Match Madness

Hello, everybody.

Long time no see.

I have been immersed in the turmoil that is the fourth year of medical school. I don't happen to go to one of those medical schools I keep hearing about where the fourth year is easy and awesome. We only get one month of vacation, which includes time spent traveling for interviews. So, with interviews, elective and non-elective rotations, my clinical skills board exam, and being a single mom, I haven't even been opening my laptop most days.

My match rank list is certified, and now I am sitting on my hands and freaking out quietly...well, mostly quietly. For the uninitiated out there, the match is a hellish roulette wheel in which about 37,000 applicants vie for about 25,000 residency positions. This year, I am one of those 37,000 applicants.

I wrote a little bit about my various pressures regarding applying for residency programs here, and that post also has a link to the Match Day topic week here at MiM.

I ended up trying to stay as close to home as possible. I would be happy at any of the programs that ended up on my rank list. I would have liked to have interviewed at more programs. I was limited by my custody agreement, and I further limited myself by only applying to programs in cities where I knew somebody.

I am terrified that I am going to have to scramble. Obstetrics and gynecology has been a really competitive match recently. The National Resident Match Program is nice enough to crunch the data from recent matches, so I have a boatload of tables and graphs to stare at as I freak out. 77.1% of ob/gyn applicants matched last year. 99.6% of program positions filled, which means only 2 positions were left for the more than 200 or so ob/gyn applicants that didn't match. I am guessing most of those applicants didn't have a custody agreement that had pretty strict boundaries.

So, if anyone has any suggestions of how I can distract myself until March 12th, the day I learn if I match, and then March 16th, the day I learn where I match, please let me know.

Speaking engagement

I've agreed to a 45-minute presentation on medicine for my ten-year-old's science class this week.

What to do? I've considered percussing out a liver, telling the story of Alexander Fleming's serendipitous discovery of penicillin, suturing a banana, showing x-ray films of kids who've swallowed various inedible objects, warning against bezoars - let's face it, medicine's ridiculously interesting.

But what would prove most spell-binding to 28 grade-five kids? My daughter's certain I'm going to be awesome, and I can't disappoint her.

Please advise.

Notes from a Post Parent

With our youngest child grown, flown and on her own, my husband and are truly post parents. Others in this phase seem to travel, or acquire pets, or visit grandchildren. Me? I have houseplants and a jar of sourdough starter in the refrigerator. Parenting is, I realize, a state of mind, and the sourdough swells to fill the space. I am always aware, on some level, that it needs to be fed and may generate loathsome smells if I forget it for too long. On the other hand, if I cultivate it properly, something wonderful may come of it, and indeed, at various points, some things already have. The girls all give us much to kvell about--one is making her way as userfriendly liveware for a travel company, one is out to save the world or pass the bar, whichever seems harder, and third is going to be a professor one day. And I reliably make quite passable sourdough wholewheat bread!

Three

Long long ago, I thought I'd have three or maybe even four kids.

Then I had one, and suddenly two kids seemed like more than enough. And I felt pretty strongly about that.

Now I have my two kids and 99% of the time, I feel very satisfied, and even relieved that I'll never have to go through it again. But then there are times when the baby is being real cute (i.e. by existing) and I feel sad that I'll never get to experience this baby cuteness again. So this is me reminding myself of the reasons I don't want three kids:

1) I hate chaos and lots of kids are all about chaos. The logistics of getting three kids out the door overwhelms me. I hate always being on the go.

2) I'm looking forward to a time when my kids are more independent so I can put more focus both on career endeavors and hobbies like cooking. I'm really excited about that. Plus I won't have to change diapers.

3) While I love many things about breastfeeding, it definitely feels a bit like being on a ball and chain for a year. And the whole logistics of bottling and sorting milk for daycare is exhausting.

4) I absolutely hate being pregnant.

5) I like my sleep. A lot. I'm lucky enough this time to have a baby who slept through the night at one month old, but there's no guarantee that will happen again.

6) Some of my friends are now pregnant with #3 and I don't feel even a tiny bit jealous (well, maybe a teeny tiny bit), mostly just horrified. Sometimes I have dreams that I'm pregnant with #3 and it's very clearly a nightmare.

7) Husband doesn't want three kids either.

8) Kids are expensive and I want to retire early.

9) Space is not plentiful where I live so three kids means always being cramped. Most people around here only have two. A large number of the people I know with three kids have one set of twins.

