Moving and credentialing are like oil and water

The last 3 months my husband O has been packing while I have been working on getting credentialed. His boxes are brown and filled with books and mine are checkie-boxes that I slowly work through. His boxes move us toward relocating while mine push us further and further away from our goal of saving money ($731 for DEA license, $130 for DC Controlled Substances License, the list goes on and on) but closer to my first job as a Pediatric Attending Physician.

The only one of us who has had fun packing is our almost 4 year old. His favorite activities include: throwing empty boxes, making forts out of boxes, and sliding on boxes. One day O and I heard a loud crash as he and his friends decided to pack his room; they did a pretty good job of placing all of his toys in a large box and then they proceeded to drag it into the hallway so he could move. It was endearing for about an hour until he began rummaging through it to get toys that he now decided he just had to have.

I am writing now so that I can take a break from packing another box of dishes. Packing dishes has helped me realize that we have a ton of dishes we don’t even use. I am purging these unused items because I refuse to pack them and I’ll be happier with less clutter. We have made so many trips to our local donation center I cannot even count them and each time I wonder where all of this stuff came from, while controlling my desire to “just hold on” to that thing I haven’t used in months but that I absolutely “need” (like the expensive Dr. Brown’s baby bottles, they are totally keepers!).

The last 3 months have shown me that working, while doing on-line orientation modules and handling credentialing just don’t mix. There isn’t enough time in the day. Thankfully, credentialing is all done and in less than 3 weeks I will be a full-fledged Attending Pediatrician! Unfortunately our movers come in 3 days and I now can’t seem to motivate myself to press on and I have no more credentialing to use as my excuse. It’s game time. Relocation here we come! But for now I’m just going to sleep.

Book Review: Burning The Short White Coat by Eve Shvidler, M.D.

I love reading books written by other doctors. Especially when I actually have time to read them. When I read the P.R. blurb on OB/GYN Eve Shvidler's Burning The Short White Coat: A Story Of Becoming A Woman Doctor, I knew I HAD to make time to read this book:

"What happens when Sex and the City meets Grey's Anatomy?… A medical chick-lit novel, Burning The Short White Coat exposes the personal battles that single women must overcome in balancing a demanding profession and the desire to find a trusting and loving relationship…"

I've been waiting my whole life for the female House of God. I was very excited to know: Could this be it?

Well, not quite. But, this light read is definitely engaging, funny, and fun.

The story follows relatable Elle Gallagher (and BFFs) through four years of medical school, and much romance. The action of the prologue draws in the reader (Overnight call! Crash c-section!). The first chapter, "The Gross Lab", is so gross, it's great. I was having formaldehyde flashbacks, myself. There are such nice touches here: the dissection of the penis by the retired surgeon is worth the price of admission.

But, the issues that plague this book also begin here: spelling and grammatical errors. Lots of them.

Now, I also write for publication, and I hate when some reader expresses extreme annoyance over a couple of typos. But there are ALOT of typos, misspellings, and incomplete sentences throughout this book, so many that even I was extremely annoyed. If I wasn't almost at the end of the book, I would have put it down at "introidus". Which appears twice. These errors make the book read more like a rough draft.

There is also heavy use of clichés, which I can forgive because at the same time, there is also plenty of fresh, unique material.

The chapter titled "Psych" is a fascinating little story-within-a-story featuring one of the creepiest cases I've ever heard. If what is described really happened, that's crazy disturbing. If it didn't, that's crazy good imagination.

One surprise for me is that my favorite character in this book isn't one of the female protagonists at all, it's the slightly immature but lovable surgeon Samy. We all know that attendings who hang out with medical students… well, that's just wrong. But this guy, he's complex, and he has some great lines. His advice to Elle on booty call vs. relationship girls is right on, and I'm not sure I've seen it done so well in a book that wasn't intended for teenagers.

The best part by far, though, was the chapter titled "Good Vibrations". I believe I had a similar hilarious conversation with my medical school BFFs. I would never have dared to write about it, though. I'm impressed!

In the end, I thoroughly enjoyed what was overall a refreshing, real-deal, feminine take on the modern medical school experience. (Yes, people, med students DO party that hard.) I just wish someone had run a spell check and an editor's eye over the text prior to publication.

