Hi. This is Laura Vandercamp. I'm a mother of five, an author, journalist, and speaker. And this is Sarah Hart Hunger. I'm a mother of three, a practicing physician and blogger. On the side, we are two working parents who love our careers and our families. Welcome to best of both worlds. Here we talk about how real women manage work, family, and time for fun, from figuring out childcare to mapping out long term career goals. We want you to get the most out of life. Welcome to best of both worlds. This is Laura. This is episode one hundred and seventy one, which is airing in mid November. We recorded it in early mid October. We have a fascinating guest today, Colleen Blanco, who is an attorney at a private equity firm, who is sharing the story of her first son's birth eight nine years ago, who is very premature and he fought through several months and then nick you and is doing great now. And she will talk about that journey and how difficult that was and challenges associated with extreme prematurity, with advice for any of our listeners who are facing such a nick you stay or potential prematurity in their pregnancies, or if you have friends who are going through such an experience, how you can be supportive Sarah, you're I mean your babies were all what thirty eight thirty nine weeks? Right? No, all babies were forty and over. Oh my goodness, three out of three. I never got a never got any bonus bonus days on this. So yes, I have no personal experience with prematurity, but I have plenty of clinical experience with prematurity because my residency was particularly heavy on nick you and of course I still actually see babies in the NICKU, not that I am their primary caregiver, but because I'm a consultant and because premis and other nick you babies do get a lot of ENDO related issues. I'm in there when I'm on call, usually at least a couple of days out of the week, so my ties have remained close. And I guess I'm glad to have had that extra training time during residency. Yeah, I mean it's quite a place. It seems like a very it's an alien landscape. I mean, like when it was actually my very first rotation at the regional nick you shout out during the regional hospital, it was slightly terrifying. They have a lot more coverage in terms of providers now than they did back then, and I just remember being like anything could happen. But the nurses are amazing. And there's also a special type of nurse practitioner called a neonatal nurse practitioner, where all they do is care for you know, newborns, and they're awesome. They're just at least from a residence standpoint, they knew everything and they were so helpful and I learned a lot from them. So yeah, I mean, because I can't even it's just hard to picture because I think of my full term newborns. They felt so fragile and tiny, and they're huge at like eight pounds compared to these premis who are being born at you know, just shy of two pounds in the case of Colleen's baby, or but even you know, three pounds, four pounds is still like half that size. I mean, it just it is hard to even capture very fragile chiny as one or like five hundred grams, which is like, what is that just over one pounds? Oh wow? Wow, Yeah, that's I mean, it's amazing how modern medicine, can you know, cope with that that? I mean that development over the past you know, a few decades has been incredible, although there's some equally important work going on in terms of, you know, reducing the number of premature berths in the in the first place, managing conditions so that you know, as many days as these potentially very fragile babies can be kept in the womb. That that's better. Yet I sort of remember with my life. I had some worries about prematurity with the last pregnancy with Henry, and he was in fact born right at thirty seven weeks, so I guess just cross that line where then he wasn't considered premature. But you know, in the course of going from I had looked up the statistics on this, like what their viability is at various points, And when you go from about twenty three weeks to twenty nine weeks, you rise from something like you know, ten percent survival to ninety percent survival. So if you do the math there, you're basically going up by about two percentage points a day. I mean, it's not continuous like that. It's probably more clustered at the beginning than at the end. But still I had that moment every you know, time, during that window of time, like every day, I'd be like two percentage points more like I may not have done anything else today, but I hear I've kept this little boy in my womb for two percentage points higher, And so that felt sort of motivational, I guess, as we were going along for that. But fortunately, yeah, it is hard work keeping him in there. So it is hard work keeping him in there. So he was good. No, it's such a tough story. It was, you know, so moving. We don't actually talk so much in the interview about the fact that she was having twins and that one of the children died right away after being born. And so I just think as I'm listening to this interview again about like, you know, how she was coping with the nick you stay at the same time that they were grieving this second child, that they thought they were having twins and then only had one surviving baby who was then fighting for his life. And I mean, it's just so incredible that, you