Depressed

I don't really know if its depression but I think it is. I have lashed out (in a pretty minor way) at my darling husband, a man I have literally never said a bad word to in the 10yrs we've  known each other.  I cry when I read something sad. I have to stop going on FB because I'm now part of some physician mothers group and the constant stream of stories of not being able to have the life they want, having to miss out on really important family events/moments, not being able to control one's life, always being judged/on a pedestal, always being witness to some of the greater horrors that can occur in our society (child abuse, death, life-altering diagnoses) and all without a lot of support.  You are the captain at the helm, you can't show weakness, you are the leader and the buck stops with you.  As a medical student it seems even worse.  I am at the mercy of the attendings and residents I am working with.  If they need to pee, drink, eat, have a moment they send me off to do something or put me with another person to continue on working.  I hardly ever know where the bathroom is, my food/drink are always too far to access.  I never know if I'm going to get a break in 10mins or 10hrs.  I have to learn to meet the expectations of all of these individuals within the first day I meet them and I work with new people every couple days or weeks.  I am expected to know a million details about every specialists' area of medicine.  I am expected to always know everything about each patient on the service.  I am expected to additionally be studying for shelves and OSCEs.  On top of it, I'm a mother and a wife.  I have the expectation to be a great mother, a great wife, try to do some cleaning, be in a good mood, put up with hardly ever sleep, rarely get a minute to myself, most definitely don't get to do any self-care.  And you know what, when I write it all out, its actually astounding that things have been going so well.  But I have a lot of anxiety and stress that I'll ruin my marriage before I'm done with this.  I have a lot of anxiety and stress that I don't keep my mood positive enough, am not patient enough, or have enough time to engage with my beautiful two daughters.  And on top of that all, there isn't really a light at the end of the tunnel.  Residency is just another 3-5yrs of not being in control of my life.  Maybe its a little better because I will be able to pee when I want, get food and drink on my own volition but I will then actually be responsible for the care of my patients in a very real way and be responsible when things don't go well.  I won't be able to take short cuts or skip studying some nights because it would mean the difference between caring for a patient well or not.  I think another source of anxiety is deciding what I want to be...its like I am at the fork and how can I measure the amount of stress that will be involved in any of the specialities?  WIll the stress actually be different depending on which specialty I go into?  If I pick what seems like an "easier" one, will I just be depressed because I don't love what I'm doing?  Or will I be more depressed when I am gone more or have a more stressful job and continue to neglect both my own well-being and that of my family?  And can I add more to the "reasons to be depressed"  list?  I really would like to have another child or two; my family is very important to me and the joy I get out hanging out with my family and reveling in the days I spend with her is super important.  But is it pure stupidity to even consider having a child in the next couple years?  If we had a baby 4th year it would mean sleepless nights and pumping during intern year which just seems like creating such a stressful environment around what will already be stressful plus knowing I wouldn't have a lot of control over my schedule or how much I would be home for a little baby who really needs some extra mom time in those early months.  