Here's to the unknowns of 2016

Anyone who knows me well is aware of how seriously I take new year’s resolutions. I think the origin of this is pretty pathetic: growing up, I seemed to always be stuck at home with parents falling asleep watching TV, even when visiting home from college (my mom forbade me from going out, “only drunk drivers out!!!" as she would say). However, I somehow translated these tragic years of missed hook-up and binge-drinking opportunities into a regimented tradition of self-reflection. In high school, I came up with different life categories that were important to me (i.e. family, significant other, spiritual, physical, goals in medicine, cooking, etc), and every year I would review what I had written the previous year and generate or recycle old resolutions for the next year.

Since my daughter was born in 2013, however, I have to admit that I haven’t been as good about this tradition as in the past; generally, all things “mommy” have been put on the back burner (yes, something I really need to work on!). Reflecting on 2015, this has been an eventful year, although we did manage to stay put in the same positions and city. After 10 years of being nomads and chronic renters, tweedle-dee and tweedle-dum somehow managed to buy a place. I had a miscarriage.... and a surprise pregnancy soon after (which has emotionally been the complete opposite of the first). I settled into being a pathology resident and love it. I wrote my first real grant. My husband settled into having his own lab. After stopping nursing early in the year, I re-claimed my boobies and have felt gloriously free since. Free of diapers, free of pacifiiers. Our daughter settled into toddlerhood and we have loved watching her unfold before our eyes.

2016 is another year of unknowns. We are soon going from a family of 3 to 4 and will learn how changing boy-diapers is different from girl-diapers. In the summer, I will transition to a year of full-time basic research in an area new to me. And who knows what other surprises and challenges we all have in store. My resolutions are now much more general and stream-lined: strive to be a solid resident and improve as a pathologist, and, outside of residency, prioritize daughter/husband, food, sleep, and exercise, in that order. And of course try to always have fun. It’s helpful of course to have more specific goals… here are a few simple ones I’ve drafted so far:

Try to find a way to go out more with my husband (even if it requires going to McDonald's for the dollar menu in order to afford $80 for the babysitter).

Yoga 2x a week (mind you this is an online streaming service I’ve used for years which I can do in the comfort of my own home- and, uh, I like to do child’s pose in the dark and fall asleep… ssshhhh)

Never ever lie. I'm talking about the white lie B.S. that we don't even realize we do (e.g. “Sorry for the late reply, I am just now getting your text! or “Sorry I can’t make it I ended up being really busy today.”) If I commit to being somewhere, you can count on me to be there. This has actually been on my resolution list for 2014 and 2015, and I still don’t feel like I have 100% succeeded. (I made this resolution after listening to the excellent short essay “Lying” by Sam Harris- highly recommended, just listen to the audiobook while making dinner or something.)

Stop picking my zits. Seriously. I’m going to stop this year. (But why can't they just go away in the first place?? Wahh)

Continue to find ways to be engaged with our community (we joined the community association, helped plant trees in the park, picked up trash, etc). May sound like a pathetic effort, but you have to start somewhere!

Pray to God that birth for #2 goes more smoothly and is an order of magnitude shorter than for #1, and that I will thrive rather than merely survive during the newborn period (admittedly not really a resolution but just very very strong prayer.. God please have mercy on me!!)

Be aggressive and enthusiastic about reaching out to mentors and people I admire… I used to be so good about this in college. I would meet with physicians, renowned scientists, anthropologists, medical journalists, you name it- of course, many emails and invitations for coffee went unanswered, but a few of these mentors were extremely influential and steered my path in medicine in powerful ways. Something happened to me during medical school where I felt like I lost confidence, or became acutely aware of how little I had to offer. I would ask myself, “Why in the world would so-and-so want to meet with me??!?” and “I don’t want to waste their time or ask their advice- I need to figure this out on my own.” I realize now that it’s sad I feel that way. When my husband was first establishing his lab here, I watched him set up meetings with people every single day, and saw how fruitful it was in establishing his network of friends, colleagues, and collaborators. Especially since I will have more time during my research year, I will strive to be more confident and bring this back.   

So, tell me… how was your 2015? What are your hopes and resolutions for the next year?

Happy New Year to all of you beautiful physicians and mommas- I hope that 2016 brings you rewarding challenges, lots of love, strength, happy memories, laughter, and good health! May 2016 bring more peace to everyone.

I Screwed Up and I'm Sorry and Damn It, I'm Going To Say It Out Loud

Genmedmom here.

Anyone who practices medicine knows that sooner or later, we all screw up. Mistakes can be big or small, can result in harm or not. Misdiagnosis, missed diagnosis, delayed diagnosis. Unnecessary tests ordered, necessary tests overlooked. Medication errors, communication errors, clerical errors. Handoffs gone bad, poor signout, lack of discharge followup. Procedural disasters, frank bodily injury.

I've seen examples of all of these; I've been involved in some. I could tell you shocking stories from training. I could tell you shocking stories from last month.

People don't go into medicine planning to screw up, but it's inevitable, and we need to think about what we're going to do when it happens.

When I rotated through surgery as a medical student, I was fascinated by the weekly morbidity and mortality conference (M + M's). It was a highly anticipated event, and the goal was a complete and bloody dissection of a bad outcome. Grizzly semi-retired surgeons, department chiefs, educators, and every trainee sat in a full hall and listened to one poor soul deliver an objective case report, which then was scrutinized, interrogated, discussed. In the end, everyone learned something, and the presenter was, in a way, exonerated. It was a ritual similar to a public confession. 

In internal medicine training, the culture was largely one of finger-pointing. Other people's mistakes were a source of gossip and ridicule; your own mistakes were glossed over, rationalized. Alot of excuses were made. Yes, there were halfhearted attempts at surgical-style M + M's. Mostly, people stewed in their own guilt and shame. It was toxic.

I work in a much healthier environment now, one in which integrity is valued. Error reporting is encouraged, not for blame and punishment purposes, but rather, for learning purposes. The reporting can be done privately, on a systems wide computer application called something like "Patient Safety Reporting". There are occasional medicine rounds M+Ms, and they're run well, but they're just not that common.

It's taken years for me to figure out my own personal M + M's. Writing up a patient safety report is part of it, but, there's more. When there's been a mistake, I try to analyze it, maybe, discuss it with a colleague or two, and then, most importantly, tell the patient.

I had to do this recently... Of course it was a lovely, salt-of-the-earth patient I have known for several years. Someone I've seen many, many times in the office, who I'm very fond of. Such a good person.

When I first realized there had been an error, I started to go in the old, toxic direction. I was just so embarrassed. I imagined the inpatient team on rounds, skewering 'the dumb primary care doc'. I studied the chart to see if there was any possible defensible position, any good excuses I could use.

But that just doesn't feel good. It feels gross. It feels like.. weaselly.

I have a mantra I repeat when I decide to take responsibility, to own the error: I'll take my lumps. It's an old-fashioned saying, but that's how it feels. I'll take my lumps. 

After a long and painful chart analysis, I marched myself up to the patient's room in the hospital and explained to her what had been missed by me in the past, that, if caught back then, may have prevented her medical issue now.

"I really prefer to be straightforward about these things," I stood with my hands folded in front of me. "I'd rather you hear it from me first. And if it turns out that [what I missed] was the cause of [her issue], then I am very sorry."

Then, I waited, waited for any one of a hundred possible responses.

She was quiet for awhile, I think, digesting what I'd said. Her face was serious.

Was she going to kick me out? Fire me? 

Her face softened into a smile. "Oh, don't beat yourself up, doc," she said. "I know no one's perfect. I know you care. If I thought you didn't care so much, well, that's a different story," she laughed. "No, I prefer to move on, go forward. I don't dwell in the past. What's the point?"

We touched base on this again later, and she said the same thing. I've seen her several times since, and she's not mentioned it again. As it turned out, what I missed didn't pan out as the cause of her illness.

Did I get lucky? Maybe. I am aware that one of these days, my M + M approach may end with me getting sued.

But I'd rather be honest and upfront and be sued, than sit in a toxic stew of guilt and shame. No weaselly excuses.

I'll take my lumps.

"Your child has a fever--Come get your kid"

Has anyone ever gotten this kind of call from daycare/school before?  (I am sure someone has...)

Yesterday I was nearing the end of my clinic day, without any more patients scheduled, when I got this kind of call.  It was about 2 PM and my first thought was, "I wonder if they can just keep her until 5?"  But they said no, come now.  I figured, "Well, no biggie, nobody is scheduled anyway."  

I went to the front desk to inform them that I was heading out early and was met with a sour face and a lecture on parenting.  The secretary informed me, "Now, you know that you need back-up child care for situations like these?"  (This actually went on for a few minutes while she proceeded to tell me how it was irresponsible of me not to know who was going to be picking up my child in case of emergency while I was in clinic.)  The conversation came to an end when she said, "When you're a real doctor, you're not going to be able to just take off, you will have actual responsibilities."  All of this, mind you, when I actually had zero patients scheduled the rest of the afternoon.