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Hot off the presses! Addendum! As of 6/27/15 I have just heard from the author that she had already realized there were many errors in the original manuscript, and she put the whole thing through a copyediting process. There will be a new release in about 2 weeks from now, sans errors.

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As an aside, I have to say, the author's blog on Wordpress (https://burningtheshortwhitecoat.wordpress.com) is VERY good reading. Her articles and essays are enormously informative and entertaining. Moms in the audience, do yourselves a favor and read her post Where's My Orgasm from June 8, 2015.

Girls Don’t Cry

I have been following the response to Sir Tim Hunt’s incredibly sexist comments on women in science and thinking about how it relates to a working mother in medicine. If you haven’t heard of Tim Hunt, he is a Nobel prize winner who made headlines earlier this month for saying “…three things happen when [girls] are in the lab…You fall in love with then, they fall in love with you and when you criticize them, they cry” at a lunch for women journalists and scientists in Seoul.

Not surprisingly, the response has been overwhelming.  Some of my favorite tweets:

and…

and my all-time favorite…

But all joking aside, sexism still exists in science and medicine.  And as a working mom I’m very sensitive to issues of sexism, ambition, and differences between men and women.

This may be because I am constantly pulled in two directions (career versus family) and wonder if my ambition is ever questioned. On the one hand, I don’t want to draw attention to the fact that I am very much pulled in these two directions and must balance work and life.  But on the other hand, I do want to draw attention to this struggle to help support other women and help others understand decisions working moms need to make.

The fact is that I make very conscious decisions that incorporate both my work ambitions and my motherly ambitions. No, these decisions do not involve being distractingly sexy or crying in the lab but they do involve taking a slower and, sometimes, more convoluted paths.

I have rejected significantly higher leadership positions because they would squash my flexible schedule, I consciously avoid travel, and I am not willing to move my entire family for my career. To some of my male colleagues, these decisions may seem crazy, but, for me, these decisions are very calculated. 

I’m very conscious of burnout and hope to keep a level of balance that helps me work full time, find satisfaction in what I do, and keep me on an ongoing trajectory so that when I am no longer in the weeds of motherhood, I will still have interesting and meaningful career opportunities.

That being said, there are times when keeping the reins on my career is hard. I wonder whether I am being left in the dust when I see male colleagues make different choices and move up the ranks faster than me. And as a working mom, I never want to compromise other women by having my ambition questioned. 

But even with these doubts, I am incredibly proud of the difficult career decisions that I and every working mother have to make.  I know I will only have a short time with my kids at home and I want to cherish that time.  I’m sure there will be time in the future to turbo charge my career if I want.

In terms of Tim Hunt, I’m not sure if #distractinglysexy and #crybaby necessarily come up as issues for my career but ambition, choices, and timing certainly do. I think if we keep open dialogues and try to respect for each person’s decisions then I think we can push the conversation.  What do you think?

MiM Mail: Medical school timing

I have wanted to pursue medicine since first being exposed to it in nursing school. Throughout nursing school and my career as a nurse I have had a desire for the knowledge, skills, decision making and leadership that comes with being a physician.

I will be finishing my prerequisites in the fall and can take the MCAT in the spring with the potential of going to medical school in 2017 with an almost 3 year old and 16 month old. (I am currently 8 weeks pregnant!)

My question is, should I apply as soon as possible or should I spend a few years with my babies while they are still babies? Would it be easier to complete school if my wee ones are are at least potty trained?

A handful of physicians encourage me to do NP, CRNA or PA but I know I won't be satisfied as a mid level. On the other hand I'm not thrilled about all the time I'll be missing with my babies!

I'm 27 years old and my husband is very supportive. We could also get a nanny at any time if needed. Looking for some words of wisdom from those of you who have gone down this path! Thanks!

MIM Intro - It gets better and better

I finally did it.  I wrote a blog.  I have been dragging my feet for weeks!  You see, I had been told that I had stories to share, and I have always been a champion for mothers in medicine, but I have always told myself that I wasn't a writer.   I am going to change that this year.

