Blog Post List

“I just watched her… suffocating.  In her own fluids. I kept asking if she wanted more help, if she wanted to go on the ventilator and all she was able to say was, ‘No’.   I don’t know what to do, M.  I don’t know how to help her.  I can’t… I can’t watch her suffer anymore.” Pixelated tears turned into currents streaming down the face I’ve loved since I was 13. We’d been through ...

“I know that name.  Let’s grab that one.” Scanning the list of patients waiting to be admitted, I watched as my scribe added this particular patient to our list.  As much as I had wanted to emotionally divorce myself from my panel of patients when I was still in primary care, I couldn’t stop yearning for the continuity of care I once had. What happened to S after I discharged them from the hospital?  Did ...

“So… who’s looking for a new job?” We scanned each other’s eyes over the Zoom screen, as if the miniature windows of these four pixelated beauties could reveal any hidden truths. Nothing. Taking a sip of my pinot gris, I soaked in the uncomfortable silence. Conversation was always going to land here.  Months spent on Slack commiserating over this foreign new world of startup culture, complaining about our ineffective EMR, griping about entitled patients – ...

“Well this was a useless appointment, wasn’t it?” As I watched W struggle to contain his hostility, I registered the absence of mine. No rise in heart rate.  No sweaty palms in my violet, nitrile gloves.  Not even an eyebrow raised in response. Nothing. This is it, M.  You have officially run out of shits to give.  Welcome back. Maybe it was the previous 15 COVID testing appointments running on 10 minute increments.  Perhaps the ...

“Where do you want these plates?” “Oh my gosh, M.  Put them down!  You don’t need to help us unpack.” “I know I don’t need to, but I want to.  Besides, that’s J’s and my thing.  We always help people move into their kitchens.” Holding up a blue ceramic plate, I looked around N’s new, white cabinets.  Her hand-picked pendant lights hovering over the kitchen island.  Granite counters with the shiny specks she wanted.  Months of planning had ...

“What’s even the point?” The receding hairline my gaze had fixated on during X’s minute of silence rotated toward the ceiling.  Now his black mask faced me, darkened from tears flowing down his cheeks intermixing with the stream of snot he was choking on.  Restless hands pulled at the tissue I’d given him 5 minutes ago as X questioned whether or not it would be ok to blow his nose in these COVID times. My ...

Early riser. As I pulled myself out of bed to turn off my aptly named iPhone alarm, I shoved down the existential dread awaiting my arrival. This was it.  After weeks of digging into everything Coronavirus related, from physician Facebook groups to non-peer reviewed articles of case studies with n=3, I was heading back into the hospital to face this new reality. But it could wait. Standing in the dark, I listened to my two ...

“I’m thinking of picking up more shifts.” “Yeah?” “Yeah.” Scanning for J’s expression on my screen, all I could make out was the pixelated outline of his face.  His iPhone 6 camera was so old, even in the best light his face was grainy.  But I didn’t need to see his face to know he was not pleased. At this point, he’s probably not happy with any of the decisions you’ve made in the last ...

*BEEP BEEP BEEP* Cursing the shrill blast of my pager, I quickly pushed the button to silence the antiquated device and read the illuminated message. “Please come to room 521, patient would like to talk about curative treatment.” Unexpectedly, a surge of frustration overpowered me.  I was just in that room 20 minutes ago.  Calling back the nurse, I shoved down the urge to hulk out.  Obviously, he didn’t know I had already seen the patient… this ...

“I’m an adult!  If I want to go out for a smoke, then I’m going to go out for a f*cking smoke.  And if I’m going to be out there anyway, I might as well just leave the hospital because you’re not doing a g*ddamn thing for me anyway!  Useless!!  All of you!!!” With every sentence, G’s pointed finger punctuated the air like a frenzied orchestra conductor.  His eyes bulged so intensely, even from across ...

“If it helps you and the team with your moral distress, I’m happy to touch base with you again in the future.  Is there anything else you’d like to discuss?” Massaging my temples, I felt the underlying muscles tense as I clenched my jaw to prevent some choice words from coming out. No, I think you’ve wasted more than enough of my time today.  Thank you for showing me how incredibly unhelpful an ethics consultation ...

“I’ve never told anyone this… not even my wife.” As I started to give W a reassuring smile to gently encourage him to continue, I quickly realized he wouldn’t be able to see it past the yellow mask obscuring half my face. Not that it mattered anyway.  Tears dammed up over the last 12 years started to fall into the therapeutic silence carved out for him as his gaze settled beyond me.  The internal struggle ...