I was furious the entire drive home (still am, as you can see).  How dare she give me a talk on parenting and doctoring!  Then I thought of a million reasons other non-parents might need to leave clinic on a short notice.  Maybe they themselves aren't feeling well (crazier things have happened.)  Maybe another non-child member of their family has an emergency.  Maybe they have car troubles on their way in and actually come late rather than leaving early.

What do the other moms-in-medicine-without-reliable-husbands do in situations as above?  Does everyone have an emergency back-up besides themselves for sick days?  Is there a single person out there who has never, not once, been to work late, or had to leave early, or missed a day altogether, for a sick child/sick parent/sick themselves?  Are we not just human people working as doctors, that do have the same ailments as our very own patients??

Comfort

I used to think that I was drawn to hospice practice because I wasn't one of those doctors that had to fix everything. I'm comfortable with the incurable, the insoluble, the chronic and unremitting. I don't see death as a failure of my medical skills. Nope, not me. I'm not like that. I don't have a personal need to cure.

Except....I do still have a need to fix things. I don't feel compelled to cure; I feel compelled to relieve suffering. I need to make pain go away, ease shortness of breath, make the nausea stop. I need the furrowed brow and the tense muscles to relax. I need to make things better. And most of the time we can. We have morphine and humor and steroids and Haldol and ice packs and Ativan and massage therapy and music and pets and chaplains and social workers and aromatherapy and our own presence. When our patients are suffering, we can bring comfort.

It's more challenging to bring comfort to the families. Pain goes away. Grief must be borne. We can provide some companionship and support; in the end, though, grief is a solitary journey. A husband's tears or a daughter's anxiety leave me feeling powerless in a way that the patient's pain and shortness of breath do not. I want to do something, and I know I just need to stand there.

Today was a little different. Today, oddly enough, two different family members needed something I could give them. Something simple and available and entirely over-the-counter. They needed water. Twice this afternoon, I walked down the hall to our ice machine and filled a cup with ice and water, carefully placed a lid on top and collected a straw. I brought the cups back to the quiet rooms and placed them in the waiting hands. And I felt much better.

Home Alone

This summer, my three kids spent several weeks with my parents in their home in Connecticut.  For the kids, this is an amazing time when they bond with their grandparents and get away from the city.  For my husband and me, this is an amazing time to spend a few weeks focusing on work, spending kid-free time together, and getting a break from the day to day bustle of life with kids.

This summer I realized another bonus: that I could be HOME ALONE!  Yes, you heard what I said. At home with no kids, no husband, no nanny -- no one but me!

For people without kids, the simple pleasure of being in your own home with no one else around may not seem that exciting but for a mom who never (and I really mean never) gets to be home alone,  this simple pleasure is on par with fancy dinners, spa days, and juicy beach reads.  Being home alone is one of the most delightful experiences of my life as a mom.

When it first dawned on me that I could be home alone for hours at a time, I felt like the little kid from the movie Home Alone when he first realized that his family had disappeared during holiday break.  I wanted to sit in my pajamas, eat potato chips, and watch movies all day.

Of course, I had other things to do and couldn’t spend hours on movie marathons but during the two weeks when I had a few hours at home with no one else, I started to think about how rare and important alone time is.  

There’s something peaceful and rejuvenating about being in your own home when no one else is there. And it’s different to be home alone rather than other places alone.  I am alone in my office a lot but that’s different. I try to get along time by going to the spa or going to a bookstore but that too is different – it doesn’t last for long and I’m not in my own private space.

As working moms, I wish we could have more times home alone.  Not just quiet time after the kids are in bed but real time – hours when we are not exhausted, can have the freedom and comfort of home, and just enjoy the special place that we have built.  I think many of us are looking for the chance to let our hair down and if not literally but figuratively sit on the couch and watch a movie marathon.

In the months since summer, I have counted the hours when I have been home alone. I don’t think I’ve hit 5 hours yet.  I don’t know if I’ll add any more hours until next summer but there’s no question that I’m already anticipating my two week break and the bliss of my time home alone.

Things I wish I knew before starting med school with kids

1. That tired drinking out of a firehose analogy...unfortunately true. I remember being appalled when I read that med students study multiple hours a day on top of going to class. I foolishly thought on my days that end at noon (Monday and Friday) I can pick my daughter up from preschool / go to the gym / twiddle my thumbs. Instead, I am thankful for an afternoon with no class so I can hole up in the library and study. The endless studying is not death, falling behind is.

2. Wearing a half-face respirator during anatomy lab makes me look like Bane from Batman. But hey, that's a pretty good trade-off for formaldehyde-free breastmilk. And the puzzled looks I get when people see the lingering lines on my face after removing the mask -- extra giggles.

3. The lactation room is the mecca of multi-tasking. Pumping can be accomplished while eating, studying, napping, crying, making phone calls, etc. Bonus points for attempting three things at a time.

4. Whatever makes your life easier, and if you have the means, do it. Examples include ordering food, dry shampoo, a breast pump car adaptor, skipping a bath or two for the kids (hey they could have dry skin?).

5. GET YOUR CHILDCARE SITUATION FIGURED OUT AND SET (x10000000)

6. You will be older than some of the MS2s-MS4s, the same age as some residents or even attendings. Bless your eye cream and good genes, although four years of this will probably negate all of that.

7. Saying no is okay.*
"Want to study together at extremely-far-from-my-house coffee shop at extremely-inconvenient-hour?" - No.
"Want to go rage after block exam and stay out all night?" - No.
"Want to join a thousand interest groups and shadow everyone possible in the hospital?" - No...maybe second year?

8. *It is also okay to say yes.
"Need help?" - YES!

9. Your classmates will be amazing people who have done amazing things. Everyone is incredibly supportive and no one is trying to sabotage you unlike the undergrad premeds.

10. And now, a visual representation of your life:

still smiling though!!! 

Introducing Myself

Hello! I'm Jay. I've been hanging out here and commenting for a long time. I used to blog on Two Women Blogging (don't go looking - you won't find it) which shut down about three years ago. I've written under my real name for HuffPo and NYT's Motherlode. Last June, my essay about my father appeared in Pulse (do you read Pulse? You should!).

These days I mostly write narratives for hospice patients. I was a primary care doc for 20 years; for the past six years I've worked full-time as a hospice medical director. That means I see patients in our 10-bed inpatient unit, do a lot of home visits, attend three IDG* meetings weekly and take weekend call with our palliative care group. We have fellows and residents and med students so I do a fair amount of teaching, too.

My daughter, Eve**, will be 16 in January - she could tell you precisely how many days it is until that momentous occasion. I love having a teenager. I'm sure you'll hear more about that. I've been married nearly 31 years to Sam** and you'll hear more about him, too.

Thanks to KC for founding and maintaining this great site and especially for inviting me to join. I'm delighted to be here. Now if I only had something to say....***
____

* IDG = Interdisciplinary group, also called IDT (interdisciplinary team). The IDT is the core of hospice work and consists of nurses, social workers, chaplains, aides and doctors.
**The names have been changed to protect the mother.
***I'm really not worried about that. It's more likely I won't be able to shut up.

MiM Mail: Am I crazy?

I am a 31-year-old, hospital-based speech therapist in TX who will apply to medical school in 2016. As a newlywed several years ago, we found out my husband is gene-positive for Huntington's disease. Obviously it's a devastating diagnosis, but, fortunately, no one in his family has shown any symptoms prior to age 65.

I have always wanted to be a physician and my husband has been incredibly encouraging of my dream. We completed preimplantation genetic diagnosis with IVF and have 4 healthy embryos.

Now I/we have been hyper-analyzing when to implant. I've thought about everything from this January to M4. If we shoot for Jan/Feb/March, I could have nearly a year with my little one before med school starts. But I could look pregnant during my interview. Should I wait to ensure acceptance? Am I crazy to consider pregnancy now?

I would love your opinions!

MeriAnn

First outsourcing of help

Well, I have done it.  After years of considering this, I have made the decision to hire a cleaning lady.  I have always felt perfectly capable of doing my own dusting/vacuuming/etc. but the time has come that I feel it is too much of a burden with not enough reward.  I feel so so guilty about the money it will cost, but I know it is a small price to pay for extra hours with my family, or just some time to relax instead of clean.

This cleaning lady was referred to me by a coworker, and I was secretly hoping that when she came to meet, I wouldn't like her, or feel that she would do a good job.  But I had such a good feeling about her and all that she said she would do... Clean the windows???  Vacuum under the couch cushions??? For me, this is a one time per 6 months kind of cleaning (please nobody judge)!  After she left, I asked my husband, "Have we really gotten to that point in our lives?"  I am turning a blind eye to the money, and I know it's worth it, I know it's worth it... is it worth it??

Our foremothers

Foremothers? Maybe it's not even a word. I was trying to find a term like forefathers.