know, he made it, you know. So I hope our listeners find this to be an inspiring story too. Well. Sarah and I are delighted to welcome Colleen Blanco to the program. So, Colleen, can you introduce yourself to our listeners? Sure, Hi, everyone, My name's Colleen Blanco. I'm thirty nine years old. I live in Westchester County, New York, and I'm an attorney in house at a private equity firm. And I have three children. Yeah, And so Colleen was willing to share her story on the program of not so much what is going on currently in her life, but what went on about eight nine years ago when you were starting your family, And so why don't you tell us a little bit about your your journey with your your first pregnancy and what happened as a result of that. Sure. So, I it was my first pregnancy and I found out I was pregnant with identical twins, which was shocking to say the least, because they don't run in our family. And it's your first pregnancy, so you're not really expecting that. And I had been told that, you know, they'll probably come early, like most twins do. But around twenty four weeks, actually twenty four weeks on the dot, my water broke prematurely at home in the middle of the night, and so we had to go to the hospital and I found out from various ultrasounds when I was there that they were let me sorry, let me back up. I thought that they were fraternal twins when I was getting all of my sonograms leading up to that. So I found out that they were actually identical twins when my water broke and I was in the hospital and they had something called twin to twin transfusion syndrome, which I had never heard of. But uh, and Sarah you've probably familiar, but it's when ident It only happens with identical twins where the blood flow in the placenta is not not even between the two children, and so one of my sons was much smaller than the other. So yeah, basically, I was on bed rest in the hospital for about five weeks with various sonograms throughout, and you know, they came to a point where they were showing that the twins were in distress, so I had to have an emergency sea section at twenty four weeks. Five days. So you said five weeks, but you meant five days of bed rest five days? Yes, sorry, sorry, because at first I was like, oh my gosh, So they made it we right, they madden to that noish, although every single day counts in every day. Yeah they said, yeah, everyone said that, and so yeah, sou so at that. So we had the emergency sea section and my son Andrew was one pound ten ounces and my son William was even smaller than that. In fact, I think we got it in gram So we used to Graham's at that point because they're so little, and so yeah, they were whisked away to the NICU immediately, and my son William only survived for two days because he was just too small. He was the twin that wasn't getting enough blood flow from the placenta. And then yeah, my son and then our crazy journey began with the with the nicuu. You know, I know that there's some there's a there's a big diversity of babies in the NICU. Like there's kids like Andrew who are all the way in the back of the nice and like stay in the back of the nic queue because they, you know, need the most care. And then there's you know, kids that are born that only need a week in the NICU because they might have some you know, feeding issues or something. So we were in the back of the NICU for a very long time. And yeah, we uh, we were there until Hurricane Sandy. And then we were at m y u H in Manhattan and we got a call or actually we couldn't get through to the Nicku. I used to call every day, and we had visited earlier that day and then on the news we saw that they were evacuating m yu So yeah, so we lived in a story of Queen's at the time. So we raced to the Triboro Bridge to get over into Manhattan, and they had closed it because it was dangerous to get over it. But my husband managed to convince them. He actually like went like this to show them how small my son was. So that made them open the bridge for us, and we literally drove over the Triboro Bridge by ourselves, raced into Manhattan, you know, waited until they brought all the babies down. Had to take an ambulance to a new hospital, and we actually went the ambulance to us to the wrong hospital first, which I thought was hilarious. We all show up with our babies on like you know, respirators and nasal canula and they're like, no, wrong hospital. So we got back in the ambulance and went back and then he was in Montafior Hospital in the Bronx for about another month. He got out right before Thanksgiving. I think it was November twenty fifth. Those are both hospitals with excellent nick u's. Did your babies start at NYU, like, did that they didn't have to be transferred in the beginning? Yeah? No, I think on the level of nick you at both was like level three or four four, yeah, which is the highest. And actually for our listeners, you know, some people, that is like a consideration, especially if you're having a more complicated pregnancy, to think about where you're delivering and what the Nikki facilities are like. Because in your case, you were really lucky to have started somewhere like NYU, because sometimes a transfer can be dicey. Yeah, yeah, yeah, for sure. I had to y. Sorry, I had just thought of that. That's so funny. So we've experienced the same place, or maybe not. I