“FYI, 643 refusing am meds and all cares.  BP 178/70.  Please advise.” It’s not even 7:30 am yet and this is the 5th page.  I guess this is just the day we’re going to have, M. Picking up my travel coffee mug, I searched for even just a few last drops of black coffee but there were none to be found.  Just enough left to taste the bitterness. Maybe it’s actually the aftertaste of you ...

You weren’t even alive long enough for me to see your face, little one. But I remember every detail. The overhead page for a pediatric rapid response team to the main lobby. Running into the pediatric social worker as I stepped out of the stairwell, casually adopting her stride as we were pointed outside to the SUV idling in the hospital’s driveway. Arriving to your mother’s screams as she tried to bear you down into ...

“I see you went with the Half Windsor.” “Yup.” Looking up to meet A‘s seafoam green eyes, I watched him calculate my smirk. How long ago was it we were debating the downfalls of the Half Windsor (wonky) versus Full Windsor (too full for a skinny tie) versus the Eldridge which was too much for A to even bear to look at? Before he quit as my scribe 8 months ago, I had tried to ...

“I know you joke about going back to retail if you quit medicine, but I can’t really tell if you’re serious or not and I can’t gauge your reaction over the phone. So what are you going to do, M?” Letting the silence linger on while I pondered my answer, I was struck by the bizarre series of events that led to this conversation.  How had HD moved from handing out rambling snippets of life ...

“Robert*!?  Where are you, Robert?  Why aren’t you here?” “I’m here, honey.  Right here.  See?  I’m holding your hand.  I’ve been here all day.” “Robert!  Where are you!?” Beads of sweat coalesced on W’s chest as she frantically tried to prop herself up in bed.  Trying to hide my grimace as I imagined the new skin growth on her elbows roll up like wet pieces of toilet paper from the friction, I sensed her daughter ...

“M… I gotta tell ya, this has been the hardest week of my attending life.” Sitting in the hospitalist work room, I watched the adonis before me shrink into the back of his ergonomic work chair, as if it were the only thing keeping him upright. Dr. T A young attending in his first year of full-fledged doctoring after residency with the frame of one of those towering Greek gods from Xena, my beloved childhood ...

“Dr. M… so glad I caught you before you walked into that room! Be prepared for A LOT of questions about vitamins and supplements in there. Husband hasn’t stopped complaining about all of the ‘horrible food’ at the hospital since you left the room yesterday.” Suppressing a sigh, I tried to barricade yesterday’s hour long discussion about how we were all trying to poison his wife from ruining my day. Again. “You are literally asking ...

Death by a thousand clicks. I could feel the anger start to boil over as I painstakingly built my new 80 year old patient’s chart in the electronic medical record. *Click Past Medical History* Type in hypertension. *Click* What kind of hypertension?  Renovascular hypertension?  Essential hypertension? *Click essential hypertension* Hypertensive emergency?  Or just urgency?  Or well controlled? *Click hypertensive emergency* *Click accept* Problem #2: Type in chest pain. What kind of chest pain?  Angina?  Musculoskeletal?  ...

“I think I’m done with medicine.” Finally uttering the words that had been on my mind since my last stretch of work left me with such a sense of relief. Followed by immediate regret. This was not the forum for this discussion – girls brunch which included someone I had barely met. That was a mistake, M. You know she’s a nurse… you just opened up a whole can of worms you don’t want to ...

“They haven’t found what’s wrong with me yet.” “Well, that’s what I’m telling you, Y. These doctors don’t know what they’re doing.” Catching the end of the conversation as I entered the hospital room, I took in a deep stabilizing breath. This was not going to go well. Punctuating the air with air quotes, Y greeted me. “Well hello, Dr. M. Did the cardiologist tell you his ‘good news’?” “They can’t find anything on the ...

“So before we get this meeting going, I just wanted to announce that J will be going part time, effective May.  We’ve hired N to take over his role as demand planning manager and they will work in tandem until she gets up to speed.” Murmurs on the other end of the conference call blared through my husband’s work computer speakers. “He’s doing it so he can spend more time with his wife.” Silence. Interesting… ...

