MiM Mail: Studying in residency

I'm a 4th year medical student with young kids wondering how others carve out time to study in residency? Of course I'm sure I'll be learning quite a bit "on the job," but I'm certain I'll still need to be learning and studying more outside the hospital as well.

I recently finished my MS3 year and was able to have a strong performance on the wards and shelf exams this year because my husband was a rock star; there were so many times that I stayed at the hospital after a 12 hr day studying and he put the kiddos to bed on his own. I also got babysitters on the weekends before exams so he wasn't doing everything on his own. And of course I carried around study materials and studied whenever I could like when I was waiting to pick up my kids from activities. I'm just curious what other solutions people have come up with. I don't want my husband to feel like a single dad forever; needless to say 3rd year was tough for him because he also works full-time. My youngest (and last!) will be 2.5 years old when I start residency and my older children will be in elementary school. I'm going into anesthesiology.

Thanks so much!

Intern of the Year

Eight years ago this month, I entered the hospital for the first time with the label "MD". My assignment was a prestigious transitional year internship at a large private/academic hybrid hospital. Amongst my rotations would be Internal Medicine, Surgery, ICU, and some electives.

My internship year was wonderful. I relished in the new freedom of managing patients and writing orders. I thrived on the stress of the endless to-do lists; each time I checked a box on my paper, I got a sense of thrill. The learning curve was so steep, and I became addicted to finding ways to be efficient. I enjoyed my co-interns, the staff, and the attendings. At the end of the year, they voted me Intern of the Year!

Then I started my residency in anesthesiology. I had done no anesthesia rotations during my transitional year and had instead chosen to focus on getting exposure to things that I was likely to not see much in the future. The change was abrupt and was not exactly smooth. Like the swipe of an eraser on a white board, all the positivity and excitement quietly vanished. The sheer volume of material to learn was overwhelming, not to mention the technical parts of the job – placing IV’s, preparing and dosing drugs, mastering the anesthesia monitors and ventilators, patient positioning, and the delicate dance of the patient consent process that is unique to anesthesia. Every day was a great battle to keep wits and stay calm while learning the academic and procedural aspects of the specialty.

As the fall months spread into winter and the days became shorter, a gloom washed over me. Rushing to work in the dark and returning home in the dark… was this what I had signed up for? Were other residents feeling the same way? How did I compare? These questions never really get answered since we don’t work together in the same OR. Come wintertime, performance evaluations from faculty started to trickle in. Some comments were positive, but the negative ones cut deeply into my motivation and self-esteem. But I was the "Intern of the Year"; what was wrong with me?

I continued to struggle with procedures, and my In Training Examination scores were well below average. I suffered from incredible fatigue and knew deep down that something was wrong. It took many months, over half of my residency, to figure out what it was: a pituitary macroademona had taken residence in my sella and was wrapping its tentacles around my optic nerve. I was going blind and didn't even notice! Within a week after my MRI, I was on the OR table being anesthetized by one of my attendings. What followed was a long hospital stay and complications of hyponatremia requiring readmission. After a long period of healing, I returned to residency and finished my training.

A stay in a hospital ICU will change you forever. My achievement record during residency, despite having been crowned Intern of the Year, may have ended up being quite lackluster... but my experience as a patient was a priceless learning experience that I'm grateful to have had. It helps me connect with my scared and vulnerable patients every day, and it is a constant reminder of how lucky I really am. And as an attending, I now thoroughly enjoy the practice of anesthesia.

I'm shortening and simplifying a very long and detailed story, but I write this to inspire all the new interns and residents with their sights set on perfect ITE scores, accolades, votes, and awards. In the end, none of that matters. Your years of training will hold a mix of times of difficulty, times of gratitude and times of great learning. Do your best to navigate these times with balance, and make sure to take care of yourself!