I can't remember when I started reading some of the posts of the MIM blog.  When I was in  fellowship I had my first daughter,  and I used a breast pump behind a shower curtain in the small nephrology fellows office.  Often times, the other fellows (all male) would come in and talk to me over the rhythmic whirring of the pump while I was behind the curtain.  I have to give it to those guys - they were brave! And respectful.  I had a hard time making enough milk, mostly due to fatigue, and so I joined my first listserv, PumpMoms.  My online community experience had begun.  I learned so much, and felt so supported by other moms that I was elated to find the Mothers in Medicine website.  It does seem to be so very different being a mom in medicine rather than not.

Fast forward thirteen years.  I know, I wouldn't doubt that I am the oldest blogger on the site.  My oldest daughter just celebrated her 13th birthday.   I have three daughters ages 8, 11 and 13 and two bonus daughters ages 10 and 13 and a husband who is a pilot and not keen on blood at all.  Most people's jaws drop and then pat my husband on the back giving him kudos for living with so much estrogen!  We have two small boy dogs, but I have to say that they are  prissy dogs and don't add a whole lot of testosterone to the mix!

Many of you may be visiting this site trying to find peace or solace about your choices regarding when to get pregnant, how to breastfeed, find child care, whether to work full-time or part-time and  how to shape your career along the way to accommodate the ferocity of motherhood that can overtake you.  I have been there, struggled through all of those events, had many, many funny stories, buckets of tears, and loads of self-doubt as I worried it if were all going to turn out ok.

But here I am, thirteen years later, pretty well settled into a full-time position at an academic university with all these girls to raise.  I still have a lot of great stories, still cry from time to time, but I am reassured that all will be well if I continue to listen to my heart.  It has guided me pretty well along the way.

As part of my first blog, I wanted to share the story of my daughter's 13th birthday party.  It was a rare day.  Seems like all 4 of the other girls had something to do that day, as well as my husband - that NEVER happens.  My oldest had invited two of her best friends to shop, visit the makeup counter and head to dinner and a movie for the evening.  My presence was requested at the make-up counter as my daughter was nervous about approaching the sales lady for a makeover for the three of them.   I met them that afternoon, made the requisite introductions between the makeup artist and the girls and gave minimal instructions about "light" makeup.  I headed off to browse the jewelry counter and give her some space.  At the end, three lovely ladies emerged only slightly lovelier and we proceeded to dinner.

You know, once your daughter is thirteen, you struggle with the fact that she is slowly separating from you.  You know that this is necessary and unstoppable, but you so desperately want it to be like when they are little and want to always sit in your lap, fix your hair or climb into bed with you.  When your daughter is thirteen, you anticipate the  increasing possibility of eye-rolling, one syllabic answers to your questions and that your presence will be undesirable. So, I offered to sit at the bar so that my oldest could be with her friends alone.   Instead, my daughter said she really wanted me to sit with her and her friends.  What a rare opportunity to participate in her life and see her interact and engage with her friends.  I had the best time at dinner, and my fears of ugly adolescence were totally put out of sight.  My mother heart was overcome listening to the three of them talk about difficult relationships with girls at school, their occupational dreams, where they would like to travel, and what they thought of the charcuterie board we ordered.  It was an experience that I shall not soon forget, and one that I hope I can have with all the girls individually along the way.  She is growing up.  I cannot stop it, but I am going to enjoy the heck out of it!

 All those decisions about how much I was working, whether I was always present in the moment at the playground while answering calls from the office, was it ok to skip that meeting to go home early?, did anyone think I was crazy for pumping behind a curtain? It was one of those experiences where you tell yourself - I did ok.  Self-doubt getting smaller by the year.

The hug that keeps going

Growing up, in my dreams of my future family, I always had two children. Two seemed like the perfect number. We had two in my family, my brother and me. There was that nice 1:1 ratio of parent to child. I also grew up hearing stories from my mother of growing up with 3 siblings - and her feeling squeezed out sometimes as a child who was not the eldest, not the youngest, and not the lone son.