“You ready to change your first diaper, daddy?  I’ve been waiting to record you!” Grandma jumped out of her seat, phone clutched in her hands.  The hot pink glitter case gleamed, ready to capture this momentous occasion. Halting my physical exam of his 12 hour old baby, I looked up at dad’s terrified face as he looked down at the black mess I revealed when I undid his daughter’s diaper. “Oh my God.  That’s not ...

“How are you feeling today, Mr. B?” “With my hands!” “Can you tell me your full name?” “B.D.” “Great! And where are we right now?” “I’m in my chair! Where are you?” Pleasantly demented. That’s how B was described in the initial history and physical, and it held true on the 3rd day of rounding on him during his hospital stay. Every morning we danced this dance – me asking the same orientation questions to ...

“I’m happy that you’re moving on to new things, Dr. M.  I just wish you’d still be around to see me get better.” Sitting at my new hospital cubicle workstation, O’s hoarse voice rang out in my ear as her obituary on my screen sucker punched me in the gut.   While I was gallivanting around New Zealand last month pondering what my transition from primary care to hospitalist medicine would bring me, she was contemplating ...

“Today is your real orientation and I promise, we try to be efficient.” I nodded my head in appreciation as the hospitalist administrative coordinator picked up a folder with Dr. M neatly scrawled on the right hand corner. “First things first, here’s the important checklist stuff.  This is the envelope for the “fun fund” – we all pitch in for birthdays, anniversaries, baby showers and whatnot.  Because God knows we need things to look forward ...

“You won’t believe what you missed on your nap!” A little disoriented from waking up in our campervan instead of our bed after crashing from our intense Roys Peak hike, I tried wiping the sleep from my eyes as J excitedly continued with his tale. “These tourists rolled up to the rope swing over there and started taking pics.  How long is too long to pose for the perfect shot?” “I don’t know… 5 minutes?” ...

“Be happy!” J yelled out as he pointed his phone down at me. If he says that one more time… I’m going to strangle him. “Just how many pictures are you going to take?!” “Of you struggling? I’ll stop when it stops being funny! Remember, this is what you wanted! You only have yourself to be mad at.” With that, he spun on his heels and resumed his ascent up the 45 degree incline toward ...

“So how do you feel?” “…I don’t know. It hasn’t quite set in yet that I’m never going back.” The last 24 hours had been the longest, yet shortest day in recent memory. After saying my last 14 goodbyes, I had spent an additional 2 hours crossing every t and dotting every i to make sure I left in the best way possible. Reality was a stark contrast to what a friend had thought I ...

“It’s your last day, Dr. M! I couldn’t remember if you liked almond or soy milk, but I got you a soy caramel macchiato!” Parked at my work station, I spied my sugary coffee treat in front of a stack of cards, gift bags and succulents. “Thank you! I’m going to need ALL the caffeine today… what’s all this?” “Oh, just a little something from us, and your patients have been coming by to drop ...

This is so painful.  How long has it been, like 30 minutes?? Glancing at my phone, the digital clock read 3:15 pm. Damn.  Only 10?  I don’t think I can do this. My gaze spilled over the Neonatal Resuscitation Program textbook splayed out in front of me, my illegible scribbles in the margins serving as a reminder of how much I was failing to remain engaged.  Even forcing myself to write out MR SOPA wasn’t ...

My friend, I remember being where you are, feeling like there wasn’t anyone who could possibly understand the darkness I found myself in. The isolation. The inability to explain the full weight of what I dealt with as a primary care physician every day to my very well-intentioned non-medical tribe. The difficulty reconciling the knowledge that I was “living the dream” but in reality was merely existing in a living nightmare, my own personal hell ...

“So I heard you’re leaving…” “I am.” “When?” “My last day is February 1st.” C shrunk into himself as he centered his gaze on his worn hands.  After 10 seconds of silence, he finally sighed and looked back at me with eyes that hadn’t known true rest for the last 6 months. “It’s hard to start over, you know?  I don’t know if I can tell someone our story again.” Nodding my head, I looked ...

“My new schedule is going to be 5 days on, 5 days off!  It’ll be like a long weekend every other week, Papa.  J and I are thinking of getting a camper too.. maybe go on those national park trips we’ve been talking about.  There’s so much out here in the Pacific Northwest.” “Mmm hmm…” Oh boy.. you know that sound, M.  Wait for it… One second.  Two seconds.  Three. “Sounds nice.” “Oh, just spit ...

