it's been about six months since the last entry. much has happened. my practice stopped being supportive of even my frugal lifestyle so some alternatives are in the works. dad is in the hospital, son tries my patience. i'm a little despondent and hard to motivate. very little brings me pleasure and i seek no hedonism. at this point i wouldn't know where to seek out my highest level of amusement.

Haven't posted for a while. Pesach has come and gone, Shavuot about to arrive. I have a lot of tasks being juggled, managed very inefficiently and half-heartedly. I gave myself a drug holiday and feel better, especially without the ssri. I'm a little more irritible and impulsive and definitely less focused but also more energetic and able to think more clearly.

It's time to think about my projects for the second half 2009, starting with finishing up the undone stuff from the first half which is most of what was on my list.

rtf

I'm recovering from my weekend on call. There were not a lot of consults but a very large census at Christiana Hospital that kept me on the go.



I've not been sleeping well for a few months despite my best efforts at proper sleep hygiene. I go to bed at the time specified but wake up at about 3:30AM most nights. On the weekends I just get up and read or see what is on TV but when I have to work the next day I try to return to sleep with varying levels of success. For the most part I do get up on time and function well through the day. I konked out after being on call but by mid-week have recovered reasonably well. Exercise still eludes me. I have eaten better this week, though, making a serious effort to avoid snacking after supper, though it would have gone better if I were more consistent with eating lunch.

I'm a little sleep deprived and a little irritated. From time to time there are key decisions to be made. AKSE's leadership finally brought me to the breaking point. I truly sincerely do not want to be there anymore. The search for alternatives is under way.

It's Friday. The sun will eventually set and shabbos will be here. I'm optimistic about a decent day but I already muffed dinner preparation, though will be able to remedy this having gotten up a half hour earlier.

Been a little more relentless in pursuit of some of the goals that I set a few weeks ago. Started articulating some of them to outsiders. Let's see how I actually did yesterday.

Job: articulated my willingness to take one, made inquiry to cdc, reviewed institute of medicine site and contacted a director. not bad pursuit.

Kitchen: I'm trying to purge containers but really didn't do what I had hoped yesterday.

Workspaces: Really did nada. I think this one benefits from a few concentrated efforts.

Writing: I wrote a rather good essay on the state of psychiatry for medscape. It's gotten very little comment. I spoke to two younger physicians about the decline in physician care at cchs, which will eventually become a good theme for something like "On Being a Doctor".

Friends: I contacted somebody at the IOM. This organization could be a great intro for new friendships.

Health: I've been making a concerted and reasonably successful effort to eat at mid-day. This seems to be making me less voracious at supper and beyond.

Today's Intent:

Job: Follow up JCAHO
Kitchen: Soak Fleishig dishes
Workspaces: No plans
Writing: Probably ought to work on JCC and/or Med Society pieces
Friends: No specific plans
Health: Treat myself to lunch out and write in my journal.

Hello to me. No office patients yesterday. I rid my desk of enough charts to see to the other end, then tackled some papers. I still have piles of charts on the perimeter of the desk in all states of disrepair, unreported lab work behind me, undictated charts beneath me. And there are more to come. This is not what I want to be doing until retirement so I need to make some serious revisions, starting with what else I might like to do instead. Yes, there are some things that still energize me. The patients do, but only when they are in my presence. My colleagues do, or at least their activities and decisions do. There is a desparate need for some type of reform so perhaps I could give up the onorous tasks to become a reformer.

iggles. playoff today. this keeps me at home doing useful stuff instead of traipsing around in the car like i do most sundays. i could use the rest and relaxation, along with a chance to catch up on some of my personal projects, of which i've named six.

1. I think it's time to replace my practice with a job.
2. My kitchen should work the way I'd like it to.
3. My workspaces should be usable and pleasant.
4. My writing should be submitted for publication
5. I will make four new friends.
6. I will meet my health goals.

None of these seem outlandish.

rmp