MiM Mail: Spacing of siblings

I am a third year medical student interested in pediatrics and my husband is a 4th year medical student applying to EM. We have always wanted a large family and lately our (almost) three year old son has started asking incessantly for a baby as well. (When I asked him what he wanted for his birthday this year, his response was "a brother and sister.")

Our original plan was to have our second child during my relatively less busy 4th year, but now that I've started 3rd year rotations, I'm starting to wonder if it is a good idea or not. Balancing motherhood with being a student for the first two years was one thing, but these last few weeks have been an entirely new level of chaotic and stressful! Is it really realistic to add another baby to the mix right now?

On the other hand, having a newborn in residency seems like it would be just as daunting, and waiting until afterwards would mean that my son would be almost 10 before he has his first sibling and I would not have enough reproductive years left to have the big family we envisioned.

I know that there never is a "good" time to have a baby, but in your experiences - what has been the better timeline?

Thank you all so much! You have no idea how much this blog has helped me survive these last couple of years!

-K

Did I miss out?

It recently occurred to me that both my kids are getting to an age where staying home all day is not really an option. Whether she likes it or not, my older daughter has to go to school. And my younger daughter is at an age where most kids are doing at least part time preschool.

Basically, the period of time when it would make sense for me to be a stay-at-home mother is just about over. I can now go to work guilt free.

But there's something a little bit sad about it. I know a lot of women who have been home with their children during this entire time, and are now just starting to go back to work, and it makes me feel like maybe I missed out on something that is now gone forever.

Should I have taken a year or two off from work? Should I have been present for every bottle or lunch or afternoon nap?

My brain tells me no. Taking that kind of time off was just not feasible. And my kids are fine. I spent plenty of time with them.

But I didn't get to have that prolonged period of it just being me and my toddler. And now I never will. I can't help but feel a little bit sad.

MiM Mail: What happens to friends and family?

Mothers in Medicine,

I'm a pre-medical undergraduate from Boston, entering my junior year. I aspire to be an Emergency Medicine physician. I'm finished with my pre-medical coursework, and the next step is taking the MCAT this Spring.

For the last two years, I pushed through my studies, blissfully ignorant to how my future career path may be incongruent with my deepest desire in life: to have children. So I'm writing to you because I aspire to practice medicine, but I'm held back by the concern that the doctor-mom work-life balance may not be right for me. I close my eyes and picture my future: My time is divided between my family and my career. I'm laden with guilt for missing pieces on either end. I'm in a perpetual state of "rushed."

I've been hunting through the Internet, and it seems as though some women in medicine feel this way. I'm attempting to be a nonpartisan hunter, because in the past my confirmation bias has prevented me from considering all of the information important for my decision.

I recently came across this website, which lists the 10 things you need to give up when you become a doctor. To be honest, I was disturbed by number six:

6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him. Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.

OK, so the author is a bit brute with the final comment, but as a general idea, it's that on the priority list, your career in medicine trumps the important relationships in your life.

After reading this, I thought to myself, "Well, shoot." This makes me squirm. I know in my heart that I would never be able to put my career over my family, in a general sense in life. But then I think, if any career were to necessitate this, it's medicine. It should be number one because it can be life or death; it's a privilege and a commitment.

I bet when number six plays out in reality, the choice between them is theoretical and it's all about balance. But the author does provide a concrete example of choosing between the two (with wedding example, above), and in that case, would I be able to choose my job? So... number six moves me to deeply consider my career options.

I 'd like to ask you guys how you feel about number 6. Are you saying, "Yes, medicine requires a commitment that may harm relationships, more so than other careers" or "No, you don't have to choose being a doctor over being a mom, no more than you would with any other demanding career," or "I never feel as though one is of more importance to me than the other" or whatever it is - I'd love to hear it.

Thank you so much for your time, I'm so happy to have stumbled upon your website. You are all inspiring. Wishing you the best in your dual careers.