What an epic last full week of 2018! Christmas Blog anniversary: 12/26/18 My birthday! As a child, my parents had to make a hard choice with what to do with a Christmas adjacent baby: Celebrate Christmas and my birthday separately Fuse both celebrations into one, hereby creating Birthmas Since my Papa was the original Scrooge, I mean minimalist, he came up with a third option: NO celebrations Due to my scripting (I’m supposed to blame ...

Rounding the corner back to my office, I spied A with his black rain coat on and immediately felt burdened with a heavy sense of knowing.  His smile (or was it a grimace?) seemed forced as our eyes locked. “Leaving?” “Yeah.” “You have all your stuff?” I glanced at the Bates’ Guide to Physical Examination and History Taking textbook clutched in his hands.  “Here, take this,” I said as I handed A the old relic from my first year ...

Click on these links if you missed out on: Act One and Act Two “When do you want to see me again, Dr. M?” “Well, everything’s looking pretty stable in terms of your diabetes and high blood pressure –  6 months should do it.” “Great!  Have a Happy Thanksgiving and Happy Holidays – I hope I don’t see you til then!” Helping my patient shrug her coat on, I held my tongue as I recalled the ...

If you missed Act One, click HERE for the first part in this three part series. *** “Soooo.. I got the contract today.” “And… ?” “Well, I couldn’t just sign it at lunch without you there, of course.” “Ok.  So what’s stopping us from doing it now?” You, M.  You’re standing in the way of progress. “Well… we’re walking the dogs currently.  Can’t do it right now.” J shook his head knowingly. “You know, you’re ...

“I need to figure out what I’m going to wear.  Are grey pants with a black blazer too different?” J looked at the outfit I had assembled on a hanger, confused. “It looks like a suit.  Why would that be too different?” Images of hordes of medical students in the same black suit being shuttled down the hall for residency interviews came to mind.  The advice given to me in my 4th year of med school ...

“Give it to me!  I got it first!!!” “NO YOU DID NOT!  I grabbed it off the shelf first!” “This Elmo is mine!!!!!!  Bob, tell her I got to this first!” Bob looked like a man who wanted to disappear into his turtleneck. “Come on, Nancy.. it’s a toy.” “DON’T TELL ME IT’S JUST A TOY!  THIS IS A TICKLE ME ELMO!!  AND IT’S MINE!!!!” Shaking my head as I walked away, I assessed the ...

Last week, the prolific Xrayvsn reached out to me on Twitter and asked if I would be willing to represent the Millennial generation in a 4 way cross-platform collaboration, looking at medicine through the eyes of different generations (click on the links to get to their posts): Baby Boomer via Hatton1 Generation X à la Xrayvsn Millennial Doctor Resident Physician by way of Wall Street Physician My first reaction was ,“This is an awesome idea!”, immediately followed ...

“Doc, I’m tired of this.” I looked at V’s wan face.  The vibrance that I adored had been sucked out of her over the last 9 months by chemotherapy and radiation.  I remembered the moment she cried in my office, angry I hadn’t been the one to tell her that her breast cancer had returned everywhere. Now she couldn’t muster up any emotion – no tears, no anger, no frustration. Just tired. She was coming in ...

One of the best things about starting this blog has been hearing the stories of my readers who’ve taken me up on my offer to start a conversation, reaching out to me to commiserate and exchange words of encouragement.  It has been my greatest joy from this whole experience, and it encourages me to keep going every week. On the day that High Plains MD (formerly known as Frontier Doc) fully told me his story, I ...

Okay M… you can do this.  Live just one little checkbox at a time. I looked at the 63 med refills waiting to be addressed on this Monday, marveling how quickly they accumulated after just 2 days over the weekend. Just batch them per patient.. now magically 63 refills become just 30! Shaking my head at the mind games I had to play to keep myself from slamming down the laptop screen and walking out, ...

“I’m going to get you a Starburst, Dr. M.” “No, you really don’t need to do that.” “Ok.. but what kind of Starburst do you want?” I shook my head at my scribe, A. “You’re really sweet… but I’m good.  We just need to make it through the morning.” I took in a deep breath, steeling myself for the onslaught of questions from a woman who was pretty sure she had a brain tumor.  After a ...

“I keep a jar of nutella by my nightstand.  Every night I take a spoonful, then brush my teeth and go to bed.” “Are you being serious right now?!?” “Yes!!! It’s soooooo goood!” “You know I’m going to tell you to stop that, right?” “I know.  But I won’t.” Sigh. “What if you just kept the nutella in the kitchen?” “No.. because then my granddaughter will find it and eat it.” “Maybe you both shouldn’t ...