mean I was, you know, a different part of it, but no, so that, I mean, that's an amazing story. I mean just that the evacuation, and I cannot I'm hardly even to picture you guys like desperate there on the triborough bitch in a storm with the police trying to get across to your baby. But I think this is an interesting point you think about because obviously you can't be there the whole time for like three months. So I mean you had to go back to school, You had to go back you know. I'm sure your husband had to go back to work or if he was in school too at the time, because because you were in school, right whenn't this happened right? Right? Yeah? I was going into my third year of law school, so it actually I was actually doing my summer associate job at a law firm, and I was like the only summer associate I went to law school later. I went when I was thirty, and so I was the only pregnant summer associate that year because everyone was like twenty three. But yeah, so I had to bail out of that early. But I ended up going back to school on time, and I just would visit. And this is a point I would make for anyone going through this is you know, I went every day. It made me feel better, but I didn't feel obligated to go. You know, I never spent the night because I needed to have that separation. And I think it's if this is if you're going through something, especially with an extremely premature child, do what you need to do to survive because it's really a roller coaster, and you know you shouldn't as much as women feel pressure as mothers, you know, like try to not feel that way because whatever you do for yourself is right in that situation. It's just it's probably the most stressful situation I've ever been in, and you know, you just need to be kind to yourself and your spouse. You know, there was a lot of at the beginning, a lot of tension there too, but you know, you really need to rely on each other and just give yourself a break and do what you need to do to get through it. It is a marathon and not a sprint, which is something. Can you talk about that because it's you know, I think people imagine the emergency scenario, but like, you know, okay, you have this tiny, tiny little baby and then they're in the NICU. But I don't think and I get it because I've seen it at least I sort of get it because I see it from the provider end that this is a very very long drawn out like you don't get to exhale, like weeks and weeks and weeks go by and things can still happen. And you know, we always learned the slogan never trust a PREMI not meaning that in a bad way, but mostly just like, take any change in their vital signs or demeanor very seriously, because you know, a twenty four week premature infant, you know, four months down the road, maybe doing very well, but if they get a little bit distended in their abdomen like that could mean that they have a very serious problem going on, whereas that's much less likely in a full term baby. So Okay, I'm going on a big digression, but what I'm saying is if somebody's listening to this and it's either has threatened prematurity or you know, is starting to go through this, like, can you talk about how you took care of yourself and dealt with it as such a long duration, because I can imagine, I can't even imagine. I mean, it must have been so difficult. Yeah, yeah, especially at the beginning, but even like you said, with the distended stomach that came up, you know, when we were in monthifor so, it was over three months, and we thought we were kind of only focused on his breathing. That was his primary problem at the you know, for his entire stay. But there was like a little bit of I forget what it's called necrosis or something of the necritizing enterocolitis exactly. Yes, And it's truly like you never get a break. There's always something new, and you kind of just become less affected by the positive nights too. You call every morning and and you know, they'd be like, oh, the baby had a good night, and it's like, okay, but tomorrow's another day. So yeah, it's very much a roller coaster. At the beginning of our stay, Andrew actually had sepsis, so we were prepared for him to die, honestly, like we were. The doctors were preparing us for that. It was it was just something that he was so small that they didn't think that he would he would be able to pass through it, but he he did amazingly. And so yeah, in terms of how we took care of ourselves during that time, we went out to eat at the diner across the street from from n Yu a lot, which was you know, very comforting but probably not the healthiest. You know. We had some friends visit, my mom would come, you know, we didn't want a ton of people coming to visit, but you know, we would have my mom come in sometimes and you know, spend the day with me there, having someone else there while you're you know, while you're doing kangarooing and stuff. It's nice because it can be kind of boring. I listened to a lot of podcasts and music when I was kangarooing him. You know, spent a lot of scrolling time. But you know, it kind of took you out of where you were, and you know, having headphones in with all of the it's a very loud place with all of the beeping in the alarm, so having headphones and helped a lot. How old is he now? He's eight? He's eight. Okay, we're gonna take a quick break and then I have a comment