yet another posting on career vs. family

A few months ago I was having a not-so-great day on the Transplant service. The not-so-great aspect of this day had been brought about by the need to discharge a single patient after his allogeneic stem cell transplant. Having to discharge a patient after allo stem cell transplant is both the most mind-numbing and complicated role of the fellow on the BMT service as it can involve the need to coordinate home health, home blood draws, line care, monitoring of drug levels, home antibiotics, home TPN, outpatient medication, PT/OT equipment, transportation, clinic follow up, and a lot of patient teaching.  In fact, no discharge would be complete without an irate call from the discharge planner about some order I entered incorrectly.

While although important, this isn't very satisfying work and I was already a tad annoyed by some of the inevitable “complications” that had arose. I was trying to hide this annoyance and get through attending rounds quickly when my attending turned to me and mentioned that there was a grant proposal meeting regarding a clinical trial our institution was trying to get off the ground. It was this afternoon and I should definitely go.

My annoyance deepened.  Oh sure Dr. Attending. With about ten thousand little BS issues I have to resolve in the next two hours, I definitely want to go to your grant proposal meeting. Wonderful.

He mentioned the trial would involve the use of autogenetic stem cell transplant in patients with HIV-related recurrent lymphoma with the goal of curing the recurrent lymphoma and eradicating the HIV.

Now he had my attention.

Although I complain about the fellow’s role on the BMT service, I actually find transplant fascinating and have considered extending my fellowship for additional BMT training.  And while it might sound strange, I also find HIV fascinating and for a brief period considered ID just so that I could study and treat HIV (the fact that all the ID peeps I know get to do some wild traveling might have contributed to my interest).

A corner of medicine that involved both? Here, at our institution? I was definitely interested.

The meeting was between the clinical transplant staff and the basic science team. It started with the members of the lab explaining each step in the development of the vector carrying the gene for HIV resistance and how it would be introduced into the patient’s stem cells. I don’t want to embarrass myself by pretending I could follow all of the molecular biology, but followed enough to become very excited by this project that bore more resemblance to science fiction than any clinical experience I had ever had.  My attending then took over and explained what they proposed would happen to the patients who received the genetically modified stem cells.

I’ve worked on a lot of dead-end and/or boring research projects. In fact, I’ve never been part of a project that really piqued my curiosity, although some have been better than others. I had certainly never felt as excited by any project as I was sitting in that dark conference room.

I wanted in. I wouldn’t care what menial task it was, although I did start to envision what it would be like to write the first manuscript of a paper on curative HIV therapy.

My unborn son thumped me and reality set in. It is not a bad reality, but it is this – I almost certainly not staying at my current institution when I am done with training, and this project is still years away from inception. This is not because I don’t want to stay– and sitting in that room I really wanted to – but because we need to move closer to family when I am done here. I am actually very fortunate in that, my husband, who has followed me three times during my training, wants to move to the town in which I grew up and I have promised both him and my family that we will relocate as soon as I complete my fellowship.

I have also already decided against additional BMT fellowship training, which would almost certainly be required of any MD who wanted to be a part of this project. I have multiple reasons for this decision, including the need for a job with regular hours (please!), the need to start paying back my loans, the obvious financial needs of our expanding family, and again, the need to relocate. I like transplant, but I don’t feel as though it is something I absolutely have to do in order to feel intellectually and professionally satisfied. 

But I can’t pretend part of me doesn’t want to go after this. After all, I started med school when I was almost 22, I am now 31, so what is just a few more years of bad hours and worse pay for the chance (and it is really just a chance…) to be a part of something huge?  Maybe this isn’t the time – after I have almost a decade invested in my training- to start passing up opportunities.  

But that wistful, sometimes nagging, line of thinking hasn’t dominated my decision-making and, at least right now, I am very comfortable with the current plan as it is in place. 

This has become a much much longer post than I had intended and I worry I might have lost some of you along the way. This is unfortunate because part of my reason for posting it is to get feedback from those of you who have faced similar decisions. To be clear, I really don’t think I will regret the decision to move and forgo the very remote possibility of being part of this project, but it is the idea of slamming doors now, so early in my career, that is unsettling.