Standing in my white coat with his hand on my chest, I thought to myself, “Is this really happening right now??” T, an unfortunate man who suffered from a stroke in his early 50s, came in with his daughter for his annual physical. As I reviewed his chart before entering the room, I remarked to my scribe, A, “This is why we screen for cholesterol elevation in young adults with strong family histories of heart ...

“I love my doctor!  She’s the best.” “Aww.. thank you!  You’re going to set some unrealistic expectations for him from the get-go… see you next time!” Turning to A, my new scribe, I pondered out loud after exiting the room, “I don’t know what it is about having you here, but all of a sudden people are coming out of the woodwork saying nice things.  It’s to fill the awkward silence of having someone new ...

“M, what do you think about a scribe?  You said you’d be open to that in the past, and I have just the guy for you.  He’s the son of a friend, and he wants to get more clinical experience before he applies to med school next year.” My partner looked expectantly at me, waiting for my response. “What’s his background?  Pre-med?” “No.. an engineering background.  So you’ll have to train him, but he’s a ...

Rounding the corner from the offices to the shared workstations, I overheard my medical assistant talking to a patient on the phone. “Yes, we have received your message about your Klonopin, and we will have the on call doctor sign it when she gets a chance. Yes, I know this is the 3rd time you’ve called this morning.  But we only have 2 providers in today, and she will get to it when she gets ...

8:23 am *Buzz buzz* Rolling over in bed, I grabbed my phone and saw an incoming text message alert.  (S/n: One of my greatest joys since finishing residency is staying in bed for as long as I want on the weekends!) “Hey M.  Check out this quick read and the comment after the post.  I think he’s dissing you!” Intrigued, I quickly made my way through a fellow physician FIRE blogger’s post which I thought actually ...

“M, I love the blog.  Everything you’ve written!  You’re just saying what we’re all thinking.” Friends from residency who had reunited to celebrate the nuptials of one of my old Med/Peds interns wanted to talk about the blog.  It was a bizarre collision of past relationships now intersecting with the future.  In my mind, these people were still my interns and I was still the senior resident. And I was setting a really horrible example of what ...

How is it possible to gain 25 lbs in 4 months?! I shook my head in frustration as I looked at the 13 year old girl’s growth chart I was just about to see.  Or rather, the data point way above the 99th percentile growth curve. How many times had I talked to H and her mother about limiting the cookies and chips?  How many more times will I have to say that regular, plain ...

“I’m sorry. You probably weren’t expecting to see a grown man cry today.” Echoes of a conversation last summer came back when Q’s name popped up on my schedule. Though it had been almost a year since we last met, I remembered that appointment vividly. Q was a healthy guy in his mid 40s who only came in when he threw out his back. “I keep forgetting I’m not in my 20s anymore,” he’d say ...

Sitting at my parents’ dining room table, I stared at my closed work laptop. “Why did you say you’d check in daily on your vacation? This is what it feels like to be a hypocrite… so much for actually taking a vacation,” I said to myself as I regretfully opened up the laptop. “Vacation” mode I was back home in Michigan to attend a residency reunion in the form of a residency friend’s wedding, as ...

“I’ll see you in 6 months, ok?” I said as I exited the patient room. Flashing a smile, I waved goodbye and turned to see my 4 medical assistants huddled around the closest workstation. All staring at me.  Imagery of hunters circling their felled prey before they delivered the final death blow flashed in my mind.  Sympathy intermixed with indecision as to when exactly was the right moment to strike. “What…. ?” I asked, a little ...

Since launching the blog on 1/1/18, it’s been a wild ride. I never dreamed anyone would read this other than old friends/acquaintances from med school and residency.  I didn’t stop to think about the impact of my KevinMD article: Should we encourage people to go into medicine? being shared 5,000 times, or that one of my favourite bloggers The Happy Philosopher would ask me to do a guest post on his blog about my own burnout ...

“You need a mentor,” an old friend from residency visiting from out of town said to me. “Mmm..” came my usual monotone, noncommittal answer. “I’m serious!  Who can you talk to about your burnout issues!?  Anybody at work?  Everyone has a mentor.  I have a mentor!” “Yeah, but you’re still in fellowship.  You should have someone to help guide you through your career goals and research all that stuff you specialists do.  My situation is different.” ...