I keep that in mind as I raise our three children (10, 7, 4), always conscious of fairly doling out my attention and time. Whenever I am on-service (which means leaving earlier and getting home later each day), I sometimes notice an increase in "needy" behaviors especially in the younger two. There's more clinging, whining, and other attention-seeking antics. I am also particularly sensitive to the contentment of our middle child who is most prone to feeling left out. He occasionally gets into these funks where he is down on some quality he has - such as that he's the only child in our family with glasses, making him feel different and more unlovable, I guess. (Mind you, he is adorable with those glasses!)

Unfortunately, coincident with being on-service is feeling more worn out at the end of the day. The kids' bedtime becomes one last hurdle before glorious rest. That means no long books. No delay tactic tolerance.

One day, when I was feeling a QT deficit with our middle child, I decided to give him his good night hug and not be the first one to let go. Just to see.  I just hugged him and kept hanging on. After awhile, I felt his little arms loosen and relax, enjoying the moment so, but still hugging. The hug went on and on. I did not let go. Finally, I felt him let go first. His arms fell to his sides. He had a huge grin on his face, sated and sweet.

I've generalized the hug that keeps going to the other two children, just to be sure they are all getting enough hugs from mama. It's not every bedtime but sprinkled in there for good measure. Often it ends in a spurt of giggles (especially if accompanied by a neck nuzzle), but always I feel glad to have hugged so slow.

MIM Intro: Doctor Professor Mom

Hello, I am Doctor Professor Mom.  No, that’s not my real name but it’s a name that makes me really proud.  My oldest son coined it a few months ago when he learned that I am not only a doctor but I am also a professor and I am also a mom.  He seemed genuinely proud when he coined the name and, of course, I was equally proud both at his creativity and at some of my accomplishments.

Even as a Doctor Professor Mom, it’s hard to feel accomplished.  Maybe it’s something about academic medicine where I feel pulled in a million different directions. I teach; I do research; I see patients – it’s easy to feel like a jack of all trades and master of none.  Add on a busy family life and mastery is not in my cards.  But academic medicine has given me incredible flexibility, variety, and satisfaction.  Plus, I get to proudly say I am a doctor and a professor.

Of course my proudest accomplishment is not that I am a doctor or a professor but that I am a mom to three boisterous, energetic, and absolutely wonderful sons.  They are ten, eight, and six (gasp - how did they get so old).  After ten years of motherhood I have a lot to reflect on in managing a household with two equally ambitious working parents and ever changing challenges of parenting. 

I became interested in writing about my experience as a doctor and mother after my first son was born.  I spent 18 months crying every day when I went to work and decided (with the incredible support of my husband) to leave my job and stay home.  Then I struggled trying to find my identity as a stay-at-home mom (I wrote about this experience in an essay called Dr. Mom).  I returned to work and decided to focus on research and a career in academic medicine.  For me, it was an excellent choice.  That being said, the struggles of being a working mom, finding meaning and satisfaction in your work, and all the other challenges of life never go away even when you feel like you’ve found the perfect job.

When I wrote Dr. Mom in 2007, so many women contacted me and thanked me for sharing my story.  I promised myself I would write more, but, not surprisingly, life got busy.  I’m thrilled to have a place to write, to be a part of a community of women in medicine and hope that something I write will resonate with someone else. 

Pregnant in the OR: When to Tell

I was 5 weeks pregnant and working in the spine room. Just as I finished my intubation and secured the airway, I turned to set the ventilator and administer some important medications. The surgery fellow started to position the fluoroscope near the patient's cervical spine, about a foot away from where I was working. "Please don't use the Xray right now; I need to put on a lead shield first," I said. "Yeah, ok... whatever..." he said, as he continued to fine-tune its position. Thirty seconds later he sighed, then started pushing some buttons and eyeing the screen. I looked at him sternly and said, "I'm serious. Don't do it. I'm pregnant."

After coos and congratulations from the fellow, resident, nurse, and scrub tech, I felt a bit awkward. Of course, I myself had just learned of my pregnancy; I hadn't even seen a heartbeat on ultrasound yet! This wasn't the way I expected to tell people my good news, and I really wish I hadn't been forced to do so in that situation. That being said, I really didn't want the radiation exposure at that time. I suffered a miscarriage a few weeks later and then had to engage those same people in some very awkward conversations.

