James' Birth Story

I have recommited myself to blogging regularly, as this is the closest thing that I have to a journal. Due to having a new job in a small town plus having a baby, we have decided to move to a different blog address that allows us to be a little more anonymous so that I can write my  feelings without needing to censor my thoughts.

We are now at http://nebraskafans.blogspot.com

I have just posted baby James' birth story! Here's a preview of our handsome little man:

Pregnancy

(This is with my 2 1/2 weeks remaining. Still not my favorite picture, but you get the idea.)

Well, if you didn’t pick it up from the last post, I am expecting a baby boy on May 4th—only 2 1/2 weeks away!! This post was intended to be written much sooner, but we didn’t tell family or friends until I was 16 weeks along, and even then this was done piece-wise because I was still applying for job positions and wanted to avoid any baby news/comments being left on social networks, which may have jeopardized by ability to get a job (yes, legally they can’t deny you a job because you’re pregnant, but discrimination is pretty much impossible to prove).

The first trimester wasn’t very much fun. If the symptom was in the book, I had it (morning sickness is a complete misnomer: it lasts all day). I think the hardest thing about morning sickness was (1) I was in Nebraska City staying at a stranger’s house (the couple is LDS with two kids in college and they’re extremely nice and were kind enough to let me stay with them so we could save on gas/commuting, but it’s hard to hide the discomfort/sickness/etc. 24/7) and (2) I was in school and on rotations [meaning first I felt way too exhausted to study even though I needed to and second, standing in a small room with patients that don’t have good hygiene = torture to the ever-so-sensitive gag reflex]. Cheerios/Chex and jogging every day got me through it. (And the morning sickness lasted until 18 weeks. I don’t know how my sister-in-laws did 10 whole months of this!)

Graduation was when I was 20 weeks. And no, I didn’t take any baby bump pictures because I had only gained 2 pounds and really didn’t look pregnant. I think my PA classmates who didn’t know were quite surprised by the announcement because you couldn’t even tell.

After graduation was a whirlwind of boards prep, moving, and starting a new job. The job never slowed down and so I still have about a billion things on my to-do list before he comes, but we have a carseat and a bassinet so that’s all we really need at the beginning, right?

We are so grateful to be pregnant and expecting our little guy soon! There were a number of years that we wondered if we would be able to have kids and so we’re overjoyed. Even though I mourn my stretch marks, miss getting five or six straight hours of sleep (which hasn't happened since about 14 weeks), and have a lot of anxiety about how I am going to be a working mom, I wouldn’t trade this opportunity for anything in the world.

My New Job

Okay, well I’ve taken quite a hiatus from blogging. I guess it falls pretty low on the priority list; there just seems to be so much to do in so little time.

I took a position in the emergency department in Crete, Nebraska, a small town approximately 25-30 minutes southwest of Lincoln. The population is just shy of 7,000 people and it has a high Hispanic population (there are a few manufacturing/production/meat packing plants). It is the home of Doane College, a private liberal arts school with approximately 1,000
students.

I work four 15-hour night shifts and a 44-hour weekend shift every two weeks, which averages to 52 hours of work a week. Although the hours are less than ideal for myself, it is the best way for Jeff and I to switch off watching the baby without having to spend too much time away. Yes, sleeping is allowed, but I can tell you that I feel a little deceived about how “low-volume” this ER is at night: you normally average about 1.5-2 hours of sleep overnight (This was the CEO's justification for why I work more for less pay...). The other day I got about 30 minutes of sleep the other night. Frankly, I’m concerned about how I am going to be able to keep up this schedule plus take care of a baby during the day, let alone survive doing this for four years and with two or three kids.

As of right now, our game plan is for Jeff to (hopefully) start dental school this fall and since dental school is twice as expensive as med school and he’s almost maxed out his student loans, I would work these night/weekend hours and take care of the kids during the day. This would allow
us to avoid as much debt as possible (particularly private student loans or credit cards). We’d still need to take out some loans (dental school is crazy expensive and I’m super underpaid here—$10k a year underpaid!), but we’re going to try our best .

More about the baby and pregnancy soon!

Graduation

[These are my best friends from PA School. Considering that spent 40 hours a week together for 13 months, they know me and my habits better than most. We made it!]