I often think about the women who have come before us. As I walk through the halls of our medical school, I see class photos from decades past with 1 or 2 women amongst a sea of male faces. I often wonder whether they had children during their training or afterward, or were they 'discouraged' from getting married or having children? How did they function as female doctors and perhaps mothers in a world that was probably less understanding than what we face today?

I would bet they faced great hardships--particularly sexism beyond what I can comprehend. They may have anguished over pregnancies they had to hide, grieved over the lack of child care options, and struggled to satisfy unrealistic expectations of their employers. And just maybe they dreamed about us--the women who would follow them--and hoped our lot would be easier.

It reminds me of a female doctor from my mom's era who didn't tell anyone she was pregnant in medical school then didn't show up for a test one day.  Yep, she had her baby and came back to school within a week!

I am forever grateful for the trails our foremothers blazed and admire their courage. They are true heroes to me.

MiM Mail: Advice for an ex-husband of a MiM-to-be

Hello!

Being a father not interested in medical school makes me a somewhat non-traditional reader I imagine.

I am ultimately writing for advice. I read a number of great posts on your blog, but I am coming at this from a different direction and was hoping one of you would be able to point me in the right the right way.

My ex-wife is a brilliant woman in her Junior year of her undergrad and planning to start applying for medical schools. We have a good co-parenting arrangement and try to do our best by our three boys (4, 5 and 7). I am no longer in the medical field but do have 8 years experience as a critical care paramedic so I can appreciate both how talanted she is and how hard her road is going to be. She is going to apply locally but is also looking at the Virginia area due to family there. I am willing to consider relocation if I can find appropriate work (I work in IT in a rather specialized area).

My question is, how can I best approach the subject of custody? I don't want to take the kids away from her by any means (she is a fantastic mom!), but I am concerned that raising three young school age boys while attending medical school will be overwhelming. She can accomplish anything she sets her mind to, but even she can't accomplish *everything*.

My initial thought is to offer/ask to take the custodial role, freeing her up to apply herself 100% at school while still affording the boys a stable home life and predictability in routine. I don't know for sure how she would receive this, but suspect she would at least be willing to consider it. Then again, as a divorcee my ability to mis-read her intentions is a matter of public record. : )

There has to be a mutually beneficial way to handle this situation that benefits all of us, and I am looking for advice on where I could look for information. I have looked at some of the schools websites for information on family services offered by medical schools but it's hard to find in a lot of cases.

If you have a moment, would you be able/willing to point me in the right direction, or even offer some insight from your own experiences?

Many thanks for your time!

Life in between my notes

Instead of doing notes this weekend I:

• made a fall collage with Zo using leaves and clippings from free magazines
• went on a date night with the hubby during which we ate amazing food and had delicious lavender mojitos and then both almost fell asleep during the movie (don’t go see the new 007: Spectre, it sucked!) and remarked countless times how we wish we had just stayed home and caught up on the Walking Dead
• caught up on the Walking Dead with the hubby. (spoiler: Glenn no!!! and geeze how does Rick run soo far in those cowboy boots and tight black jeans, I’d have blisters and chaffed thighs!)
• listened to Oprah and Deepak’s day 6 and 7 morning meditations. It’s beautiful but I don’t quite know how to pronounce the meditations.
• washed clothes and then folded them with Zo. Who knew 4 year olds were such excellent folders?!?
• made amazing pumpkin chili (check out http://www.popsugar.com/food/Pumpkin-Chili-Recipe-35890481)
• am thankful that after finishing this post I’m just going to go to bed and it’s only 10:21pm and I’ll start the note writing again tomorrow morning at 5am. Only 38 to go!

Cheers to a week of chaos

This past week was pure chaos. Our nanny of three weeks did not show up Monday morning. Nor did she show up Tuesday or Wednesday. It is now Tuesday the week after and I have yet to hear from her despite multiple calls, texts and emails. I'm not quite sure what happened. At first we were worried and imagined the worst, but a little social media sleuthing revealed she is alive and well, but decided to take a vacation and just doesn't care about coming back. I'm shocked that people act like this (I mean really, are you ever going to give my keys and carseat back?!), but I'm over it. This isn't the focus of my post, but rather, the amazing people in my life that rally and always seem to help make things work out. I am a little late to the thankful train, but I am very very thankful for...

My husband who handles chaos like a pro and always reminds me we're on the same team.
SK for being as patient as a 4 year old can possibly be while watching me stream respiratory lectures. She was very confused as to why I don't learn about mermaids in school and suggested that I bring this up to the administration.
SE for sleeping 9-10 hour stretches at 5 months (bless you) and being the happiest, smiliest baby ever.
My amazing mom who jumped on a plane as soon as she heard about our nanny nightmare.
My kind classmate who volunteered to switch spirometry labs with me so I could work out alternative childcare plans.
The timing of this chaotic week...at least it was the week before Thanksgiving break and now we are all together celebrating with family and friends.

Happy Thanksgiving all (even you, former nanny).

MiM Mail: Making residency safer for pregnant residents

Mothers in Medicine! I am seeking your advice/expertise on the difficult subject of how to treat pregnant residents. A little background: I am a chief resident at a busy anesthesia program that takes frequent and draining 24 hour calls in the OR. Those calls are such that, most of the time, the call room is a distant fantasy. I am also a mom to an active preschooler and pregnant with #2. All was going well until after a particularly exhausting 24 hour call, when I started having frequent, regular contractions at 20 weeks. I had to take several days off work and (thankfully!) things calmed down. I'm now trying to ease myself back into the OR call rotation.

My question for all of you who have been through a resident with tough, frequent 24 hour calls or night shifts... how did your program handle pregnant residents? I've heard from friends at other programs about policies that were put in place to limit calls because so many pregnant residents were going into preterm labor. Other programs limited night shifts for the same reason. Obviously, these changes put strain on non-pregnant residents. Was there widespread resentment to enacting such restrictions?

Amazingly, I'm the first resident to be pregnant at our program in over a decade, but I know there are many women behind me hoping to do the same. I'm hoping to find some common sense changes that can be made to keep pregnant residents working, but in a safe way for mom and baby.

Thanks in advance!

Welcome to Topic Week: Being Thankful

Welcome to our MiM Topic Week! Posts from regular contributors and readers will be spread out over the next week. We hope you will join us in reflecting on this topic as we explore being thankful from our different perspectives and experiences. Thanks for reading and being part of this community.

Scroll below to find the posts.

It Takes a Village

It’s a good day to be thinking about gratitude. I just got the results of my Pediatrics boards and, mercifully, I passed. Like many things in the life of a working mommy, the whole boards process felt fragmented, stuffed into the crevices of an already packed schedule. I studied in stolen hours, early in the morning, late at night, during E’s naps, during quiet moments on call. There existed the dream of reading the textbooks cover-to-cover, mastering the seemingly random landscape of dysmorphisms and eponymous genetic syndromes, committing to memory, not for the first time, the detailed physiology of the nephron. Instead, I did as many practice questions as I could and read all the explanations and made a stack of index cards that I only had time to review once before the test. Studying certainly helped, but what carried me through the process were my patients, the hundreds of people whose stories constitute my fund of knowledge. The symptoms they had, the way their bodies looked and felt under my hands, the labs and images I reviewed in an attempt to understand them, the medicines we prescribed, the way things turned out. All the babies whose birth weight I guessed just before putting them on the scale. All the toddlers who scribbled, babbled, stooped, and recovered during their well-child visits. How do I remember Hurler’s syndrome? I remember A, from my first year as a clinical student, and his mother who carried him everywhere in her arms even at the age of seven, because she could not afford a wheelchair. In the boards review study book, they used phrases like “coarse features” and “macroglossia,” but I just remember his face, whose beauty became more apparent to me over time, and all the grief and tenderness in his mother’s voice as she sang to him, more effective than any medication at calming his agitation. I can only hope that what I have given is somehow proportional to what I have received.

The medical path – and especially the parent-in-medical-training path – has been much harder than I expected and when I reflect on this path I chose, gratitude isn’t always right there on the surface. But when I opened the Boards score report, it was right there. I looked up from the computer and the first thing I saw was my spouse. I thought to myself, “How can a person be so steadfast in the support of another?” I am in awe of it. I was the one who first brought up the idea of having a baby in my last year of medical school, before starting residency. I spelled it out to her over the Formica table in our then-kitchen – how we would have an infant while I was taking 24 hour calls and working long days, how it would be an insane juggle. She said, “That seems like it’s going to be really hard.” But it felt like the right time. We gambled and got a jewel, our daughter E, who is infinite light and delight. But it has been harder than hard. Over the last three years my spouse has done breakfast, drop-off, and pickup almost every day, dinner and bedtime too many days, whole weekends, whole weeks, whole months, sick days, unexpected call-in days, holidays. She gives our daughter what I wish I could be giving her when I’m not there, and so much more. She gracefully bolsters me in my mommy role even though I spend less time with E, when I can imagine a different person laying claim to the “parent-who-knows-more” position. She keeps us well-fed, keeps our household functioning, and through her eyes, I feel beautiful and powerful every day. She does all this while navigating her own full career as an artist and teacher. She has sacrificed some of her own creative and career advancement over the past three years so that I could forge ahead. I know it is painful for her at times – not what she signed up for, even though she did (good love isn’t as simple as they say) – but her loyalty and support just keeps shining and it lights my way and keeps our family warm.