The decision of when disclose a pregnancy in any situation is a highly personal one. Unfortunately, there is a lot of misguided shame surrounding miscarriage in our culture, and thus many expectant moms often wait until their first trimester has passed in order to disclose the good news. But in my line of work, there are clear benefits to telling others earlier rather than later. First, anesthesiology (like surgery and many other specialties for that matter) is a relatively physical practice. Say you're feeling faint during a procedure, battling nausea, needing frequent snacks, or have a constant urge to urinate. People are going to think you're having issues and might worry about your work performance... unless of course they know you are pregnant, in which all of these situations are commonplace and understandable.

In terms of shift scheduling, call assignments and specific work days for any given week are often determined well ahead of time. Usually, requests for days off or vacations are done so about 1-2 months in advance; however, because I work in an academic hospital, the summer poses a major scheduling challenge due to new resident orientation/training. If a baby is due in the summer, special arrangements need to be made so as to not impact the delicate balance of staffing during the transition period for brand new residents. In a private practice situation, far advanced notice might be necessary if the due date is around a major holiday. Therefore, alerting the appropriate vacation/call schedulers to a pregnancy earlier rather than later may affect your entire practice group.

In addition, pregnancy status may impact daily work assignments. At my institution, the schedulers try to avoid giving pregnant women assignments that involve consistent or high doses of radiation, such as what is encountered in the interventional radiology suite or cath lab. (I hope to address this more in a future blog post.) It's difficult to avoid assigments in orthopedic rooms since these cases are so ubiquitous, but you might want to also alert the nurse and scrub of your status so that when they mix the methacrylate joint glue, you can step out to avoid the fumes. And you definitely want your protective lead suit if a fluoroscope is in sight!

Just like disclosing a disability at work, it's a "know when to hold 'em, know when to fold 'em" situation. The right point to fold will be different for each individual. Because my first pregnancy (the one in the story above) ended in miscarriage, I was initially keeping things much quieter with my current pregnancy. However, a similar situation with the fluoroscope still happened again at 7 weeks! I got zapped twice in one day despite my veiled warnings, and after the second time I frustratingly blurted out my news to everyone in the room. Of course they paused, congratulated, and then took things much more seriously in the radiation department. It shouldn't have to be that way, but unfortunately most people are very nonchalant about radiation exposure.

Aside from that incident, I waited until about 10 weeks before I was open about my pregnancy. After I had a couple of ultrasounds under my belt and my IVF docs told me that my miscarriage chance was very low, I notified our anesthesia scheduling partners of my status. They have respectfully given me lower-exposure, lower-stress assignments (like fewer, less physical cases per day with limited fluoro, etc.) As far as other pregnancy symptoms are concerned, I have had my days of nausea and moving slowly, but it hasn't seriously affected my performance at this point.

Has anyone - trainee or practitioner - experienced issues with disclosing a pregnancy? Share your thoughts with us!

When I grow up...

It's residency application season! ERAS opened a few weeks ago (coinciding with the sudden onset of palpitations among fourth-year medical students across the country...) As I work on my personal statement and gather letters of recommendation, I've been doing a lot of thinking about why I came to medical school and why I'm choosing my particular specialty.

I came to medical school fueled by a love for biology and a deep desire to help people in need. I'd always liked studying and was willing to work hard to learn how to best help my patients. Yet, after my daughter was born, I began to seriously consider whether or not I wanted to finish medical school. Suddenly, all of the caring energy I'd poured into my patients was directed toward one tiny little human. Morning rounds were replaced by silly songs and walks to the park; sign-out by baths and bedtime stories; overnight call by q2 hour feeds and diaper changes. There are plenty of people who want to be doctors, I thought, as I cradled my daughter in my arms. I'm the only mother she has.

When my daughter was 8 weeks old, I went back to school to finish my third-year clerkships. Those first months were harder than I'd expected. I hated being away from my daughter, hated scrounging for time and space to pump, hated feeling like I was less than half the mother and student I wanted to be. I had a hard time switching between hospital-mode and home-mode - it seemed that by the time I'd settle back into being a bumbling first-time mom, I had to leave again to be the clueless third-year medical student who couldn't remember the names of nerves or the proper technique for position patients on the operating table.

