sense...until it is my mom or husband or son circling the drain. Then I want to try everything. Everything.

No easy answer to this question. Meanwhile, I'll go with whatever the family wants and seethe behind closed doors.

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The Runs

In four years, four months and 23 days and Son has never had diarrhea. Until now. Lord help me. I'm almost glad I'm going back to work tomorrow.

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Overheard 47

"I found out your were fat on your blog."

-Brother, chiming in on Sister's complaint that she learns about my life on this blog, not by phone or in person.

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Stuff White People Like

OK, so Rachel Ray Junior, oherwise known as my brother's wife, sent us this book. And I can't stop thinking about it.

You know those highly educated white people who like to think they are so different than other people because they like Starbucks and Indie films and farmer's markets? The point is, they are just like every other highly educated white person.

This book is a highly amusing spoof...I think. Anyway, it's a quick read and you'll laugh out loud as you recognize your friends and yourself. I don't think it is just about white people, by the way. I know plenty of black people and middle eastern people who this book may have been written about.

Don't want to order the book? The website has its amusing posts, too, but I really like the book. Tightly edited short chapters...perfect for the bathroom.

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Spoiled Holiday

One of my patients, whose PCP happened to be my sister, died on Christmas Day. It was not an altogether unexpected death, but the timing was horrible.

With her long term chronic illness, she couldn't fight this pneumonia. Because she had chosen to allow natural death, we didn't intubate her to see her through this infection. Given the severity of her underlying illness, it is a choice I would make, too. A pneumonia is actually a "good" way to go for someone with a terminal disease.

Still, her family will have a cloud hanging over this holiday. Forever.

On my mother's 26th birthday, she went to her parents house for her annual birthday breakfast. Her father was cooking and asked her to wake up her mother. Her mother had died in her sleep that morning.

Forty years later, there is still a bittersweet feeling on my mom's birthday. She has accomplished so much. Three children, six (almost seven) grandchildren, a great career and happy marriages...a lot to celebrate. But every birthday, she remembers her 26th.

As I get ready for yet another family gathering to celebrate Christmas, I can't help but remember this family, whose Christmases will never be the same.

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Overheard 46

"I didn't get a belly button."

Son, when asked if Santa brought him everything he'd asked for.

Merry Christmas!

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Perfect Evening

Yesterday I did 8 workups, 5 discharges and 15 followup visits. Today I worked just a regular day, but I'm so very tired and ready for a few days off. Luckily, tonight was just perfect.

Seattle Redhead went to Vegas for a wedding and then couldn't get home because of the snow. She called last night asking if she could spend a few days with us and flew in this afternoon. Yay! I love an unexpected visit from my cousin during the holidays!

Husband made potato soup with dumplings (carb heaven!) and grilled cheese sandwiches. PaniniFreak walked up with her dog to join us. When Mom gets off work, she will come over for soup and, if I play my cards right, she will scratch my back.

Son is in the bathtub playing "Flushed Away"...he lines up his toys on the side of the tub and then knocks them in the water while repeating "let's see how you like it" just like the villain mouse in the movie.

Daughter is resting in various arms.

Life is good.

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Just Plain Odd

PaniniFreak walked her dog down to visit us. I asked her if she had a suggested blog topic.

She said, "What about that story on CNN about the doctor who found a foot in a brain?"

Well, I had to go have a look. And you should too.

Discuss amongst yourselves.

In other news, we had our first post-placement social worker visit today. It went well.

Later, gators.

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Give the Gift of Fresh Air

Looking for a charity this holiday season? If your family is like mine, the adults are always looking for a charity to accept our meager collected donations (about $25 per adult) each year. We give gifts to the kids, but rather than buy for each other, we support a charity every year.

The Fresh Air Fund sponsors 5,000 inner city New York children to go to one of five camps or have a free vacation in a small town or in the country with host families.

They also need host families in the northeastern states. If you are interested, here is an FAQ. They also take donations to sponsor the children. I'll have a button on my sidebar for awhile. Check it out at your leisure.

What a fantastic program!

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