Thoughts?

Guest Post: I won't be the first, and I won't be the last

"Are you crazy?" This question, or others of the same variety, that range from "are you SURE?" to "Is your husband okay with it?" describe most of the reactions I get when I tell people that I plan to start medical school this summer. While the reactions were a bit less intense when I declared my medical aspirations as a single woman during undergraduate school, the shock factor increased exponentially once I got married and pregnant, with a baby due this April before the summer I hope to begin.

One part of me wants to scream, "No! I'm not sure, I'm freaking out, and your skepticism and complete lack of confidence is not helping!" The sane, collected persona that answers, however, jokingly replies "I'm not the first and I won't be the last! I'm sure we'll be okay."

In an effort to quell the bubbling fears of anxiety that increase with each kick of my growing baby and doubt from my peers (interestingly, mainly from my parents' friends and less from individuals of my own generation) I look to websites like MiM and other blogs that discuss women with similar experiences. I take comfort from their humor, honestly, and tales of unimaginable successful balancing acts.

I look forward to joining the community of people that "are not the first and won't be the last." I am excited to pursue a career that I have a passion for and a deep interest in.  I hope that with all the changes in healthcare, I can still make my current ideal of a family physician or pediatrician a financial reality. I also hope that I find a voice to one day inspire those that are looking down the same path, the way that many other anonymous Mom MD's inspired and bolstered me.

-M2B


I am an aspiring medical student, starting medical school in August 2012. I grew up in Los Angeles, but am waiting to hear where I'll be studying medicine next year. I am married to a wonderfully supportive man who has no idea what a wife in medicine will bring, but is up for the challenge. I am expecting our first child in April, and am excited to start on this crazy adventure.

Overheard in a MiM car

[On the way to 4-year-old son's doctor appointment]

MiM: We're going to the doctor's! Do you want to be a doctor when you grow up?

Son: I can't.

MiM: Why do you say that?

Son: (Pause)...are there daddy doctors?

MiM: Yup. There are daddy doctors.

Son: OK, (with glee) I want to be a doctor!

Doctor, Heal Thyself!

Who here hasn’t needed to lose a few pounds? Well, I am a bit beyond needing to lose a “few”…

Babygirl is officially a month old, and I am officially a month postpartum. For two pregnancies now, my usually healthy diet slid into more of a “everything in moderation, and I mean EVERYTHING” diet. I don’t binge, and I don’t even like junk food or fast food… BUT I love me some dense whole wheat toast with tons of butter for breakfast, and high-quality dark chocolate for snacking, and a cup of premium ice cream after dinner, and… you get the picture. Two years of this kind of snacking, and I was bound to gain some weight.

Especially since I used to be very active. Like, distance-running, cross-country-skiing active. BUT for two years, that whole part of me has been on hold. During my pregnancies, I maybe did some prenatal yoga, and took some walks here and there, but basically, I became a slug. I did hire a trainer after Babyboy, and I did lose 15 pounds then… But as soon as I was pregnant with Babygirl, I slid right back into snacky-snacks and slugginess.

So, this week, I finally stepped on the scale to see what the damage was. Ouch!

I am a full 40 pounds above my normal healthy weight, with a BMI of 30. That means, I am obese.

And so, horrified, I decided to take action.

I have NEVER in my life been so fat. Sure, I gained a lot of weight during med school, and then residency, due to lack of sleep/ time/ stress/ poor diet. But never THIS much. Both of those times, I shed major pounds by eating low-carb and exercising.

Now, I am a huge fan of diet and lifestyle changes towards better health. I counsel all my patients over and over again on the merits of a diet high in fruits and veggies and lean protein, combined with regular vigorous exercise. I ask my obese patients to come back every 3 months for weigh-ins and blood pressure checks, and I spend a lot of time with them, describing what is a healthy diet and what is real exercise.