Many nights were spent with me crying to my poor beleaguered husband (who was taking on most of the childcare responsibilities while I was back on rotations) about how I hated all things medical. We went over all the possible scenarios we could imagine, looking for an exit strategy: maybe I should just drop out and save us all a lot of misery; maybe I should graduate but not pursue residency; maybe I should keep going and hope it would get better.

On many occasions, I came close to choosing one of those first two options. In the end, though, I always stuck with the third. And as time went on, it did get better. I finished the rotations I'd been less fond of, the world miraculously emerged from winter, and life began to look a little more hopeful. When my daughter was five months old, I started an Acting Internship in the specialty I'd been planning to pursue - and to my relief and even delight, I found that I enjoyed it just as much as I had before she was born. Although I still felt sad when leaving in the morning, I was quickly engaged in pre-rounding on patients and discussing management decisions with the residents and attending. I looked forward to seeing my patients each morning and found it exciting to collaborate with other providers to find the best diagnostic and treatment options. I began to feel a sense of professional identity that had faded somewhat in those first postpartum months. When I came home, I was eager to talk with my husband about the diagnoses I'd made, and even more eager to throw myself wholeheartedly into feeding, bathing and snuggling my daughter until bedtime.

Those four weeks of Acting Internship - during which I felt for the first time that being a mother in medicine was not only a possible option but actually a life-giving one - are part of what has kept me motivated to finish medical school and complete post-graduate training. I feel that I have rediscovered the passion that brought me to medical school in the first place, and am grateful that it has been proven in the testing fire of new motherhood. I know that residency will bring many challenges, both familiar and novel, but I am encouraged by the fact that as I advance in my training, I will move increasingly into the areas of medicine that I most enjoy - the areas that give me a sense of purpose distinct from and complementary to that which I find in motherhood.

What about the rest of you MiM? Were there times when you questioned whether medicine and motherhood were compatible? What motivated you to become a physician, and what keeps you going in your field?

Just like mom

My daughter Mel has one of those annoying friends at school who always has a bunch of things to say to me when I pick up my daughter. Before I met this girl, I thought annoying friends like Skippy, Kimmy, and Boner weren't real and just added in for extra laughs during 80s sitcoms (for bonus points, match the annoying friend to the 80 sitcom).

The other day, when I was picking Mel up, her annoying friend came up to me and said, "I fell down and scraped my leg today!"

"Oh, too bad," I said, trying to act like I actually cared about the fact that this random child had fallen and scraped her leg.

The friend smiled. "But Mel said that since her mom was a doctor, she knew exactly what to do to help me. So she did!"

My heart swelled with pride. There's nothing that makes you feel better about yourself than when your daughter wants to be like you. "So what did she do?" I asked.

"She brought me to the teacher," she said.

Hmm.

Well, it's the sentiment that counts.

Now is as good a time as ever

Hello, dear mothers in medicine! There's nothing special about today, other than blogging for the first time. (Yay, I'm posting!)

I am so happy to be a contributor to this group of incredible doctor moms. I've been a reader of this blog since the beginning, which was about the time I became a mother and was a fellow. Now I am a faculty member at a prestigious medical center in the South. I spend most of my time doing research to improve the care we provide and reducing errors. The balance of my time is spent teaching on the general medicine wards while we care for patients--maybe reducing the suffering they have just a bit.

The others in my family? Well, I'm married to an happy-go-lucky, always positive attorney who spends his days solving problems. He's my partner in the adventures of life. We have 2 kids who keep us busy--not sure how I'll refer to them here--maybe daughter and son is good enough! One is in elementary school, the other in preschool. We don't have family nearby, but our parents can travel here to help us out sometimes with childcare. No pets at the moment...

For all of us mothers in medicine, we definitely did not pick the easy route in life, but I feel lucky to be where I am. I certainly didn't imagine I'd be where I am 15 years ago when I started med school as an 'older student'. Seems like I may be one of the older bloggers here...I'm definitely ok with that. I feel like I'm a better mother and doctor as I learn more about the world.

