Masochist or just stupid?

I started working with my trainer this week. We met for the first time on Tuesday. She told me we would spend the first few weeks on basics. She wants to stress form while she gets to know me and my limits. I can only schedule twice a week predictably, so we are doing full body work-outs each time.

We did an hour on Tuesday. The first time that I have worked out my muscles in almost 18 months. The worst part for me as always was the ab exercises. Keri (that's my trainer) gave me lots of encouragement, made sure that I wasn't cheating, and let me feel that I was actually accomplishing something. She told me to expect to be very sore on Wednesday, but to work through it by running. I could tell that I had worked out on Wednesday, but in all honesty I have been more sore from bad OR days.

My second work-out was last night. Friday's are easy to book in this town - everyone else has a life and no desire to be at the gym. Keri asked me how I felt after the last workout. This is where I made my fatal error - I told the truth. I knew that it was a mistake the moment I saw the light twinkle in her eye. She had already been way to excited to learn that I had just finished my residency. I think that just means she knows that I am used to being abused and take it well. She then proceeded to beat the crap out of me for the next hour. Getting dressed this morning for work required sitting down to put on my skirt - I couldn't lift my legs high enough. I can barely lift my arms high enough to type this blog. However, I did run today. . . not my fastest time ever, but I did it so that has to count for something.

I need a hug

Have you ever had one of those weeks where you can't put your finger on any one thing that went horribly wrong, but yet you finish the week feeling like you were run over by a bus? I am having one of those weeks, and would really like to get the name of the bus driver than ran me down.

The funny thing - when one really big thing goes wrong, I can usually shrug it off and move on. I tell myself that not everything can go my way and that I should just get over it. It is much harder for me when it is a lot of things - even if they are all individually very small. I go to this place where the whole world is out to get me, and things will never again go my way. (I've never denied being overly dramatic.)

I know in my head that this is just an unusually crappy week. I just have trouble selling it to my heart. It usually helps to get munchkin time, but I can't convince Kris to send Matt and Grace down - some nonsense about school or such. Oh well, I have the weekend to recover - or not. We get an extra hour this weekend so to carry on a 10 year tradition - I am on call.

Great personality?

I have been reading a little about investing and retirement planning. I have spent my entire resident life living paycheck to paycheck. I want to make sure that I make good decisions now that I potentially have a little extra money, and don't spend it all on shoes and clothes.

I ran across a quote last night that made me smile. It is attributed to Sophie Tucker.

From birth to age eighteen a girl needs good parents. From eighteen to thirty-five she needs good looks. From thirty-five to fifty-five she needs a good personality. From fifty-five on she needs cash.

Time to work on the personality.

And I paid for this?

One of the to do's on my "getting a real life" list was hiring a trainer. I want flat abs, but if I can't have them at least give me a little muscle definition somewhere. I am not asking for miracles (I know exactly how old I am) - I just want to be able to show that some effort went into the way I look.

I have a workout room in my condo building, but it is always empty. I prefer that feeling of shared sweat and pain that you get from a busy gym. I also figured it would be easier to meet with a trainer. I did some research, and decided to splurge a bit and join Equinox. In reality, it is not a huge splurge because they give a fairly sizable discount for doctors (who knew that would come in useful someday). The main reason that I picked Equinox is that the trainers there have great reputations - it helped that it is incredibly pretty and located next door to a Jimmy Choo store.

I had my Equifit test this morning. Basically, you meet with you trainer and she/he tests to see how out of shape you really are. They do weight, BMI, body fat percentage, flexibility, strength and VO2 max tests. The theory is to track your improvement in 6-8 weeks. Let's just say I have a lot room for improvement.

My problem areas according to my trainer: body fat percentage of a 50 year old woman, flexibility of a 90 year old man, weak lower back and lower extremities, and asymmetrical upper extremity strength (rt MUCH stronger than lt). This getting a real life stuff is more depressing than I thought.

Rusty

After almost four months off work, I knew that I would be a little "rusty". My friends kept telling me that it would be in the OR, and everyone felt sorry for my first patient. Oddly, it wasn't the OR that concerned me. I was more concerned about getting back into the rhythm of the hospital

My concerns were valid. I had my first case on Monday. Although it was incredibly stressful being the one ultimately responsible, I didn't feel rusty. The OR has always been a place of comfort for me, and thankfully it was no different. Put me in gloves and had me a scalpel and life is good for me. The bigger problem that I have had is all the stuff outside of the OR.