My oh so supportive husband who was there when I was stressing out, neglecting housework and meal making, and understood when we hardly saw each other during test weeks.

My grandparents were there too, but I guess in all of the hustle and bustle we never got a group picture. Jeff's parents also came, but quickly left after the ceremony to head back west.

Hours of Lecture: 2,500

Hours spent in the Cadaver Lab: 1,200

Clinical Hours: 636+

Patients Seen: 2,000+

Surgeries Seen: 150

Babies Delivered: 60

Sutures Stitched: 1,000+

Hours of Lost Sleep: Countless

Cap and Gown Rental: $70

Months Spent Apart from my Husband: 8

Length of Program: 28 months

Total Cost of Program: $90,000

The Satisfaction of Achieving your Educational Goals: Priceless

Boards is Thursday, January 5th, so instead of feeling like I get to enjoy the holiday weekends, I'm stuck studying all day. I'll post more about Christmas and our future plans after boards is over!

The Job Hunt

I am 1 ½ months from graduation and as exciting as that should be, I feel as though I am in a frenzy to get my to-do list done that I hardly have time to appreciate that there is a light at the end of the tunnel. The first item on my to-do list: find a job. It’s funny how everyone always says that in healthcare you will always have a job, but I think that the fine print to that statement is that it may not be in the field or location of your choice. My classmates that are staying in the Omaha/Lincoln area are also unable to find jobs because there aren’t many out there. If you’re willing to move to rural Nebraska, South Dakota, or Kansas, you’ll have a job. And I’m not trying to be picky; I’m limited because we have to be close enough for Jeff to go to school. Lincoln is the preference, but I would commute to Omaha if I found a job there.

In addition to our geographical requirement, I’ve had some significant concerns about how to reconcile being a working mom with being at home with my child often. I personally think that this is impossible for someone that needs a full-time job with benefits. (And no, this is not an announcement. But the reality of our financial circumstance requires that I will have to work for at least the next three or four years to get started on paying our $220k+ debt and we can’t wait until we can afford for me to be a part-time working mom before we start having kids.) Can I find a job that doesn’t have call? Weekends? Holidays? Long weekdays? What about a job that we allow me to pump? There’s no way we can afford formula and it’s not as good for your child anyways. Will I have to commute and how will that work with childcare? How are we going to afford childcare? Who am I going to entrust to take care of my child? There are many concerns that present themselves for someone who wishes she could be a stay-at-home-mom.

Everyone seems to ask what field I’d like to get a job in. There just doesn’t seem to be a perfect answer, as there are pros and cons to each and sometimes I’m unsure if my trying to find something that will fit my family clouds me from knowing what type of medicine I really love, but I think my top choices are pretty congruent with a good lifestyle/hours. Dermatology and ER are my favorites, but I would really be happy doing anything. I’ve observed that the most important thing about getting a job as a PA is to find a supervising physician who respects you and your knowledge and allows some degree of independence.

ER

-pro: 15 12-hour shifts a month (but don’t let that fool you: that still adds up to 45+ hrs/week)

-pro: pumping would be a definite possibility to squeeze in while waiting for lab and x-ray results

-con: working at a hospital means that you will have to work nights, weekends, and holidays

Dermatology

-pro: a nice 8-5 without call, holidays off

-con: pumping seems far less possible

-con: if I were to get a job with this, I would have to commute 1 hour each way, which equates to 2 additional non-quality hours I don’t get to spend with my child. And it brings to question, do I seek childcare in Lincoln or Omaha?

But at this point, beggars can’t be chosers. And with 35 of my classmates trying to get the same job, I will take any job offer I can get with decent pay and benefits. Sometimes it’s more about putting food on the table and paying off debts than it is getting your dream job. Maybe one day when I have more experience I can afford to be a little more picky, but right now I just need to find A job.

OB/GYN

(This was the best picture I could find. You'd be amazed at how many strange pregnancy pictures come up on Google images...)

[One day I promise I’ll catch up. Maybe I’ll post my previous rotations weekly with some medical tidbits for you.]

I did my second month of OB/GYN in July. I already had my required rotation and this is my primary care elective. I actually tried to get this switched to ER in Omaha or Lincoln, but all of the months until graduation are full and so I did OB/GYN.