How do other mothers in medicine out there feel about getting older?

MiM Intro: Anita Knapp

The first thing you should know about me is that my real name is not Anita Knapp.  This was a name that I penned for myself during residency interviews, and it describes how I feel most of the time.  If only my daughter would sleep in once in a while!

This intro has been difficult to write, mostly because I am going through a time of huge transition in my life.  My husband, N, and I just made a 15 hour move from our home state to our new home where we will complete our residencies.  And we made our move just one day after graduating from med school!  My residency will be in radiology, while N's will in ophthalmology.  However, for the time being, we will be interns in the same transitional year program.  Yay for working with my husband!  Sort of :)

If you would have asked us five years ago what we imagined for ourselves in the next five years, becoming parents would not have been on the list.  Nevertheless, we became proud parents to our daughter, A.K.A. Itty, at the very end of our third year of medical school.  Itty has changed our lives, certainly for the better, although the daily stress we feel has been multiplied exponentially!

I am so honored and excited to be an MiM contributor this year.  During the past 2-3 years, I have relied so much on this blog as I have forged my own path as a MiM.  The path has been very difficult at times, and I find myself in my darkest and most difficult place as a mother right now.  The sadness and loneliness I feel over moving so far from my family is great, but the guilt that I feel from moving my daughter so far from her extended family is overwhelming, as mine and N's parents have played such a large role in Itty's life so far.  I am worried about finding childcare, spending time with Itty, and spending time with my husband, all while trying to figure out how to be a physician.

I am looking forward to getting to know all of you this year.  It is sure to be an exciting one for me!  Any encouragement that you could throw my way would be greatly appreciated :)

Change in Schedule

As an Emergency Medicine physician, I work weird hours, 8-10 hours at a time. I prefer the evening and overnight shifts for lots of reasons. This complicates my “outside life,” as I call my home life and I need a small army of babysitters and the daycare to accomplish this. This summer, Blur1 is out of school for the first time (he just “graduated” pre-k) and we’ve added camp to the mix of my arsenal of childcare. With camps and school and daycare, why do I need the babysitters too? Hubby’s job starts at 5a and he has to leave by 4a. Babysitters come to my house at 4a on nights I work overnights and he has to work; I pay ridiculously for this.

Having done this for 10 years now, I have figured out what I need to do the overnight, schedule-wise. 7a wake up the morning of the first one (The Blurs’ fault), do a heavier than normal workout, a pre-shift nap (1 hour or less on the couch), overnight shift (11p-7a), get The Blurs to school/camp/daycare, get to sleep by 9a, wake up by 3p, maybe preshift nap, and repeat until the overnights are done. I abstain from alcohol this entire time and don’t worry about my diet or working out. I also try not to schedule anything important for the morning-early afternoon hours because I know I won’t make it. Sometimes, before the 3rd or 4th overnight, I’ll go into work early and get some administrative or academic things done, especially if I’ve flipped good or have a pressing deadline. After the last overnight, I have a beer or two with dinner and only one cup of coffee when I first get up to help reset me to going back to days. With this regimen, I flip back and forth from days and nights as easy as one can.

For the most part, this regimen has worked with The Blurs and Hubby. They are at school or work while I sleep and vice versa and we spend our evenings together. However, this summer has put a cramp in our schedules. School is out and camp doesn’t cover the entire summer. I have had to adjust my routine and it sucks. This week I had an isolated overnight but no childcare for Blur1 during my prime sleeping time. I tried taking a much bigger nap preshift and it worked by giving me 2 additional hours of feeling awake after my shift. Too bad I needed 5-6; Hubby can’t get home until 11a at the earliest for special things and this wasn’t one of those days. The shift happened two nights ago and I’m still hurting. I know what I need is more sleep but I also know that is not going to happen.

I am curious how others cope when their normal schedule, abnormal as it may be at baseline, is disrupted. Do you have things in place to help you adjust? I thought 10 years would have been enough to figure this out but The Blurs keep adding new wrinkles I never previously considered.