Love and blessings. J

My Mother’s Daughter

My mother is a doctor who started a solo practice in the 1970s when there weren’t many working mothers, let alone working mother doctors.  She worked tirelessly to establish her practice and then became one of the busiest primary care doctors in the area. I think she was happy with her decision to practice medicine but I know she has regrets about working full time.  She often told me that she wished she could have worked part time or taken off time while we were young.  When I started a family, her advice was to spend less time working and more time with my kids.  

I’ve taken her advice very seriously and have tried very hard to find a happy balance between work and mothering, but in many ways, I am my mother’s daughter.  I am a doctor.  I am a mother of three children.  I struggle with issues around work and balance and guilt.  But I am also very driven to succeed and my mother’s path may be a big contributor of that drive.   By witnessing her courage, strength, and perseverance, I knew that women could work and their kids would still turn out to be great.   

That’s why it’s so encouraging to see research that supports what I always knew – that the children of working moms are very likely to succeed.  

A few months ago, researchers from Harvard Business School published findings from a study where they found that daughters of working mothers were more likely to work themselves, have supervisory roles, and earn higher incomes compared with daughters of non-working mothers.  

This is exciting and affirming news for all us working moms.  And in some ways it's not so surprising.  When I think about my kids and who they will grow up to be, I often wonder what will motivate them, what will make them happy, and what will shape their future selves.  There’s no question in my mind that role models play a huge role in shaping their decisions, their paths, and their destinies.

As for my own mother, I shared this study with her and she wasn’t surprised by its findings.  But she still feels sad that she wasn’t always around after school and on the long days of summer and in the classroom as a volunteer.  Those feelings seem pretty universal and hard to shake.  

The good news is that she is now retired, has six grandchildren, and lots of time to enjoy them.  Plus she has three kids who are successful by any definition and who deeply love her and are grateful for her hard work and for the role model that she was to us.

A Little Gift To Take To Work

We just returned from a week's family vacation. The kids have been off from school, and Hubby has been off from work, so, we've all been together 24/7.

I have afternoon clinic on Mondays, and we dilly-dallied away the early Monday morning.

Finally, reluctantly, I packed my lunch bag, kissed Hubby and the kids goodbye, and set off on foot for the train.

My three-and-a-half-year-old daughter called out to me from an upstairs window: "Mommy! Mommy! MOMMY!"

I looked up from the driveway and yelled back, "Yes, honey?"

"Will you do me a favor, after work?" She says "favor" like "fay-vow" and "work" like "wowk".

"Of course, Honey! What is it you'd like?"

With adorable preschooler excitement, she stammered out, as loudly as she could: "Will you- will you- will you... I mean, after work, will you... please just come home?"

Oh, so, so adorable. So simple. I melted, I promised I would come home, directly home, and I kissed her on the head.

I kept remembering her sweet little three-year-old voice saying, begging, …will you please just come home?, and it kept me smiling all day long in clinic.

Guest post: Miscarriage

I thought I was over my miscarriage, but I’m not. It started when I wishfully wasted a home pregnancy test a few days ago (negative.) This past weekend I’ve been taking the Advanced Life Support in Obstetrics course, delivering rubber babies with shoulder dystocia and fighting back tears the whole way.

Let me start from the beginning. I’m 35 and just starting a family medicine residency. I’m newly married to a wonderful man; he will be joining me when he finds a job in the far away city where I moved for residency. I found out I was pregnant in May. It was my first pregnancy and we were overjoyed.

One month ago, I had my first prenatal visit at an OB/GYN practice in my new city. I went alone. I wore my favorite blue dress. I was happy and confident and looking forward to taking home images of my 8-week future baby.

The appointment started with an ultrasound. I wasn’t alarmed when Monica, the sonographer, asked to switch from a transabdominal to transvaginal view. No problem, I thought. When the imaging resumed, I asked Monica if she could calculate my due date. She paused for a second, and then said, “Well, I’m seeing some concerning things here.” The floodgates opened and I started crying. In the nicest way possible, Monica described the enlarged yolk sac and absent heartbeat. The embryo had died ten days earlier.