about the loudness. Okay, we're back. So what I was going to say is, actually, believe it or not, nick U's in the last i don't know, five or years or so have actually become a little bit more sensitive. And I think the trend is really that they're trying to work on keeping certain rooms really quiet during certain hours because there's been studies that show like if you can mimic the daylight cycle and like a lot of calm and like there's a movement towards like not you know, grouping the exams on the baby. So I actually wonder if your experience would be slightly different in twenty twenty than it had been twenty twelve. So that's just a fascinating little tidbit that they're continuing to work on that, because yeah, it back when I trained back of the Stone Ages of like two thousand and eight or nine or whatever. Yeah, it was always loud and bustling and hustling in there, and I find that now and I am in a different health system, but it's more hushed, Yeah, slightly more womblike than that. Poor babies are thrust into this and they're in a rough shape anyway. So yeah, so we were talking about sort of how you can manage this. So if you have, yeah, advice for people who are going into or who have friends who have, you know, a premature child, How could people be supportive of you and what should everyone expect? I think if you have other children, Luckily you know silver Lining. This was our first child. So there were other families that had kids in the NICU with other children, which I can't even imagine how hard it would be to manage that. So I think, you know, being very upfront with your family asking for help, if you have family nearby or friends childcare for that, that would be very helpful. Because you do want to spend a fair amount of time. I did. I wanted to spend a fair amount of time in the NICKU. You know, like I said earlier, do what you need to do. Don't feel pressure to be there all the time. Seek out therapy. Me and my husband started therapy almost immediately because of the you know, the trauma of losing William and you know, just having a child in the nick I thought that was really helpful. Early Intervention. I don't think this is just a I think this is state by state, but at least in New York, your your children can get certain therapies like physical therapy, speech therapy, ot through the state through a program crowd called Early Intervention, which I actually had never heard of before. You know, we started taking him to the pediatrician after he was out of the NICKU. So if you have a lot of downtime in the NICU and your child was extremely premature, they probably will need a little bit of you know, therapy, probably PT at the beginning, but you know, over time, I'm other therapies too potentially, so start looking into that and it takes a long time sometimes to get ramped up. So it might just be good to know that you know what the process is so that you can hit the ground running when you're you know, when your child is out and I think it usually starts around six months, depending on which therapy it is, So just kind of familiarizing yourself with that because there was a lot of new terminology for us, and it just I think you know, when if you're familiar with something, it's more comfortable to you, and you know not it's easier for you to move forward with it. Absolutely. How many months did he stay in the nick? You just shy of four months? And what was that getting out of that process? Like, because I'm sure that was sort of like when is it going to happen? You have to reach certain milestones right for them to allow him out. Can you talk a little bit about that? So his problem was mostly breathing. He was on a respirator, then he was on the CPAT machine, and then he was on nasele canula for a long time, and they have to be without support and not de SAT. It's called desaturation right in your ox such at your blood oxygen level for a certain number of nights or certain number of days before they can get out and so and the clock restarts if they have any d SAT during that time. So there was a lot of that. I forget if it was five days or ten days, but it was like you'd get to four days and then overnight there would be a d SAT and you would start all over again. So yeah, I mean, and then one day they just, you know, they just told us, hey, he's been d SAT free for you know, however many nights so you could take him. And we were like, uh, you know. It's so it's very odd having and after having like two full term children after this, it's very odd to take you know, your baby home after having them in the hospital for four months. You're like, what you might because you've been a parent for four months, but you haven't really like had the normal experience. So you take this baby home and you're just like, how are you allowing me to take this baby home? It's he's needed so much support and now we're just taking him home. Like it just but it was just you know, it was like it wasn't like that, but it was just one day he was ready and you know, did your friend would he's had you know, he didn't have He's had other you know, you know he needs therapies and stuff like that. But I mean, no other hot hospital stays or that's amazing. Did your hospital have you room in because I know we used to do that. Well we still do that even at our hospital, where some families will spend like a