In our practice, we have a diabetes nurse who helps counsel patients, and I send her my pre-diabetic patients, as well. If I were my patient, I would probably send me to her. Diabetes runs in my family, and I did have a sort of high-normal glucose tolerance test in this second pregnancy.

And so, because I recognize that without some major changes, I may be headed towards a bad health outcome; and because I need to follow my own advice; and because I really don’t want to have to buy a whole new wardrobe (!) I got started right away.

As soon as hubby got home that day, I asked him to watch the kids so I could go running. Luckily, he is also really into fitness and eating healthy, and he was totally supportive. Shocked, but supportive.

I found and pulled on a (very tight) jog bra OVER my nursing bra, laced up some stiff sneakers, and headed out the door. There was about 4 inches of slush on the ground, and it was drizzling. YES! I love this. I imagined that drivers saw me as the intrepid warrior, determined to run in spite of the elements. Really, they probably saw a mooselike creature in ill-matching baggy pants and her husband’s rain jacket toodling up the hill like a manatee on land. BUT, I pulled down my baseball cap and ran harder.

I had not run in almost a year. I made it maybe a few blocks, then walked. Then ran, then walked. I did this for about a mile and half, total-- a laughable distance for me who has run three marathons. BUT, it is a start, and it’s better than nothing!

Hubby also dutifully went to the grocery and bought me my list of South-Beach-Diet-Style foods. (I don’t get any money from them, BTW, the diet just works for me is all). He came home with my veggie juice, Canadian bacon, eggs, cheddar, ricotta, almond butter, and tons and tons of veggies.

That was three days ago. Since then, I have been sticking to the diet, albeit with probably bigger portions and more snacking than is intended (I am breastfeeding, after all).

The late nights up breastfeeding are very tough. I HAVE to eat something when I am up feeding Babygirl at 3 am. Just, now, it’s less likely to be a huge bowl of Cheerios, and more likely to be a cup of plain ricotta sweetened with Truvia.

And that’s OK. The diet, plus exercise- with the goal of getting back to my previous level of active—WILL work.

The diet is meant to stabilize blood sugar swings and reduce craving for carbs. It’s amazing to me how I feel when I drop the carbs and go to this type of diet. At first, for a few days even, there’s a slight woozy feeling, and some intense carbs cravings. After a few days, the wooziness is gone, and there’s almost a buzz of energy as my body starts to burn fat. It feels really good, especially after exercising.

And so starts my effort to get healthy—and slim down.

Now that I’ve blogged about it, I really have to stick to it!

Call Hierarchy of Needs

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.

*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."

*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).

*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.

*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)

**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Ob/Gyn Kenobi

MiM Mailbag: Return to medical school?

Dear Mothers in Medicine,

Over the past month or so I have come across your blog and have become so interested in reading all of the wonderful stories and insight that you post. You might wonder how I came across it...well it's a bit of a complex story. After graduating college in 2009 I decided to pursue medical school. I really felt that I wanted to help people and work with children in my future, eventually enter pediatrics (at the same time though, I think I may have just fallen into this track as I had the "premed mindset" for a very long time). I gained acceptance and started medical school July 2011. Yet about a month into starting began to question my decision. Although I loved living on my own, and had a wonderful relationship with my peers and staff, I could not help thinking about my future and if it would really be anything but work-filled. On top of that I was being pushed to my limits, depleted really, and feeling anxiety and bouts of depression. By this past Christmas I decided to take a leave of absence to decide if medicine truly is the right path for me, as everything seemed to be spiraling in the wrong direction.

After being home for about a week now, my mind is more confused than ever. Is the stress/anxiety/depressive feelings something that will get better as school continues and I adjust? When I start practice will I be able to balance my career with family (mind you, having a family and being invested in them has always been my number one priority)? If I leave now, am I going to look back and regret this...but if I don't leave, what kind of impact is this going to have on my future health and family life? Would being a nurse practitioner satisfy me? Do I want to physically endure residency? And am I willing to sacrifice the next 7+ years of my life and give just so much of myself to a career when there are so many other things I yearn to invest my time in as well?

