I am a mean, nasty person… on call.
I may be a mean, nasty person when I am not on call, too, but I have no insight into that. 🙂
On this call weekend, however, I am well aware of the edge to my voice, the tension in my whole body, the force with which I am typing notes, and my aching head. I am acutely aware, and I feel really, really bad, about taking some of this anger out on my kids.
So I’m taking a half an hour to vent about it.
While this call has not been “busy” in the sense of a long inpatient rounding list, nor “busy” in terms of numbers of phone calls, it has been “heavy” in both medically complicated, unclear, and/or logistically challenging inpatient cases as well as a number of… difficult patient phone calls.
The inpatient issues: I discharged a patient Friday, who came right back into the hospital the next day. This is a supreme no-no. It’s called a “bounceback”, or re-admit, and I get scrutinized/ criticized for it, as presumably, I sent the patient home before they were really ready to be discharged, and this is costly to the hospital and insurance company, and bad for the patient. Now, I know that I felt very comfortable sending them home, and that this plan was corroborated by another attending; and I know the patient wanted to go home. But no matter, it’s now a bit of a mess, and I look (and feel) like a jerk.
I admitted another patient who was very ill, but the cause was a bit of a mystery. After spending literally hours analyzing the labs and studies, and reading up in the textbooks like I was a medical student, doing a huge long writeup, and having a discussion with the patient and the team about what I thought was going on, it looks like I was wrong. She will be fine, but again, it’s a bit of a mess, and I look (and feel) like a jerk.
The outpatient issues: There were many long, convoluted phone calls requiring alot of my time and listening skills, as I was pretty much helpless in all cases. 20 minutes talking one patient down from a panic attack. Several 30 minute-plus calls listening to long angry rants about the perception of poor care received in 1. a local ED and 2. a local nursing home. Endless discussion about why one narcotic wasn’t working and a new prescription for another narcotic is now necessary. Logistical messes sorting out administration snafus- I kept getting erroneously assigned to patients on another service. Then also sorting out when one of our patients was assigned to the wrong service. Just alot of headachey stuff.
So I was here at the hospital all day yesterday, much longer than I anticipated. I was stuck here as the pager kept going off and I simply couldn’t get up from the damn chair on the nurses’ station. The beeping and alarming, the lights, the noise, the constant crises make me crazy. The pages were making me crazy.
Then I got stuck in a traffic jam on the way home, and was paged in the car several times, requiring me to fiddle with the pager and the cell phone, hoping that the police didn’t pull me over; and then I was late to relieve the babysitter.
I was paged at home as soon as I got home, and while I was trying to pay attention to Babyboy, and even trying to make cookies with him (his favorite mom-time activity), I was obviously distracted. And it was a long, difficult phone call about narcotics, and I was getting pissed.
So was Babyboy, and he showed it by shoving Babygirl, and then sitting on her. Now, he is 2.5 yrs old and not too heavy, but she is a petite little 13 month baby and he squished her. So now I am trying to manage this phone call and get him off of her and soothe her.
I got the lady off the phone and of course, the pager goes off again. Babyboy, undeterred by my forceful admonition, started giggling and picked up a pile of Legos, throwing them down onto our lazy fat cat, who had made the mistake of relaxing amongst the toddlers.
I again grabbed Babyboy, tried to get him to look me in the eyes, and said “No! No! Kitty Ouchy!”
He again giggled and again took up an armful of toys and threw them down onto the cat, who is not too bright, really, and had only relocated a few short feet away.
Now I had Babygirl crying, Babyboy apparently determined to hurt the cat, and the pager going off. Again.
Babyboy grabbed another handful of Legos and ran towards the cat, ignoring my yelling, giggling even. So I overreacted. I slapped Babyboy. Just with the tips of my fingers, but enough to sting, I’m sure. And he cried.
Now I looked, felt, and WAS a jerk.
Babyboy put his hand up to his cheek, crying, and then, heartbreakingly, he came over and held his arms up for a hug from me, crying, “Mommy, Mommy!”
I hugged him and held him and said, Oh, I am so sorry, mommy is so sorry. I meant it.
And I called my mom. Compounding this whole situation, Hubby has been traveling, so I was on overnight Babygirl duty Friday, and she was up her usual 3 times… I’m tired.
Mom came over to help out so I could answer phone calls. The calls stopped. The kids calmed down. We played Legos. I talked about it with her, and later with Hubby.
I know I lost my temper in the moment, but it is not Okay. I know that the strain of call and the fatigue were the background factors for me to lose control, but they’re not the direct reason, nor the excuse.
Call sucks. Medicine is hard. That’s why not everybody gets to do it. It’s a privelege and an honor, but it’s not for everyone.
My immediate plan is to THANK GOD that Hubby got home late last night. He was up with Babygirl several times last night so I could catch up on sleep. I talked out my bad behavior with him and my mom, and I’ll be on best behavior henceforth, as they are now watching this along with me. I feel like I am being held accountable to better parenting.