THe only pro would I would have some extra time home with baby before intern year started.  But I HATE that this career path does get to dictate when I have babies.  I want to have a job where I can just decide that I want to have another baby in 2 years and have it be no big deal.  I want to be able to have a 3mo maternity leave and not have it be a big deal.  So then, do I wait until right after intern year?  Obviously that would be more reasonable, I would have had time to get comfortable with my environment, my work load, my environment.  But then for sure I would only get 6weeks home at the most. And then, if I did a 5yr residency and wanted a 4th baby, what would be the attitude if I got pregnant a second time during residency?  Whereas if I did a 3yr residency I could have a baby as an attending..not sure that makes it much better timing in all reality to be new in a job and having another baby.  Good lord, who knew that when I started on this path it would be this way!  I think I always mocked medical students and physicians who acted like they had the hardest job in the world but now I can see a little where some of that attitude comes from, there are very few jobs were you have so little control for so many years over your life.  How so many other things have to take a backseat to medicine.  How you are constantly under extreme pressure all the time and can never do everything right...they always make sure you always feel right on the edge of failure or always feel like you need to work even harder to meet expectations.  I'm tired right now.  I am hopeful that with just 2 weeks of vacation at Christmas time I can buck this but I think the depression is just so deep set right now because the future just seems full of uncontrollability of lack of ever being able to do me without feeling like I'm neglecting everyone else.  Having to slowly get used to the idea that I will never get to be the reliable parent who can show up for everything like Kyle can.  That the girls will always have to hear that "mommy is busy at work" whenever they want me somewhere.  That if they are sick, they have to be headed to the ED for me to be able to ditch work and stay home with them.  I'm not sure how easy it is to reconcile all the things I can tell myself that "I'm a good female role model" "I'll be able to help provide them good opportunities in life" "I will have an interesting exciting career that I can share with them"  I'm not sure that's enough.  I'm not sure if I can be content with that.  When I consider surgery and how much I would love to go that route, I can always find a female mentor with kids who tell me its doable and not that bad...but then I wonder, what kind of mom are they? Are they the kind of mom I am where I think time with my kid is so amazing?  Where my vacation days, time off are days that I rush home to spend with them and not days I still send them to daycare so I can have time for me-cause there are a lot of moms like that and that's just not me.  Oh yeah, that's another current depression causing stress...I love surgery.  I think its a good fit for me.  But can I pick that as a specialty and not be like my dad?  Getting to have the career I love but neglecting my family as the trade-off?  Can you really have both? I'm not sure I've seen that.  Its easy to be like, its just like working any other job, but its not really.  Very few other jobs hold you so hostage...you can't just run off when you are in the middle of surgery.  You can't half-ass it when you have a big surgery the next day.  You can't just play hooky when you have a day of patients or cases the next day.  What have I signed myself up for?  I hope I look back at this and laugh.  But I'm not sure there's a lot to laugh about right now.