So there are many layers to the gratitude I am feeling on this, the first day of the rest of my professional life. Gratitude to my patients, who are my teachers, who have accepted my inexperience and given me the gift of their trust and allowed me to participate in their lives in a profound way. Gratitude to my spouse, for EVERYTHING. Gratitude to my parents, which is a whole essay in its own right, the YEARS of patient attention and thoughtful decision-making, late night high school research paper crisis management and SOS babysitting saves, self-sacrifice and deep concern for my well-being. Gratitude to my friends, who have stuck with me through long silences. Gratitude to my colleagues and attendings, for saving my ass and helping me find my voice and for caring so much and taking great care of patients and teaching me by example. The African proverb “It takes a village to raise a child” has become so cliché at this point as to have almost lost meaning, but I’m thinking today about the village that raised me, and no words of gratitude are adequate. I will have to thank them by trying every day, with the best of myself, to be of service to the world.

Not the last...the first

I am thankful for many things as I reflect on a tumultuous year.

I am thankful that a program that didn't even exist yet became available to me last year enabling me to move back to my hometown for fellowship.  I didn't know that only months after I accepted the position I would discover that my mother's breast cancer would come back all over her body.

I am thankful for a supportive fellowship program - colleagues, mentors and my mothers doctors all in one.  I am thankful that they are on my team, and on her team.

I am thankful that my daughter can go to "grandma's house" multiple times a week.  I am grateful that they are buddies now - both at a loss if they haven't seen each other for more than a day.  I am so grateful for this time.

I am grateful that my husband who has been stifled in his career by the location of my residency is now managing a large group and doing a job he loves.  This move has been good for all of us.

I am grateful for impromptu dinners with my siblings, my best friends, who I haven't been able to hang out with for years.

Most of all I am thankful that when I feel tears well up as I realize that this Thanksgiving and this Christmas may be my last with my mom, I can instead focus on the fact that it is really the first -  The first Christmas my sweet baby girl gets to spend with Grandma.  The first Christmas that I have been able to spend with my entire family in 13 years.  I am thankful for first - with a mustard seed of hope that this will be the first of many.

I am thankful for family and the sweet gift of each day we get to spend together.

How It Could Be, How It Is

Genmedmom here.

I was in the grocery store last week, which is rare because at this point in our crazy two-working-parents-with-two-small-children lives, we have everything that can be delivered, delivered, and this includes groceries. It's seriously saved us about three hours a week, ordering our "big shop" right from a cell phone, and having it all magically appear early Saturday mornings.

But, that week, I'd ordered on the fly and, of course, forgotten a few things, plus an item or two had been out of stock. So, in an unexpected free hour on Tuesday afternoon, I found myself wandering our local Big Food Store.

I'm so out of grocery-shopping mode that I got a little disoriented. In the old days, I'd have my list jotted down, roughly organized by aisle, and I'd zoom through the place in relative ease.

But there I was, bouncing from Snack Foods to Produce and back again because I couldn't find the damn Pea Puffs Babygirl likes. Then, way over to Dairy for the cheddar cheese sticks I absolutely have to have with my apple for lunches, and that you can't order online for some reason, and then back over to Crackers because Hubby texted that we're out of the kids' favorite crackers... et cetera.

Then I was lost, searching for the powdered instant breakfast stuff we shake into the kids' morning cup of milk to make us feel better about their nutritional intake. It wasn't with the Cereals... I saw a couple of young employees standing in an aisle, with bar code reader-things.

Oh good, I thought. People I can ask.

But just as I was rolling near, one of them started griping, loudly:

"Man, I am so ready to get off work. Get me the heck outta here!"

His buddy replied:

"Yeah, work sucks. The whole thing sucks."

I veered away, pretending I hadn't been about to ask them something. I wondered how working in a bright, overstocked first-world grocery could possibly be THAT bad. It was kind of a downer.

I never found the stupid instant breakfast, and I was almost out of free time. I aimed for a checkout line.

The man doing checkout was still scanning items for the person ahead of me, but he looked up, smiled, and acknowledged me, calling out cheerfully:

"Hello! Beautiful shopping day, isn't it?"

He turned back to the shopper and took her coupons.

"Smart lady, you're going to save some money today. You should treat yourself to something special, you deserve it!"

The woman and I exchanged smiles and chuckled. In the space of less than a minute, the atmosphere had gone from Ugh, errands to I can't help but smile!.

Now, I've seen this guy before. He's older, has a thick accent, and he's ALWAYS cheerful. Not in a fake, annoying way. I mean, he's just really genuinely cheerful. He always greets people and says nice things, makes a lighthearted joke or two. He's very efficient at checkout. He also bags items with care. He acts like someone who loves their job.

As I stood in line, I studied him. Given his appearance and accent, I guessed that he was an immigrant. I imagined that he had come from a developing country, and had known oppression, hardship and hunger. Maybe it had been difficult for him to get to the U.S., and then to get a job. He might have a family he desperately needed to support, and so, he's amazingly appreciative of the opportunity to work the checkout counter at the Big Grocery Store, and help bag groceries for harried and distracted moms like me.

Whatever Mr. Positive Attitude's story was, he cheered a couple of people up that day. I truly wish everyone was like him. Imagine that!

And whatever the Griping Employees' story was, their complaining brought me down. It's depressing to think how many people sludge through this life like they do.

I've been thinking about this a lot lately. I find that I'm sensitive to negativity, I want to run away from negativity. This regardless of whether it's expressed by my colleagues at my own job, or by friends. Examples at work might include the judging of another provider's care, complaining about some administrative issue, or griping about the electronic medical record. With friends it may be grousing about our school system, grumbling about a spouse, or sharp self-criticism.

I think some venting with a trusted confidant, in private, is okay, and even necessary sometimes. Even better if it's with a mental health provider. Emotions can be validated, and a response discussed. You know, "talking it out". This is head-housecleaning. It's therapeutic.

But pointless negativity (aka "Work sucks") is just toxic. It's just pollution. It serves no good purpose. It should be banned. And there's alot of it.

People who have known me over the years may be surprised to hear me saying this. I was kind of the Queen of Complaining in residency and fellowship. What happened? Well, to sum up: in 2006, the years of sheer physical and emotional exhaustion, unhealthy coping, poisonous relationships, and social isolation brought me to the lowest point in my life.

The struggle upwards involved hundreds of hours of therapy with an excellent provider, liberal antidepressants, formulating meaningful life goals, clean living, and meeting my husband.

Through our very different journeys, we've been touched by the pain and hardships life can offer, and we've been witnesses to some true horrors. A twist of fate, bad luck, the finger of God... bad things can happen to anyone. When they do, some people are consumed, crushed even, and yet, others transcend.

I'm thinking of my patients with devastating diagnoses who choose to stay positive. I'm thinking of our family members who have lost children, and choose to go on living and loving. I'm thinking of the people I've known in Central and South America who suffer true deprivations, but choose to hope. I'm thinking of all victims of random violence who choose to forgive. I'm thinking of the immigrants around the world who are being shunned, but choose to go on in search of better lives.

For everyone who chooses to say:"I'm going to take it day by day, and be grateful for every sunrise", I'm thinking of you.

We are so lucky, so blessed, and we acknowledge that. In our house, we joke that if we ever won the lottery, we wouldn't change much, because we've already won the lottery. We are passionate about our hard-earned careers. We've been blessed with our beautiful kids. We enjoy a place in a wonderful community.

Is everything perfect? Duh. Of course not. Read my blog.

But our eyes have been opened to what could be, and so, we're thankful for what we have. And we are truly happy.

Family bedtime

Every night before bed, our family of five gathers in our middle child's bedroom. It's dark except for the hallway light that shines in from the open doorway. We pile in somewhere in the darkened room. Maybe on our youngest's mattress that lies on the floor (and will continue to live there until our 4 year old decides his own bedroom is not haunted by The Arm). Maybe on our other son's bed. Maybe sitting on the desk chair. We settle in and start our bedtime ritual.

It's our family bedtime prayer. We start by each saying what we are thankful for that day. I'm often struck by what my children are thankful for: having a house, food, their school, our family, mom and dad. Our daughter, the oldest at 10, sets the example for her two younger brothers by being reflective and thoughtful. (That girl's natural gratitude for everything in her life is a point of immense joy for me and that perhaps somehow, during our many missteps parenting, we did something right.) I enjoy hearing what my husband is thankful for - another window into his day. And I find it therapeutic to think slowly through my day and select what stood out for me. I find that I am thankful for many things and that this reinforces my generally positive outlook on life.

Next, we each say something we are sorry for, or want to do better with next time. We emphasize that there is always something we can do better. The children's responses often involve times that day when they were annoyed or angry with the other. Never any judgment, just sharing.