As I’ve been going through my stuff looking for things to throw out for my 30 days of Minimalism challenge on Instagram, I happened upon a gift my patient S gave me on my last Internal Medicine clinic day of residency. Memories came flooding back “Are you staying in town after residency? Can I follow you?”, S asked me with hopeful eyes, set back in his sallow face. S had been a patient of the ...

While I’ve been researching various ways to get myself out of my current job aka mindlessly scrolling on Facebook physician groups in search of ideas to jolt me out of complacency, I’ve had an epiphany: Most of the people active in these groups are women.  Why is that?  Are women just more active on social media than men? As I paid more and more attention to the common threads of their posts and comments, I ...

Last March as I was preparing to do my taxes, I found my Goodwill receipt after a closet purge around Thanksgiving last year.  I had donated: 30 shirts 2 dresses 5 pants 4 skirts 3 sweaters 1 pair of jeans 2 shorts 12 pairs of shoes I remember thinking as I was collecting these items how insanely lucky I was to have so much excess.  The thing was, this was my second go through my ...

Last Sunday, I rolled out of bed and got ready to head into the hospital to round.  I was excited to do my favourite part of my job – I was going to be one of the first people to welcome a new baby boy into the world, on Mother’s Day no less! I love the ooohing and aahhing that comes with marveling over a new life.  I relish the sigh of relief when I ...

“Hey M, you’ll get a kick out of this,” the nurse practitioner I work with said to me last week.  “I saw one of your patients when you were on vacation last week and she said the funniest thing.  She was upset that she was seeing me for the appointment and said, ‘I can’t believe I can’t depend on my own doctor to help me when I need her!  I think I might have to find ...

Monday: 6:45 pm The phone rings.  Caller ID: J. “Hey… are you on your way home?” “Yeah.  Just a few minutes out.” “Late day at work?  Everything ok?” “I’m fine.” “Ok… I guess I’ll see you when you get here.” After going through pre-med, med school, residency and attending life with me, J knows the tell-tale warning: “I’m fine” almost never means I’m fine. As I came through the door, I could smell hints of ...

I have a confession to make. Last Wednesday, I spent the entire morning planning my escape from medicine. I don’t even know how the ball started rolling, but I found myself lost in the math trying to figure exactly how little I needed to live on.  I’ve long known the 4% rule – if you can live off of 4% of your total investments, you could presumably retire. Are you good on $40,000/year?  Your number ...

This was my second week of going down to 4 days a week in an effort to work my way through burnout.  But that’s only one piece of the puzzle. I talked about needing to refocus on restocking my joy fund in a guest post on Worthy, excerpt below: If you’ve already read that post (thank you!), I’ll get to the good stuff now: How will I restock my joy fund? I’m going to start ...

Since being out of residency for the last 3 years, I have marveled at how much my training didn’t prepare me for the real world.  Most of my medical training was hospital based – I know how to manage someone’s high potassium levels so their heart doesn’t stop, how to stabilize someone’s ulcer from bleeding them dry and how to adjust insulin levels on a sliding scale. In the clinic setting, these are not my ...

The last week has been a little surreal. My KevinMD post: Should we encourage people to go into medicine went viral in a way I hadn’t anticipated with more than 2000 shares! It’s been a roller coaster of conflicting emotions: Happiness that my writing resonated with so many people Horror that someone called me a “thought leader” for the millennial generation Guilt for making people in med school/residency aware of their regret for going into ...

I did it. I cut back today.  Again. I marched into my office manager’s office and declared, “I need to go back to 4 days a week,” daring her to tell me I couldn’t. Instead, what I got was, “Ok.  When would you like that to start?  2 weeks or 3?” Well, that was a bit anticlimactic. It just shone a spotlight on who was actually holding me back. It wasn’t my work.  It wasn’t ...

“You’re all F****** idiots!!!  I’m going to report Dr. M to the state board and get her medical license revoked!  You’re just after our money, trying to make us come back to get re-examined again!  You’ve just lost four patients, you F****** M************!!! … To repeat this message, press 7.” I sighed, handing the phone back to my medical assistant. “Well… I guess just try to document that in a phone encounter and censor it ...

For the last week and a half, I’ve been lost. After experiencing compassion fatigue and realizing I wasn’t even close to pulling myself out of burnout, I’ve been racking my brain trying to rethink my situation yet again. I reached for my old faithful habits.  I became more consistent with my lunchtime mindfulness sessions and re-instituted exercise, yoga and hiking.  I even went phone free for the weekend, though admittedly this was totally unintentional.  Without the ...