My first required OB rotation was supposed to be in Kearney, but after some issues that came up with my preceptor there, I ended up moving back to Omaha. Frankly, it was a relief to not have to live out of a hotel and try to figure out how to eat halfway nutritious microwave meals on a budget for more than a week. I could have done it, but I’m glad that I didn’t. My OB/GYN preceptor in Omaha was cool and let me deliver all of his babies, but since he was Catholic, I felt that my overall experience was somewhat narrowed and limited since he would not discuss contraception or sterilization with his patients.

My second OB rotation was an elective. I had already decided that I did not want to do OB, but since I couldn’t get an ER rotation closeby, I stuck with the OB rotation I had planned in Lincoln and lived with my parents during the week.

I absolutely loved this rotation. I love OB and it is so gratifying to deliver babies and be part of something so special. Depending on the situation, I would sometimes get teary because you got to witness an unforeseen, unexpected immense amount of joy that comes after the misery of labor. It’s such an intimate moment, with normally just the couple in the room, and it’s satisfying to be a part of such a sacred event.

One of the parts that made this rotation so great is that I had an AMAZING preceptor. He truly would be like a second father to me, we just had that great of a relationship. He didn’t let me get away with anything: he set aside 1 hour of his schedule daily (even on his days off) to pimp me and ask me questions. He was a great mentor and let me do everything (operative vaginal deliveries—like using a vacuum for example, repair episiotomies/tears, etc.). And I loved how he would tell the resident to back off so I could deliver (because technically I’m on the bottom of the totem pole as a student). So if you’re ever in Lincoln, expecting a baby, and in the search of an OB, I’ve got a great recommendation. Yes, he’s a male, but he has such respect and love for women that I think he’s more sympathetic and loving than women OBs.

So after this rotation, this would put my totals at (approximately) 30 vaginal deliveries and 25 assisted c-section deliveries.

My preceptor in Lincoln kept telling me to go back to med school because he thinks I’m smarter than half the residents he trains (residents are graduated med students). His comments were flattering but annoying [going to PA school over med school was a choice, not a back-up plan because I’m not smart enough or something]. But I’ve decided that no matter how much I like OB and women’s health overall, I could not solely do it (unless it is the only job I found), because the cool stuff (deliveries, surgeries, etc.) is done by the physician, not the PA. PAs do annuals, paps, birth control, and colposcopies (which is a more intense pap where sometime you remove part of the cervix if the woman has cell changes that could become cancerous). Not too exciting, nor gratifying.

A few things you may not have known: [Warning, this contains what would be considered private/personal feminine-type things]

-If you think you have heavy periods, you can pre-dose some Ibuprofen the day before and the first 2-3 days of your period. This will decrease the blood flow to the lining of your uterus, thus resulting in decreased blood loss (and less cramps too). If this still doesn’t do the trick, there is a new pharmaceutical available (but it’s crazy expensive)

-The best way to induce labor or ‘ripen’ your cervix: intercourse. The semen contains prostaglandins (i.e. the chemicals in your body that make you feel pain and accompany labor) that may speed up your labor

-If you don’t get a period every month (and you don’t use oral contraceptives or have a Mirena IUD in), you should see your doctor about inducing periods. Not that anyone likes having periods, but not shedding the lining of your uterus monthly predisposes you to endometrial cancer

-The most cost-effective permanent sterilization is having your hubby get a vasectomy. It is much more expensive (and invasive) to get your tubes tied or an Essure placed (spring-like wires that cause your fallopian tubes to scar over so sperm can’t reach your eggs)

[And after much consideration, I will eventually be changing our blog URL address. It would put me at ease to speak/write my mind (especially now that I am looking for employment) if I did not have an address that is easily connected to my identity. So if you have any suggestions for an address, let me know!]

Emergency Medicine

I spent the month of May in the lovely town of Scottsbluff, Nebraska doing my emergency medicine rotation. It was a lot of fun to be able to see a variety of conditions. I was hoping to see more trauma (I really like the blood and guts), but I guess a small town in western Nebraska doesn’t have too many gunshot wounds or stabbings.