And its been a year...

I couldn't, for the life of me, figure out how to access this account so there were SO many posts I wanted to write but didn't get too.  I have to go back and read the post about having a positive pregnancy test because since then, I had a glorious summer off with Lydia that was filled with pretty terrible nausea all throughout the day and low energy that made playing with her sometimes a real challenge.  I'll admit, there were many days that were a real struggle bus and made me mourn a bit the lost free summer with Lydia.  Misquitos were also a real problem at home.  But we did have tons of fun playing at the park, traveling to either Merrill or Tomahawk, library time, books, crafts, lots of travel to visit Grandma Mary and Aunt Bernadette and Evey and so on.  We also took an amazing trip to Glacier with the whole Jacobson family where we announced our pregnancy (at a whole 12 weeks along).  School started back up and I had the pleasure of continuing to soldier through another semester of commuting, testing, anatomy labs, and testing all while growing more and more pregnant.  It was an awkward time as my classmates didn't really know what to do with me (I am a n=1 and only 1 of 2 mothers/parents in the class).  I was pretty relieved to go on xmas break.  Along the way, we had some health scares in that I got immensely big VERY quickly (good-bye to my running :(), had excess water and did a bunch of extra testing and scanning to make sure everything was ok.  Everything kept checking out normally but it was sure stressful knowing all the things that could be wrong and all the medical resources to look at to scare myself silly.  After a really great xmas break with some really really fun times with Lydia, I was off to my first 6 weeks of clinicals.  4 weeks of IM at Marshfield (6d/week and pretty long days, generally at least 6a-5p plus 2.5hrs of commuting). Then a week of psych where I got to just sit.  I was supposed to do a final week but knowing that the main doc was coming back and hoping I'd go anyday, I called it done.  But then no baby came...by Tuesday evening I was pretty nervous, at some point school would be expecting news of a babe!  Wednesday still no babe.  But then at 12a Thursday morning I woke up with contractions that were continuous and exceedingly uncomfortable...woke Kyle up and told him he could stay home from work.  Contractions continued ~8min for 2min at a time but never got closer.  As the morning progressed my frustration grew.  We walked to copper lake and all the way out to the island and back.  I'd have a contraction every 10min but that was it.  Are you serious I thought?  Then they picked back up to q6-8min but stayed that way.  Kyle's folks came for dinner and a walk.  Then they went home.  All of a sudden I started timing things again and realized they were coming every 3-4min and lasting 2+min.  I waited it out for a while and then went to show Kyle the timer schedule.  He called his parents who said they would finish up dinner and be over.  I got a little nervous wondering if that'd be soon enough but figured itd still be a while.  I was definitely getting very very uncomfortable. I tried music, moved around in all different positions, sat on the ball which didn't help like it had for Lydia.  I jumped in the shower and that did help.  Finally, Kyle's folks came.  I was in go mode.  He tried to make the bed for them and I said, we just have to go!  I tried to say goodbye with a normal face/composure and then collapsed in the car.  Distinctly not feeling great.  I texted Amy Falkenberg to tell her I would most definitely be getting an epidural.  Kyle called the hospital to tell them we were coming and I told them to make sure they knew I wanted an epidural too. Kyle started our 50min drive and I tried not to count how many contractiosn I still had to get through before we got there.  We were much too far away for my comfort at this point.  About halfway there my contractiosn changed and I started screaming through each one.  After a few I realized I was pushing!  The baby was coming NOW.  I told Kyle and he laughed.  He was so nervous he didn't know what else to do.  Luckily for me, he started driving faster!  We got there and I could feel the baby's head during each contraction. He pulled up to the front and got a wheelchair.  Registrtaion tried to stop up but I told them unless they wanted to deliver my baby, we needed to move!  He ran me down the hall, up the elevator, and into the birthing center.  I was hardly paying attention except to crawl in bed, they wanted me on my back but I couldn't tolerate it.  Each contraction I just screamed through.  The doc showed up, had me push and 4min later dumped a hot squirmy crying babe on my chest.  Best moment and best feeling a momma can experience.  It was amazing.  Little Louise Frances, born 4 min after we got to the hospital at 7p.  8.5lbs and 19" (though I think she was actually bigger).  Just a stitch or two and life and love filled our hearts once again-couldn't be more grateful and so happy for yet another gorgeous daughter.  Her smile and chill personality, the way her face lights up everytime she sees me, how she sleeps so well at night, cracks a smile the minute she sees her big sister and is growing by leaps and bounds just has me bursting with joy and love every day.  6 weeks of maternity leave-amazing and much much much too short at the same time.  Who knew how great kids would be?  To experience life always wanting them to experience things and learn gives you an opportunity to re-explore the world at the same time.  It is a most precious gift to live again with the wonder of a child as an adult.  My heart is so full.  I am such a lucky women.

followed by 1 week of in-patient psych that I just did with Trista

as the doc was off. For the month of IM, it was a huge learning curve, so much

course work, projects and presentations, long days, and 2.5hrs of driving on top

of it-it was pretty exhausting but interesting. The week of psych was nice

short hours but boring-probably a good way to head into maternity leave. I was

supposed to start a second week but I was so cashed and assuming the baby was

coming any minute that I emailed everyone on Monday to say I was in labor. Of

course, I grew more and more frustrated as the days passed and I wasn't in

labor! I got to the point where if I wasn't in labor after Thurs I was going to

go back, but lo and behold, I awoke at midnight Thursday morning in labor!

