Eureka Moment

I was wrapping things up at a rare early 3:30 today and filed my slides. What to do? Attack the pile of journals three months thick sitting in the far left corner of my desk. I flipped through the Journal of Arkansas Medical Society, the latest CAP Today, and the Arkansas State Medical Board newsletter. Picked up the August edition of Archives of Pathology and Laboratory Medicine. Hit an article titled "Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees."*

I'm a sucker for the latest tech tools, so I read the easy page article eagerly. I was flabbergasted. I could hold up my iphone to the left eyepiece, steady the camera, and take a microscopic pic? One that rivals my $2K microscope camera that is so complicated I get anxiety whenever I decide to use it? Without an app or anything? Unbelievable.

I practiced the image capture that the article described - they were right the steadying of the phone while taking the pic at just the right moment took a bit of practice but five minutes later I had this:

Which I found in a gallbladder. Just kidding. It's a honeybee mouth. I got it at a local science store a few years back, along with a planaria and an ant and a couple of other fun bugs for the kids to play with under my scope when they came up to the office with me occasionally on the weekends.

I used the zoom function on my phone and got rid of the shadowed vignette, just as the article recommended:

Well it is still framed by iphone bars but I imagine this can be taken care of easily. Note how little energy bars I get in my lab basement. The ease and accessibility of this is astounding. Conferences. Sharing hard cases with co-workers (HIPAA restrictions intact and observed, of course). And as the article mentions, high-quality images suitable for presentations, posters, and publications. With your phone.

I ran around in nerdy glee showing off my newfound skill to my fellow pathologists - all as excited and disbelieving as I was and practicing with varying levels of immediate success. My fraternal rival good friend partner caught on quicker than I did capturing a fantastic picture of the lung pleura he was examining (he crowed that it must be his new workout routine). I copied the article and placed it in everyone's box, and noticed that it was written by a dermpath doc I haven't met who works at the University of Arkansas at Medical Sciences - he is a recent transplant and although I spent a day last week visiting all my former attendings and fellow residents (below me!) who are now attendings I haven't met him yet. I hear he's quite good but dermpath is one area I stay away from so I hesitated outside his door and decided familiarity was more important in my limited time off. I enjoyed chatting with a former co-resident who was just hired as chief of pathology at the VA, as well as many others. Man time flies.

*Smart Phone Microscope Photography. A Novel Tool for Physicians and Trainees. Morrison, A.S. and Gardner, J.M. Archives Pathol Lab Med - Vol 138, August 2014.

Guest post: Doctor guilt

I have been a faithful reader since sometime in med school (6 years ago?) and have so appreciated all of your posts! I haven't found a community anywhere else with as many talented, empathetic, articulate and amazing women. I'm a family practice doc in a rural town practicing full spectrum family medicine. I have been in practice for two years since residency and absolutely love my job, even when it is stressful and hectic. I am a wife to an underemployed lawyer and mom to a beautiful, sweet, developmentally delayed 11 month old girl with tuberous sclerosis. She is the joy of our lives.

Having worked my whole life, I was really looking forward to maternity leave. I thought, finally, time for a break! As any mom knows, maternity leave isn't any kind of a vacation, but it really was a much needed mental and physical break from work. However, it was also disorienting to not have a schedule and frequent social interaction. I absolutely loved maternity leave and I think part of what kept me sane was knowing that I was going back to work. When the time came closer, people warned me about how hard it would be, and that I was going to cry my first day back.

I shed a few tears the day before, but the day I went back to work I was 100% ok. I enjoyed it, actually. I felt like I was back at my second home with my second family. The first night back I assisted with a crash c-section and had a blast.

It's been 8 months and I'm still going strong. I work in clinic on Monday, Wednesday, and Friday. I do 4 to 5 24 hour ER shifts per month. I am there nearly every day rounding on patients, since I almost always have a patient in the hospital. In reality I probably average 40 hours per week even though I'm considered "part time." I love having every other day off. After a crazy clinic day it is nice to have the next day to decompress. After having a day of playing with my daughter and being at home I look forward to the fast paced environment of being at work the next day.

