this is really embarassing

OK, so I need to apologize to my loyal readers: and I know you are there--HOW? Because so many of you came to visit yesterday despite there being no new post for a week. This means I broke the promise I made to you just recently, and my life is out of control.

Well, maybe not completely out of control, but time seems to be at a premium.

 

There is time for sleeping (some times, when I am not on call), time for eating (most days, but not all), time for family (especially when I fly to Boston to see my daughter, son-in-law and grandson), time for taking care of me (really?), time for friends whose children both young and grown are giving them fits), time for shopping (a few major holidays are on the way). Oh, did I mention time to go to work, take care of patients, deliver and write up yearly performance reviews, solve problems, recruit new physicians, run committees and attend meetings? I also have make time to read 1200 pages of background materials in advance of  attending a national committee meeting for the American Academy of Pediatrics later this week, to be held in Tuscon--three plane rides away.

And then there is time for social media and blogging, or not.

I love this blog. I love TO blog. I know it therefore follows that I would naturally make time to blog.

And I do.

Until I find that I love something more, or I am more inclined to do something else, or I am more compelled to complete a specific task on my "to do" list. So I do find the time. Its just that when I find it, there isn't very much of it. And so it goes.....

And so it goes. I am not COMplaining. I am EXplaining to you, my devoted readers, why I have disappointed you this week.  And it's not that I have been slacking off and lazy. I have been working on it. I have four or five drafts of posts in varying degrees of "done-ness" on a variety of topics. I want to finish the one on performance reviews sooner rather than later. Then there is one on the nature of diversity in medicine, one on why hospital acquired infections are so hard to prevent, one on change in healthcare, and one on the perils of paying medical students to work in health-related fields. They all need fact checking, grammar checking, and multiple revisions before they are done. They need to be read and re-read before they are ready for YOU to see them. I have time for this, but just not enough, and just not right now.

So, this is where you come in. Write something for me, to me, to share here. It could be about how you spend your time, the things you try to make time for, but just can't seem to manage, or it could be advice for me or others who seem to have some difficulty managing all the time sinks in their lives. Or anything you'd like to write about. Knowing we have a community growing here at this site keeps me going, helps me devote the time even when other tasks are calling and demanding their share, fair or otherwise.

Forgive me, and thanks for stopping by.

Comments

Who has time for anything? Haha. I would rather read your blog posts when they are well thought out and not rushed, so TAKE your time! Time is just one of those things that we will never have enough of unless we allow ourselves to use it for what we think is best and not worry about the things we can't get done (I should take my own advice).

Becca, Ahh motherhood. I think you are right--to a certain extent. When I was a working mom (well, I still am a working mom, but my children are grown) I was very stressed, thinking or feeling that my kids might be missing out by not having enough of my time. I had to cut some corners, both at work and at home. I postponed many things I wanted to do (getting my MBA, for example) and I had to settle for less than perfect in my housekeeping, cooking (your dad did most of that)and crafting. But we all survived. And one day when you were about ten, we were talking about my busy schedule and I think I was suggesting I might quit and stay at home with the three of you. You told me that although I might not always be at home when you wanted me, it was clear that I was happy to be with my kids when I was able to be. Apparently that wasn't always the case for the stay-at-home moms among your friends. Made me feel happy, and let me know that the corners I was cutting were not harming you in any way.

Thanks for writing. I am amazed at all you manage to get done.

Lauren, Thanks for caring enough to find the TIME to read and leave a comment :)

Well...I read this last night and was about to reply "I would write a reply if I had more time." But I didn't even have enough time to write that. So now that it is the next day, and my son (your grandson) is napping, I have exactly 2 hours free. Not free really, but usable. In that 2 hours, I have to unload the dishwasher, load the dishwasher, take a shower, blow dry my hair, change the laundry, pay bills, send out emails to fulfill my responsibilities as managing director of my acapella group, work on my grad school applications, and eat lunch. If I can find 5 extra minutes during that time, I will work on the advent calendar I am making for my son (I'm running out of time because the 1st of December is tomorrow) and respond to my mother's blog post. I always thought stay-at-home moms were lucky because they had all the time in the world. But I can't tell you how often I find myself wishing I had a job to go to just so I could get something done. My peers with office jobs seem to have much more down time than I do.

