So far, so busy...

2 AM.

I'm in the call room, just finished pumping some milk for Brynna. We've been slammed with back-to-back-to-back-to-back-to-back admissions from the Emergency Room, so I've been going nonstop since I got here at 6 PM. This is actually a good thing as I have had no time to be tired, and the time is going by very quickly. (Though I've got to admit, the ED from med school is looking super-good compared to the crappy service we're getting from them down there tonight!)

It's very annoying not to know the computer system, as it keeps me from being efficient! Also, the computers are terribly slow, so the combination of my slow speed and the slow response once I do figure out what button to click on is a dreadful combination.

My senior resident is wonderful.

I am not a complete moron, as I have gotten along well with my patients, discovered physical exam findings similar to my senior's, and have a generally correct idea of what we should do with these patients.

And...the peak of my achievements for this evening...I left my senior a little while ago, on another floor, at the other end of the hospital, and I FOUND MY WAY TO MY CALL ROOM. With nary a wrong turn, thank you very much.

Heading back to the ED for another admit.

I'm really hoping Alex and Brynna are having a good night!

Let's Start At The Very Beginning...

So, Sunday night, I will be working as a doctor for the first time! I am starting with a two-week rotation called "night float." I'll be covering the medicine service (adult patients in the hospital) overnight, from Sunday through Thursday nights. That means I will come in at 6 PM, talk to the daytime residents about the patients, and then handle all the nursing calls about existing patients and also  admit new patients that come to the hospital during the night. I will have a senior resident (a second year, this time) working with me, which is very, very excellent. I can sleep if people stop coming and/or calling, but I'm not sure how often that will happen. 

Then at 7 AM, I will meet up with the daytime residents again, tell them what happened overnight, and then leave. That evening, I will report back to the hospital 10 hours after I left (so, sometime between 5:30 and 6) and repeat.

Why 10 hours later, you ask? Well, there are 4 main rules regarding "duty hours" for residents:

1. Residents cannot work more than 80 hours per week, averaged over a 4 week period. (A decade ago, 120 hour weeks were often the norm, especially in surgical programs)

2. Residents must have at least 10 hours free of clinical duties in between shifts

3. Residents must have at least 1 day (24 hours) in 7 free from clinical duties, averaged over a 4 week period

4. Shifts cannot exceed 24 hours, though those 24 hours can then be followed by 6 more hours for education, transferring patients, outpatient clinic, or continuity of care. (For example, on our combined obstetrics and pediatrics service, I will sometimes come in at 6 AM, work for the day, then stay to cover the overnight until 6 AM the following morning, and then spend 6 AM to noon continuing to round on the patients on OB and peds or seeing my own outpatient continuity patients in clinic. I have to leave the hospital by noon on those days because that's when 30 hours is up. (Call like that cannot happen more often than every third night, but that frequency is rare in my program...plus, as you can see, you'd burn through your 80 hours for the week pretty quickly that way.)

These rules are mainly to protect you, the public, from exhausted doctors. There's a move afoot to limit them further, such as to 60 hours per week, but I think then that residencies would all need to be lengthened a year or two. Now that I have a baby, this is a trade-off I think I would be willing to make! I must say, though, that I think my program does the best it can to organize our schedules in a humane way. 

After my 2 weeks of night float, I do 4 weeks of sports medicine, which is office based and thus 8-5 or so. During that time, I will take overnight call on the OB/Peds service (called Maternal Child Health or MCH at our hospital) once or twice a week, and cover the Medicine floor sometimes on the weekends. After that, I start my first really intense rotation, with 6 weeks as one of the daytime interns on the medicine service. 

We're hoping Brynna does OK over the next couple of weeks. She is not taking bottles at daycare, so she eats lots of solids during the day, then nurses when I pick her up after work and several times through the night. We have no idea if she will take a bottle (or sippy cup) of breastmilk at night when I am at work, or not, but if not, it could create some long nights for Alex. 

Our current plan is that I will take the handoff from Alex when I get home from the hospital in the morning, and nurse Brynna and play with her for a little while. Then I'll take her to Miss A's and come back home and get some sleep myself. When I'm done sleeping, I'll pick B up again to nurse and hang out, and then depending on Alex's work schedule, either hand her off straight to him in the evening, or take her back to Miss A's for a little while until Alex can pick her up. 

As you can see, Alex and I are pretty much not going to see each other for more than a few minutes during these 5-night cycles. I do have the weekend off in between, though!

Triathlons, Part 2!

So, last weekend we competed in triathlon #2, the Eastman Splash, Mash, and Dash in Grantham, NH.