night in like a separate room but in the hospital in case anything happens or they have a question. Did you guys get to do that or I guess not. We only stayed over the night of Hurricane Sandy because we kind of had to, Like I think we didn't have Oh no, I think we had the car. But yeah, we only stayed over that one night. You can. I think I think there were some families that did. But I always want I always wanted to go home. Honestly, it was just the separation was was good for my mental health at that point. Oh no, I just meant for the very last night before you took him home. That's a thing in a lot of places so that you can kind of ease that transition, like, Okay, we did our twenty four hour room in and then you go home. Oh no, no, I don't think that that was offered to us. So no, it was just kind of like, come get your baby, and we did. And so you said, there weren't really any big incidents. Then once you once you came home that he was he was relatively stable. But how how has the prematurity then then played out? I think a lot of people don't know how it what what is likely to happen as as a result of extreme prematurity in terms of child's developmental path Yeah, I think it can be like very wide ranging. For Andrew. People have commented on how amazing it is that he doesn't have more severe, severe issues, like you mean, you could have CP. You know, there could be kind of real serious issues. And Andrew has more I would say global delays. He gets he gets PT, he gets OT, he gets speech, he has attention issues. So you know, it's not you know, it's not an easy path and it's not to compare him with my other children, but it's just so different, like a premature baby versus a full term baby. But you know, he's on grade level academically, he's very bright. So we've been very lucky to not you know, have to face those sorts of issues. But it's more kind of his uh you know, I would say gross motor and fine motor and oral motor. That's amazing. He's breed level a moment, you know exactly. So then you know, I mean you were doing this while you're in law school? I don't, I don't know, you know how then he comes home and you you are having to I mean, is there any sort of leave you took at the time or you guys, just what was your then care situation for you being in law school and him coming home from the hospital then as this tiny baby even though he's four months old. Yeah, we it was a combination of so I made my schedule kind of. I took a regular class load, but it was also going into my third year, which anyone that has been through law school kind of knows you already have you already you may have your job locked in at that point, which I did, so there was a lot of a lot of pressure removed there. But yeah, it was a kind of we had this crazy schedule with my mom coming, my husband's mom coming and based on my schedule, when I could take care of him myself. And that lasted until, you know, until the summer where my where we could take care of from ourselves, and then I had to study for the which was, you know, another thing. But but yeah, it was just a lot of family. Luckily we you know, we have family relatively close by, so that's that was a huge help and continues to be a big help for us. And then a couple of years later, you decide to have another baby. So can you talk about that sort of mental process, like having been through this trauma of what happened with the twins and having a child then being extremely premature, and then you know, here you are having a pregnancy which sounds like it was relatively normal then the second one, but I'm sure there's a lot of trepidation involved in that for sure. So I knew from the beginning that I would need to have a sea section that based on how they had to do the sea section my first time that I vaginal birth was not an option for me. That was a little bit disappointing, but yeah, I mean I so I had to have a sea section of thirty eight weeks for both of my youngest children. And yeah, it's so it's it's so surreal to just like get your baby and meatia it lee and you know, go home after three days in the hospital. You know, see what see what kids can do at certain ages. Because Andrew was delayed and continues to be delayed. So it's it's just it's almost like having like my middle son, Matthew. It's almost like having he's my first because this is like, you know, a typical, a typical way that you have a child and see them develop. But I also think that, you know, we appreciate Andrew and what he's able to accomplish that much more seeing you know, where he started versus what a full term baby is able to do. But yeah, we waited a while too. We waited about five years, so we definitely were a little bit gun shy, but we're happy that we have more more children. He did it again. So I have a question because I heard a little rumor, maybe from your email, that Andrew was mentioned in a certain state of the Union. Yes, I should have I should have at it, not by name. It's not like Obama was like Andrew Blanco made it through the nique, but yeah, they I guess the State of the Union was, you know, shortly after Hurricane Sandy, and they had invited one of the nurses. I cannot recall her name, unfortunately, but they had invited one of her to be a guest of him and Michelle Obama, and so he acknowledged her during his State of the Union and said, you know that