My workdays have been spilling over into my evenings and weekends, folks. There– I said it. I haven’t wanted to admit that I’ve been, well, busy. It started with a couple of large and complex communications projects in late winter, at the same time that I picked up a consulting gig for a health/technology marketing firm. More recently, I’ve taken on a new role at work– Medical Monitoring on our clinical trials. I wasn’t sure I’d like it, but maybe it’s not surprising that I do. So what is a Medical Monitor, anyway? This article goes into greater detail, but basically:

“Medical monitors provide medical expertise and oversight for the entire clinical trial, from initial study design through final study close-out. They ensure the clinical integrity of the trial subjects and provide safety accountability across the duration of the study, while acting as expert points of reference for both investigative sites and study team members.”

It’s as close to patient care as one can get in industry, really. I’m thinking clinically again, and while I was prepared to hate it, I’m very much enjoying this work. I’ve kind of thrown myself into it, actually. There’s a lot of stuff to learn, some of it heavy and technical. Like, how to navigate and efficiently utilize EDC’s, or Electronic Data Capture systems, which are the software platforms in which de-identified patient data is collected, and very reminiscent of EHRs. Except we use like three of them, and one is for running data analyses, which is its own new beast. Then, today’s late-in-the-day responsibility: How to quickly but carefully evaluate a patient enrollment packet. This is a job for very sharp and detail-oriented eyes, which is why having awesome clinical scientists reviewing the data with me is essential (shout-out to the CS team!). When one of these comes in, it means there’s a desperate patient waiting to start on a hopeful treatment, and you need to act fast. Then there’s the popular How to judge a protocol deviation– which is essentially the patient’s care team “breaking the rules” of the written protocol; and of course, How to identify and assess side effects. Some side effects may not be obvious at first, like, blood pressures or liver function tests trending upwards, which is why data review and analyzing data for trends is key. It’s so important to patient care that this and more is all done well, which is intimidating, and thrilling. I feel like I’ve been tossed into a subspecialty fellowship, and I’m having a blast!

So that’s why I was Slacking and emailing and Docusigning well after-hours today. And poring over hundreds of pages of regulatory documents trying to understand the rationale for one of our trials’ designs over the weekend. And why I haven’t blogged in over two months.

Now, I’m trying to wrap up this post while Hubby is at a sports event (on the clock), my daughter is haggling for a particular new video game, and my son is negotiating for a later bedtime. I leveraged those asks and got the dinner table cleared and the dishwasher emptied, but I’ve got to push these pre-teens into bedtime… I’ve been reminded lately of all the inevitable collisions of work and home life over my career. I can’t resist re-posting one of the many, many, many essays I wrote about work/life imbalance. This one below was written when my kids were 3 and 4 years old. While it’s different now– Clinical trials are not primary care, and preschoolers are not preteens– it’s also reminiscent, and worth revisiting:

WHEN WORK AND HOME COLLIDE (EPISODE 1247) originally published Sept 4, 2014

As many times as this has happened, I have no graceful coping strategy.

Last evening, just as Hubby and I were herding our two wound-up kids upstairs towards bathtime, my pager went off. Hubby said he could handle things, and I went to the dining room to call the patient.

It sounded like a simple upper respiratory infection that had triggered an asthma exacerbation, but I was asking a lot of questions to make sure it wasn’t a really bad asthma attack, and that there wasn’t a high liklihood of pneumonia, or some comorbidity to prompt urgent care.*

Then: “What are you doing, Mommy?” Babygirl wandered into the room.

Hubby was right behind her: “Come here, come back! Mommy has to make this phone call!”

Great.

“Who are you talking to, Mommy? Can I sit on your lap?” She started climbing up into my lap.

Meantime, I’m trying to continue: “Have you had any high fevers or chills?”

“MOMMY! Can I talk on the phone too? Can I have the phone?”

Babyboy ran into the room. “What is everybody doing? HEY get away from my Legos! Those are mine!” Babygirl had grabbed Babyboy’s police station Lego setup that we had placed on the dining room table for safekeeping. A tussle ensued. On my lap.

“That’s MY policeman and police car! You can NOT play with that! I did not say you could play with that! MOMMY she is playing with MY LEGOS!”

“But I WANT to play with them. I WANT TO!”

Screeching and wailing, grabbing, flailing, and some hitting. Hubby tried to intervene, and finally picked Babygirl off my lap and carried her and the Legos in question to the living room.

Me, to the patient: “I am so sorry, please excuse the chaos over here…”

She, chuckling: “I raised four of my own. It’s no problem at all.”

We had almost got through the call when Babyboy came dancing through the room, holding his crotch.

