New Beginnings

I made the very difficult decision to change jobs. I was with Anesthesia Service Medical Group (ASMG) from 2011-2022. My time at Scripps Memorial Hospital in La Jolla was incredible. There are wonderful and competent surgeons, stellar nurses, fabulous anesthesia techs, dedicated ancillary staff, and collegial anesthesia partners. The reason for my departure: work-life balance. For me, work-life balance is being able to spend time with my family. The way our call structure is designed is to constantly be available to the hospital for add-ons without knowing a time that you are done with work. This often leads to 2-3x/week of not knowing when I can give my husband and kids a set time when I will be home. My kids are 4.5 and 3.5 years old. I want to be more available to them for school activities, dinner, and bed times. My husband and I both have very demanding jobs and I could see the toll my current job was taking on him as well as the kids.

This led me to look at other models that may be more receptive to a working mother who wants to work hard as well as be a present-mom with less mom guilt. This is a personal decision.

I landed on a model at Kaiser where I will know when I will be done everyday as it is primarily shiftwork. Yes, I will still take call, work weekends/nights/ holidays,etc… but when I am done, I will be done. I am excited knowing that I will be able to tell my kids that I will be home for dinner or home to tuck them in. The littles are growing so quickly. Kindergarten will start for my oldest in 2023 and G will follow in 2024. If I break down their ages in 5 year timeframe… 0-5 is almost complete. Next will be 5-10 and 10-15 and 15-20. The first 5 year time frame went by quickly. Everyone says it goes by so fast. I want to stop and enjoy this time.

I still want to work hard and push myself career-wise, and I do plan on doing that. My goal is to continue evidence-based practice focused on patient care, dive into more ERAS guidelines, bring my private practice experience to the Kaiser model, encourage well-being mentally and physically, and lean into more leadership roles acting as a mentor and role model.

Kaiser Blogs:

The Permanente Journal

Kaiser Health News

Health & Wellness

Thrive Together

Thrive: Center for Healthy Living Latest Blogs

Center for Total Health

Burnout

Burnout Rate and Risk Factors Among Anesthesiologists in the United States:

• Perceived lack of support at work and at home were most strongly associated with burnout syndrome on multivariable logistic regression modeling
• Age was the only personal factor that was associated with burnout syndrome

I’ve felt my own burnout throughout the years. The earliest times I remember it was in my childhood. I would be in school activities and extracurricular activities until about 9pm and then come home and then start my school homework. That was my initial taste of burnout. Luckily, I was able to work on my time management skills. In college, burnout reared its ugly head again when I had a ridiculous idea of taking 21 hours in a semester with honors and research and made a 4.0 that sememster. Just for reference, 12 hours a semester was full-time. Then, there was medical school. Talk about hooking yourself up to a full throttle fire hydrant and devouring the info. Residency was more about lack of work-life balance. It was all work and occasional play. Fellowship was more relaxing, more focused, and less burnout. Finally, real-life job. The hours can be grueling as well as unpredictable. The only predictability is knowing you will be done early or working late. This became much harder when we had kids. It’s impossible to say with certainty that I will be home for dinner or for activities or be home in time to tuck in the kids. This is also burnout.

I’m not the only one. Clearly. Study after study are coming out looking at the toll of burnout on healthcare workers. One of my colleagues with kids has said she’s starting to feel the burnout as well. We’ve been in private practice for 10 years. It’s not like we’re new to understanding the nuances of our jobs. Throw in family life and being a mom and it really gets tough.

Best thing to do is knowing how you feel when you are burnt out. What will you do to get help? Who is your support system? What can you do to decrease the workload/burden of work/family? Know that you are not alone and that help is close by.

National Suicide Prevention Lifeline: 1-800-273-8255

TeamHealth.com

J of Business & Financial Affairs, 2018;7:4. Burnout and its Organizational Effects: A Study on Literature Review.

J of Graduate Medical Education. Dec 2009. Burnout During Residency Training: A Literature Review.

J Psychol Brain Stud. 2017, 1:1. Stress, Burnout and Coping in Health Professionals: A Literature Review.

Introducing a 13 month old to newborn sibling

We weren’t really sure how to do an introduction.  Arden is very observant and we didn’t want to cause a bunch of anxiety or jealousy with bringing home a new baby.  I don’t think she’s old enough to understand the concept of a baby brother, but I could be wrong.  So, we’re introducing her slowly to her lil sibling.  At first, she was very curious and _____________ (surprised? shocked? curious?).  She wanted to touch him.  It also seems like she wants to be held more and we want to giver her that love just as we always have.  More and more, we have Garrett in the same space as Arden and she seems to be ok with it.  She fought her naps the day after we brought G home from the hospital…. skipped them all.  That was new.  So maybe she feels the difference?  Arden is my OG, my Bug.  I’d feel terrible if she felt any less or even threatened with a new baby that requires more attention.