I know that ultimately the decision rests with me. I have tried speaking with others who have been through the same things as myself as well as those in the profession, but am still having a difficult time deciding whether returning to school would be my best option. It has been a difficult decision to even take a break from school as I have always been the overachiever who just pushes through no matter what-yet this was the first time my body made me take more drastic measure and really reevaluate where I'm heading.

Although you may not have the answers to all my questions I'm hoping that some of you might help shed some light on my fears and whether you ever went through any of this thinking. Looking back do you feel that this career has suited you well (family, health, lifestyle, and all other things considered) or would you have done things differently. Any advice would be much appreciated.

Look forward to hearing back from you all!

It's a Stressful Life

During our drive home, my daughter Mel requires a snack. So every day, I have to bring a bag of chips, some crackers, or whatever leftover baked goods were lying around the nursing station for her to nosh on during the ten minute drive home. Sometimes I'll get something extra yummy and I'll be excited to see how happy she is. She even brags about the snack to her friends. "My mommy always has a snack for me in the car."

Yesterday I purchased a little cup of custard for her from the hospital cafeteria. I have always been a fan of custard and I thought she was going to love it. I expected lots of thanks and hugs and a happy drive home.

When Mel got into the car, I presented her with the custard cup. She looked excited and asked me to open it. She took one bite. "I don't like it," she said. "It tastes bad."

I tasted the custard and she was right. It tasted like cardboard.

"Can I have something else?" she asked.

Usually I keep an emergency snack pack of Skittles in my pocket, but I had recently changed coats, so I had nothing else to offer her. "Sorry, honey," I said. "We'll have a snack at home."

"But I'm SO HUNGRY!!!!" she wailed. "I'm going to get a rumbleache!"

"Well, what would you like me to do??" I retorted.

She didn't have an answer, but continued to sob as I strapped Baby into her carseat. I recently purchased a new coat for Baby and overestimated her size, so she's basically floating in this comically large pink coat. And because we're frightened into making the carseat straps ridiculously tight, Baby was screaming by the time I had her secured.

I started the car with both kids crying in the back seat. My blood pressure felt like it was a million over a billion. I considered maybe stopping for fast food on the way back, but really, the only stop I wanted to make was at my OB/GYN to get sterilized.

I don't like stress. Stress stresses me out. While I adore my kids more than anything, it would be so nice to be able to take one shower without someone busting in on me and asking when I'll be done. It would be nice to spend a whole day in bed getting to do whatever I want to do. Something like that feels selfish, even decadent, to me now.

For a brief time, I was trying to do some meditation to help me relax, but in general, I just couldn't find 10 quiet, uninterrupted minutes in my whole day to do it.

The crazy thing is, I don't think I have that much more stress than the average mom. Yes, I work, but lots of moms work. Yes, I have two small kids, but I know lots of working moms who have three or four small kids.

Maybe we're all giant balls of stress. There's this woman I always see at the daycare who comes to pick up her three year old and her twin toddlers, and she always looks so miserable. Is it just a given that when you're a working mom of small kids, you're going to be constantly stressed out? Will I just not be able to relax for another 4-5 years?

final thoughts on last post

As my last post concerned what is arguably the most disturbing aspect of parenthood, perhaps it is appropriate to post, in bookended fashion, on the most joyful.

We brought home our newborn son five days ago. He is healthy and perfect. I am filthy and happy.

I will have to blame poor judgment brought on by the insomnia of manning a 24 hour milk bar for a brief sojourn into the well worn subject matter of writers far more talented by myself.  The death of a child is meaninglessly tragic and unfair and I can't imagine to where or whom one turns for solace. Perhaps the only answer to the question "why" is not truly an answer but a visceral response - to love and love and keep desperately loving the children that we do have. 

I think (and sincerely hope) this is the last time I post on this subject matter. While never forgetting, it is best to move forward and focus on the humor and joy of early parenthood. 