she kind of coordinated the evacuation of the nineteen I think it was nineteen premature babies out of the m y U nick you So yeah, I wasn't watching it. My friend actually texted me to tell me and she said, oh, you know, Obama mentioned Andrew and I was like, my name, but no, it was But it was cool enough that is and that's a lot close to have ever been to the st Yeah, we're basically best friends. Yeah, exactly when you and Obama here like that. After this podcast, you can be on Michelle. I hear she listens to us for guests ideas. Definitely, so we Sarah, do we want to go ahead and do the Love of the Week or did you have any more questions? I think that was mostly it. I guess we'll tell us how old all three of yours are now and I don't want you don't have to go through a full day in the life, but can you just give us a summary of what life looks like for you right now, eight years post this incredibly difficult and dramatic time, I'm assuming things have settled out a little bit. Yes, So Andrews eight, Matthews three, and Natalie is just about eighteen months, and we're totally done. That's it. And yeah, they you know, obviously a day in the life is a little bit different now. But my eight year old, Andrew, he goes to school two days a week in person, it's a hybrid model around us. And my three year old goes to pre k three days a week, half days, and my eighteen month just drives us insane the entire the entire day. She's very, very precocious. So yeah, I mean, I have my this is my home office slash bedroom, and I just kind of have breakfast with them, come up here, do some work. We typically have lunch together, or I'll hang out for a little bit with them during lunch and then come back up here. And the days are just kind of like for everyone just melding together and just one long, you know, groundhog Day. But saper lining is I'm spending a lot more time with them than I ever would have, and maybe even more than I would ever want to. But were you were you pre pandemic, commuting to the city every day. I was, Yeah, it's shut down just about in mid March. So yeah, I've been home since, and I don't I mean, I don't think that we're going back anytime soon. So that'll be so interesting if you find out you never have to come back. Oh my gosh, yeah, I would, you know, I was working one day from home anyway, and it would be great if I can make that like two days from home or I doubt three, but two days would be wonderful. But I do like going going in sometimes I do think there's some positives to it. But I hope, yeah, I mean, I hope that like most people, I think, you know, having this more flexibility and seeing that your job can still you can still do your job and companies can still function with people working remote. I hope it leads to a bigger change. And that's a really good point, and it does not have to be all or nothing. That's a really good point. Might be the future. I think it will be put that out there. Very cool, awesome, Well, this is quite a story, and yeah, for great advice for any listeners who are facing a nick you stay or have friends who are going through that as well. So we always lend with a love of the week. So Sarah and I can go first, so that you are listening to us if you run time to think about it, Sarah, what are you talking about this week? Simple pleasure of those phone screen protectors. Protectors, you know, just those little five dollars ones that you get on one or whatever and you stick it to your phone and miraculously you can drop your phone fifty times and it doesn't break. I mean, let's just like a moment of silence for how much better that makes our lives not having to replace a broken glass screen because I personally drop mine like daily. Yeah, that's my love of week. Well, as we have like teens and pre teens with their phones, this is you know, important, this is a critical thing. We'd have a lot of broken phones one way or the other. Although I have broken mind too, so I will not cast stones on that. I was gonna say, I love a pandemic development here, which is that nobody is sitting in waiting rooms anymore. Like we've been sort of curing back up with dentist and doctor appointments and things like that, and now we're always just like texting from our car, calling and then they say, Okay, the waiting room's ready, now come in, which is great. You know, I don't like kids licking toys and dirty waiting rooms. And so now we don't have to anymore sit and watch a movie in the car until it's time. So big thumbs up for that development. Hopefully we continue with that, because it's you know, unclear why anyone needs to sit in a waiting room anymore. Colleen, how about you, I would say, hand me down clothes. So we just switched over in New York. It's you know, turning now, and we just switched out all of our kids clothes. And I got a ton of clothes from friends and family for my daughter, and so she basically has a brand new wardrobe for you know, for nothing, and some people bought nicer stuff than I would ever buy for her. So she's she looks great. And so yeah, I think hand me downs is they're great. There's no reason to get rid of a lot of those, A lot of those clothes when kids wear them for such a short time at this age. Yeah, totally. We have a huge hand me down closet, although it needs to be organized because I feel like there are twelve to eighteen month