Then we share one thing we are proud of doing that day. Maybe it's doing their best on a test. Or being a good friend. A piece of art. Another great insight into my husband's day for post-kids' bedtime follow-up. I love hearing what everyone is proud of.

Finally, we name who we each want to pray for. For a long time, our 4 year-old said "Santa Claus" every night and now that has seasonally transitioned to The Pope (formerly pronounced "The Hope") and Wilson, our deceased cat.  Our middle child, 7, tends to pray for large swaths of people - the homeless, people with cancer.  We finish with a prayer that we say together.

I don't know how long this family ritual will hold together. For now it works for us all. I didn't grow up saying prayers or consciously thinking about what I am thankful for. I hope supporting this daily habit gives them as much meaning as it has given us.

Thankful for my American Dream

Isn't it crazy how verbalizing something so simple can be so challenging?  It took me almost a week to figure out how I would write this post... Yet every day, I feel so thankful for all that I have in this life!

When I was a little girl, my family didn't have a lot of money.  We always had food on the table, but I never had the clothes, toys or snacks I wanted.  I dreamed of a day when I could go to the supermarket and pick out whatever suits my mood and just buy it.

The day is now here, and I am living the dream.  If you read over my previous posts, you can see I struggle everyday with some aspects of my life that I'm not thrilled about.  But that in no way shapes what the overall theme is of my life:  I made it, and I'm living the American dream.  Of having a one-in-a-billion amazing husband.  Of having a daughter so sweet and smart.  Of having a positive outlook on life (mostly.)  Of having our health, and not least importantly our mental health.  Of just being happy overall.  Of not counting pennies.  Of buying my daughter the toys I want for her (and the toys she wants).  Of having a new car (seriously, sometimes I drive in my new-ish car, about 3 years old, and I marvel at how I grew up to buy myself a new car!).  Of just living this life the way I envisioned more than 20 years ago.  I may not have the dream job (right now), or a dream house quite yet, but I have a dream life, and for that I am thankful every minute of every day.

In the first Sex and the City movie, Charlotte becomes pregnant and says to Carrie, "Nobody gets everything they want! Look at you. Look at Miranda. You're good people and you two both got shafted. I'm so happy and...something bad is going to happen."  Sometimes I worry about being so overjoyed at all that I have.  But then I remember, it's not that bad things haven't happened to me recently, or that everything has just been perfect.  It's that I still have what I need to make me happy... and eternally thankful, for the health that's been given to me and my loved ones, for the ability to work hard, and for the mental prowess I possess to persevere, and look beyond the losses and negatives that come my way.

A very happy Thanksgiving to all!

Thankful for my village...

They often say it takes a village to raise a child.

As your typical OCD, type A personality, I was not one to ask for help. Before motherhood, I would say my life was quite simple. My innate desire to excel at everything I do was never challenged. I was born into a typical Korean family in America. My parents immigrated to America shortly after getting married to provide a better future for their children. I was my parent's pride and joy. I did well academically. I got accepted into a combined BS MD program in high school. My life was planned out. I would go to college followed by medical school and become a doctor.

Who knew I would meet the love of my life and get married by the end of medical school? And better yet, who knew I would get pregnant during my intern year?

I certainly did not. I lived in denial throughout my entire pregnancy that I got this. I was so wrong. My whole world turned upside down. I loved my baby girl more than life itself but for a control freak like me, having a child was the ultimate test in learning how to let go.

Fast forward 2 years and 10 months later, here I am. I cannot be more grateful. My life is a lot more complicated but I wouldn't change anything. Everything truly happens for a reason. It wasn't medical school or residency that proved to be my biggest challenge. It was the combination with motherhood.

I'm thankful that the challenges of motherhood and residency has taught me how to ask for help. It has made me a better person. Life isn't a competition. And I am constantly grateful to the people in my village that help me raise my child and pursue my career.

So here is my thank you.

Thank you to the others moms I've met during this journey whether it be a simple look of camaraderie when little C is throwing a temper tantrum in the middle of the supermarket to those who  have reached out to let me know that I am not alone in this process.

Thank you to my daughter's teachers. Thank you so much for being so understanding. Thank you for making little C love pre-school. Thank you for providing a safe environment for my daughter while I go to work. Thank you for answering all my paranoid questions.

Thank you to my pediatrician friends for answering this radiology resident's questions (whose entire medical knowledge seems to go out the window when the mommy cap is on!) from how to dose tylenol, to answer questions about little C's rash and even regarding her intense stranger anxiety (thank goodness that phase is over!)

Thank you to all my friends that stuck around. As a resident and as a mom, it doesn't leave much for a social life. Times like this has made me realize that true friends are few. Thank you to those that have been understanding and we can pick up where we left off despite the times we talk and get to see each other are few and far apart. To those who didn't want to stick around, that's okay too. Thank you for once being a part of my life but I understand that I may not be the friend you need or want. Thank you for teaching me that as we grow older, it is not possible to be friends with everyone and that it is also okay to not be liked by everybody.

Thank you to this blog for providing a sense of community. I feel grateful that I get to share my stories with other women just like me.

Thank you to my attendings. I've had my share of attendings who seem to forget how hard it is to be a resident let alone a resident and mom. However, I've also had my share my attendings that do remember and this is my thank you to the ones that tell me to go pick my little C early when things start to slow down at the end of the day.

Thank you to my husband for always listening to me and making the best out of the situation. Despite the entire country between us, you try your best to make sure I don't feel alone this year.

Thank you to my in laws for being understanding and patient. Thank you for not complaining about not being able to see little C or us that often. Thank you for supporting our careers and our journey to parenthood.

Thank you to my dad and brother for sharing your wife and mother with me. I know me and little C have taken her away from you two during the past 3 years. But neither one of you ever complain and love little C just as much as I do.

And my biggest thank you goes to my mom. Thank you for raising little C for 2 and a half years as her primary caregiver and now that she's in pre-school, thank you for spending your weekends with us, thank you for always packing us food for the week, thank you for watching little C when I'm on call and thank you for always being available when little C is sick and can't go to pre-school. You are the main reason I've made it this year.

Thank you, my wonderful village. I couldn't and can't do it without you all. Here's to 38 more weeks of long distance and to 30 more weeks of residency! I can see the light at the end of the tunnel.

Dear beautiful people in my village, my success is just as much yours as mine.

Guest post: No longer twenty-two and thankful

This has been a reflective week for me. My two-year old, the fourth and last of our kid posse, ditched the diapers. My husband and I are on the verge of making the decision to repatriate our family to the US after five years of living in South America. And I received my first-ever acceptance to medical school.

It's been a long and non-traditional road. When my husband and I met in organic chemistry many years ago, he had already switched his major to English and I was an enthusiastic pre-medical student. After college he took a job that required him to stay in our alma mater's location. I had a track injury that kept me in school for a fifth year. After my graduation, we decided I would take a deep breath from the hamster wheel of school, athletics, research, thesis, more school, and the insular world of which a 22-year-old college student is the center.

As often happens when one takes the opportunity to step back, my horizons broadened. A Masters degree. Marriage. My first year teaching high school with 153 teenagers. A surprise pregnancy. My mother-in-law with terminal cancer. And I hadn't yet reached my twenty-fifth birthday. Sometimes I felt like taking the deep breath was more like having the wind knocked out of me.

Fast forward a few years. My husband's parents have both passed away. We have four lively, enthusiastic children. Our career paths have been eclectic, and we are considering returning to the States, where we will find ourselves at another life junction.

"What do you want to do?" my husband had asked me a couple years ago.

"Well, the same thing I've wanted to do for a long time. Go to medical school."

He smiled, chuckling at the roundabout trajectory we had taken to get to this point from our chemistry classes way back in the day. "Well, let's go for it and see what happens."

I flew back to the States and took the MCAT seven months pregnant. I asked my thesis advisor if she could dig up the letter of recommendation she wrote for me over a decade ago. I finally filled out the tedious AMCAS application. I went to my first interview wearing a green suit (slate green at least!), and quickly realized that everyone else was wearing black, with a dark navy or two thrown into the group. But I am okay with being non-traditional.

I am no longer twenty-two, and I am thankful. Thankful for the crazy road of life, that has left me with unexpected joys, scars of sorrow, and varicose veins. Thankful for a family that has encouraged me through multiple moves and international transitions with uncertain futures. Thankful for the medical admissions committee members who decided to give me a shot.

And thankful for all the Mothers in Medicine, who have shared their stories and their journeys. Many blessings to you as we finish another year celebrating all the lives with which we are intertwined.

A soon-to-be MS1

Thankful For That Creepy Wiggle

Every year, there is always so much to be thankful for. As physicians, I don't think this idea is usually lost on us; we see patients suffering with difficult health challenges or even life-and-death situations on a daily basis. But what is sticking out this year as the thing I'm most grateful for?