I am struggling getting back into a rhythm with the patient. I have always felt that I had a fairly good bedside manner. I was either wrong, or it has temporarily deserted me. I have yet to feel that special connection with patients that I always enjoyed. I am also struggling figuring out this whole Attending no longer a resident thing. It is a weird line to walk.

The saddest area of "rustiness" - early mornings. For the past 12 years, early mornings were a fact of life for me. I even thought that I had turned into a morning person. Wrong! Four months of getting up at seven and having a slow start to the day have ruined me. It doesn't help that the sun doesn't even rise until 7:30. I literally live on the East coast - shouldn't the sun get up with me?

Oh well, time to get back into shape - in more ways than one.

Fear

I have my first case as the Attending physician tomorrow - two cases actually. Four months ago, I wouldn't have thought either was a big deal. In fact, for the past several years my cases for tomorrow wouldn't have even gotten me to the operating room. They are without a doubt junior resident cases.

Since nothing else going on tomorrow, my Thoracic fellow (way more dedicated than I might have been) is planning to show up to do the cases. Let's recap. I have two relatively simple cases that I have personally performed hundreds of times with an experienced resident. My question - why am I scared to death?

No Prince Charming for Me

The glass slipper no longer fits - for that matter, neither do the blue paisley heels, the red open toe heels, or the black patent leather flats. I have spent the last 3 1/2 months either in flip flops, running shoes or barefoot. It didn't occur to me that there would be consequences. I was just going for comfort.

Last week, my play time ceased. In the real working world, they frown on flip flops - even here in South Florida. As many of you know, I have a "couple" of pairs of shoes. Like most girls who have struggled with weight, shoes were always something I could buy and feel good about. Regardless of the scale, I was always a 7 1/2 medium. I say was because something seems to have happened to my foot. I put on a shoe, and it feels fine when I leave the house, but after 8 hours at work they have transformed into torture devices. Now each morning has become a game of which shoe hurts my existing blisters the least, and where are the new blisters going to pop up.

These are not new shoes. These are not shoes that I haven't previously worn to the hospital hundreds of times. These are shoes that I normally spent hours in walking around the hospital at unnaturally fast speeds for a girl my height. Currently, these shoes hurt to sit in all day. What happened? Did my feet grow? Horror of horrors - did they get fat? This is so unfair. It is common knowledge that your foot really does grow during pregnancy (has something to do with hormones released that loosen your pelvis), but no one told me that taking 3 months off would cause my feet to grow. I am choosing to believe that my feet have grown "soft" with all the vacation, and just need to toughen back up. Hope with me, because I REALLY love my shoes.

Baxter Health Care Plan

Every time I turn on the news these days, all of the talk is about health care. Unfortunately, we seem a little short on plans and a lot long on opposition. As a member of the health care industry, I sincerely hope we as a country don't let this opportunity pass. However, in the meantime, I thought I would offer up my own health care plan.

My plan has very little to do with such silly things as insurance companies, payees, payers, preexisting conditions, and the uninsured. My plan focuses only on Physicians. That's right, it is all about me. For two days now, I have spent what felt like an inordinate amount of time sitting in classrooms. So far, I have learned how to dictate. [If you are thinking, doesn't that just involve talking into a phone? You would be correct. Irony of ironies, I still have another "class" on dictation to go.] I have learned how to use two different versions of an electronic medical record (EMR), and my schedule this week is littered with 7 more computer systems - one more version of an EMR, three versions of computerized order entry (COE), and three versions of electronic radiology viewing (PACS). I haven't even included the VA yet.

This brings me to step one of my plan. "We" should all get together and come up with one version of the EMR, COE and PACS. When I started training, we wrote notes and orders on paper and had hard copies of X-rays. I am not one of the diehards that thinks we should go back to those days, but every hospital even within the same system surely doesn't need a different EMR, COE and PACS. The VA actually led the charge in the "paperless" charting world. The same system is used in every VA in the country. The truly great thing - all the different VA systems "talk" to each other. I can access here in South Florida the operative report for a surgery my patient had at the VA in Alaska. Isn't it a little embarrassing that the VA is ahead of the "civilian" sector?

Also on my schedule this week is not one, but two coding meetings. I have already completed three hours of computerized modules, but now I guess they want to test me in person to make sure I learned something. As a medical student and resident, you learn that chart documentation should be a clear and concise story of what is wrong with your patient, and how you plan to remedy the situation. As an attending, you learn that chart documentation is a legal tightrope of three choices from column A and two choices from column B with careful attention to include certain "key" words so that you don't get charged with insurance fraud.

