Organic Free Lunch….or why I can’t be a pediatrician in the American suburbs

As I ponder the mysteries of being an American pediatrician again. I find myself struggling to relate to American Moms who come from my socioeconomic level….

1. Moms shell out for organic, soy, sensitive, Free range, IQ boosting formula but won’t breast feed their babies.  They shell out for organic, homemade, free range, rice based baby food…. But they won’t breast feed their babies And they are really snobby about their organic free range formula….  There is nothing more organic or natural than breastfeeding.

2. They shall out for your Baby Can Read products/Baby Enistein….turn off the TV and talk to your baby, read to your baby…..FOR THE LOVE….TURN OFF THE TV.

3. They yell at me for not prescribing antibiotics for their 24 hours of nasal congestion…..ITS A VIRUS. I can’t fix viruses and it will be gone next week Yet they wont let me vaccinate their child against h. flu which killed a un-vaccinated child in this CITY last year.  Nasal drops and Tylenol vs. watching your child seize in the PICU on a ventilator…..  ?!??!?!!?! NOT TO MENTION THAT WHOLE VACCINES CAUSE GREEN HAIR/AUTISM/GENERAL BADNESS is bad, bad science and there is a very expensive law suit in England as a result of it.

4. Moms who yell at our team (including the attending) when we cannot get their child butter pecan ice cream to their child in the hospital and threaten to leave AMA…NO JOKE.  We have Graters for crying out loud on the menu…. and Ice Cream vs. your child has cancer..??!?!?!

5. One of my colleagues spent an hour with her Private Practice preceptor last week consulting an irate family about the lack of success of acne treatment…being  a teen is rough don’t get me wrong, my baby sister struggled with acne but yelling does not make it better and I counter yet again…acne vs. nearly every other medical problem known to man…what would you pick?

6. I recently had a allied health professional make fun of an Amish patient and another make fun of a patient from the inner city….cultural sensitivity is not our strong suit…and still a colleague make fun of a visually impaired fellow We say we want diversity, we say we want tolerance but we like it better when THOSE people stay on their side of town (I dont know if the visually impaired fellow has a side of town…I guess its my side of town….).

7. We say we want women to be able to be mothers and work and do it all but its not acceptable for a women to pump at most places of work (although it is where i work ) and its often not culturally comfortable for a woman to breast feed outside of a cramped bathroom stall in public.  (yes I know two of the top 10 are about breastfeeding)

8. Then they is the other extreme….(and I am about to be called a heretic)…the stay home at mom who is snobby about being an organic, free range, non-vaccinating homeschooling stay at home, Sunday School teaching, Women’s Bible Study leading Mom who will condemn my single Moms/married but working two jobs in poverty sending their kids to day care and public school in the inner city for not staying home.  Where is your compassion that you preach about?  I love you and I grew and went to church camp with you but I can’t be your pediatrician.

9. The Moms who see one of us come into the room and say “No way, I don’t want a  resident, medical student, fellow, attending under the age of 35 touching my child.” Or my favorite: “They can practice on SOMEONE’s ELSE child.”  I understand Moms, believe me I do, I have had many clumsy orthopedic residents do a lot more than examine me over the years but in the end I also helped train a generation of pediatric/skeletal dysplasia doctors so that the next generation of my tribe gets better care.  This is why so many training hospitals/Resident clinic are in the inner city or the worst part of towns because we care for the indignant SOMEONE ELSE’s child so we can finally get enough gray hair to graduate and move out to where we can take care of your grandkids. No Medical Education = No well trained doctors.

10. Another colleague was recently at a church gathering where one of the other girls is pregnant and said: “I don’t think I can go to a pediatrician because they are so militant about things like vaccinations and breastfeeding….”  

yes I am militant but its only because its all about the babies and they are wroth fighting for…no matter where they live, what language they speak, where they go to school or how much free range, organic gruel they are fed.

…..off soapbox….

Complications…

Life is so much harder sometimes than I saw it going in my head….or maybe it is how I saw it going in my head….

6 years ago while I was in Belarus, my best friend from childhood got married against her parents’ wishes.  My family went to the wedding and my sister Victoria stood in for me as a bridesmaid.  I remember crying laying on my bed in my stuffy little room in Mogilev because I could not be there. I also remember suppressing the image of opening a door one day with her holding a suitcase saying it was over.

Figuratively that happened this week.   I find myself a marriage and then a grief counselor and in my 26 years I find little experience to channel considering I am perpetually single and my life experience consists of a lot of medical education and wheelchair backpacking. And even though I saw it coming, I had hoped it wouldn’t come. Then it did.

I am back to square 0 with the hip, the steroid shot is wearing off and it makes that tell tale sign of two unhappy surfaces crushing one another when ever I sit or stand up.  I knew this would happen in residency. I knew that transition in CIncy would be a problem.   I have even tried to find a ortho here yet I have been unsuccessful. My sweet classmates have called in every favor they have as young aspiring pediatricians for me to find me someone to give me a shot. I act as if the shots will save everything. But in the back of my mind I know I am now holding a ticking time bomb.  The shots will stop working. This is not fourth year of medical school. I can’t work if my pain is full force for longer than a month or so before I am not sleeping. The decisions I make at 4 in the morning are far too important.  I knew the right hip would fail in residency….now it is and I act like its a surprise.