I was able to stay with my brother and sister-in-law and their six children. It was a little crazy (and I was happy to return to my regulated little apartment), but I loved being able to have time to spend with them. I got to go to a nephew’s graduation, be there for a niece’s birthday, and spend almost every evening reading bedtime stories and brushing our teeth together. [Would I live there? Definitely yes: I loved have something scenic to look at while running, the wide open spaces, and Johnny and Jessica live there. The city is big enough to have two LDS wards and even a Target! If we could get a deal with Jeff getting his loans paid off, we would do it (I think we would go anywhere, since we are in loads of debt and will likely triple our current debt by the time all is said and done)]

What I loved about ER:
-Variety
-Stitching, stitching, stitching (I think I’m a pro at suturing)
-Trauma (the blood and guts stuff: elderly falling with no visible cuts is far less exciting)
-Quick Pace
-Hours (It is shift work, meaning you work 12 hours shifts and don’t have to stay after unless you have paper work to finish. Unlike clinic, where you’re essentially putting in 10-11 hour days because you have to dictate (document) in patient charts, you chart during your shift so you can normally leave. This is pretty ideal for someone like me who’d like to have time at home with the kids but will have to work full time.)
-No Follow-up (meaning once they leave the ER, they aren’t your patient anymore. This is nice because you get some very needy patients and the unlucky family practice physician has to deal with them all of the time)
-The Funny Stories. Sometimes the reasons people come into the ER are pretty ridiculous but what is even more funny is the story they give you about what happened. Wait, how did you get a cucumber stuck up your butt? :)

What I didn’t love about the ER:
-Drug Seekers (you know, the people who come in with “pain” who really just want narcotics)
-Overnight Shifts [the worst was getting pimped (asked questions) by the physician at 3 o’clock in the morning. Seriously? If you wanted a decent answer, you should have asked when the shift started]
-No Follow-Up (meaning you never know what happens to the patient once they leave the ED or get admitted to the hospital. To look it up would be a violation of HIPPA or patient privacy)
-Definitive Diagnosis: essentially in the ER you always get an x-ray or CT scan (both to cover your butt and to determine the diagnosis). This is nice because you almost always know what it is (or isn’t), but sometimes when discussing what I thought it was based on the clinical presentation, I would get the “well let’s just see what the scan shows.” Don’t get me wrong: you still have to use your knowledge base to rule out different medical conditions, but sometimes it’s a bummer to “wait for the radiology results”.
-Malpractice: this is a problem in every field, but especially in the ER because you don’t want to miss anything. If a lady comes in regularly for migraines but you miss the one time she comes in for a stroke, that’s a lawsuit. So you always have to step lightly.

A few notes:
-In the medical field, we actually call the ER the ‘E-D’, which stands for the Emergency Department. This was changed because it would sometimes get confused with the OR (operating room)
-If you are going to go to the Emergency Room, it is very expensive (you have at least a $75 co-pay at the door, the hospital facilities fee (~$200+), the physician fee (~$200+), a scan [X-ray or CT scan] cost (up to thousands of dollars), and radiologist fee (the physician that reads your scan in much better detail), so that comes to about a $500 minimum. So I would recommend you try to get into your primary care physician/pediatrician first or urgent care as a second if you want to save money.
-When not to go to an urgent care: a lot of bleeding (a very deep cut that may have gotten your blood supply), a possible broken nose (you have to get a CT scan), an eye injury (a bleeding, possibly broken bones eye: getting something stuck in your eye or scratching your eye while taking out your contact can be handled by your primary care), most car accidents, broken bones (they will not typically set or cast them)
-When not to go to the ER: if you have a chronic problem, then it is not considered an emergency and so you’re paying a lot of money to get nothing done. For example, a lot of people would come in with chronic knee pain and we really didn’t do anything because what they need is an MRI, but since it’s not an emergency, we can’t order/schedule it.
-If you are to dismember yourself (may none of us have to experience this), you should always bring the other half to see if we can salvage it.
-Getting stabbed is a terrible result of road rage. Don’t tail someone who cut you off—it never ends well!

Everyone I talk to always asks me what my favorite rotation has been and what I want to pursue when I graduate (which is coming up in December!). It is hard because every specialty has its pros and cons and I’m also trying to take into account the flexibility and the potential of me working part-time in that field (when one day we can afford for me to be a halfway stay-at-home mom). So here’s my short list thus far:

-Emergency Medicine
-Dermatology
-Inpatient Medicine (hospitalist)
-Surgery
-Pediatrics

And as it is my week of summer break, I hope to be posting more about rotations and just life in general soon!