10) Another kid means less time for the ones I already have. I'm looking forward to a day when we can all go to the movies together and see, like, Snow White in 3D without worrying about a baby crying.

On the other hand, my reasons for wanting a third are along the lines of:

Baby socks are so cute!! Sock!

Ultimately, since I'm still in my early thirties, I guess I don't have to decide now. When good old Mirena expires, I'll still be young enough to readdress the issue. But I have a strong feeling that I'm going to choose Mirena #2 over Baby #3. Ooh, and then someday maybe I'll be a grandma. That seems like a pretty sweet gig.

The 5 Trimesters Clinic

When I started in medicine, I thought it might make me a better mother, were I lucky enough to marry and have children. And it has, sort of. But I never expected that being a mother would make me a better doctor.

Six months ago, I organized the 5 Trimesters Clinic, offering psychiatric evaluations to women with problems related to fertility, pregnancy, and childbirth. My co-founder has three young children, the chief resident is pregnant, and the resident who does the work is about to get married. Together our decades of mothering experience have given us a perspective on the whole range of issues that the medical literature on women’s health covers in little Balkanized buckets. (Are you imagining leather buckets with gypsy embroidered covers? I am). Seeing pregnancy and childbirth within the context of an adult life, not as a medical/mechanical problem, seems quite novel to my obgyn colleagues. Seeing psychiatric difficulty as a normal element of pregnancy has been equally intriguing to my psychiatry peers.

Having been there, done that, bought the tee shirt and had to wash baby fluids out of it, I have an interest in many problems that are simply off the medical radar. I am, for example, interested in “Motherbrain,” the transient cognitive impairment some women experience after childbirth. The medical literature pooh-poohs this, but I believe it is real, because I had it. More importantly, it needs to be acknowledged so that we don’t expect new mothers to pass high stakes exams or the equivalent before their babies sleep more than 2 hours at a time. (The scientific studies of this problem excluded mothers who were depressed, the population most at risk for sleeplessness and poor concentration—duh.)

Our clinic pays attention to many matters—the role of fathers and grandmothers, women’s anxieties about bonding during pregnancy, new mothers’ loneliness—that come directly from the experience of those who run it. To integrate mothering with doctoring brings me enormous satisfaction. The greatest joy is passing this wisdom on to the resident embarking on the same journey. My kids are grown, but I am and will be until retirement, a mother in medicine.

Doctor picture

After so much drawing, I needed a break. So I asked my daughter to draw a picture of a doctor and this is what she came up with:

Daughter: "I drew her with blond hair because most doctors have blond hair."

Me: "I don't have blond hair."

Daughter: "Yeah, but most doctors do."

Me: "Like who?"

Daughter: "They just do."

Also, halfway through, she said she was going to draw a nurse instead, and I had to persuade her to make it a doctor. Then as I was scanning it in, she told me to make it pink.

(Cross posted to my personal blog)

My mom is a blogger???

My daughter Mel is learning to read. At school, she is learning "popcorn words" which are basically two and three letter words that are commonly used. When I'm reading something, she'll point to the words she knows and say, "I know that one! It's one of my popcorn words!"

(Why is everything kids say so darn cute?)

Anyway, I know reading is just around the corner, which makes me realize that soon she'll be able to read things like... this blog. And that makes me a little anxious.

I feel like she may not "get" the things that I write online. Maybe this will be yet another piece of evidence that her mom is hopelessly uncool. Or worse, maybe she'll be offended by some of my posts that involve the challenges of being a mother in medicine.

I could, of course, continue to keep it a secret. My parents don't know I blog here, nor do my friends. But it's a little harder to keep it a secret from someone I live with, especially since she'll probably be using my computer sometimes.

For those of you who are bloggers and have kids old enough to read, do they know you blog? What do they think about it? For those of you with younger kids, do you plan to tell them?

Listen to Susan

As I sat at the funeral of a friend this past week - a brilliant former NASA astrophysicist and mother to two sweet boys, 5 and 7 - I felt the collective reverence emanate like an aura over the pews for a woman who was truly extraordinary. Susan and I met through blogging years ago and though we were writing in a medium that engaged distant audiences, we happened to live within miles. For as long as I knew her, she carried a diagnosis of inflammatory breast cancer (diagnosed in 2007). With courage, grace and honesty, she blogged about her journey through chemo, mastectomy, remission, recurrence, hospice, and too much pain. Yet what defined her was not this; it was a true joy of living, of living each breath, of tremendous advocacy, that made her luminous beyond the normal range of our ordinary mortal existence. She was the type of person that if you met her, you loved her. Simple as that.