clothes that I'm just not finding, Like where did they all go? I don't know, I need them now. Managing all of that is very difficult. I agree. I'm always like, where's my son wore four tea for a year at least and I can't find them for the life of me. Somewhere. Yeah, she suved in a drawer up in a closet shelf somewhere. Awesome. Well, Colleen, thank you so much for joining us. So this is this has been wonderful. We really appreciate it. Thank you. All right, Well, what better way to end that wonderful interview than with a question about the other side of delivering babies, A question from an obgyn. So I thought this was a really interesting, well personally interesting question because I could sort of like, I get what she's you get, So why don't I read it? Because I think Sarah has much you know, as the expert on this, so I will. I will read it to it. So this obgyn sees about twenty to thirty patients a day, and her notes need to be locked in the system. I assume that she needs to complete them in forty eight hours for her particular you know, provider services goals or whatever. She says, she has schedules patients from eight thirty to four, with a lunch break. Throughout the day. She might have five to ten minutes where she could go in and finish notes or call patients. But if she feels like this leaves her more frazzled when she's trying to do multiple things at a time. Unfortunately, if I leave it to do in batches, it means time away from family by staying later at the office, or time from my husband by working on it after the kids are in bed. I'm tired anyway, or you know, the kids are up at six or seven, So it's hard to do in the morning unless I get up four am. She says, I work through lunch most days, which helps, but I struggle with finishing afternoon notes and doing everything else. My preference is to batch tasks, but I can't find a good time to get it done. Any tips for being efficient with notes, okay? Sarah well, and she specifically is asking also about batching versus doing them in small bits. She gave me some more details. She added that she's on call one in ten and she's off every Monday, and she notes that this is a scaled back schedule for an OBI, and it does sound like a decent schedule. She's working a four day week. She's on call one out of ten days. Like, I get that, that's pretty decent. But she's really struggling with these notes. And the reason that I can relate isn't necessarily so personally because I'm lucky. I'm in a field that is just it's not super super high volume, and so I can usually get done and not leave super late and finish my notes and or do a lot of the notes in my room. But I'm guessing that she sees, Yeah, she sees probably about double the number of patients that I see for each day. So that's going to increase the challenges there. So the reason just so I know, because I want to ask this for the what what are the notes you're doing? Like I don't, I don't even understand what this means. Is like you have to write up a paragraph about everybody or like you just fill out certain boxes of what you did. I mean, what is the note like sitting here, Like doesn't everyone know? Oh that's so interesting. Okay, So it's not like we sent our notes, right, I mean, there is a move for you to start getting Like for my patients, there is a button that we can press where they do automatically get a copy of notes. Okay. So, in order to facilitate medical records and building billing, almost every physic, not every physician, but like nine percent of physicians in the United States now use electronical medical records. I've mentioned ours is called EPIC. There's con certner. I don't know which one this person uses. Every single patient encounter you have, even if the encounter is like three minutes, you have to complete this whole online form that are not well designed in many cases. I mean, I've, like joke many times, learned that everyone hates EPIC. By the way, I hate EPIC. There are great things about EPIC, but it's clear that the people who designed it are not the people who are living their lives click click click, click, click click. And I have also found myself as a very fast computer worker that like they're not quite as responsive as that I would expect them to be in the year twenty twenty. Like I don't want to wait two seconds for a page to load. I want it to be instant anyway, So add up all those seconds, and every time you see a patient this person notes that she spends I think she said like six minutes to close each chart. Well six minutes times thirty patients is one hundred and eighty minutes, so that's three hours writing notes. So you can see where this gets you if she gets behind. She mentioned she can sometimes like do her morning notes like partly in the room and then partly at lunch, but then she's left with like these fifteen other notes that she has to close, and like when does she do that? And the reason I can say I can relate even though I don't personally have to deal with this as much, is because of Josh, so I cannot. I don't want to, you know, talk too much. But he does struggle with completing his notes, and he sees a much higher volume than I do in his clinics, which I'm sure are extremely busy. I don't think he has a lot of downtime to finish them during the clinic, and I'm not sure he likes to work in dribs and drabs either, so he tends