Through my tears I met the nurse practitioner who explained my options: since I was starting residency in just over a week, I chose surgery. I spoke with the physician, who booked my D&E the following day. Everyone asked me: where is your husband? (Florida.) Do you know anyone here? (No.) Who will be with you for the surgery? (I don’t know.)

OB/GYN offices are filled with pregnant women and their spouses, best friends, mothers and sisters. It hit me hard when I waited alone for my pre-op bloodwork, then for my Rhogam shot, surrounded by women who still had their babies. I felt their eyes on me, felt their pity. An hour earlier, I too had been smugly pregnant, thinking how elated my parents would be when I told them about their first grandchild.

My husband flew in the same day (I have never asked him how much his flight cost.) The D&E was uneventful; I had no pain after the surgery. We went out for steak that night; I had red wine and blue cheese, because I could. Because I was not pregnant anymore.

The past month has been a whirlwind of excitement, of new long white coats and responsibilities and stresses. Amongst the distractions, I haven’t grieved. But I remember something my physician said before the surgery. She said: “Miscarriages are very common. They’re the norm. But in our society, we don’t talk about them. I wish women talked about their experiences with miscarriage instead of grieving in secret.” And so that’s what I’m doing here. I want to tell you that I’m sad, that I’m angry, and that I’m not okay with what happened. I hope it helps me move on.

MiM Mail: Advice on starting med school with a long-distance relationship

Hi there future colleagues!

I am a long time reader of this blog, though so far I can't call exactly myself a Mother in Medicine - I am a 28 year old nontraditional student who is just about to start medical school one state away, with no kids. I have a wonderful, extremely supportive live-in boyfriend of 5 years who has been on this fun (-ish) journey to get into medical school every step of the way, though he will be starting business school this fall 8 hours away from me by car.

Our short- and medium- terms goal are to end up with summer internships in the same city next year and get engaged sometime after my second year/when he is done with business school. I will try my damndest to get some away rotations scheduled near him during my third and fourth year, and make every connection I can in my home state so we can ideally settle back here for residency, as most of his business opportunities are here (though really, who knows what will happen with the match). Eventually we would like kids.

As a type A, uber organized planner who is madly in love with this man, the uncertainty of a long distance relationship is quite scary. I am reaching out to this wonderful community to see if you all have any advice for me regarding 1) how I can set myself up for success in medical school to enjoy myself and eventually match well and 2) any tips for maintaining healthy long distance relationships.

Thank you in advance - I am honored and humbled to be entering into a profession with the inspiring women I see on this blog and I can't wait to hear your thoughts.

J

Feeling like the worst mom in the world...

My introduction post was mostly about how I get to know Mothers in Medicine, which was when I found out I was pregnant. I also talked about where I am today. I never talked about what happened in between those 2 and a half years.

So during those 2 and a half years, I went from first year radiology resident to fourth year radiology resident. I just took my boards last month!! (Ask me again in 1 month how I felt about it, which is also when I'll get the results.) My husband, big C, went from 4th year orthopedic resident to a 6th/chief orthopedic resident. He just graduated last month!! Currently, I started my first month of my last year of residency and my husband is actually, right now, taking his orthopedic boards. He'll be moving to the east coast in exactly 2 weeks to start his spine fellowship.

So basically, I'll be a single mom for a year. But what you don't know about me is that my little C has been with my parents in a city 1 hour away from our  city of training for the past 2 and a half years. That is how we did it. So your recent blog post Anita Knapp really resonates with me! It was an extremely difficult 2+ years. But given my husbands 80+ hour work weeks and my most difficult years of residency ahead (combination of both majority of my calls during my 2nd year of radiology residency and studying for radiology boards/multiple board review sessions during my 3rd year of radiology residency), we felt that this was what was best for little C. 