For instance - I am not sure if I should admit this (and again will blame the insomnia) but I was a little shocked by the appearance of my newborn son. His face was purple and squished. Flame colored stork bites stained his upper eye lids and the lower lids were swollen shut by two thick coats of vernix. His nose appeared to have been flattened in order to better accommodate a large crop of infant acne (milia) that sat upon the wide tip. His cheeks sank below the level of his lower jaw, giving the appearance of an edentulous old man. 

The last few days have revealed him to be a reserved little man who doesn't do much in the way of complaining. His emotional range seems to oscillate between boob? and BOOB! I know this range well as I have spent near every waking minute of the last five days staring at him in an almost spellbound fascination. 

I was immediately, and continue to be, deliriously in love. 

Mis-Match

I have a friend, another MiM, who is nothing short of inspiring.

Born in the former Yugoslavia, she was raised in Germany and ultimately went through medical training there. Like all of us, she has stories to tell about her specialty, OB/GYN, that range from hilarious to horrifying. Like us, she has a family - two children, both born in Europe during her medical career. Although training in Germany, as in the US, was demanding, she found the time and courage to return to her home country for a short time during the Balkan War. She worked on casualties in a hospital there while bombs dropped in the distance.

When her husband wanted to accept a job offer in the US about 6 years ago, she didn't hesitate. She dropped everything, including her career, and helped organize the move to a different continent. She supported her children, who didn't speak a word of English at the time they arrived. Since then, their family has thrived. Her son and mine play ice hockey together. We are both now rearing teenagers and commiserating about their lack of frontal lobes!

She did all this thinking that eventually she would resume her career here in the States. To prepare for this, she passed all the USMLE steps and met all the criteria for the match. I remember when, more than 2 years ago, she asked for my help in preparing her personal statement. Having fortunately sailed through my own match as a newly minted American grad, I thought, "Boy, this should be easy - who wouldn't want such a brilliant physician in their program, one with such a broad range of experience?" I'm sure she thought, "I've been through OB/GYN residency, a war, and a move to a different continent - how hard can this be?"

Boy, were we naive.

Since then, my friend has been through two matches without even a single interview. She has done research in an academic GYN lab and is published as a result. She spent a summer in the Himalayas doing medical mission work. Despite everything she tried, she had no success.

I am astonished at what I have learned through her frustrating experience. At the two hospitals where I work, I frequently encounter physicians who are foreign medical graduates (FMG's). Because of this, I assumed there were plenty of opportunities for all comers. Not so.

Speaking to two different residency program directors, I heard the same story. These days, it's all about year of graduation from medical school. If you are more than 2 years out, your application is not even considered. It goes straight to the trash - American or foreign grad.

The other factor is the competitiveness of the market. With the economy in its current miserable state, applications to med school are through the roof. Med schools, seeking extra tuition, are expanding the number of spots available. New med schools are opening in response to the perceived worsening shortage of physicians. However, residencies are not adding positions - they are federally funded, and there is no extra government money for expansions.

This translates into lots of applicants for available residency spots - brand new, shiny American graduates. One program director told me that by 2015, there will be more American med students graduating than there are residency positions to be filled. She said, "At that point, we won't even be looking at Carribean graduates, much less FMG's. If she doesn't find a job by then, she's doomed."

Wow. I had no idea.

We hear a lot in the media these days about the projected national shortage of physicians. We are all concerned about this. How will it affect our jobs? How long will our wait times for new patients become? Who will take care of us when we (or our family members) become ill? How will we divide work with physician extenders?
If this shortage is such a huge problem, why on earth are we shutting out an excellent source of new and yet experienced physicians? There must be hundreds of physicians like my friend, eager to work and already skilled in their fields of expertise. These are intelligent, productive people who will support their communities and pay taxes. If there are not enough residency positions available to accommodate them, why can there not be a parallel program tailored to bringing FMG's into the workplace? Perhaps an apprenticeship model would work...