to do them like at night or early in the morning or both really really rough. However, I will also note that he feels fine, and I feel fine actually with him coming home later a few times a week, and I think you need to maybe give yourself that permission to have a little bit longer workday to Like when I was doing all the calculus of this, I'm like, you know what, come home at seven or eight, two or three days a week, and probably that will enable you to keep your mornings, keep your evenings, kind of keep the rest under control. And you have to remember that if there's seven days in the week and you're coming home late three days in the week, that's four evenings that you're still getting to spend with family as well as most of the weekend because you're only in call one and ten. So that's my thought. I agree with you that it can be very hard to get notes done in dribs and drabs, but you might want to think about doing the results calls in dribs and drabs, because nobody wants to sit late at night calling patients at least I don't that's a different energy than doing the notes. So as much as you can sneak those in between the patients, I think that the calls and the lab results, and I also this may not be an option, but if you can outsource some of that to a medical assistant or force your patients to use electronic messaging, that is what I do. Now. When I hand them the labs, they get a piece of paper that's like, your results will be on my chart. I will be responding to you about your lab results on my chart. Now, if there's some terrible result and they need to talk to someone, of course I'm going to call them. But for routine follow ups, it's so much faster for me to write one line of thyroid labs look fine, continue current dose, and actually it's a little bit more clear than leaving of a phone message that they may misinterpret or something. So that is my long and drawn out potential solution. But I think if this were my scenario, I would see if you could just come home late a cup two to three times per week and just make that like finishing time, so that you can have the rest of your time be more unspoiled. Yeah, I mean I heard this question, and obviously Sarah has more experiences with than I do. I have no idea what a note even was, So there you go. But to me, just seeing her schedule, I mean, eight thirty to four is not a particularly long schedule for you know, and I since they're scheduled until four, so she may not be finished with them the joy or something well, I don't know, Yeah, I mean, but just if you know the last patient is at four, I mean, yes, people will probably go over. But even so, I mean, if it's like four forty five, let's say that they're out of the room, you know, just saying I'm gonna work till five thirty or six as a regular matter, I mean, an eight thirty to six day is not you know, a huge long day, especially if she's only doing this four days a week. I mean, you know, having four ten hour days is actually a normal full time schedule. I mean, then she obviously has her call, but that's part of being a physician, so you know, working a forty hour week is just doesn't strike me as like so over the top. And so if she was doing that, you know, they're out of the room by four forty five. She's got four forty five to six six thirty to do her notes every day, so she could probably get through the afternoon ones, especially if she's mostly on top of the morning ones, and just accept that that's her schedule. I mean, she has Monday off so great. You know, she has a forty hour work week in that cluster, and I who knows why she thinks that she needs to be home earlier than that, I don't know, but that strikes me as the most obvious way to fit this in. Yeah, I agree, and I think it's probably less painful to just sit there and finish at work and then come home, unless she's gonna miss the whole evening with her kids multiple days a week, and then then she may want to think about like doing it, you know, staying late some days, doing early some days, if she doesn't want to miss all four nights. Like I don't know if she has young kids that go to bed at seven thirty or something, but but yeah, I guess what you said, like do two days to just blow through bedtime, like stay at work till seven thirty eight, and then the other days come home at four forty five. I mean forty eight hours. It might be the best to do like Wednesday and Friday be your late days, and that way you can close any charts from Tuesday on your lin on Wednesday, and then you can close any charts from Thursday or late night on Friday and have like a clean slate for the weekend. Yes, it can be disappointing not to be done early on Friday, but my husband is never done early on Friday, and I've just accepted it. It's like whatever, we can start a little later, but we still get to have a weekend, so it's okay, there you go, there you go. All right. Well, this has been best of both worlds. We've been talking with Colleen Blanco on nick Us, stays and prematurity. We will be back next week with more on making work and life fit together. Thanks for listening. You can find me Sarah at the shoebox dot com or at the Underscore Shoebox on Instagram, and you can find me Laura at Laura vandercam dot com. This has been the best of both worlds podcasts. Please join us next time for more on making work and life work together.