In the homily, I learned something new about Susan: she had undergone an accelerated Rite of Christian Initiation of Adults (the process by which adults convert to Catholicism) to develop a deeper relationship with God and to draw strength from this relationship through her illness. Seeing her and her family at church each week, I had assumed her faith and religion were constants in her life equation - not something so new and dynamic. I thought about my own RCIA experience 9 years ago and how much that has meant to who I am today.

Since her death, so many who loved Susan have written about her and about how they will honor her. Encouraging their children to love science, to practice present-parenting, to support breast cancer research, to schedule their mammograms. For me, she will inspire me to have more faith, less doubt. Yes: More faith. Less doubt.

Because, I doubt. I worry. In the almost-year that my husband has been stationed in Afghanistan, the anxiety has ebbed and flowed, with occasional spurts of outright fear. I play mind games with myself, practice superstition, believing that the course of events could hinge on a mental misstep. In everyday life I worry too. Small things that shouldn't matter. Small things that wouldn't matter if I had Susan's perspective and her faith. Why not practice more faith, more optimism, more belief in the goodness of others? Because life is too short to worry so much for things beyond our control.

A friend on Facebook shared this recently: Worrying is like praying for what you don't want. I never thought of it that way, but how true. Why devote such time and energy to such negativity when there is living, loving to be had? Why not allow one's faith to carry some of the burdens?

Susan was good at many things but perhaps what she was the very best at was loving others. This was evident at her funeral - her love reflected in all those who came was evident. Radiant. Uplifting. Her best friend, a professional musician, sang the Gospel hymn "His Eye is on the Sparrow" in a voice so pure and clear - quite possibly the most beautiful thing any of us have ever heard. We were rapt. Silent. Reverent.

If we all could believe and love a fraction of what Susan could, imagine how many more breaths would be filled with joy instead of fret. Hope instead of worry. Striving towards this is how I will remember Susan. She is the cheerleader I'll hear on the inside. The hug from within.

In a wonderful interview last year, Susan was asked, "you're a role model for finding beauty and joy in life no matter what happens - what are your top 'little things that count?'"

Her answer:  Children’s laughter. Soap bubbles on a summer afternoon.  Reading books together in an easy chair.  Family meals.  Cuddling.  Taking time for a night out with friends — even when there is other work to be done. Stargazing or watching the clouds pass by. Asking a child a question, and listening — really listening — to her answer.

We said goodbye to Susan this week but her inspiration lives on inside us all.

Guest post: If I can’t freeze time, can I slow it down?

It’s FirstBabyBoy’s third month birthday today! Ack! Already he seems to be growing up too fast. It feels like yesterday when we weren’t sure whether he was smiling for real or smiling because of gas, and in truth, he has been smiling for real for ~ 7 weeks… we think.

I want to slow it all down. Stop it all even. Freeze. Like Evie from Out of This World.

I've been trying to juggle learning to be a new mother, taking care of lovely FirstBabyBoy, showing up to academic days, working on my research project, and trying to study. I know what I have to do to balance it all – efficiency, focus … but I don’t seem to be able to focus currently on things as intensely like I usually did pre-motherhood. I am determined to debunk mommy brain myths and not give us MiMs a bad reputation. But the plan is not working as well as I’d hoped… yet.

I am constantly struck by how I have had misconceptions in various stages of life and have to continually re-evaluate. I read my own journal entries from months previous and worry of even posting on this blog because I am concerned I will come back one day and say: can I retract what I said? There’s no second chance to make a first impression, but please, I am a different person now and am not really that ill-informed.

For instance:

Pre-Birth Thoughts: Being a first-time parent is going to change my life, but in some ways, it must be easier than residency, and I should have more time. After all, I’ve had all those call shifts to prepare me for sleep deprivation.

Post-Birth Thoughts: Hmmm…how is this going to work? It’s like falling in love all over again, and just like the first time (i.e. falling in love with professional husband not in medicine), I now have new goals on top of all the other life goals that I wanted… and wasn’t even sure I had time for those pre-baby goals before.