I have had my share of mommy guilt during this time. I questioned my decision all the time. I felt like a horrible mother. It definitely put a strain on my marriage with big C because who likes being around a negative and sad person all the time? But little C was my heart and soul and it just didn't feel right being away from her Monday to Fridays and some weekends. 

Well little C is all moved down. It's so funny how kids can be so resistant to change at times and also so easily adaptable. I took 2 weeks of vacation to help get her situated. In less than a week, it was as if she already forgot about her 2+ years with grandparents (much to my mom's dismay). During those 2 weeks, she and I attended her 2 week orientation at the pre-school associated with the university, which basically meant spending 1 hour a day for 2 weeks with her at the pre-school. That part went fine. In fact, the entire 2 weeks was awesome for our relationship. I got to just be her mom without even thinking about residency once. 

I thought the transition to pre-school would be easier. She attended part time pre-school during her last 5 months with grandparents almost as a preparation for what's to come. She had a hard 1st month but eventually grew to love it and was out the door to go see her friends as she would say.

However, she must feel like her whole world is upside down now. It's been almost 2 weeks into her new pre-school, which is obviously now full time and every day she cries and cries. Drop-offs are so painful. I spend the mornings just thinking about her crying little face screaming for mommy.

She refuses to eat at pre-school. She's potty trained at home but refuses to pee on the toilet at school. She also doesn't nap. When I go pick her up, she seems okay but I can't seem to shake it off that this is just a transition period. Is she ever going to adjust? Am I just the worst mother in the world? Was this a mistake? Was I being selfish by taking her away from the princess treatment that was given to her by her grandparents? 

I don't know if I can go back to the former life. I love picking her up. I love eating dinner with her. I love putting her to bed. I love that she runs over to me and wakes me up in the morning. But do I need her more than she needs me? Am I not able to give her what she needs? 

It almost feels foolish that I thought the mom guilt that I carried with me for those 2+ years since maternity leave would disappear once she lived with me. 

But right now, I can't help it. I'm feeling like the worst mom in the world yet again.

How am I going to survive once my big C goes to the east coast? 

Days likes this. Cutter's blog post comes to mind on whether this (as in medicine) is worth it? I simply say "no." 

Friendship

Last month I did a dermatopathology rotation, a really interesting subspecialty of pathology (and dermatology!). For both the pathology and dermatology residents who rotate on the service, it is probably the most laid-back and responsibility-light rotation we have... I felt like I finally had time and space to breathe after a few tough months.

My second week on service, I noticed a familiar face around the multi-headed microscope- a mom from day care, a dermatology resident! Our daughter (who just turned 2 last week, sniff sniff!!) goes to a day care our hospital owns, so all the parents are hospital employees- physicians, post-docs, etc. I am constantly lamenting to my husband how unfortunate it is that the parents don't know each other well because, understandably, all the doctors are rushing in and out during drop-off and pick-up... also, when kids are screaming and crying, it doesn't exactly feel like the right time to have a little chit chat! Her daughter is 3 months older than ours, and had been in the same infant and toddler classroom as ours...  I had seen her in passing maybe only once or twice but with only a smile and, "Hi."

We beamed at each other and waved, and as soon as sign-out was over we started chatting. I simply felt like the floodgates had opened, haha... I had found a kindred mommy-doctor-wife-woman spirit, and a burden over my heart had been lifted. Our similarities were uncanny, from getting married in a courthouse on their anniversary date (ours at 6 years, theirs at 4 years), to both of us nagging our husbands to stop smoking their incessant cigarette or two a day during times of stress. Finally, another psycho who is reluctant to get a babysitter (us only once, them just twice) because they genuinely want to just hang out together as a family, but also hates themselves for it haha. We also have in common crazy moms, resulting in chronic husband vs. in-law issues. Both of our husbands are equally ambitious and passionate. We are both in day care without extra help, and we talked about how we deal with weeknight routine chaos, fitting in studying, etc etc.