(I do understand the concerns about FMG's. The American system is different even from Europe's, so it is hard for them to adjust. Language barriers can be significant, even crippling. The quality of FMG's is not consistent, so it is hard to know how much remediation may be necessary on the front end. If a physician has been away from training or practice for too long, the knowledge gap may be large. However, medical training is never easy with any group of students - these concerns are not insurmountable.)

Beyond this, I have concerns about future MiMs in particular. If date of med school graduation is a key factor in residency applications already, this means possibly catastrophic difficulties for women who want to take time off for pregnancies or to care for small children. Admittedly, 2 years is a long time, but it seems to me that even one year off could be considered a serious liability in this competitive climate. Add to that the pressure of student debt. What happens to the med students who cannot match, cannot get a residency position, but owe large amounts? With what means will they pay off that debt?

My talented, courageous friend is the canary in the mine. The difficulties she has experienced with the match process are a harbinger of things to come for many of those who seek to follow in our footsteps.


Encouraging note: My friend is now actively in a preliminary general surgery residency position. We are hoping that this will be the foot in the door that will lead to either a categorical surgery position or a primary care match for her.

Ode to Birth Control

Sometimes people write in to Mothers in Medicine with guest posts, asking, "Should I become a doctor?" Whatever the answer to that question is for you, the truth is that none of us would be doctors and this blog wouldn't even exist if not for one thing:

Birth control.

My great-great-grandmother had ten children. She wasn't so much thinking about whether OB/GYN or family medicine was the right decision for her. I don't know if she worked but she sure wasn't considering a career that involved nearly a decade of intense training. It wouldn't have been possible.

The earliest female physicians such as Elizabeth Blackwell were unmarried and didn't have to worry about children. Most women with any sort of career were unmarried. Being pregnant nonstop and caring for a brood of children makes it very hard to have a career outside the home.

I think it's easy to forget that up until recently, birth control wasn't a given. As recently as the 1960s, many states actually prohibited use of contraception. In 1965, the Supreme Court ruled that a Connecticut law prohibiting the use of contraceptives violated the "right to marital privacy." It wasn't until 1972 that the case of Eisenstadt v. Baird expanded the right to possess and use contraceptives to unmarried couples. That's only 40 years ago!

Think about what your life would be like if birth control wasn't available to you. What would your career be like if you had ten children like Great Great Grammy McFizz? And what if birth control was suddenly taken away from you? How would that affect your career and your family?

So I have to say a great big thank you to birth control. And express my anger that there are people out there, potentially in positions of power, who would like to take it away.

MiM Mailbag: Giving up the baby

Dear MiM,
Has anyone else had to temporarily give up their children in order to facilitate their career in medicine?

I am a junior general surgery resident a few weeks away from delivering my first child. The pregnancy was a surprise, but I am eagerly awaiting the baby. I wrote "I" rather than "we" on purpose- although I am married, my husband lives in another city, some 1500 miles away, where he is at the top of another incredibly demanding, long-hours, "mistress" profession. We did originally live together in intern year, but with my blessing he accepted his current position and moved away. It was shortly thereafter that we found out about the pregnancy.

I have had a dream pregnancy with absolutely no problems- no morning sickness, no cravings, no complications, a total weight gain of 15 lbs, and no stretch marks! My clinical performance has not been affected and I remain passionately committed to surgery- it is absolutely the right specialty for me.

Here's the problem: I have 4 wks of maternity leave. The baby will come in February, which means I return to work in March. My husband will get a month of paternity leave and spend it in my city, which he will take for the second month of the baby's life. This puts us through to April, but I will have 2.5 months of the academic medical year remaining. The hours of a surgical resident, it goes without saying, are not conducive to single parenting- how on earth could I arrange for nannies/ au pairs / daycares to cover 90hr weeks, weekends, night call, unpredictable hours, etc-- especially on a resident's salary? We have no family within 2000 miles, and no family members can take off 2.5 months to be the primary caregiver. So, we have concluded, the only thing to do is to send the baby away to be cared for by relatives, who will love and adore him and give him the 24hr, unconditional attention I cannot.