Strangely enough, I never experienced the mommy guilt that is so prevalent among working moms of every profession. I love both of my jobs. I know my daughter is in good hands. (My husband is with her most of the time when I'm at work, and we have a wonderful neighbor who helps). I miss her when I'm working a 24 hour shift but that's not the same thing as feeling guilty that I'm not there. I don't know if it's because I'm the primary breadwinner or some other reason. I am 100% at peace with my decision to work. How many men who are breadwinners feel daddy guilt? Is mommy guilt something that is part of our genetic makeup or something that we are told culturally we are supposed to experience?

What I have felt sometimes is doctor guilt. I think part of this is because I was 32 when I gave birth so working is what I've known my whole life. I wonder if I should be working when I'm playing with my girl. I wonder if my colleagues are jealous that they don't get more time off to spend with their kids. (They never say anything - I just wonder). Maybe we'd all be better off as doctors, moms and dads, if we had the flexibility to have more time with our families.

Anybody else have doctor guilt, rather than mommy guilt?

MiM Mail: Two parents in residency possible?

Hello! I am a pre-medical student and wanted to share with you how much your blog has comforted me about my future in medicine with a family. Although I do not see kids in my near future, I have been with my boyfriend since freshmen year of high school and am confident that we will end up married (side note- he is also pre-med). I am one of those people who needs to have all their ducks in a row, so to say. I obsess over the future and planning, which I know is not always convenient when it comes to both motherhood and medicine. Upon looking for advice about when the best time to have children was in the medical career, I found many people who said that it was best to give birth during medical school. This just seemed extremely difficult to me because there is so much studying that needs to be done, and I don't want to add years to my training as I plan to do a general surgery residency and then continue to specialize for about another 4-5 years afterwards. I went on to search for advice/experience from women who were juggling babies and residency, and that's when I found your blog! It has been immensely comforting to read from women who have made it through and to not have to read comments from male doctors that "a woman should either be a mother or a doctor, because each one requires 100%" (seriously, one doctor ranted about this on a discussion board, but failed to explain why it was okay for him to work full-time and barely see his kids just because he was a male...)

My boyfriend and I are the same age, so we would be in the stages of our training at the same time....is it possible to manage children with 2 parents working in residency? (if it helps, he is interested in a radiology residency, although I know that both our choices could change over time). I know many of you have had such difficulties when only one parent is in medicine, so it scares me that my situation may be impossible.

Thank you again for writing such a wonderful blog for anyone interested in the medical field to turn to. I believe that as women we shouldn't have to give up what we love to do for our children, but I still want to be able to have a good relationship with my children. I realize my questions might seem premature considering I'm only pre-med, but the ducks must be in a row for me...... :-)

All Holidays

A friend of mine came to me with a dilemma I thought this community could be helpful in solving.

She is a nontraditional student who is midway through medical school. She is going through a divorce and about to become a single parent. For that reason, she asked me if it's possible to have a career in medicine where she could be off during all the school holidays. Not the entire summer, obviously, but during the Christmas break, the winter break, Easter vacation, all the major holidays, and the weeks between camp and school starting.

I told her probably not.

Considering in an earlier post years ago, I was skewered for suggesting that people with young children have some priority in getting to choose which holidays they needed off, I figured she would be burned at the stake for asking for every single holiday off every year. But maybe I'm wrong. Maybe there is some job for physicians that allows you that kind of schedule.

Taking Care Of Ourselves

Genmedmom here.

A patient of mine recently asked me how my kids are, and what cute things were they doing nowadays? I'm very open about my family with all of my patients. They've seen me huge and pregnant, and they've seen my colleagues during my maternity leaves. My kids' photos hang in my exam room. We often trade parenting experiences as part of the visit.

So, I was not at all put off by her asking about my kids. Her visit was over anyways, and we were only making small talk as we wrapped it up. I described how Babyboy is a little engineer, always building and figuring things out, and that Babygirl is full of sass and song, teasting and challenging and singing all day long. She laughed and said a few things about her kids, how they were all grown up, how she missed their little days, but didn't miss how hard it had been.

"Make sure you take care of yourself," she said, suddenly not laughing anymore. It was a bit abrupt, this serious turn of mood.