Ps. Those of you with older kids than mine (5 & 2 yo), what wrinkles should I be on the lookout for?

Hi from Keekster

Helllllooooo fellow medical mommas!

I am so excited to be a new voice in this community which has been such a haven for myself and countless others. 

A little about me... I'm a "military brat" (specifically a Marine Corps brat!) from a very non-medical family, and grew up moving around all over the place every couple of years. I'm one of those annoying people who just KNEW that I was destined to be a doctor- specifically a surgeon- since elementary school. My early inspiration? I am embarrassed to say it was Dr. Nancy Snyderman... yes, I was inspired by Dr. Snyderman on Good Morning America as a small child. She was so smart! And I was told by my parents that she was a surgeon! I had to be one too. And a medical correspondent, at that.   

My 7th grade careers project? How to remove a brain tumor, complete with step by step instructions in how to perform a craniotomy. Gray's Anatomy was my middle school bedtime reading (a birthday present when I was 12). For Christmas one year, I received The Visible Woman model kit (even with a special insert for pregnancy!!), perhaps the most beloved gift I have ever received.

  

You get the picture. I shadowed surgeons in high school. In college I had the enormous fortune of being mentored by one of the most accomplished pediatric plastic surgeons in the country, and spent many early Saturday mornings in the OR. I also happened to fall in love with the world of academia, basic science research, and PhDs, all completely foreign to me. 

Fast forward to medical school (after working abroad for a couple years with my now-husband). The pre-clinical years were tough for me. Why couldn't I get credit for narrowing the correct answer choice down two answers? Is it really my fault I always picked the wrong one?? Standardized tests were not my friend. I prevailed, however, but began having doubts about surgery. Was there something else for me? I am a major self-help book addict and found this book:

 

Hmm... general surgery was actually not really sounding like a good fit for me. Maybe ENT? Or derm? The one chapter that piqued my interest, however, was pathology. Pathology?? Wasn't that just a course in medical school? Had I ever even met a pathologist? 

I mentioned I love research. I received a wonderful fellowship that allowed me to take time away to work on a project. One year turned into two, and at last I returned to my clinical years. Surgery was my first rotation and I was in absolute heaven in the OR. However, I happened to have strange circumstances with the surgical specialties to which I was assigned- no overnights and even two months without rounding (no residents on-service)- not exactly a reflection of reality. I continued to plan for applying to surgical residencies (met with the program director, started getting letters, etc) but as my third year went on and I gained more clinical experience, little voices started popping up in my mind. Taking care of patients was not as gratifying as I always imagined. When specimens were removed for surgery, I wanted to follow them and slice into them and feel them. I wanted to diagnose disease, think about mechanisms of disease, find causes of disease. And as selfish as it sounds, I also plain and simple just wanted to sleep in the same bed as my husband! And I finally remembered pathology. I remember I was hiking alone one day after being post-call for psych, and said to myself, that's it. I have to pursue this... and I took the plunge.

As I've alluded to, I have a husband- we met when I was only 19 and here we are a decade later! He has a PhD and has his own lab (academia). And yes, there is a little person in our lives too... a daughter. She is perfect in every way of course :) Her 2nd birthday is coming up right around the corner. She was born at the beginning of my 4th year... lots of stories surrounding that experience and the interview process! 

I think my family is still in mourning that I am not a surgeon- I am convinced they believe I changed my mind because of my pregnancy. I know in my heart that is not true. I did take a leap of faith though and trusted my instincts- now that I am at the end of my first year of residency, I know I made the right choice, though I initially had doubts. We all have to find our little niches in medicine- I am convinced more than ever that there is a place for all of us. 

Over the weekend, we took our daughter to a big science museum, where there was an exhibit on the marvels of the human body. We watched videos of bronchoscopy, held models of brains, looked at disease aortas, and pieced together a skeleton. It took me back to my teenage self and my obsession with the Visible Woman model kit... I felt proud and happy that now, decades later, I am doing professionally what I loved so much all those years ago. I may have never dreamed of being a pathologist, but that's only because I didn't know what a pathologist was :) 

Looking forward to sharing stories!