I was determined to avoid another swim disaster, so we ordered our rental wetsuits a week early and went twice to a local lake to do training swims. We also got Farmer John-style (bib) wetsuits rather than full-body ones, which are easier to get in and out of and also give a less constricting feeling overall. Our practice swims went great, and so I was feeling very optimistic about the race—not so much that I would be able to go fast, but that I would at least feel comfortable in the water and be able to front crawl the whole way.

Grand and M came up to play with little B during the event, so on Saturday morning Alex and I got up super-early, turned Brynna over to her grandparents, and headed up north. It was a cool and overcast morning, which (as long as it didn't actually rain) was perfect weather.

Alex had been going back and forth about wearing his wetsuit (he's much cold-hardier than I am!) but after dipping a toe in the water did decide to wear it. He was in the first swim wave with the young guys, so I got to watch him start. My wave of young women started a few minutes later. I positioned myself on the far outside of the line so as to avoid a lot of the crowding, and at the whistle ran forward and started swimming with everyone else. This time, it was just like in training! As I had practiced in the lake over the last week or so, I would take 10 full strokes and then look up to make sure I was going straight (I often wasn't) and then do 10 more strokes. And the pack didn't leave me in the dust! I kept this up all the way around the first buoy, then the second, and once I turned back toward the beach and knew that I had things well in hand, I even started to swim a little harder. (This increased my pace from "baby tortoise" to "tortoise.")

I came out of the water with a big grin on my face and jogged into the transition area, unzipping and starting to pull off my wetsuit as I went. Then it was onto the bike. (Mom, Dad, and Brynna were there to cheer as I ran out of the transition area and mounted my bike.) The bike course was an out-and-back 12 miles, with the first half being mostly uphill. Unlike the previous triathlon, this road course was on a rough and poorly-graded road. It was not washboard or rumble-strip bad, but pretty close. I was pretty aggressive during this leg, and passed quite a few people, especially on the hills. The out-and-back nature of the course means that I got to see Alex and shout encouragement partway through. He was in the midst of a very impressive-looking pass of his own. The bike course ended with a long, hard uphill (passed a couple more people!), so I was definitely ready to switch over to running.

The run (5K, or 3.1 miles), was a pretty decent combo of trail, dirt road, and a little bit of pavement. I moved along a bit faster than the last time, got to high-five Alex as we passed, and midway through even felt like I was running, not jogging, and was in good enough shape to actually race a bit. For the last mile or so, I traded places back and forth with another woman—we ended up pushing each other quite well to the finish. (She ended up winning. That won't happen again!)

Tired but thrilled at the finish, I found Alex—who had had a very successful running leg as well—and the rest of our cheering section. In time, we'd learn from the full results that we managed to reduce our time (quickened our pace) in all of our events.

Eventually, my parents took off with Brynna so she could nap in the car, and Alex and I got into line for the excellent lunch. They had veggie burgers, lots of fruit and veggies, yummy desserts, and local chocolate milk! While we were eating, we also got a look at the results...

...and were shocked to see a little number (3) next to both of our names! We both finished third in our age group! (This probably says a lot more about there not being that many serious 25-29 year old triathletes than it does about our athletic prowess.) So, we hung around for the awards ceremony, when we collected our PRIZE TRIATHLON SOCKS!

So much fun!

[ps - we would post additional pictures from the event, as we did for the first tri. However, the pro photographers hired to capture the event are charging ridiculous prices for their images (like $40 for a single hi-res file). we object!]

Take a Stand, Little B!

Brynna has been working on her own personal triathlon. For awhile there, we thought "tooth" was going to beat out "walk" and "talk," but now I think "walk" is making a good run for the lead. Check out the end of this video:

It looks like George is going to be a good reading buddy.

She's also showing off a few more of her new skills as she plays with the wonderful little toy box that Grandma and Da gave her for Christmas:

Triathlons, Part 1 (Finally!)

So, at long last, we bring you the tale of our first triathlon.

Our training over our last 10 weeks or so in Minnesota went great. We were swimming, running, and/or biking five or six days a week, including many days where we did a combination of events. I worked up to the point where I could swim 2 sets of 600 yards (about 1/3 mile each) in the pool, and this made me feel quite prepared, since both our planned triathlons had 1/3 mile swims.

The move itself made training difficult—our bikes had to be boxed up and put in the truck, and we lost access to the pool several days before our actual move. The whole packing up thing rather interfered, too! We tried to consider these couple of weeks a "taper" rather than a setback, though!

Triathlon #1 was the King Pine Triathlon in Madison, NH, a ways north of us. We went up the evening before and met my parents, who came to hang out with Brynna during the big event. This triathlon always has a lot of first-timers, so there was a very helpful rookie meeting where they explained the event and talked about the most important rules (such as No Drafting during the bike leg). We also took the opportunity that night to get into our rental wetsuits and give them a spin (a swim?) in the lake.