"I mean you need to take the time for care for you, because you need to replenish your strength, to be able to care for your kids. Exercise, salon time, friends time, it's really important. You need to do that." She was beseeching me.

"Uh, okay, yes, I know what you mean, absolutely..." We were moving towards the door.

She stopped, and said, quietly: "No, really, I can see how tired you are. You're really, really tired. Remember to take care of you. I need you to, too!" Here she smiled, and the door opened and she was gone, leaving me unusually flustered, standing there for a few seconds, wondering what next.

I know I carried on with my clinic, and then went home, and did the dinner/ bathtime/ bedtime routine with my kids. I know I crammed in some mail opening, bill pay, and reading. I know that sleep was likely disrupted by something... If not one of the kids (usually Babygirl) then the cats, or this nagging cough I've had. I know I am really, really tired.

Now, I have alot of help from a wonderful husband and my untiring mother. I do get to exercise twice a week. I write, which is therapeutic. Hubby and I sit down for dinner every night that he's not traveling, and we have family dinners every week. I don't shop much, or see friends that often, and I can't remember the last time I went to a salon.

I honestly can't tell if I'm taking care of myself enough or not. I think I am. But if patients see me as exhausted, drained, that's not good. I'm not sure how much more time I can carve out for "down time" things, and I'm not sure I feel that strongly about making that happen.

What do others do to take care of themselves? How much down time do you need?

(Don't) Hide your kids!

The first year after my daughter was born, my end of year evaluations digressed into a lot of talk about whether or not I was mommy tracking myself.  The criticism was not about my work ethic or my skills. Apparently, there was an extensive discussion about how overly preoccupied I seemed to be about my daughter.  I mentioned her too often.  The suggestion of part-time residency came up and the sentiment was that I would no longer reach my full potential.  These meetings are supposed to be confidential-ish but I was told afterwards that perhaps I should try to hide my kid.

The instructions to hide my daughter came from a good place.  It came from an attending who had my best interest in mind.  He mentioned that in this world even though I was working just as hard, family issues were going to be looked down upon.  I would be stereotyped.  People aren't used to mom surgeons, especially not as residents.  He told me a story about sneaking off from work as a fellow to pick up his sick son by making up some elaborate story to hide the reason that he had to leave.  “It is more respectable to meet friends for beer than try and pick up your child from daycare,”  he told me.  My response…I would talk about my child incessantly!

So, I did.  I figured, if the world wasn't ready for women to be both surgeons and moms, than I would help to make them ready.  The end result is that I feel this has brought me a lot closer to the other hospital staff who are sometimes more open about recognizing the importance of family.  Being closer to the hospital staff makes my job easier.  I chat with the nurses, scrub techs, office managers about our families.  I feel like it gives me a sense of legitimacy and realness which means we are all on the same team.  Also, an unexpected result was that I became the “mama hen” of the residents.  There are a few more junior residents with kids or husbands and the associated stress.  I try to keep an open door policy for them.  And we have real and frank conversations about how hard this can be.  The supportiveness of being able to have this dialog goes both ways!  Also, I find that many of my attendings take an interest in my family life as well as my surgical development.

This past year’s evaluations had no mention of mommy tracking.  In fact, I was made chief resident.  Last night, as I sat finishing up work in the chief’s office while my baby girl bounced around watching Dora and coloring, I felt I made the right decision.  She knows all the names of the other chiefs and incorporates them into her world.  She loves coming to the office and is well known throughout the department.  She chats with me at night about her day and asks about my day.  She tells me she wants to be a doctor like me when she grows up (well, a doctor and a cowgirl of course).  I’ll never hide this beautiful girl!

The things they carried (in their Dora backpacks)

I had been looking forward to the summer, thinking things would get easier once I didn't have to deal with making it to school in time to catch the late bell or nightly homework. I was really wrong.