At work, I am trying to NOT get emotionally worked up about the inpatient problems or difficult phone calls. I am asking a colleague to take over my inpatient rounding for future calls, so I don’t have to cover the inpatient side ever again (our practice is moving towards hospitalist coverage anyways). I need to admit that it’s just too much, and though it feels nice at times to be prancing around this great hospital in my white coat, and though my patients like to see me, it’s not fair to them or my family. It’s just too much and I can’t manage it anymore.
But the phone calls will continue. I plan to block my clinic this week to be as light as possible, and though that will put me behind in ‘productivity’, it will have to be. And I plan to cut back on my clinic hours on a permanent basis, as soon as this is financially feasible.
I would love to say that I will exercise more, and do yoga, and get therapy. Ha! With all my free time! Not. I’ll pet the cats more is what I’ll do.
And I will try very hard NOT to be a mean, nasty person… on call.
That was one beast of a day! Do make more room for yourself, but don’t beat yourself up over it. You were in an impossible situation, trying to handle a work situation, by phone, with your toddler in the room. It’s plain impossible. No one can do it. No toddler can let that situation exist. My younger kid, now 5, is an almost-not-toddler, but he regresses by 3 years the moment I get ambushed by an unexpected work call. It’s like he can smell it, even if I’m across the house answering the phone. A phone is a toddler’s worst competition, and they’ll do everything to make sure you can’t have that conversation. Including goad you into lashing out. Even my 8-year-old will suddenly, inexplicably, need me urgently the moment I’m on the phone, and will suddenly forget that he can reach the cabinet himself, or whatever, and also forget that he’s old enough to handle waiting a couple minutes. I am lucky to mostly be able to avoid the problem, because my work doesn’t involve being on call. When it happens, because I didn’t realize it was a work call coming in and either lock myself in my office or let it go to voicemail, it’s inevitably a rough situation. I’ve had to tell people I’d call them back because suddenly there’s a screaming preschooler climbing up my leg trying to grab the phone away. Or running off to do something he knows is illegal and highly dangerous, looking over his shoulder to see if I plan to do anything about it. And I’ve certainly yelled and scolded after phone calls, my anger coming from that ball of humiliation at the pit of my stomach from just how unprofessional I had ended up looking. I’ve talked to lots of moms, and my assessment is that this phenomenon is nearly universal. And it’s aimed most squarely at moms; dads are allowed about 5 minutes’ leeway of phone time. Hang in there, and if it’s at all possible, be sneaky about taking phone calls!
Lara, Thanks so much for reading and for your input. It’s so hard to know what is normal. It’s reassuring that the phone competition is universal — and not likely an “autism thing”. And that my reaction was forgiveable. Appreciated.
Oh, I recognize myself so much here, especially when my kids were younger. FORGIVE YOURSELF. You are your own worst critic, and the kids won’t remember the rare meltdowns. Call weekends suck. I’ve done some things in anger I am waaayyy to ashamed to admit. Similar to what you have posted here. And my kids are, at 9 and 7, happy and well adjusted and getting excellent grades and report cards. We all lose it occasionally, and that is normal and OK.
Once when my toddler and baby were fussing and fighting I got pushed to my limit and screamed and wailed. That got their attention! Natural consequences ensued, they melted down. We hugged and cried together. It was so cathartic. So I looked on the bright side – we all needed that:)
I’ve rarely done things in anger that I couldn’t justify. We all have. You are an awesome mommy and doctor.
Thanks so much- so good to know other doctor-moms have been there. I hesitated to post this, but my instinct said I couldn’t possibly be the only one…
Ooh that sounds like a rough rough weekend. Definitely cut yourself some slack, you are being hard on yourself & talking about “bad behavior” and “best behavior”—you are full-on taking the blame. When something like that happens in our family (and it has, usually its the mornings when we’re late that we both find ourselves not living up to my parenting ideal), I try not to take it as a personal failing but attribute it to a system failure. Something broke down this weekend & caused you, a great mother, to react in a way you consider inappropriate. From the outside, the fact that you were on call and solo parenting sounds absolutely untenable. You need backup so that you can leave the room and answer the calls in peace because as stated above, no young child will allow you to neglect their attention like that. If you can’t work your call schedule so that your husband is around when you’re on, you may need to get your mom to come over. Its not about you “trying hard to not be a nasty person”, but about setting everything up so that your childrens’ needs and your patients’ needs are not overlapping.
Good luck to you. I have two littles fairly close in age, too, and it is very very hard. I can’t imagine having a call weekend without my husband pretty much taking on 90% of the parenting.
I have a crystal clear memory of telling my two,at the age of about 3 and 4, that they were never to bother mommy when she was on the phone on call unless they were on fire. They are grown now, and are apparently untraumatized. Don’t be so hard on yourself.