Tips that I received from friends, teachers, moms of multiples:

• Make her feel like she’s helping with caring for lil brother.  This will distract any anxiety and confusion.
• Arden. Don’t worry. In no time you will be trying to “help” your baby brother!  Replacing dropped bottles and pacifiers, returning rattles, sharing your food (shhhh, don’t tell anyone I kept handing noodles to my nanny’s grandbaby).
• Early on before Evie, I taught Sam to be by himself and play, etc.  when I had both at home by myself, Sam knew I was taking care of Evie so we read together and played as soon as she napped.  Big thing is getting Bug involved, simple things, grab a rag, grab a wipe, make a big deal of it.  Sam loved being the helper.  Thankfully Evie was super chill her first 3-4 months, eat poop sleep…that was her routine.  She even slept 6+ hours a night from the minute we brought her home.  Even Debbie got to sleep.
• We did a few things to prepare Jacob.  We told him that he was going to have a new friend come and play with him.  when we brought Dos home, we had gifts ready for Jacob that we said were from Dos.  We also tried to get Jacob involved – like why do you think Dos is crying?  Do you think he’s hungry?  Do you want to help me change his diaper?  etc.  And thank and acknowledge when they are helping out.  Also, make time for someone with Arden – it’s so  hard in the beginning when you’re tired/nursing frequently but hand G to grandma or dad and cuddle/nap/walk with Arden.  You got this, mama!!!
• When people came to visit or Facetime, have them greet/chat with Arden first about her.  And keep it about Arden instead of asking “how’s it feel to be a big sister” or “how do you like your baby brother”.  I felt like Jacob was too young to understand what big bro/lil bro meant but he did know about someone new being in my lap.  It’s a work in progress still, but Arden and you guys are doing great!!
• Mana is 18 months older than her “Tita”.  we modeled gentle touching and interactions, and said: “This is your Tita” to help her understand it’s her tiny baby sister.  Ownership of that special relationship helped, I think.  But I can relate to feeling so sad and guilty that I had a little less to give the OG girl.  It turns out just fine.
• Love on Arden – let everyone else love on Garret – he just needs someone to hold him doesn’t matter who!!!
• Don’t worry, kids adjust very fast.  They are at a very young age.  Just shower both with love and they will love each other.

 

Week 1

Arden as slowly adjusted.  She was a bit more sensitive at school and was challenging with her naps while there as well.  At night, it would take around 30 minutes to calm her to get her to go to sleep.  We have slowly incorporated G into daily life.  He’s around when we do dinner.  Now, when Arden gets home, I take her and play with her and hold her and papa takes care of G.  For some reason, Arden is clingy to me even though Bear/papa takes her to school and picks her up and does most of her diaper changes.  Even during the last month of my pregnancy, Arden would be picked up and held by her papa more and more bc she was just getting too heavy for me to lift and hold.  Over this week, she has slowly adjusted and has gotten better about going down for “night night” at night.  The last 3 nights, she has gone to sleep easily without a fight.  We lay her in her crib and she rolls over onto her stomach and goes to sleep.

New changes we’ve incorporated:

• Mama greets and holds Arden when she gets home from school
• Wash her hands (tons of germs from school)
• Mama holds and plays just with Arden before dinner
• Dinner time, mama/papa/G are present (usually I wear G or breastfeed him at same time
• After dinner, we clean up and Papa plays and reads with Arden
• Getting ready for bed, we do a nighttime diaper change… get her into her sleep sack… have milk.  G is present for this depending upon how Arden is doing.  If she’s super frustrated, then I will take him separately and either feed him or put him down.  We both will be with Arden for her last nightly milk feed, teethbrushing, hugs/kisses/cuddles before papa puts her down in her crib.

 

Slow Cooker Beef Stew

Earlier this week, I was craving some beef stew.  It complements the cold evenings so well!  Plus, I need more iron in my diet.  So, the stars aligned.

I gathered my basic recipe foundation from Food Network: Slow Cooker Beef Stew.

But, I had to make some tweaks to the recipe based on what my tastes are and what I had on hand in the kitchen.