Fetal movement. Yes, that weird sensation inside of my own body. My first child is due December 11, right between Thanksgiving and Christmas - the time that we most contemplate gratitude. This is not my first pregnancy, but I have never gotten far enough in the process to experience fetal movement before. I started feeling the movements around 20 weeks gestation, which began as little "pat pats" in my low abdomen that were easily confused with gas bubbles. They have now transformed into squirmy, distinctive wiggles several times throughout the day.

Overall, I have had a pretty easy pregnancy. My early nausea was fairly mild, I was able to continue with moderate exercise and work throughout my first and second trimester, and I have had no major complications as of yet. My tall stature has blessed me with a long torso within which baby can stretch, and I haven't been confined to maternity clothes. However, in my third trimester I have developed severe leg swelling that has significantly limited my activity (and my work, which usually involves being on my feet most of the day). It is very uncomfortable with constant itching and pain throughout my legs. To keep my mind off of it, I have been trying to focus on the good things... like the consistent blessing of fetal movement, a reminder of why I am going through all of this.

Many have described the sensation of fetal movement as "creepy", "surprising", "uncomfortable", etc. Expectant parents jokingly refer to their growing fetus as a "parasite". To me, the squirmy turns of my belly, the head-butting of my cervix and the kicking of my diaphragm are welcome reminders every day (every hour, really) of how hard I've tried to become a mother: the months of IVF cycles, shots, staying home instead of traveling, rearranging work schedules, waiting, hoping... And about how after all this time, it's finally going to happen!

Ten reasons this primary care pediatrician is thankful to her patients and families

1. Thank you for asking me questions, listening to my answers, discussing options together.

And for answering the many questions I ask of you.

2. Thank you for brushing your teeth in the mornings.

And in the evenings.

3. Thank you parents, for letting your teens talk with me in private.

I always encourage them to share with you what we discuss.

4. Thank you for asking for refills before your medications run out.

And for using your inhalers with spacers.

5. Thank you for understanding how important vaccinations are for your children.

And for getting your own influenza and pertussis vaccines, as parents.

6. Thank you for modeling healthy behaviors.

Reading, drinking water, minimizing inattentive screen time, and getting exercise every day. Together.

7. Thank you for letting medical students and residents learn pediatrics.

You are their teachers too.

8. Thank you for working on quitting smoking.

Call 1 800 QUIT NOW.

9. Thank you mothers, fathers, aunts, uncles, grandparents, great grandparents, neighbors, and cousins for caring about the children you bring to the pediatrician.
It takes a village.

10. Thank you for sharing your stories, and inspiring me to grow and learn with you.  So we can all be as healthy as possible on this journey.  
I'm listening. 


(an earlier version was posted previously by me at www.pediatriccareer.org and I'm still thankful)

To my patient

I had started a thankful list, a real one from the heart. And yes, I am thankful for those things. But then the precarious balance of my life got upset, so new post.

I got shingles - it’s the thing that has upset my life balance. Stupid, burning shingles. My pain isn’t too bad but the burning isn’t affected by pain medications. Occupational health cleared me to work as long as the rash was covered. So to my next shift I went.

It was the shittiest shift I have had in a long time. By the end, I was hating everyone and everything but especially myself and my job. It was a shift where I felt like I couldn’t or didn’t help anyone. Most of my patients didn’t need a doctor, they needed better coping skills and over-the-counter remedies and time. 

But my last patient, I need to thank him. He needed an Emergency Doctor for his problem. He changed my whole day for the better. His sense of humor about why he was there and interaction with his wife reset my outlook for the day. And I could and did fix his problem too. Spiritually and doctorly, I was better. 

That patient refilled my compassion cup. Usually that’s the job of a million little things: bad television and sports, beer and coffee, my Sleep Number bed, Mirena, goofy t-shirts under scrubs, nail polish of extraordinary colors, my Chuck Taylors, t-shirts and jeans on off-days, Twitter, my KitchenAid mixer, and the color orange. Or the job of some big things: Hubby and The Blurs.

So thank you, sir and your lovely wife, my next shift was much better because of you. My balance is restored (mostly, because stupid burning shingles are still here).

Guest post: Unexpected gratitude

I love Raymond Carver's poem "What the Doctor Said." The doctor tells the poet he has widespread metastatic lung cancer. The poem ends with this:

I jumped up and shook hands with this man who'd just given me
Something no one else on earth had ever given me
I may have even thanked him habit being so strong

I may even have thanked him. 

I don't have to tell people they are dying. I'm a hospice doc. My patients know they are dying before they meet me. Everyone knows they are dying. They may not want to say it out loud, and they may use a variety of euphemisms, but everyone knows. I don't have to say it. I do have to find a way to answer the question "How long?" I always start and finish my answer by saying "I don't know." We never know for sure. I am frequently surprised - I am surprised how quickly some people die and how long some others linger. I am surprised by so much about this work. I am surprised by the peace that I feel at the bedsides of the dying, and how comfortable it can be in our inpatient hospice unit. I am surprised at the laughter I find when I make home visits. I am surprised by the capacity of family members to do the hard, dirty, physical work of caring for their loved ones.

And I am surprised when they thank me.

Patients thank me for coming to their homes. "A doctor who makes house calls! In this day and age"! Caregivers thank me for the medication that eases the symptoms and makes their job easier (even though it's the nurse who tells me what they need). Family members thank me for clear explanations of the medical system and for signing forms (although most of that credit should go to the social workers who do all the actual work). All of that makes sense. I have done something, given them something, provided an answer or solved a problem.

Then there's the question no on ever wants to ask: "How much longer, Doc?" It's often asked in the hallway of our inpatient hospice unit. Someone is usually crying. Sometimes the someone is me. I am as honest as I can be when I don't really know. I say "I don't see anything that suggests it will be the next few hours...", but I know the patient might be gone when we walk back into the room. I ask what the family needs - what decisions are they wrestling with? Who needs to come in from out of state? Who are they trying to protect? And at the end of the conversation, they say "Thank you." I am always surprised.

I don't really know why they are thanking me. Perhaps it's for some clarity and honesty after the muddle of modern medical care. Perhaps it's for the moment of connection and the respect I hope I'm communicating. And perhaps it's what Raymond Carver wrote about - that I have given them something no one else ever has.

Those moments will continue to confound and humble and amaze me, and for that, I am thankful.


Jay is an internist working full-time in hospice and palliative care and mom to a 15-year-old daughter.

Thankful in this moment

I am thankful for this hour of quiet. My father is in town helping us for 4 weeks while my husband is away doing research. I signed up to take Zo trick or treating but the greater than 50 notes I have to finish from the last 2 weeks are weighing on me and I have vowed to finish them this weekend.

I am thankful for the opportunity to care for my patients and their families. There isn’t a day that goes by that I don’t laugh and smile and sing and dance with my patients and think to myself or say out loud how wonderful they are. From the teenagers affected by gun violence who are working so hard to graduate high school and stay out of trouble to the school aged children who get so excited telling me about their dreams. To the new parents whose babies are growing and thriving. There cannot be another job like this!

And I am thankful that my position has just the right amount of joy coupled with dysfunction to keep me motivated but to also remain committed to finding solutions to enhance the work experience of community pediatricians. I cannot imagine how folks continue with this schedule for years and years. I have been practicing full time for less than 6 months and I seriously need a scribe, personal/house assistant, cleaning person, and driver for our son. Out of discomfort comes great things so I will work hard to building a better future for myself and future providers as well. It has to get better. And I have some ideas on how to make it happen.

I am thankful for being given the opportunity to raise my beautiful, outgoing, silly, passionate 4 year old with my extroverted introvert of a husband. I am thankful that my husband’s schedule is flexible enough to accommodate random days off from school. I am thankful that my new salary allows my husband the ability to pursue his research interests. And I am so freaking thankful that at this time next year he will likely have a full time job with benefits so that I can work on a schedule that gives me more freedom to pursue my research and advocacy interests.

In this moment I am thankful. And that’s all that really matters.

Entertaining injury

Just wanted to share a quick story that has made me smile to myself all day today... Last night, I started cooking poorly planned stir fry for dinner while my two-year old daughter was playing with some toys around the kitchen island. While veggies and tofu were sizzling, I started reaching for a few items for sauce, and had the terrible realization that we were somehow out of soy sauce. Ack, I told my daughter! But bad mommy- as I scrambled to throw together some alternative marinade, I didn't keep a close enough eye on her, and in a total of about 5 milliseconds, she managed to pull out a giant glass jar of applesauce from the pantry (when I lamented we were out of soy sauce, she heard "apple sauce" apparently haha). She triumphantly yelled out, "Mommy, I found some sauce for you!!" came over to me, and held it up to me over her head. It slipped out of her hands. ONTO MY FOOT. Mother*%!?!**!!!!!! I fell to the ground in agony. The ensuing events are what have made me crack up and smile to myself all day... she immediately retrieved her beloved comfort cloth/rag, which she calls Addy, and ran back to offer it- "Mommy, here's Addy, here's Addy, feel better?!??" She then proceeded to stroke my back with urgency and say, "It's okay mommy, it's okay, you're okay, feel better? Need a kiss? Let me kiss your foot. Better now, Mommy? Need some ice? Here's some ice. Better now??" This circuit of questioning and comforting went on and on for several minutes in her high pitched concerned voice. I was tearing up and laughing simultaneously- it was like she was doing a condensed/abridged performance of all the things we've ever said to her when she gets hurt, haha...  Despite all the pain and my bruised foot, I'm very comforted to know she's internalized these things and knows how to mobilize to help others. And yes, of course her kisses made my boo-boo better :)

Girl Power

I just finished two of my best weeks as attending on the wards. It’s hard to describe exactly why these two weeks were so great but I think it had to do with a great team dynamic that involved trusting my residents, great teaching opportunities, and interesting patients.