Step two of my plan, take physicians out of the billing altogether. We the physicians should go back to clear and concise stories followed by well-developed plans. We should not be thinking about including documentation about length of time spent with patient or pertinent ROS. The only key words should be those pertaining to the health and care of my patient. We should do the job we were trained to do, and leave the business aspect to business people.

I concede that it is a relatively simple plan. It includes no "pork" and I have consulted with no lobbyist. I haven't vetted it through the Congressional Budget Office, and am fairly certain that it will not save a single penny. However, the peace of mind to physicians - priceless.

Once you start you can't stop

Once you start you can't ever stop. These are the words my mom repeated to me for the two years I had to beg before she would let me shave my legs. Many of my friends had started shaving around 12 or 13. I was 14 and starting 9th grade before my mom caved.

Her argument - no one could see the sparse blond fuzz on my legs, and she certainly didn't approve of boys rubbing my legs back then. (Wise beyond her years - a guy rubbing my freshly shaven leg a turn on to this day for me.) She kept telling me that shaving really wasn't as fun and glamorous as it sounded. She also pointed out that it wasn't something you could take back. Once you start, she would say, your hair turns dark and becomes stubble. You will be stuck shaving the rest of your life.

I am starting to think that her advice may apply to more than shaving my legs. I have put considerable time and effort into avoiding a "real" job. (I mean who else do you know that did not one, but two fellowships after a general surgery residency? ) I really thought I was ready to grow up and sit at the big girls table. . . that is until I got the call tonight that all is official, and I can actually start work tomorrow.

Am I ready for this? I am pretty sure that once I start down this role of actual responsibility I won't be allowed to stop. Is this another case of the idea being more fun than the reality? Guess we will find out . . in the meantime, I need to go shave my legs.

High Maintenance Hair

I have made peace with my hair - for the most part. Do I occasionally dream of waking up one morning with a full head of thick, luxurious hair with a slight tendency to curl - sure, but who doesn't? I recognize the limitations of fine hair, and am just happy that I at least have a lot of baby fine hair.

All of that being said, I still get very nervous when I have to go to a new place to get a haircut. (One of those limitations is it doesn't hide a bad haircut.) It is becoming increasingly likely that I will actually start work next week, so it was time to hide some fairly impressive roots. . . first impressions and all. I asked around, got a couple of names and set out to find my new hairdresser. I found an incredibly nice lady, who doesn't speak more than two words of English, but we managed well enough.

I left the salon feeling pretty good. I had good color, no roots and as much body as my hair is capable of giving. It was Reese Witherspoon in Sweet Home Alabama, just not quite as blond. It also cost me about half of what I usually pay. Went to bed feeling pretty good.

I woke up this morning with the shaggy, tousled hair of a teenage boy. Not good. I ran a brush through it, and ended up with the hair of the Partridge Family (they all had the exact same haircut so take your pick). Trying to remain calm, I broke out the hairdryer and a curling brush. Two hours later, although not the same as yesterday, I had hair that could be seen in public.

The problem - my idea of hair maintenance is a comb before an air dry. In desperation a low pony tail. I don't currently have the length for a pony tail and the know how for maintenance. I guess baseball caps here I come.

Sold!

They say every girl has her price - turns out mine is a mall. In my defense, it is a REALLY great mall. As many of you know, I have struggled falling for Miami. I tried the beach, the pool, the "strip", and even the museums. I was learning to like it, but still not overly infatuated.

Well that ended yesterday. I have avoided malls since moving here - something about taking an alcoholic to a bar, but yesterday I went in search of Apple and Aveda stores. I needed a jacket for my phone, and conditioner for my hair. I started South of the city in Dadeland Mall. It was okay - it has a Saks, but was arranged oddly. I found my Apple store, but no Aveda.

Therefore, off I went toward Ft Lauderdale and found nirvana . . aka Adventura Mall. Somewhere between Kate Spade and Bloomingdale's - I was in love. This is the real thing not some short-lived affair like the ones in my past. Adventura and I can be happy for years to come. I only walked out with the needed conditioner and a Body Shoppe body butter, but do I have plans once I get a paycheck. This could get dangerous.

On the work note, it looks like the stars might actually align this week. I am now official at 2 of the 3 places, and looks like the last one should come tomorrow. I am beyond excited, but will admit a little nervous. I'll just have to remind myself that money is necessary for shopping.

Made me giggle

The lead off story for the second straight morning on the local news - cold front moving through. With a completely straight face, my weather lady told me to brace for the cold temperatures. The high today is only expected to be a chilly 86 degrees. Now where did I put my parka?