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!