I wish we had photos...actually video would be more amusing...of us trying to wriggle into the wetsuits. They are tight.

Once we wandered down to the beach, feeling like superheroes in our stretchy suits, we encountered a problem. The water was really, REALLY cold. The mid-sixties that we'd been promised had fallen to 61 degrees thanks to a few days of rain.  But, you might ask, what about the wetsuits? Why would cold water be a problem?

Well, the wetsuits did a great job of covering virtually our whole bodies. But not our faces. And it turns out that when you dunk your face in 61 degree water, your mammalian diving reflex kicks in and strongly discourages your body from breathing out underwater. Because you need that oxygen! Except, if you are trying to swim across a lake, the breathing out part is quite important because it allows the breathing in part that comes next. I was really glad to have encountered this the night before the race rather than the morning of, and we stayed in the water until I felt a bit more comfortable getting into my front crawl rhythm. (Alex, being a far more experienced swimmer, had a lot less trouble adapting to the temperature.)

Anyway, we went out for a fabulous pizza dinner that night in North Conway, and Brynna gave us a decent night of sleep, and we got up bright and early the next morning, tossed Brynna into bed with my folks, and headed to the race site. We got our bodies marked on our way in (they write your number and age on your arms and legs to keep track of who's who). Alex, who was not yet changed into his swimsuit, had to drop trow right there in the line to get numbered high on his leg! We set up our transition spots with our biking and running stuff then wriggled into our wetsuits once more. Then the whole crowd of neoprene-clad triathletes headed down to the beach.

Here's everyone warming up:

photo credit: Kimberly Keyes

Naturally, sending off this whole crowd at once would cause serious traffic and safety issues in the water. So, we were broken up into waves based on age and denoted by swimcap color. That's us in the neon green - the first wave. When the whistle sounded, off we went. Alex took off with the pack. I ran into the water, started swimming...and promptly came up gasping. I couldn't get a rhythm going in the chilly water, and though I appreciated the warmth of the suit, the tightness made breathing difficult, and I started to feel a bit panicked. I never really recovered, and ended up breast-stroking pretty much the whole thing with my head out of the water, which was very different from my expectation of front-crawling the whole way. 

Here's Alex, zooming along. He had a great swim leg:

photo credit: Kimberly Keyes

Aquaman exiting the water:

photo credit: Kimberly Keyes

And me, after my veeeerrrry long, painfully slow swim, thinking "whew! All on dry land after this, thank goodness!" I think I was the second-to-last person from the first wave to leave the water. The silver-swim-cap guy just behind me started in a wave several minutes behind.

photo credit: Kimberly Keyes

Then it was time to bike! Here's Alex taking off out of the transition area:

photo credit: Kimberly Keyes

He followed this impressive start with a strong bike leg. (We were relieved to find that the roads were actually quite smooth and fast.)

And here I am. I was SO happy to be on dry land. I am a much better biker than swimmer, so I got to pass lots of people, making up time, which made me feel really good :

photo credit: Kimberly Keyes

After about 12 miles on the bike, it was on to the 3.8 mile (6 k) run. There was a bit of running on the road, but it was mainly on dirt track and trails, which was lovely. Here's Alex coming in to the finish:

photo credit: Kimberly Keyes

(He beat that lady next to him by a second. Though, being in an older age group, she's started a full 8 minutes after him, so really it wasn't much of a contest.)

And here I am finishing:

photo credit: Kimberly Keyes

The triathletes celebrate:

Brynna with her M:

She loved watching and listening to the crowd and the commotion, and she was waiting to cheer us on near the transition area. In a few years, maybe she'll be doing the kids' race!

Overall, we had a great time. I was really disappointed about my swim, but thrilled to have persevered to finish, and especially happy with my very strong bike. Alex was pleased with all his events, though he wanted to work on quicker transitions from swim to bike and bike to run.

And next time, the tale of triathlon #2...

From the Finish

From the finish of the Splash Mash and Dash triathlon in Eastman, NH.

We WILL blog about our triathlon experiences, with more pics, soon.

Bye, Bye Car...

So, apparently my car took us a little too literally when we asked it to pretty-please just get us back to New Hampshire. Yesterday I took it in for its state inspection (and a few other things as well), and then we got a phone call that told us it would require a tremendous, expensive amount of work just to pass the inspection.

My car is a 1994 Subaru wagon with almost 140,000 miles on it. We aren't going to spend thousands of dollars to fix it.