After my work related lunchtime rant last Friday, I arrived home and made a beeline for my fridge.  Waiting for me were delicious Kona Koko Brown Ales, ready to embrace me with open arms.  As I popped open the top and took a sip, I pushed away intrusive thoughts, “You know, doctors have high rates of alcoholism.  You don’t want to start a pattern.” “Think of the calories!!  You were doing so well with your ...

I’ve been ready for it to be Friday since Monday afternoon.  It’s been a trying week, and as I came into the office this morning, I was readying myself to make it til 5 o’clock through sheer willpower.  I charged up my computer and opened the electronic medical record.  Welcoming me were 10 online messages from patients sitting in my inbox from overnight, some of them sent at 2 in the morning. I sighed, knowing ...

Today, you came to me with a chief complaint: Right breast lump. You told me you’ve only been aware of it for the last 3 weeks.  Your eyes told me your terror of not realizing it was there sooner. You told me there wasn’t a history of any breast, endometrial or ovarian cancer in your family.  But you held back that you knew there isn’t always a family history. You told me you had a ...

When I first started working in my primary care clinic after residency, I was adamant I was NOT going to prescribe long term narcotics. Unless you’ve been living under a rock, I think most people are aware of the opioid crisis that is storming across America. I’m talking about Oxycontin, Morphine, Norco, Vicodin, Percocet, etc. During training, I already had my fill of drug-seeking patients in my residency clinic, ER and the hospital – there ...

Recently, a friend of mine approached me and asked if I would help her with her MCAT studying.  She would be a non-traditional med school applicant after taking a few years post pre-med to do great and wonderful things, including organizing cancer research at a local academic centre.  Because of a few gap years, she felt the need to ACE this standardized test to prove she still has the academic chops to both herself and ...

This horrendous cold and flu season has been an exercise in running on auto-pilot.  Running from room to room every 10-15 minutes has been a blur of declaring, “Virus – no antibiotics needed.  Virus – no antibiotics needed.  Ear infection – here’s your amoxicillin.  Flu – Tamiflu sucks and you’re going to feel like dying for the next 7 days, sorry.  Maybe take me up on the flu shot next year.” This was my life ...

A recent comment on one of my posts stopped me in my tracks – “Thank you for your positive reflections.” Whoa I don’t think I’ve ever been told I’m a positive person.  Like EVER. In fact, when I was a senior resident on my adult ICU rotation, I vividly remember one of my interns telling me I had a black hole where my heart was supposed to be.  I think the words used were, “It’s ...

Papa, There has been a lot of talk about immigrants on the news lately, which has made me start thinking about your story.  And I have a lot of questions. Did you ever dare to dream within one generation, you’d move from being a rice paddy farmer to your daughter being a doctor?  When you looked through the half built thatched roof next to your paddy, how did you have the audacity to reach so ...

Welcome to February How are you doing on those New Year’s resolutions? Have you started losing those pesky 5/10/25/50 lbs yet? Have you turned into the gym rat you knew was living in you all along? How about decreasing your time wasting on social media? These are just a few of the resolutions my friends and patients have told me they planned to work on at the turn of the year. But, the stats show ...

As I type this, I’m enjoying coffee and an amazing breakfast sandwich at Kitchen Sink Food + Drink in Portland, OR (shout out to women owned businesses!). On my to do list today was: Sleep in Walk the dogs Yoga with Adriene Breakfast: Chorizo egg sando, coffee and most importantly, a stout with a miso brown butter cookie It has been one of the best days I’ve had in a long time. I do intend ...

Today, on this Saturday morning, I drove into the hospital to do one of my favourite parts of my job:  Newborn rounds.  As I was oohing and aahing at this beautiful new baby’s full head of hair, mom smiled at me and asked, “Do you have kids?” “No, not yet,” I replied with my usual canned response. “Oh.” The dynamic in the room quickly changed The warmth was sucked out of our interaction as I ...

Most people in their 20’s and 30’s assume they’re going to wake up tomorrow.  They believe they’ll get to make good on their plans a few weeks, months and even years from now.  Death is a thing that happens to old people, therefore, they have plenty of time to worry about that later. Not for me.  Death is a constant companion of mine.  Whether it’s talking to my patients every day about diet and exercise ...