I love your blog and your kind accountability here to us is so nice. We will stay tuned because this is a place to land that is engaging, helpful and committed to the community. So .... you, our good doc, are most definitely forgiven. Enjoy Tuscon!

Hello Dr Ackerman,

In reading the paper today, I ran across the article regarding Lewis Gales appeal to establish a NICU. While I am not sure what you can share on the idea, several questions entered my mind and hopefully you can shed some light on the situation. I am somewhat familiar with Lewis Gale as they were not prepared as a facility to treat my son back in 2008. He was 8yrs at the time. The lack of Pediatric Specialists and devoted team to the Pediatric patients left the care lacking in many ways. Thankfully we were transferred over to your Childrens Hospital and have sought care there when needed either with the hospital or ongoing with the Pediatric Pulmonology group. How would Lewis Gale with a NICU be able to provide specialized care and support to these babies if they do not have a dedicated group of Pediatric Specialists in the various fields?

Thanks,
Karen

Dear Karen,
This is an excellent question. While I cannot comment specifically on the situation you mention, I can tell you that the Commonwealth of Virginia has a lengthy set of rules that governs the care of neonates, and specifies levels of NICU care. Much of that revolves around access to pediatric sub-specialists as you mentioned, such as pediatric pulmonary, GI, genetics, and surgery, among others. In addition, it specifies the minimum number of beds that should be in a NICU to allow reasonable access to those specialists. If you don't have a large enough patient population, you cannot attract those pediatric specialists. In addition, the regulations specify other services that must be available for certain levels of care. There are many hospitals throughout our state that have lower level NICUs without the variety of sub-specialists available. Those lower level NICUs or special care units can provide care for infants born at a certain gestational age, and with a certain number of limited medical problems. Any infants requiring a higher level of care must be transferred to another center where the care is available. One nearby example of what is known as a "level II NICU" is the NICU at Centra Health in Lynchburg. Neonates there who require surgery or sub-specialty care must be transferred to Carilion or to UVA, but many of the bigger premies are cared for there without a problem. The health commissioner is bound by the regulations in making decisions regarding whether or not to allow a new NICU to be created. She has to take into account the impact on any currently operating NICU in the area. For example, any existing NICU has to be quite full much of the time, in order to justify the creation of a new unit.

You are very perceptive in asking questions about the access to sub-specialists. This is a problem that all of the Children's Hospitals in Virginia are struggling with right now. Those include Inova Fairfax in Northern Virginia, Children's Hospital of the King's Daughters in the Southeast, VCU-Richmond Children's Hospital, UVA Children's Hospital, and Carilion Clinic Children's Hospital. There are not enough of these sub-specialists to meet the demand, and we are considering trying to share some of the ones in shortest supply. Supporting them requires having a certain number of patients so that a hospital can have more than one (not even the most dedicated doctor wants to be on call every night), and recruit the best available. Because of the extensive training they have undergone, they are typically more expensive to hire than general pediatricians, but because their patients are so complex, they spend more time with them during a visit, and therefore collect less total money from insurance companies than general pediatricians, as they see fewer total patients in a day, a week or a year. That is why most general hospitals never get to the point of wanting to have a comprehensive children's center. It is simply too expensive.

We are fortunate to have a wide variety of subspecialists at CCCH, and I am grateful that this allows us to keep children like your son in the region. Otherwise, children requiring sub-specialty pediatric care would routinely have to travel to Charlottesville, Winston-Salem, Richmond or Durham for excellent care. Sometimes that is still necessary for some very rare or complex conditions.

I hope I have addressed your question adequately. If not, I would be happy to have an off-line conversation any time. Just let me know, and thanks again, for stopping by.

I love reading your blog--when I have the TIME!! Have fun in Tulson and remember to TAKE the TIME to smell the roses!!!

Thanks Vanessia. I did have fun in Tuscon! It was wonderful. Then it took me an extra day to get home than it should have, so much of the good I experienced there was lessened by the time I got home. Ah but still I was refreshed and invigorated. Thanks for stopping by.

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