And so, in the midst of this rainy weather, we are a one car family and on the lookout for a much-less-used Subaru wagon! Luckily we are in northern New England, the Subaru heartland, and finding one shouldn't actually be all this difficult. I think they all might come with a complementary Obama sticker, too.

(Yes, I would love to have a hybrid, but we need a car with more cargo space than a Prius, Accord, or Insight.)

Getting Started...

I've just had my first two days with my fellow new interns. They all seem lovely, and we've had a chance to bond during our two days of Advanced Cardiac Life Support class. This afternoon, we all passed our certification test—a quick written exam and then the impressively named "Mega-code" practical scenario. Hurray! We're off and running...

Alex and I are also busy getting ready for triathlon #2 coming up on Saturday. (Yes, we know that we haven't yet blogged about triathlon #1. We're waiting to get our pictures from the photographer first. Suffice it to say that I am hoping to have a better swim this coming weekend.) I wanted to get one more open-water swim in this week, so this evening we headed to Clough State Park. I rode my bike out there (it's about a 20 min drive south of us), met Alex and Brynna in the car, Alex and I both had fairly short swims in the lake there, and then Brynna and I drove back and Alex biked back. We probably won't repeat this sequence on a weeknight ever again, but it should work well for weekend training!

As if all of this is not enough to be getting on with, we are doing our first evening of house-hunting tomorrow night.

Off to bed. We're all quite tired this evening...

An Interview with the B

Commute

I've finished my second week at my new job. There's not much that I can say about it in an open setting such as this blog. So, instead, I'll talk about my commute.

My last job, in Rochester, was delightfully close by. So close, in fact, that I had a mere 17 minute walking commute from front door to my desk. That was quite nice. In fact, I was so junior at the company that, even if I wanted to drive to work, it would have done me little good: I would have had to drive away from my job, park the car, then take a shuttle back in. Yup, walking was a great way to go - even in minus 20 weather.

Now, however, I live in Concord and work in Manchester. So, I not only have a 20+ minute commute, but it's a driving commute. I'm sure many of my more urban friends will laugh at that, but it's a big deal to me.

I don't begrudge the time in the car all that much. Traffic isn't too bad, it's almost entirely a straight shot on the highway, and I listen to NPR going to and from. I do worry about the miles, though. My Jetta manages 30+ mpg on the highway, which I consider pretty good, but 40 miles of daily driving is a hit to the pocket and to the carbon footprint no matter what I'm driving. The gas cost is about $3.50 with current prices. If I figure in insurance, depreciation, and everything else that goes into the IRS' $0.55/mile reimbursement rate, it becomes an extra $20/day compared to my old job. There's also a $1 toll each way, which is easy to forget when using the EZPass.

I'd be stoked to get a car with better mileage, but it is tough to justify replacing perfectly good automobile just to reduce my gas consumption by only 25-33%. Taking out a car loan right now would be a poor tactical move in our quest to securing our next mortgage. Besides, if we're replacing any car in the near future, it's probably going to be Hilary's, uhhh, hale Subaru wagon - 15 years old and 140,000 miles.

What is the solution to this problem of commuting? I'm not sure. It is almost certainly too far to bike. Even in training it would be an hour each way - time that I can ill afford. There may be carpooling or shuttle buses available, if I can make that work with my work (and Brynna's daycare) schedule. Moving closer is possible, but it is probably more important for Hilary to remain close to the hospital.

Perhaps I'll just get used to it, like most everyone else does. I hope, even if I can accept it, I don't ever forget it.

Red Sox Nation

One of the wonderful things about being back in New Hampshire is that it is Red Sox country. There's a big article in the sports section every day, I can listen to the game on the radio if I happen to be in the car, and if we were willing to ante up for cable, we could watch all the games on TV.

Especially happy days right now, as the Sox have just finished up a very satisfying sweep of the Yankees.

Little B got an early start on her path to loving the Sox:



And apparently this lesson sunk in well. At daycare, Miss A uses some blankets on the edges of the Pack 'n Play to help make it nice and dark so Brynna can sleep. She told me today that one of them is a Red Sox blanket, and when Brynna is trying to go to sleep, she strokes the logo over and over.

We'll have to get her a bigger Red Sox T-shirt now, I guess!

Weekend in Pennsylvania

This past weekend, we went to Pennsylvania, where my dear friend Sara was being ordained as a minister. Brynna was an absolute trooper, happily altering her nap, bed, and feeding times to accommodate the car rides, the church service, and a lovely party the next day.

Here she is eating on the run in the hotel room before the service on Saturday night. (Better to put the dress on after the meal, you see.)


And here we are playing in the aisle during the sermon.