But I also have to wonder if my great experience was because my team was all woman including a resident and a medical student who are both moms.  Here are a few observations from my rotation.

First, resident mom and med student mom AMAZE me.  Resident Mom has two school aged children which means she has had kids during her entire residency.  Med Student Mom has an infant and is on her second rotation after maternity leave.  She drives an hour each way to get to the hospital and leaves her baby for long stretches with her mother. I am exhausted just thinking about her schedule.

What amazes me most about Resident Mom and Med Student Mom is how calm, unstressed, and pulled together they seem.   They work the crazy hours of training yet never seem stressed or tired or cranky.  This is quite different from how I felt (and likely appeared) when I had my son during residency. I cried every morning when I left home and complained a lot about the fatigue and stress I felt.

Resident Mom and Med Student Mom appear quite different.  They are super calm and seem truly on top of everything.   I am in total awe of their dedication and composure.

The second thing I realized is that mothers in medicine need to support each other and the hierarchy of medicine shouldn’t get in the way. There is no question that training will always be grueling and the workload will be heavier for students and residents than for attendings.  

I can’t change this system. But I can create a better culture where people feel safe to talk about the pressures of training, particularly being a mother in training. 

Mothers in Medicine blogger, KC, wrote about a different approach when she became a division chief and met with a new mom who returned from maternity leave.  “We talked about her transition back to work, their childcare arrangements, and where she stood in terms of identifying academic areas of interest,” she wrote. This was a total reversal from her own experience eleven years earlier with male bosses.    

My recent experience on the wards reminded me of KC’s story.  As mothers in medicine start to rise up in the ranks, we can create a culture that supports other mothers, especially those who are still in training or early in their careers.  We are the ones who recognize that it is not easy to be a mother in medicine.  It was natural for me to ask Med Student Mom if she was able to find a lactation room and ask about Halloween costumes and understand that some mornings are harder than others.  

For some of us, showing this support comes in the form of blogging and writing and working for policy change.  But for many of us, support comes in a quieter form – a silent culture revolution. It can be asking questions of how another mother in medicine is doing - whether she’s feeling stressed or guilty or exhausted.  It can be breaking down the hierarchies and treating each other not as students and residents and attendings but instead as adults who share a common thread of motherhood. 

MiM Mail: DO or MD school and motherhood

Dear Mothers in Medicine,

First of all, thank you for being so helpful and encouraging. When trying to decide whether or not to pursue medicine, I read just about every post and every comment on here! Now I am writing to pick your brains about MD/DO. There is a lot of information out there on the residency "merger," and the differences and similarities of the MD and DO approach.

However, I am writing to you because I want to know how getting a DO degree over an MD degree might impact my future specifically as a mother.

Right now I can either apply DO this cycle (the application season is longer) and start school in the Fall of 2016 or wait to apply next year to MD and DO programs and have more options, but start in the Fall of 2017. I am already 27, so starting sooner is very appealing to me, but I don't know how much my age should matter. Either way we will be having children while I am in medical school and residency.

Although I am pretty set on primary care, I worry that I could be wrong. Two years ago when I started this journey, I didn't think I really liked science --- I thought I just needed to get thru the pre-reqs so I could go into pediatrics or FM to provide care to rural and underserved communities. Turns out though, I LOVE science. For a few good hours I considered pursuing a PhD in biochemistry instead of medical school.

Now there is a small part of me that wants to keep my options open incase I fall in love with a specialty I don't even know exists yet, or if I decide to do research. But this --- always wanting to keep all my options open for as long as possible --- is one of my weaknesses and I don't know how much to indulge that part of me!

From reading all the posts on here that mention osteopathic medicine, it seems like a few regret their decision to go DO (momstinfoilhat and RH+) while a few (mostly students) left more positive comments. RH+ wrote in 2008:

"Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship."

But, this was back in 2008. So I don't know if it is still true? I also saw someone mention that DOs have to do more away rotations in their third year than MDs? With the young children we hope to have, this could be frustrating.

A few physicians on here have mentioned taking time off to care for a newborn and doing research during their time off. Is this an option that is available to DOs? I ask because I haven't heard of any DOs doing it, but I like the flexibility that idea offers.

So, all this to ask, if going the DO route limits our choices later (in terms of a research year to care for a new baby or options for residency locations or job locations... which could limit access to family support), then maybe I should wait the extra year and try for MD while also applying to DO schools?

To those on hiring committees (MD and DO), have you or your colleagues ever passed over DO applicants in favor of MD applicants?

To DOs who are doing their residencies and DOs who are working: Did you feel limited in the match or when applying to jobs? Do you regret your decision to go DO? Do you feel like you have had to work harder to prove yourself as competent as those with MD degrees? Did you feel like your clinical training (years 3+4) was as strong? Can you think of any unexpected ways being a DO might have influenced you and your families lives?

Thank you so, so much for taking the time to read this. I really appreciate any help and advice you can share.

All the best,
Confused pre-med and pre-mom

The End… and the Beginning

When I was first queried about writing, specifically for a blog like this, I was excited, nervous, surprised… would other mothers in medicine actually want to read what I have to say? Would this be an opportunity for me to reflect upon my own clinical and academic practice? Would this enable me to grow as a physician mom? 

Like many things I’m sure you all can relate to, this idea fell to the back burner, simmering. I now find myself at a critical point in which the stew that is my professional and personal life are bubbling, coming to a boil and I find this the opportune moment to jump in. This comes on the heels of a gentle reminder from KC, for which I am thankful. 

I am approaching the final stages of divorce. In order to proceed with finalization, I have been required to attend parenting classes. I won’t go into just how asinine I thought this was given he has no requirement to attend said classes. Nevertheless, I showed up with intent to learn as much as I could that I’ve not already discovered through trial and error in the co-parenting adventure. I was surprised that they started with Elisabeth Kubler-Ross and the stages of grief. I took that with a big arms across the chest eye roll, then softened a bit as I thought more about each stage and the fact that this transition does in fact mark a loss… I’ve since considered my own transition through the stages and thought back on the years we were together. 

It’s taken nearly three years. I asked him to leave almost three years ago with our eleven month old son on my hip, seething with anger and pain. Eight years of emotional roller coasters. Eight years of infidelity. Eight years of me not acknowledging my own value. In that moment, that decision, I chose myself and my child. I chose to remove myself from a relationship and marriage which was so far removed from anything I wanted to model for my progeny. I had finally come to the complete realization that my husband would not every remain faithful and tend to his responsibility and commitment to me as a life partner. I did not want my little one to watch and live in an environment where a person whom is purported to be loved is treated that way. I have come to terms with the fact that I have zero control of half of this equation (my ex), however I have full control of my own actions, behaviors and decisions. 

So, if you will, walk through the stages with me. 

DENIAL 

Every single time I found out about another indiscretion of infidelity, I refused to believe it or give it any power. I denied how devastating his actions and betrayal had been. I denied that he’d made a seemingly meaningful connection with anyone in this world other than me. I denied that he’d violated my trust. I denied that I deserved to be treated with respect, dignity, love and commitment. I denied my value. I denied my intelligence. I denied my sex appeal. I denied everything and assumed it was my fault. I stuffed my emotions and hurt into a little box and told myself he’d be better. I denied my visceral sense that his behavior would never change. I denied my better sense. I denied my friends’ pleas to remove him from my life, over and over again. 

ANGER 

This emotion is incredibly primal for me, particularly in regard to this situation. My instinctual, somatic response was long buried due to a longstanding practice of compartmentalization. The trouble with compartmentalization is that it is both protective and destructive. I put those sad, hurtful, scary, heart wrenching things in a box, I lock each box, then I dissociated from those feelings with the hope to never, ever have to feel those terrible feelings again. I felt comfortable, or at least I felt that I was well enough in control of my life to go about my day to day. Then there come times when I’ve run out of capacity in my emotional compartments and for me, that’s usually when I feel least in control of this primal behavior. On the surface, I perceive myself to be fairly calm, cool and collected. When my fully stuffed compartments start to overload, the anger floods over me, forcing my hand to process what’s in those boxes. This is also the crux of that inherent destructive nature of compartmentalization as well. 