Over that week we overlapped on service, we talked. And talked. And talked. I don't know how long it's been since I've connected with someone like her. Unfortunately, she and her family are moving an hour away so that she can start a position as an attending. I hope we will make plans to see each other and get the girls together. But it reminded me of the power of female friendship, of something I didn't realize had been so sorely missed.

Attending Status: let's go!

I woke up to the sounds of the birds chirping and then “Mommy!” as my almost 4-year old tried to start his day at 6:45am. Quick detour for a potty-break and then promptly back in his bed because, “It’s still too early. Time for sleep.”

As I sit at our desks, I double and triple check that my Epocrates app is up to date so that I can quickly calculate drug doses. Today is my first official day as an Attending. I am returning to my dream health care system to work in the pediatric clinic I did my third year community pediatrics rotations in. The Attendings and many of the front desk staff remember me back when I was a medical student and they, like me, are super happy that I have returned.

We had an all-day orientation yesterday that was truly inspirational - yes, I’ve drunk the Koolaid as they say and am already one of those super happy people to work where I work. Providing care to children in our nation’s capital is truly an honor and one that I do not take lightly.

During times like this I refer back to my favorite book The Alchemist (Paulo Coelho). I was tested immensely in these last few years, but every second of the journey brought me closer to the realization of my dream. Every struggle. Every triumph. And I’m here. In this moment. Feeling the immensity of years of pre-medical studies, MCAT struggles, public health school, medical school, biochemistry challenges, clinical year excellence, pregnancy during USMLE Step 2, birth, and being a mother in medicine.

I am totally ready for this aspect of my journey. I vow to do great things. So let’s go. Let’s get it. Pediatric Attending status 2015! (happy dance, happy dance, happy-praise dance!)

See you in a month, Itty!

A couple of weeks ago, my husband, N, and I found out that we both started our intern year in the MICU.  We soon realized that this meant that we would almost never be able to pick our daughter up or drop her off at daycare. Considering it would be her first month ever in daycare, we were stressed!  Nanny interviews commenced, and we tried to ignore the impending financial doom that our first month with a paycheck would bring (due to the high cost of nannies). 

Soon thereafter, my mother-in-law suggested that we take our daughter, Itty, back home to spend the month with grandparents, aunts, and uncles.  Just for reference, we moved 15 hours away from “home, home” a month ago, and we have no family nearby.  Initially, I was resistant to the idea, as I couldn’t imagine a month without my Itty, but we eventually decided that it was probably the best idea for everyone.  Itty would get to see her extended family, who previously provided all childcare for her, and N and I would have a month to focus on our new roles at physicians.

She’s been gone for 4 days now.  While I was very sad during the first couple of days, I’m now realizing what a great idea it was.  Grandparents are happy, Itty is happy (at least for now, she doesn’t miss us too much), and we do not have to worry about her at all during a stressful day at the hospital.  I had forgotten what it was like to not have to think about picking her up, feeding her dinner, giving her a bath, getting her ready for bed, and putting her in bed.  Not to mention the middle of the night awakenings that still seem to happen although she is almost two years old.  Once you have a child, it is difficult to remember life without one.  

Part of me almost feels badly that I’m enjoying this “me” time so much.  I miss her tremendously but also feel that a significant burden has been lifted, at least temporarily.  Has anyone ever done anything similar?  This is probably the only time that we will ever send Itty away for a whole month, so does anyone have any childcare tips if we are ever in a similar situation again?  We were so worried about having multiple new caregivers in such a short period of time, especially with the limited amount of time that she would be able to see us anyway.  I can’t tell you how many times I’ve asked myself, “How are we going to do this?  What did we get ourselves into?  Why did we move so far from our families?”.  However, I’m confident we’ll figure it out, little by little, with a lot of help from others (hint, hint!).

On another note, I was a physician today :)  Crazy!