As Brynna was playing in the aisle, she saw a couple of ushers sitting a little further back in the church. They were older gentlemen, and happily returned Brynna's enthusiastic waves and smiles. After one such exchange, Brynna reached down, grabbed the hem of her dress, and lifted it waaaaay over her head. Peek-a-boo! We are now referring to it as Brynna's Marilyn moment.

The service was about two hours long, and we managed to keep her happy and entertained throughout. She spent the last bit walking in the back with my dad, and clapping for the newly ordained ministers—she loves clapping! (She clapped extra for Sara.)

The next day was even more fun. It was a beautiful day, and Sara hosted a wonderful picnic, complete with Indian food. Brynna spent awhile wandering around in Sara's arms (I really wish I had taken some photos), sitting with us and tasting some Indian food, and hanging out with Grand and M. Here she is watching everyone play frisbee from her Pack 'n Play:



She was so charming throughout the trip!


And here's Jasper, who also enjoyed himself at the picnic. He even ran around in the vicinity of a tennis ball for a little while. (We wouldn't exactly call it "fetch" yet, but at least he doesn't run away from the ball like he used to. Now he even pounces on it, and sometimes picks it up!)

Zonk

We have just had a milestone.

"What is it?" you may ask.

A tooth?

Walking?

Talking?

No (though she is clearly working on all of those things, it's a race to see what happens first).

Today, I moved a sleeping Brynna from her stroller (where she had fallen asleep only three minutes from home) to her crib to continue her nap, with nary a fuss. Amazing! I have waited more than half an hour to blog about it, lest I jinx it.

We've actually been working hard over the last couple of weeks to convert her from a rock-to-sleep baby to a falls-asleep-in-her-crib baby (though with a hand of support from one of us). It's been going pretty well.

It's probably helped by the fact that she is so incredibly busy during the day, between daycare and her playroom here.

Here she is with her shelf of goodies in the playroom:


Playing peek-a-boo with the curtains:


Hello, everyone! Look at me go!

The Big Day, With More Photos

So, I am a doctor now. (Yikes!)

Graduation was a good time, despite having to go early in the morning for no apparent reason (lots of standing around in a conference room, which at least was a chance to chat with classmates), and despite the fact that the faculty were given a breakfast buffet, but not the pending graduates!

Brynna and Alex had to watch from the upper level of the auditorium, where they banished the babies. There were very nice speeches from one of the PhD students and one of my classmates, and then we traipsed down to center stage one at a time, collecting our hoods on the way. We heard our names with "Doctor" in front for the first time, were hooded by two of the deans, and received our diplomas from a third. Yippee!

With dear friend and classmate Beth, who is also going into family medicine (if you live in Wisconsin, she's the doc for you!)


Beth and I with Dr. B, our research mentor and psychiatrist extraordinaire:


With my proud parents, who have supported this entire journey in every way imaginable:


Ah, the indoctrination begins. This is Brynna with my old Fisher-Price doctor's kit:


We celebrated big-time that evening at one of my favorite restaurants. I don't seem to have those photos (if you were there, and have some, send them to me!) but there was lots of red champagne and Brynna smeared beets all over her face, making such a mess that the very helpful waiter took her tray away to have it washed in the kitchen before we left.

We're Online!

Cute photos to tide you over until we really get our act together (Brynna may in fact be really, truly teething now and is taking up quite a bit of our energy)...

Trying out her new maple-flavored teething biscuits:

(You will note that she is not wearing a bib. Silly Mommy did not realize that teething biscuits create an ENORMOUS mess. Jasper eats his biscuits quite tidily, after all...)

The crazy hat people!


We're wading through our emails and to-do lists, hoping to have the majority of the settling-in (and blogging) done by the time I start orientation in a week and a half. Brynna did very well at daycare again this morning (I want bonus points both for leaving even though she was crying, and for not crying myself). When I arrived to pick her up at 12:30, she was sitting happily on Miss A's lap on the porch, eating yogurt out of a tube. She briefly acknowledged my arrival with a smile but then turned her attention back to the yogurt until she was sure that it was all gone, at which time she agreed to be lifted into my arms. I think she feels slightly gypped that we did not provide her with a big brother before now, as she clearly adores J. The admiration is mutual—he blew her kisses as we wheeled away down the street.

Arrgh!

Still no internet. (Thanks, Comcast. Thanks a lot.) Tomorrow, we hope. And then a bunch of updates!

We are recovering from the triathlon,

Brynna spent her first morning at her daycare today. She seems to really like Miss A and her four year old son J,

And Jasper also did pretty well during his first stay at Concord doggie camp, our across-the-street neighbor.

More to come...