But wait, I try to reason, it’s only for some time i.e. 5 years if not more for fellowships or masters or research or other such pursuits. And one can always be more efficient with time. And work harder. And do more.

In reality, here I am doing things slower than ever… and dare I confess, enjoying the slowness. I was given In Praise of Slowness by my mother-in-law, and I am often tempted to practice it…. Or who am I kidding? Maybe I am practicing it more often than I should.

Maternity leave makes me feel like I have the luxury of time some days (a mirage if I am to accomplish all above goals). But there is such joy in puttering at times.

FirstBabyBoy is in week 14, and still, every smile feels like a gift. To smile at him and see that moment when he registers my smile and his lips start to curl, the corners of his eyes crinkle upward, and his face lights up, transformed, beaming with sheer joy: it feels worth every moment taken.

Right at this moment – FirstBabyBoy and Hubby are both lying asleep, rhythmic breathing, content after a home-made family dinner, baby having fallen asleep early… allowing hubby and I time to read interesting non-fiction literature, discuss those pieces, as well as check-in. I even got to chat with a friend as well – an amazing MiM resident who is transitioning back to work and has not seen her 13 month old for bedtime for a few weeks due to the nature of her current rotation. I don't feel like trading places. It is the first time since entering medicine that I have been able to celebrate the full 15 days of Chinese New Year with family.

Maternity leave is a gift.

But maternity leave also has its cons - there are challenges to being away from residency especially with procedural specialties like anaesthesia where being good and fast is very important… there’s always talk of the residents coming back who aren’t that slick. I don’t want to be that resident. Barash, Miller, other textbooks wink at me from the book shelf. And maternity leave may have paused residency for a while but the play button will resume. I would want it to. But it is a little bit of a changed game now. More than ever, it feels like a triathlon where I won’t be the best runner, cyclist, or swimmer, but need to be good enough at all three to be the best triathlete I can be.

Things will get more and more demanding on all fronts. As much as I want to think things are challenging as a junior resident, it will only become more so in further transitions as one moves towards senior resident in future years and attending. Not to mention as baby grows up and mommy responsibilities expand. And if I want this marriage to thrive through it all, as well as contribute meaningfully as a daughter and sister, it is going to require time and effort and efficiency, speed, not slowness. And compromises. Juggling between the various experiences. How will it all happen?

Everywhere I go, I see examples of women who have done it,who seem to have it all – the dazzling career, family, kids, beautiful home with the home-made meals and crafts. And the façade of ease. But how is it actually done?

As usual, pre-reading to prepare, I turn to scouring the world out there for information.

Imagine my relief at finding Mothers In Medicine, and the kind of community and voice a blog creates. A group of people willing to write, share, laugh, support, nurture…Being an extrovert, growing up in a tiny fishing village in a third-world nation, I very much appreciate community. This is different than a fishing village community, but it is an amazing and inspiring community – a global village.

I read recently that the difference between extroverts and introverts are that extroverts tend to de-stress by discussion with others whereas introverts de-stress by spending time on their own. Being extroverted Myers-Briggs, I do find that it’s in the multiple discussions that insights appear. So please, do share what you think of this fast, slow conundrum. Although, as my introverted husband points out, I also cherish these silent moments to write and reflect. But, add resident + wife + kid + daughter + sister + friend = very little time for such conversation with multiple people in life or for writing and reflecting. And now add “mother” to that list. How will this all fit?

It makes me think with renewed respect for those MiMs who have gone before, who in many ways had it much harder. Thanks everyone.

Now has anyone else had a secret urge to freeze time at times?

-ASA

overheard, son in bathroom, reading my journals

"Mom, you've had that Pediatrics in here a long time," says 5 year old son in the bathroom, seeing my copy of this journal on the step stool aka magazine rack.

"But you know what? I get a new one of those every month in the mail," replies MiM from the kitchen.

"Yeah but this one's been here waaaaaaaaaaay too long," he persists.

Time to get reading? Get the dust off my journals? Move it to my bedside table? Get an iPad/e-reader?

I'm Bringin' Sexy Back

The OR desk just called to inform me that I was supposed to be starting my first case at 7:30. I glance at my clock. Its 7:25 and I’m sitting at my kitchen table eating a bowl of grapenuts. I look again at my calendar, its empty. My notoriously anal surgery scheduler must have forgotten to put the case on my schedule. I hate the feeling of starting the day 3 steps behind. As I hurriedly get dressed, I realize that I have not done laundry. The only clean bra left, is a black lacy push up number that I bought on a whim for my last anniversary. I have only worn it once. Normally it lives at the bottom of the drawer next to the unmatched socks. Oh well, I think as I pull on my shapeless dark green scrubs over head, no one will know. I grab a banana and head out the door.