This arrangement will only be for those three months. I'm starting my gen surg research years in July, and the lab I'm entering will be in my husband's city. So we will all be reunited and normal again after a few months.

We have received a variety of comments on this arrangement, some of which are meant to be helpful ("don't do anything you will regret forever"; "you should sue your hospital;" "why can't you just take a normal 6 month maternity leave."). Many others are to the effect that I am an unfeeling monster who is a defective female and should never have children in the first place. Most people- especially at work- assumed that I would terminate the pregnancy, and were shocked to learn that was unequivocally not on the table. I won't deny that there has been a lot of guilt (my husband, who is unbelievably excited about being a father, feels a great deal of blame) and concerns about emotionally managing the separation, but we truly believe this is what's right for our family and our unborn son.

I was wondering if any other mothers in medicine have had to make a similar choice, and what their coping strategies were? I know, for example, many foreign-trained residents have to leave their children behind when coming to the States for residency. I would really like to hear some stories from people who have "been there," and not to feel so alone.

Thanks very much for the blog- I really enjoy it and its variety of perspectives, particulalrly the advice from the women in long-hours specialties.

Best,
L

In the Air

On December 26th a helicopter went down in Florida, taking the life of a heart transplant surgeon, an organ procurement technician and the pilot. Although the donor heart could not be used, the intended recipient was fine and awaited another donor match.

I heard the news through a text message from my on-call partner, interrupting me two stories into the bedtime routine with my 3 year old son. “A helicopter went down going to get a heart.” The heart transplant community is a small one, this news hit close to home. Often these procurement missions include multiple transplant teams (i.e. heart, lung and abdominal) with young surgeons in training riding along. I often send my fellows or students and have gone myself.

On a rainy night in September I drove along a narrow road on the far side of the airport. I was looking for the private hangar, and once I arrived I pulled into an empty parking lot. There was a dim light on inside so I grabbed my bag and headed for the sliding glass doors. I stood in front of the door and waved my hand but the sensor was not on. I knocked and a handsome man in a flight jacket walked over and let me in. I told him I was part of the transplant team and he looked at me skeptically. I wondered if I should have identified myself as “doctor”. I was the first one there so I sat in the waiting area and helped myself to some coffee and spiked it with hot chocolate.

The last one to arrive was our heart transplant surgeon. With the team complete we carried gear to the awaiting plane. The supplies were placed in the cargo area, but the cooler would ride with the passengers. I lifted it into the cabin, I noticed it was light and empty. As the heart transplant surgeon grabbed it from me his gaze held conspicuously on my belly. Even wearing scrubs I could not conceal the fact that I was five months pregnant. He then climbed out of the plane and practically lifted me up into my seat, he was sure that I did not miss a step.

Once we were strapped and secured into our seats I studied his face and could tell there was something on his mind. I met his glance confidently and smiled slightly. He shook his head, “Do you know how dangerous this is? An entire team from Michigan was lost a few years ago. You know, I am a pilot for fun, and know a lot about aircraft. These guys are good, really good I make sure of that. You must always insist on safe transport. Never go in a prop plane and never let them take you in a helicopter.”

I took in his advice, committing it to memory. As we taxied in the darkness my mind considered the precious cargo including 2 pilots, 2 attending surgeons, 2 fellow surgeons, organ procurement specialist and myself. Then I thought of my patient that we were leaving behind, in the CCU on a balloon pump desperate for a new life. Finally, as we sped down the runway and I felt the first few bumps of flight I placed my hands on my belly and said a little prayer. To the hands of God I give the battle for life, miracle of healing and trust in His protection. The only tragedy that evening was the untimely death of our donor whose family gave the beautiful gift of life.

As the details of the accident in Florida unraveled I learned that I did not know the individuals involved. Not personally. But the event awakened the reality of how close we dance every day on the brink of life and death. Upset, I asked my husband to finish the bedtime routine and retreated to have a short conversation with my colleague. He summed it up perfectly when he said, “This job is humbling…. in so many ways.”