Things were going along well. I walked round, tried to eat little snacks, drink

lots of water, and just pass the time. I was able to doze on and off but knew

this was the real deal! In the morning I told Kyle we were a go but by 10a,

things really slowed down and I got pretty disheartened. We ended up taking

Lydia on a long walk down to copper lake, across the lake to the island and

back. I'd have a very strong contraction every 8-10min but that was it. I

really started to feel bad that Kyle had stayed home. Later that day, Grdma and

Grdpa Jacobson came to visit and we went for another long walk. Again, I'd have

a strong contraction every 5-10min but nothing was seeming to get faster. Then

they left and things really picked up. I stopped timing things because it was

pretty frustrating but I was definitely very uncomfortable, it was difficult

because Lydia wanted to see what I was up to and I was jonesing for a little

more support from Kyle but he had to hang with her. I showered, listened to

relaxing music, and tried all different positions. Finally I started timing

things and realized they were getting really close and long. We hemmed and

hawed about calling Sandy and Dave but finally did...they said they;d be back

over in 1.5hrs (since they had just got back to the cabin). I was a little

nervous about that but figured I still had plenty of time. I was definitely

exceedingly uncomfortable and concerned about how much worse it was going to

get. I texted Amy Falkenberg and told her I would probably be getting an

epidural because I didn't think I could do it. In-laws showed up and I barely

made it to car..I was getting grumpy with Kyle because he wasn't moving as quick

as I wanted and with an hour drive ahead of us we still had to get there. On

the drive I must have been laying in the perfect position because we weren't

more than 15min in the drive when the quality of the contractions changes and I

found myself screaming through each one. It took me a bit before it dawned on

me that this was pushing time! I told Kyle, I think I can feel the baby's

head...he laughed. I said, I'm serious. He started driving faster. We got to

the hospital about 7:05. He pulled up to the door, grabbed a wheelchair as I

screamed through another contraction and wheeled me in. They were trying to

register me at the front desk but I looked at them and said, unless you want to

deliver my baby right here, we are going to keep going. Run kyle. We got up

the stairs. To the room as I struggled through another contraction. The nurse

was like shit! The doc came flying in the room and asked how dilated I was. The

nurse said, I saw the baby's head on her last contraction. It was go time! 4

minutes later, after a lot of screaming and refusing to move from my side to my

back, a squirmy, super warm, snuggly little bundle of joy was dumped on my

chest. Louise Frances. Born 5 minutes after we arrived at the hospital. </P>

Surg-Ortho Trauma

Interesting speciality; liked the doc I worked with because he was super careful and a perfectionist in all his repairs. Was a huge adrenaline rush to get to 1st and 2nd assist.  Retracted, cut sutures, sutured a bit, held cameras, suctioned, and just got to be all up in the business of surgery.  For sure in my next life I'll go into surgery.  I love the motion of it, the sense of completion, of making a real definitive difference for a patient, for having an actual solution to a problem.  But its also hard on you, you're hungry/thirsty/have to pee but it doesn't matter.  Your arm might go numb holding equipment but you just keep standing there.  As the surgeon, no one else can solve the problem.  You are alone and any shit that hits the fan is solely your responsibility.  You can have that big ego but you better be good.  For me it was a super interesting but exhausting week. With a 2.5hr drive and long hours of standing sans food/water I was pretty knackered and had a tough time being "on" as a good mom all weekend when I really felt like I needed to take care of me but of course had no time/option of that.  I lost 3lbs in 1 week which rocked except I felt so weak and worn out..likely it was mostly muscle loss.  Got to scrub in on an ankle repair, distal humeral repair, total hip, several hip pinnings, tibial avulsion fx repair, SI pinning, shoulder reduction-all in all a great week.  Made me realize again how much more fun/interesting surgery is at least in comparison to primary care.  The surgeon's life seems to require a coddled way of life for the surgeon which is obviously not likely to happen in my life.  It was extremely difficult to feel like a good mom and that was coming home at 6:30p and leaving before they woke and weekends off..itd be a lot worse as a resident and that;d linger for years. Lydia was being super crabby and so I asked her if she preferred to be at Sol's house and her reply (at 2.5yrs)? "No mom, I'd prefer you didn't go to work." Ha. Poor kid.  Born to the wrong mom :( mommy guilt sucks.