A Week in My Life
(as a pediatric psychology postdoc)

I start my week by meeting with a family for a feedback session. We had an intake session together last week through our Medical Coping & Wellness (MCW) Clinic (postdocs complete two intakes per month). This family was referred by our Neurology colleagues (we receive referrals from all medical services across the hospital and outpatient clinics); they noticed that the child was displaying symptoms of medical traumatic stress after brain surgery. The family and I discuss recommendations for therapy.

After a quick break to jot down some notes from the feedback session, I have two supervision meetings, first with Kate Dahl (primary supervisor on the Kidney/Liver Rotation), and then with Michelle Brown (primary supervisor for MCW outpatients and either Cleft & Craniofacial Clinic or inpatient Stem Cell Transplant patients, depending upon which rotation you’re on at the time).

As a side note, I was an intern at Stanford prior to postdoc, and one of the main reasons I decided to stay here was the incredible quality of the supervision I received. All of my supervisors have simultaneously been brilliant (during every supervision meeting, they cause me to think about cases in completely different, deeper, or paradigm-shifting ways) and supportive (they regularly go out of their way to connect me to opportunities related to my areas of interest and provide needed encouragement during inevitable challenging times). Even attendings from other services look out for teaching moments for us, such as taking extra time to explain a medical concept or share past learning experiences.

We often have supervision (and other meetings) outdoors – another one of my favorite parts of working here (and this can occur all year - a novelty for me since I’m from the Midwest!)

This is a picture of one of the (many) private outdoor terraces for staff at the hospital (patients and families have their own outdoor areas, too!). The red fruit in the tree is a pomegranate – you can pick them for a snack if you want!

Monday afternoons begin with multidisciplinary dialysis rounds, a weekly meeting attended by every provider involved with the dialysis service – nephrology (attendings, fellows, NPs, RNs…), nutrition, social work, child life, music therapy, the hospital school (among others!); I attend to represent psych. I love working with this team, as they’re always so attentive to families’ psychosocial needs and interested to hear (and implement) our recommendations.

Next comes our weekly kidney transplant selection meeting. I present a summary of the family I saw during their pre-transplant evaluation last Thursday. This week, the team is particularly interested in our assessment of the child’s anxiety and whether they’re emotionally ready for listing. We discuss ways to support the family, and the child is accepted for listing.

I walk back over to our child psychiatry clinic to see a therapy outpatient (referred to the MCW clinic by Pulmonology). We’re working on strategies for procedural anxiety.

I pack up and head to the Caltrain station to go home. I don’t have a car here, and I’ve never felt as though I’ve needed one, as the public transit system in the Bay Area is fairly robust (it’s not perfect, but it does the job). Our postdoc benefits pay for my Caltrain pass, so my transportation is completely free! 

Tuesday mornings are usually pretty calm. We have seminars in the morning, but the number varies throughout the year. Today, we have a free hour, so another postdoc and I decide to grab coffee and go for a walk around the Arizona cactus garden.

Tuesday afternoons begin with psychosocial Stem Cell rounds, organized by social work and attended by psychology, nutrition, child life, music and art therapy, chaplaincy, and the hospital school teachers. We review how all of the patients on the inpatient Stem Cell service are doing and collaborate in addressing various support needs.

After rounds, I walk over the hospital to see one of my inpatients on the stem cell service. They’re having a good day, and discharge is approaching!

I end my day with two MCW outpatient appointments (referrals from Oncology and Pain), and then I head home.

On the Kidney/Liver rotation, your Wednesday activities will vary, depending upon which week of the month it is. Today is a Dialysis Clinic week, during which all dialysis patients have their monthly multidisciplinary appointments. Today, the team has asked me to see 3 of their patients; referral questions include: upcoming transition to adult care, difficulty coping with a sudden diagnosis, and anxiety resulting in adherence difficulties.

As these patients’ appointments are spread throughout the day, I walk over to the hospital in between visits to see one of the patients I follow. I typically have at least 2 admitted patients at any given time, a combination of inpatients on the Stem Cell service and MCW outpatients who required admission due to issues related to their medical conditions.

Early in the afternoon, I attend a care conference for one of the patients I follow. This patient has an upcoming admission, and the team is concerned about the symptoms of anxiety and depression he often experiences during hospitalizations. Everyone on his care team attends, including his primary attending and representatives from nursing, the pain service, social work, and child life. We collaborate to create a trauma-informed care plan to support him throughout his admission. I’m reminded of how committed teams here are to supporting the whole person – physically, emotionally, and spiritually – it’s another one of the reasons I decided to stay at Stanford for postdoc after my internship here.

Later in the afternoon, I have a meeting with Lauren Schneider (primary supervisor on the Heart/Lung rotation) and physicians on the Cardiology service to discuss recruitment for an upcoming research study. We’ll be implementing an intervention to support parents with symptoms of posttraumatic stress related to their child’s medical history. We’re all very excited about the study! If you’re interested in interdisciplinary research, there are plenty of opportunities here.

Thursday is Renal Clinic day. On a typical Thursday, you’ll have a few consults with post-transplant patients during their follow-up appointments, as well as a pre-transplant evaluation.

Today, one of the Stanford practicum students and I (we have frequent opportunities to supervise) are meeting with a child who recently received a kidney transplant to complete our post-transplant protocol. Modules in this protocol address strategies to promote adherence, scaffold independence in managing aspects of medical care, and support the child/teen in re-integrating into their daily activities after transplant. Today’s patient just received the exciting news that he’ll get to go home soon (we often work with families who reside far away from Stanford, but they must remain nearby in the weeks following transplant for close monitoring and frequent follow-up appointments)! We discuss the family’s concerns related to maintaining health upon reentry to school and talking about transplant with peers.

I catch up on documentation in the team workroom while waiting for our transplant evaluation patient to finish meeting with other teams. As other providers return to the workroom after meeting with the family, they update us on any psychosocial concerns or challenges they noticed. Our social worker and I meet with the family together, then, we split up so that I can talk with the child individually about mental health and their thoughts on pursuing transplant, while our social worker continues speaking with the parents. After we finish our meetings, we update one another. Today, we discuss our thoughts on the underlying cause of some past adherence challenges and brainstorm recommendations to address these difficulties. We’ll share our thoughts with the larger interdisciplinary team during Monday’s transplant selection meeting

Usually, Fridays are good days to work from home, but today is a special day, because one of my outpatients is having his bell ringing ceremony to celebrate completing his cancer treatment. I have nothing scheduled in the morning, so I sleep in for a bit before heading over to campus to attend his ceremony. All of his providers attend, and we collectively fail in holding back tears as he rings the bell and we reflect upon his journey.

The Oncology clinic is next to the Dialysis Unit, so I stop by to check in with one of my patients during her dialysis appointment before walking back to the psychiatry clinic. I have three telehealth appointments with MCW outpatients this afternoon (referred by Cardiology, Nephrology, and Palliative Care).

After work, I meet up with another postdoc for dinner at Spark Social, a food truck park in San Francisco. We have a lot to celebrate, as we both accepted Faculty Scholar positions at Stanford for next year!

On Saturday, I walk to the farmer’s market at the Ferry Building to stock up on produce. Afterward, my dog and I take a long walk on the Embarcadero and admire the Bay Bridge. It’s a beautiful day, as always.

On Sunday, I meet up with a friend. We go on a hike at Land’s End to see the other bridge.

Afterward, I do some chores and rest up to prepare for next week!