From Food Network: Slow Cooker Beef Stew

Level: Easy

Total: 8 hr 40 min

Prep: 20 min

Cook: 8 hr 20 min

Yield: 8 to 10 servings

Ingredients

• 2 pounds beef chuck, cut into 1 1/2-inch pieces — cut as much fat off as possible
• 1 teaspoon smoked paprika (that’s all I had in the kitchen) plus more for garnish
• Kosher salt and freshly ground black pepper
• 2/3 cup corn starch (what I had available)
• 3 tablespoons olive oil
• 1 pound small white potatoes, halved
• 1/2 pound cremini mushrooms, halved
• 4 medium carrots, cut into 1-inch chunks
• 1 medium onion, chopped
• 4 stalks celery, cut into 1 -inch chunks (addition to recipe)
• 2 tablespoons tomato paste
• 1 cup red wine
• 2 cups low-sodium beef broth
• 3 sprigs fresh thyme (I used several dashes of dried thyme as that’s what I had)
• 1 teaspoon caraway seeds, optional (didn’t use this bc didn’t have)
• 1/2 cup loosely packed parsley leaves, chopped
• Sour cream, for serving (we used greek yogurt)

Directions

1. Toss the beef with the paprika, 1 1/2 teaspoons salt and 1/2 teaspoon pepper. Coat in 1/3 cup corn starch and shake off any excess.
2. Heat 2 tablespoons of the oil in a large nonstick skillet over medium-high heat. Add the beef and cook undisturbed until it begins to brown, about 3 minutes. Continue to cook, turning the beef as needed, until mostly browned, about 3 minutes more. Remove the skillet from the heat and transfer the beef to the insert of a 6-quart slow cooker
3. Add the potatoes, mushrooms, carrots, celery, and onions and stir to combine.
4. Heat the remaining 1 tablespoon of oil in the skillet over medium heat. Add the tomato paste and stir until the oil begins to turn brick-red, about 1 minute.
5. Add the 1/3 cup corn starch and wine and whisk until thick (it’s OK if there are some lumps).
6. Add the beef broth, thyme, caraway if using, 1/2 teaspoon salt and a few grinds of pepper and bring to a simmer, whisking
7. Continue simmering and whisking until the gravy is smooth and thick, about 4 minutes.
8. Pour the gravy into the slow cooker, cover and cook on low for 8 hours. The meat and vegetables should be tender.
9. Season with salt and pepper and stir in the parsley.
10. Serve the stew in bowls with dollops of sour cream/greek yogurt and a sprinkle of paprika.

I browned the meat the night before and set the crockpot on low overnight.  When it was done, I took out the crockpot insert and left in on the stove top to cool.  Got home around 5:30pm and was ready to serve for the family.  This modified recipe was able to feed 4 servings the first night, and 3 servings for leftovers.  Keep in mind, we used large bowls.

This recipe definitely tackled my craving (yep, 24 weeks preggo!) and satisfied my husband and my mother-in-law as well!  Bonus, our 9.5 month old really enjoyed eating the tender beef and vegetables as well!  Family friendly meal!

Get out there!

We are nature people.  There’s no denying that.  I absolutely love the mountains, and Bear loves the ocean.  Between the two of us, our lil one is destined to love being outside — in fact, she already does!  I am looking forward to when she can hold her head up so we can take her hiking!

So, after some research on the best baby hiking backpacks…. here’s what I found:

Switchback Travel Ranking

Safewise.com Ranking

The Adventure Junkies Ranking

Outside Online Ranking

Baby Gear Lab Ranking

 

With all that info, the key things that would be important for us:

1. comfort for both parent and baby
2. size adjustability (I’m 5’7″ and my husband is 6’0″ so we don’t want two packs)
3. safety
4. durability.

 

After all the research, we ultimately decided on the……….

//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=krismd-20&marketplace=amazon&region=US&placement=B014EC648G&asins=B014EC648G&linkId=41f379f88246fe3ad525bf33fdd1c0be&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff

 

I must say I’m a bit biased toward Osprey products because they are incredible.  My current hiking pack is an Osprey and it’s been through multiple international travels as well as both Kilimanjaro and Patagonia.

We’re super excited to get this thing out on the trail!!

 

What are your favorite hiking backpacks for yourself as well as your family?

When to let go

I came across this blog post and was really struck by it’s honesty regarding the nature of medicine and death/dying. Back in 2011, I was faced with a very real scenario regarding my father’s health. Throughout medical school, we are taught to do no harm. However, there is a fine line between living and just barely surviving. Even as an MD and having been trained to deal with death and dying, I had to eventually come to grips with what was best for my dad. It has been said that medicine is both an art and a science. Practicing the art of compassion and empathy, I have learned a great deal from patients and their families as well as my own. Despite all of the advances of modern medicine, nothing helps more than listening to the patient.

The Greatest Act of Courage