Me: “Oh! Oh, excuse me-”  I put my hand over the receiver and yelled: “HONEY he has to pee! Can you help him? HONEY!” Then, back to the patient: “I am so sorry, I just need to get my husband, our boy is potty training…” Hand over the receiver again. “HONEY! I don’t think he can get his pants down!”

Hubby came running, clothing was sorted, pee happened, and in the right place.

The patient, again, was understanding: “I’ve been through that a few times. When they gotta go, they gotta go!”

We wrapped it up with a plan, and I hung up. She had all the medications she needed at home, so I didn’t need to then also call in a bunch of prescriptions. Bathtime went fine, but bedtime was dragged out. By the time both kids were down, I was down too. Literally, I had fallen asleep on Babygirl’s new pick shag rug. And she had too. (Lately, this is how she prefers to fall asleep. On a pink shag rug.) I hadn’t charted the call, and I needed to send the note to a nurse, so they could call her in the morning… I knew I had today off, so I decided to chart when I got up.

This morning, I was up fairly early. I came downstairs, got my coffee, and was just opening my computer to log into work, when…

“Hi Mommy!” Babyboy came padding downstairs. “What are you doing Mommy?”

“Oh, honey,” I just couldn’t not feel frustrated. They hate it when I’m on the computer. “I just have to do a little bit of work, honey.”

He came up and pulled at my hand. “Can you read me a story, Mommy? Can you read me the story about the trains? It’s right over here. Come sit on the couch with me, Mommy.”

Ooooough. I hate this. I kicked myself for not forcing myself to log in and chart last night. Why did I go to bed without taking care of this?

I sat on the couch and read Babyboy the train story. We cuddled a bit, and then I tried to make my exit. “Ok honey, I just need to go in the other room for a minute…”

“Can I watch a Curious George, Mommy?”

Now, a TV show would get me the distraction I needed to log into work and write my note. But, it was a school day, and he had to eat and get ready for school. We don’t usually do cartoons in the morning on a school day. It’s setting a dangerous precedent.

“No, hon, you can play with your toys for a few minutes, then you have to eat and get read for school.” 

“Naoooooh!” Dramatic flourish.  “I want to watch Curious George! Please, Mommy, just one Curious George?”

Hubby came downstairs and tried to step in. “I’ll read you another story, honey.”

“Noooooh! I WANT MOMMY to read me a story!”

I had gone into the other room and was logging in to work, clenching my jaw. I just needed to type one damn short note and hit send. This would just take a minute. Just needed to get it done.

“No Mommy! Don’t do work! Don’t turn on the computer! I want you to read me a story!”

“I’ll read you another book as soon as I’m done. If you’re good.”

Babyboy thought for a moment, then rolled onto his side on the couch. “Oh- kaaaay Mommy. ” The past few months, he’s been the easygoing one. When we  set limits, he protests, but then, usually, he concedes, and admits defeat, with this hangdog “Oh-kaaaaay. ” It’s both adorable and heartbreaking at the same time.

And he was Okay. He lay on the couch and waited, quietly. When I shut the laptop, he perked up. “Are you done working Mommy? Can you read me a book now?”

“Yes honey, I’m all yours. One book and then you need to get ready for school.”

I thought about this episode all day. Would some kind of shift work be better for my family? Would it be less stressful to have complete separation of work and home life?

Once, a few years back, I was rounding on our inpatients (back when we still did that) and a lovely hospitalist struck up a conversation with me at the nurses’ station. She wanted to know what my work hours were, how many calls we got after-hours. I told her, that usually I was at work 7 am to about 4 pm, sometimes leaving earlier, sometimes later, and calls were few. “Gosh,” she marveled, “It would be so nice to have normal working hours, with some flexibility on when you can leave for the day. I’m stuck here for twelve hours, whether I’m done or not. And the shifts can vary. It’s so hard to have that unpredictablity. My kids get so confused, and it messes up their routines when I’m not there for dinner and bedtime.”

Recently, I saw a healthcare provider as a patient. In the course of the visit, it came up that she had left clinical work to work in industry. What she did, exactly, was not entirely clear to me, but sounded like consulting of some sort. I asked her if she missed clinical work. “Oh, sure,” she said. “The-nine-to-five cubicle world isn’t for everyone. I know my clinical skills have rusted away. I can’t go back now. I wonder sometimes, but, I had to do what I had to do.”

So, maybe it’s true that the grass is always greener on the other side. And that the devil you know is better than the devil you don’t.

And so, I’ll stick with outpatient primary care and the after-hours pager, and work on my coping skills….

*As always, case details have been altered, and no real identifying information has been divulged.