I drive quickly to the hospital. My scheduler rarely makes mistakes. Tell myself it’s not the end of the world. I make myself calm down before I call her. She apologizes.

As I rush into the hospital my phone rings. It’s the radiologist calling with a CT result on a different patient. He is concerned for malignancy . The corridor is loud and crowded, I can’t hear him clearly as I race down the hall. Holding the phone with my left hand, I place the index finger of my right hand in the opposite ear in order to help drown out the background noise. As I briskly march down the corridor in intense conversation with the radiologist, I notice several people looking at me quite funny. A couple folks even point and laugh. How rude, I think, rather irritated in general. As I approach the elevator, I realize the source of laughter. I was holding the banana in my right hand… which was held to my right ear. So to everyone in the corridor I had appeared to be having a serious conversation while using a banana as a phone. Nice.

Next stop is the OR. I took a couple of deep breaths, apologize for my tardiness, reviewed the charts and performed the surgery. I then head to office where I am greeted by a very sweet “I’m sorry” coffee, from my scheduler. All is well with the world, other than getting a couple teasing texts from people about my banana phone.

I finish up late and head to my dermatology appointment. I have had several atypical moles in the past, so I get skin checks every 6 months. As I arrive at the office, the nurse takes me back hands me a small paper gown and says ”everything off but your bra and underwear” then quickly steps out.

At this moment I begin to panic. I suddenly remember that I am wearing my sexy bra.

What is my dermatology colleague going to think when they have me slip off the gown and I stand there being analyzed looking like I stepped out of a Victoria secret catalog, except add 15 pounds, spider veins and pasty January legs.

I weigh the options: reschedule appointment, get completely naked, make bra joke or just pretend that I don’t look like a wannabe pin up girl.

I go with ignoring the elephant in the room.

Attractive dermatologist, who is my same age and is seen at regular social functions, steps in the room. I make no small talk just look straight ahead as I drop the sheet at let them exam me.

I stand up tall and proud. I’m all cleavage and cellulite in the always flattering florescent lighting of the cold exam room.

“All’s good. I’ll see you around,” Dr. Derm says awkwardly.

I take another deep breath and laugh.

On the drive home I think back over the silly day I’ve just had and realize that in general I take myself way too seriously. As physicians we get held to higher standard, but at the end of the day doctors are just like everyone else. We have bad days. We forget to do laundry. We have cellulite.

I could have rehashed the day in anger. Instead I told my stories to my husband over a nice glass of wine that night, and we had a really good laugh.

MiM Mailbag: Interviewing pregnant

MiM,

I am a fan of the blog and have been scouring looking for advice from anyone who has interviewed obviously pregnant for residency positions. I am down to Psych vs. Peds probably Peds, but was wondering if anyone had any advice on this one.  I would not want a non-family friendly program but at the same time don't want to end up scrambling because no one in their right mind considers a pregnant interviewee? 

 

Thanks! 

Reliable Moms

Believe it or not, I have a fair amount of medical publications to my name. I enjoy writing and I find it incredibly satisfying to see my name in print (even online print).

During my fellowship, I had a bunch of articles printed in peer-reviewed journals and even got to write a short book chapter (wrote it, not first author on it, still cool). But since then, things have been a little quiet on the medical publication front.

Recently, however, I was approached by a well-respected colleague at work about contributing to a book chapter. He was straight with me that I'd probably be doing the bulk of the writing and if so, I'd get the credit.

Him: "Do you have any interest in this?"

Me: "YES!!!"

Yet at the same time, he was scaring me a little. He kept asking me questions like, was I sure I'd be able to dedicate "a large chunk of time" or about what my childcare situation was like. He kept asking me if I really thought I'd be able to do it.

And as much as I really, really wanted to work on this project, I started to get nervous. I didn't want to, like, give up seeing my children for the sake of this chapter. And what if something came up with them? Some illness or god knows what?

I always thought of myself as super responsible. When a project is due Friday, I like to have it done by Wednesday. But when you're a mom with a full time job, is it really possible to be completely reliable?