Everyone has that one friend who’s just winning at life.  The one who has all their stuff together – the perfect job, the Pinterest worthy home, leads some impressive committee and yet still finds time to volunteer at the local shelter.  They glide through life with ease and grace – no word is ever misspoken, nothing is ever out of place and you’re pretty sure they are part of the gorgeous I woke up like ...

When I started working in primary care, I expected my daily working life to consist of a lot of ear infections and talks about weight loss.  What I didn’t expect was to be hit by a daily onslaught of depression and anxiety, but after about 2 years in, it’s pretty much become routine.  However, last year I collided with anxiety in an entirely different form, rooted deeply in a controversial social issue: Black Lives Matter ...

After I posted my burnout story [read Part One and Part Two to catch up], I was dumbfounded by how many people reached out to me.  People who I hadn’t spoken to in years, all of them telling me the same thing:  “I’m burned out too.  And I thought it was just me.  Thank you for sharing your story.” As I’ve reflected on burnout in general for myself and my peers, the thought occurred to me – ...

You always remember your first.  Your first video game console, first car, first boyfriend/girlfriend.  I remember my first real patient as a med student, my first patient in my adult medicine clinic in residency. Today, I remember my first patient in private practice to die on me He was a skeptic from day one.  I had just taken over for Dr. T – a wonderful, caring, good listener who left the practice to go into ...

Every January, I go through my spending over the previous year to see where my money went using Mint.  It just hit me today – since refinancing my student loans in Dec 2015, I have paid off $100,000!  It has felt like such a slow and painful process, but finally I’m at a tangible mark – $100,000 certainly feels like a HUGE accomplishment. How did I do it? At this point, you’re probably expecting a ...

Clawing my way back out of burnout has been a slow and steady crawl. If you are not familiar with the struggle, read my previous post, Burnout – Part One. Once I recognized the problem for what it was, I was determined to fix it. If I want to do something, it will be done. Drive a stick shift? Done. Install a laundry dryer by myself? Done. Shingle a roof with a nail gun? Done ...

Burnout. This term is everywhere nowadays. When it’s an entire topic with multiple pages at Huffington Post, you know it’s gone mainstream. The term “burnout” was actually coined in 1974 by psychologist Herbert Freudenberger in relation to job-associated stress. As described in Psychology Today, burnout is a state of chronic stress that leads to: Physical and emotional exhaustion Cynicism and detachment Feelings of ineffectiveness and lack of accomplishment People like me are at high risk ...

I lied to a patient today. It wasn’t something I thought I’d ever do on purpose, but today I made the conscious decision to do so.  And quite honestly, I have no regrets.  What would compel me to do such a thing?  I always thought I’d be the doctor that would lay it all out there for patients – here’s your diagnosis and here are the treatment options.  Let’s talk about what best fits in your ...

One of my biggest regrets of going into medicine is not fully investigating the costs: the costs to my personal life AND the financial cost.  I remember the idealism of my teens and early 20s – I was going to help people!  I might even save lives one day!  What greater contribution to society could one give?  Any costs brought on by my education was worth it, so I took out the full amount of ...

Do a quick Google search on “Millennial Doctor”. First one that pops up for me is the Forbes article Do we have a Millennial Physician Problem? in which the author outlines a common theme about millennials in general.  We’re “entitled, narcissistic and self-absorbed”.  Certainly problematic if we’re relying on such people to help maintain health. My personal favourite is What to Expect When Millennial Doctors in Training Become Doctors in Practice in MDMag.  In it, the author outlines ...

When I turned 30 and had essentially completed everything on my bucket list, I was left with the crushing weight of my student loans as the last goal to tackle.  I was able to walk away from undergrad without any student debt – I was fortunate to have gone to premed before skyrocketing tuition rates, had several scholarships and was lucky to have parents who had saved for higher education since I was born.  But, ...

Most people don’t think of fitness as a dealer of life lessons, but this is where it started for me. However, these lessons didn’t come until after I experienced great disappointment in my fitness goals. Let me explain. One of my first attempts to claw my way out of my downward spiral into despair was through fitness and goal setting. “Exercise is good for you”, I told myself. How hypocritical would it be of me ...

Chris Cornell.  Chester Bennington. When their suicides took place in rapid succession, all the memories of my teenage high school angst took stab wounds to the chest.  As with all reports of celebrity suicides, we feel compelled to find reason in them.  How could people who have all they could ever want or ask for, including fame, fortune, successful careers doing what they love just throw it all away? Logically, it doesn’t compute, so after ...