With both kids in camp, the list of things I have to do prior to getting them out the door is overwhelming:

--breakfast
--pack lunch for both kids
--snacks
--if needed, diapers or wipes
--put both of them in swimsuits
--clothing over the swimsuit or packed in bags
--swim shoes
--normal shoes
--towels
--remember if there's a trip that day, and if so, the cut off time for arrival (anywhere from 8 to 9:30)
--if there's a trip, remember camp T-shirt
--remember to freeze water bottle the night before, then remember to remove from freezer
--sunscreen
--if Monday, remember to bring blanket for naptime

Honestly, it's a miracle we get out the door anytime before noon.

Is the summer over yet?

Where is the grass greener now?

An anecdote to describe my life:
I found a new work bag that I wanted, told my husband about it, he went out and got it for me in the color that I wanted, and I changed my mind the next day.  Returned that bag, bought a different shaped one (same company) in a different color, was finally settled with my decision, then decided I wanted the first one after all.  The grass is always greener on the other side right?

How does it relate to my more important mother/wife/doctor life?
I know a mother, whose life I so desperately want, but so do not want at all.  She is not a physician, she is a stay at home mother.  Since the birth of her first-born, and she has been for many years.

She has a lot of help, a housekeeper, a couple of babysitters.  Her kids go to school full time.  I so don't want to ask the awful and judgmental question 'What do you do all day?' But I wonder.

She leads the life that us working, 24-hour-call-taking mothers dream of.  But I saw her in her own zone recently.  Angry and yelling at her kids.  Frustrated with them, frustrated with her husband, frustrated with herself.  And I thought, "Wow, I hope I don't become like that!"

For once the grass was greener on my side.  But it didn't stay that way for long.  Maybe I should spend more time with her...

The grass didn't stay greener because soon after, I went to a playground with my baby after work.  It was an unusual thing for me to do after work, but I did it.  There was a mother there swinging her daughter next to me and SHE struck up a conversation with ME.  We talked for a while and I found her pretty likable, her daugher was my baby's age, and she was a stay at home mom, and I was even thinking that this would be a perfect opportunity to make a new friend with a baby that is my Doll's age in the area since I really don't know any moms.  I wanted to ask her if she wanted to do something like a playdate (which I have never done, because I don't know anyone around here and because I don't have time) and the entire time, I was replaying Fizzy's old post about playdates in my mind.  The post said that the stay at home mothers do playdates only during the week, because weekends are "family time."

To make a long story short, a friend of this woman came up to us and said, "Wow you guys are chatting away!" and this woman responded with, "Hey, she's firing out the questions left and right, it's not me!"  It seems the psychiatrist in me had reared it's ugly head...

I had not felt like I was asking a lot of questions, and if I was doing that, it was because I was so excited about meeting someone new.  I felt like she had asked a good number of questions herself.  But perhaps the conversation was more one-sided than I imaged.  I went home that day without a playdate and feeling awful about myself as a mother and as a person.  Was I really shooting out questions like I am so used to doing at work?  Am I really not able to put work behind me when I'm home?  Was her facial expression when I said I was a psychiatrist only in my head?

The mother I spoke of earlier in this post has playdates all the time (or at least had them when the kids were younger.)  She has other mother friends.  She used to go to the playground during the day in the middle of the week.

 I have always wanted to be an involved mother who provides a healthy and social environment for her children outside of daycare, and I just haven't been able to do that.

So... the grass is greener on the other side.  It is true.

MiM Mail: How happy should you feel in residency about your specialty?

I am a third year psychiatry resident and a mother to a precious 21 month old little girl. I often find myself wondering how happy I should feel as a resident in my specialty. I was very ambivalent about choosing a specialty and considered family medicine and pediatrics as well. I ultimately chose psychiatry because I felt it would be less stressful and offer a better lifestyle. I also tend to not believe in myself and wondered if I could handle the rigors of those other specialties. As a resident I often wonder if I made the wrong choice. I don't hate my specialty but often find myself wondering if my personality would have been a better for the aforementioned specialties. Sometimes i feel "too nice" for psychiatry and I despise emergency psychiatry and the legal aspects of the field. I have thought about finishing psychiatry and then completing another residency but I just don't feel that I have the stamina for that and want to work part time as soon as possible. I'm just wondering if others have struggled and ultimately found happiness in their field? I'm hoping my feelings are related to burnout and don't indicate I will never find fulfillment in psychiatry.