When this happens, my transition to anger is a painfully exhausting one. Each of us experiences it differently, but I can tell you how it feels for me. I develop an ache in my chest, then my heart rate quickens, blood rushes to my head, my jaw clenches, my nostrils flare, my posture becomes more erect and inevitably, my left eyebrow raises. My hair stands on end, my pupils dilate and I coil into position to strike. If it happens too quickly, it blends with the hurt and tears well up alongside my venomous words. At the same time, the sense of power that comes with anger is intoxicating. If it happens more slowly, I can calculate my response, choose my words and actions in a much more strategic way. I feel much more in control and strong. It’s a delicate balance, however, between the primal emotion and the controlled response. My ex, whether intentionally or not, can always find ways of awakening the beast within me. I’m still learning my own triggers and how best to turn each experience into something productive rather than destructive, with particular focus on self preservation. That, however, is for another conversation. 

BARGAINING 

Anger is powerful, but it’s also energy intensive and exhausting. That adrenaline rush only lasts for so long and in general, I’m a big softie. So, let’s get to part of my own challenges with him. The mind is strong, the woman is strong, the flesh is weak. I rationalized that if I reclaimed him, I somehow won. Then I’d turn the blame onto myself. I’d make lists of the things I was or was not doing that must have somehow had an impact on his behavior. If only I wasn’t studying so much, if only I spoke another language, if only I were more exotic, if only I wore more makeup more often, if only I were thinner, if only I were funnier, if only: insert any markedly self-deprecating phrase, he wouldn’t have strayed. I’d consider what I could change about myself to keep him from doing it again, maybe if I were more shapely, or if I colored my hair, or if I wore more makeup, or if I spoke another language, or if I had perfect skin, or if I had perfectly manicured fingers and toes. I was just certain that I could do something to inspire change in him, then in my depression, he’d feed into the bargaining and do bargaining of his own: “I’ll delete her number, I won’t work with her anymore, I’ll delete that email account, I’ll go to counseling, I love you, not her, I don’t know what’s wrong with me.” On and on. Of course, this spoke to the caretaker in me as well. There must be something wrong with him and I can help him! What a poorly rationalized thought which cost me the better part of a decade and emotional scars which will eventually heal, but not disappear. 

DEPRESSION 

I spent eight years ping ponging between denial, anger, bargaining and depression. It happened so frequently that it just became the norm and an expectation. It was just a matter of time until it would happen again, then pieces of my heart would chip away, I’d become furious, buried in anger and wanting to lash out. When he, the person in my life to whom I’d given everything I could possibly think of giving betrayed my trust and discarded me as if I was worthless, I became worthless. I devalued myself. My life lost it’s color. Everything was grey. Tears ran until there were no more tears. The ache in my chest became colder, darker, then numb. I anesthetized and dissociated myself from the situation, from our life together. I ached for connection. I ached to be desirable. I drank, a lot. 

The most marked period of depression in all of this was not actually after I finally asked him to leave. It was when he told me he didn’t love me and wanted a divorce. I packed my bags. I had no idea where I was going. I searched frantically on Craigslist and found a furnished studio which fit into my budget. It was close to the subway. It was close to a grocery store. The grocery store had wine. I could get to work. I could get food, not that I had an appetite. I became a hermit, a one to two bottle of wine per night hermit. One day I woke up and realized that this was not at all in my best interests and pulled back on the alcohol, found a 10 mile race to train for (I’d never run that far in my life) and redirected my energy. Slowly, the depression lifted which softened my heart and he came back into the picture, again. In my softened state, I let him back in, of course, but that’s a story for another time. 

ACCEPTANCE 

This may sound strange to you, but the last time I let him back in, I knew it wasn’t going to work. I had decided that he was not going to change, but I was going to give it one more go. You may be thinking to yourself, “WHAT?!?! Is she crazy?” Maybe, a little bit. We all have our own pathology and demons and this was my path to take. My decision to let him back into my life and my heart was complicated, as these situations often are. As was our cycle, there was wooing and there was romance and of course there was sex. Then one day I realized I was incredibly sensitive emotionally, my breasts were swollen and sore, and GASP! I was late. I immediately ran to the drugstore, bought a pregnancy test, walked to nearest coffee shop and went into their bathroom, and melted into the bathroom stall as two pink lines showed up. Did I forget to mention that I was tapped as a chief resident for the next academic year just one week prior??? 

He never wanted to have children. I could just not tell him. I could cut him out of my life forever. I’d always wanted to be a doctor and I’d always wanted to be a mom. How in the world am I going to do this alone? I knew he was going to completely flip out. It would be so much easier to not include him. Alas, that wasn’t the right thing to do. So I told him. He was livid. “How could this happen?” Ummmmmm, I know you’re not a doctor, but seriously? Remember all those times I reminded you that I wasn’t on birth control anymore because I didn’t think it was necessary given I was alone in a studio apartment drinking my life away and maintaining solitary confinement? Well, we had many conversations about termination, so much so that I went to Planned Parenthood for a preliminary appointment. This was followed by a call in tears to my best friend in the entire world about how there was no way I could do this alone and that I couldn’t count on him for anything, so wouldn’t this just be easier. Thankfully, she talked me off of the ledge. She knew that I wanted to be a mother more than anything and that all of the excuses I was coming up with were silly in the grand scheme of things. I’m a strong woman and I thankfully have a wonderful circle of friends and I would figure it out. I would be ok. We (my kiddo and I, at least), would be ok. 

Then it became clear that he was still involved with tomfoolery with one of the many women from his past. She got involved and there were text messages and emails. I have to say, the level of class demonstrated by all parties is fodder for another time. Ultimately, he cut ties with her, promised to go to therapy for his “sex addiction” read “narcissism.” By the time I was eight months pregnant, he’d demonstrated sufficient amounts of commitment that I finally moved back in and we planned for the arrival of our baby. 

I knew it wasn’t going to work. I. Knew. It. Was. Not. Going. To. Work. I felt compelled to give it one last go for the sake of our little one. I also had an inner dialogue that was determined to figure out how to at least be a parent with this man. We made a small person. I’m stuck with him no matter what happens between us and our relationship. I have to tell my child when they’ve grown bigger and understand more of the world that I did try to make things work. I also had to give my ex the opportunity to be a father, though he never thought he wanted to do that. I wanted to be able to look into the eyes of my pride and joy when they ask why mommy and daddy aren’t together and speak frankly, honestly, that I did everything in my power to make things work… and they just didn’t. I want to say that we both love our child and have our child’s best interests in mind and want them to grow up happy and healthy. 

So, when I was in the midst of my first year as an attending, spending a fair bit of time as a solo parent with our newborn given my husband’s work related travel, and my little was 9 months old and I got a phone call from my father-in-law. He was nearly hysterical as my mother-in-law had just had a CT scan with a mass and mets EVERYWHERE. I knew what this meant. My father-in-law had an inkling, but not a full understanding. He’d tried to call my husband. No answer. I tried to call my husband. No answer. Text. No answer. Another phone call. No answer. I called the hotel where he was supposed to be staying for his work related conference. “I’m sorry, ma’am, there’s no one by that name in this hotel.” Call to his boss. “I don’t think he’s checked in to the hotel yet.” After trying to reach my husband on an emergent basis for two and a half hours, he finally called back. How do you deliver bad news to the love of your life after you’ve been unable to contact them for a prolonged period of time? You don’t ask too many questions about where they were, who they were with and what they were doing… after all, their mom is dying and they don’t even know it. You take a deep breath, tell them you have some difficult news and follow that with as much promise of support as you can. I told him they’d found a mass, it was very concerning for widespread cancer and we needed to figure out how to get him home and us on a plane to see her. I called my colleagues, got shifts covered, booked our flight, headed across the country. 

My husband stayed. I came back to work and essentially be a single parent. I facilitated conference calls with specialists, primary care physicians, hospice providers, and my husband, father-in-law, brother-in-law. I was the tele consult 24 hours a day, while caring for our infant, managing a nanny who left a bit to be desired, managing my board exams and finding my way as a new attending. My mother-in-law didn’t want treatment. She wanted quality of life. Her sons and her husband could not fathom this. My father-in-law understood her desire, but his heart was broken. He was watching his love slip away right in front of his eyes, in his own home. The boys on the other hand were going through their own grief process. My husband was distant. I expected this. I figured it was his process. At the same time, just hours after we celebrated her life in a remembrance ceremony after her death, the text message that came from his paramour, while not unexpected, her timing was audacious. “I think he’s lying to us both. I hope he comes clean with you.” 

That was THE moment of acceptance. I knew it would come. I just needed to go through the whole process. That was the moment our marriage and relationship was over. Now, don’t get me wrong, there certainly followed moments of depression and anger and a sense of loss, but there was no bargaining and there was absolutely no turning back. That was the point of no return. I am worth more than this and my child deserves to learn that I will not accept being treated this way. My kiddo deserves at least one parent who strives to demonstrate the value of meaningful and lasting relationships built on communication, openness and trust. I refuse to accept that life anymore and am moving on with my new life and my little one.

Here's to new beginnings.