I met this lovely little girl a couple of weeks ago. She has leukemia but not the good kind that has a 85% cure rate.  When I read through her story and then when I met her, a beautiful pale blue eyed 4H champion…I knew it was going to end badly.   I acted all surprised when I found she had gone to the PICU overnight but in the end looking back I knew three weeks ago.

My seniors think I am naviee because I do not believe in the infamous JINK or JUJU of call and resident life…where if you make declarative statement like “Tonight is going to be a good night” or Its quiet,  or if you say the name of a frequent patient THREE TIMES etc you are doomed.  I believe that sometimes things are just to be or not to be and there is very little you can do other than swim through what hits you…..life happens.     No I don’t believe in the juju but then again I don’t even seem to believe in the things that I know are going to happen,

I am a perpetual optimist to a fault.

alas….as my Grandfather loves to say A Cheerful Heart is a continual Feast…

The ivory tower has a view

Occasionally I stare down from my ivory tower of my home away from home… my premier world famous childrens hospital into the rainy streets  below and ponder the ironies of where I stand.

I am among a very friendly, although intense community of young physicians who inspire me and challenge me.  They also want to do things like a be a pediatric heptatologist when they grow up or a palliative care/hematologist/oncologist or be a cardiac ICU doctor.  They are impressive and are being groomed to have impressive careers.  Occasionally I get caught up in the mist of it and try to play the game  but win or lose I find myself looking down at those streets and thinking about how different my life will look in 10 years than nearly every other graduate of my program.  Sometimes I don’t know how to fit my career goal into some sort of acceptable academic mold. (Although if I was really trying to FIT IN maybe I would give up the TIE DYE t-shirt collection on call…and actually WEAR my white coat).  WHen people ask me what I want to do with my life….the expression on their face when I say global health doctor is something akin to shock or a sad smile as if to say “We’ll see how long that lasts….”  Then there are my recent attempts into the array of ACADEMIC global health which is just like what it sounds…. a complete paradox. So far it also seems like a mess….its like combining developing world bureaucracy with academic medicine bureaucracy which make s system that makes Africa time look like a New York minute and Eastern European bureaucracy look like excellent customer service… In T-minus 24 months I am supposed to have a plan. I am supposed to live the dream and all that jazz. In a year I need to be turning in applications for either EM or a mission agency.  This is it…this is what I want to do with the rest of my life…but who knew the rest of my life was only 24 months away and who the heck knows how to get there….

Then there is the typical double agent-ness.  Although its been a really good year in terms of my life as a patient. Its a calm before a familiar storm.  The steroid shot is buying me time.  How long is yet to be determined but if I have another winter like this past one I don’t think I will want to go through a third.  So despite the fact I haven’t taken the green machine to work in two weeks, I know I am simply riding a false high that will eventually bottom out most likely sometime like the middle of PICU or worse my first month as a Sr in the ED and force me to come to grips with despite two years of magic I still have a chronic illness and I am facing another life altering 6 months of a massive surgery that will most likely per usual live me with a hgb of 7.5 followed by mild hysteria over how can I work 7 days a week and go to PT 5 days a week and keep my health insurance….so that I can pay for the monstrosity and live to tell about it.  Its most likely going to happen before I graduate.    I may be the doctor now but that does not give me a immunity. I also cant help but occasionally despite how different here is than back home in terms of patient/family care….chiming in with the other half of my life on rounds….and finding everyone staring at me like I have three heads when I suggest we introduce two of our patients close in age and with the same type of cancer…. FOr the love….we can get their parents’ premission first…I am not crazy I just happen to have be a agent from the light side (for we all know that the doctors are part of the DARK SIDE )…on second thought I will go back to updating discharge summaries….ignore me I just work here…

Compassion Found

I am back on the wards after two months being elsewhere. I read back over my last post and marvel at the burnout I had three months ago.  Its not all gone but its better.  I smile at children again, I savor the little things and I am in awe of all that we can do with our seemingly infinite resources with medicine here. And more than anything I care again, I have found my compassion and my heart for this work.  I am in month 12/12 of internship, I have 24 days to go and I will be a 2nd year.

I also have  a new house that will one day have a garden and already has a roommate and a dog. The house has big windows, nooks and crannies and secrets it seem that hide amongst its 100 year old walls. Its also a minutes walk from a little Square where there is several cafes, coffee shops, a post office, a library and  a small park with fountain.It reminds me of being in Barcelona or Paris with the square, the occasional street noise reminds me of Bucharest  but my big back yard, my trees and my big windows remind me of North Carolina (the 80 degree weather is helping too). The history and the big porch remind me of my beloved Virginia mountains. Its a prefect blend of my favorite places. For the first time since moving here for residency, I feel like I have a home and am not merely camping waiting for my life to restart again in three years.

I sing of your mercies…..