"Creative Block"

When do you find time to be yourself?   The self you are outside of medicine and parenthood? (Maybe the glimpse of a self you were before medicine and parenthood?)  Outside of being a pathologist and parent I also derive joy from making art.  Well, maybe not immediate joy, but it is a sort of deep satisfaction.  I see making art like I see working out: Sometimes it sucks when I'm doing it, but afterwards I always feel better that I did it.  When I finish a painting and I’m happy with it, I feel the same deep satisfaction and pride that I do when I look at my beautiful little boy.    

But when I say “time” I’m not talking about the hours and minutes.  I have hours and minutes.  My toddler goes to bed at 8 pm every night.  My husband splits the housework and childcare with me.  I go to bed at 11.  That’s almost 3 hours each night that I should technically have to myself.  But I find myself too tired to use it effectively.   I have the time but not the energy to be creative.  I feel like it’s all drained from me by the time our baby is in bed.  And maybe that’s to be expected.  I work full time.  We have an 18 month old.  To be creative you have to have a certain amount of energy.  Those three hours are also the only time I have to get my ADLs done...shopping, taxes, doing the dishes.  Even as I sit here writing this at 9 pm, I’m so so tired.  My eyes hurt.  I’m tempted to throw up my hands, give up.  Make my tea and read a book (sadly sometimes merely Facebook).  I even have a studio and a painting I’m currently working on (sporadically).  But the time I’m in there is often so infrequent that I can’t remember what colors I was using each time I return.  I have completed precisely one piece of art since our son was born.  When we bought our house I picked out the room I would use as a studio.  My husband is proud of me that I do this other thing outside of medicine.  But sometimes I tell him that it’s silly that I have this whole room to myself when I barely use it.  I have had other dry spells in my life that were not related to having a baby.  So maybe having a baby is just an excuse?  Or maybe there is something to this feeling of being spent, dissipated at the end of the day that leaves no room for creativity?  

I haven't written on MiM as much as I planned to either....Sometimes a blank word document is just as terrifying as a blank canvas.  What do other MiMs do to keep themselves creative?   How do you find the energy? 

Last Week

My little family had a tough week last week. In addition to the usual chaos of single-working-mom-with-two-kids life, which includes (but is not limited to) two morning drop offs during the week, ballet, play rehearsal, soccer, swim class, my own personal interviews for a potential promotion at work, and a snow day during the week (oh how I could do a single lengthy post on the chaos of being a doctor mom with two kids on a snow day!), three year old E got sick. And we landed in the hospital.

I should mention that my seven year old daughter, M, has immunity of steel. She had the usual colds, fevers, early childhood sicknesses until roughly 18 months old, and then she’s been rock solid since. I can’t remember a time in 5 years that she’s seen the pediatrician other than for a wellness physical.  

And then there’s E. He’s had an ongoing solidly built relationship with our pediatrician which has landed him in her office so many times we all stopped counting. Sometimes I see her so much (and I like her SO much!) I think I should take her out for coffee or something!  For a while it was bi-weekly, for a new cold, fever, cough.  Between the ages of 6 months and 16 months, this kid was hospitalized three times for respiratory problems.  The frustrating thing was he would get overtaken by a cold which would turn into brochiolitis, land in the hospital with hypoxemia, get treated with oxygen (and time) and get better, but no one could really put a name on it.  It wasn’t asthma. He got tested for CF (oh, that was a harrowing day!), amongst other things, and the pediatricians landed on a diagnosis of “tracheomalacia” and told me he’d grow out of it.  So for 2 solid years, we walked on eggshells with this little guy and his tenuous health.  And, slowly, he seemed to get better and the “colds” got less frequent, and I slowly let go of some of my anxiety about him getting sick.

Last week, he wasn’t himself on Monday and had a low grade temperature. I didn’t think much of it because he wasn’t coughing and thought he’d rest a little on our “bonus” snow day. On the morning after the snow day, he still had a low grade temp so I kept him home from school but I needed to be at work. I was precepting for three residents, two of my colleagues were away on vacation, and there was just absolutely not a single soul (believe me, I racked my brain!) who could precept those residents for me. So, I brought E to work with me -- he was psyched! He sat at my desk, drew pictures, played on the computer, got fawned all over by my colleagues, and enjoyed the bonus graham crackers and apple juice in the ‘supply’ closet! He was really acting fine, even a little energized by being at my office, but a slow, barking cough began to emerge.

We left my office midday and went to the pediatrician (it was a covering doc as our usual pediatrician was out that day! Sigh.) to find he had since spiked a fever, and his room air pulse ox was 92%.  He had a right lower lobe pneumonia [ok, this is the part where I confess I listened to his lungs when he was in my office -- which I try to NEVER do, except I did this time -- and thought I also heard a pneumonia but tried to leave that to his real doctor to decide!]. They gave him nebs in the office (I told them they never work, but they always say it’s worth a try) and his pulse ox remained at 92%.  So, we left with our amoxicillin prescription and a word of caution: “You know what to do. You are a doctor. If he gets worse overnight, don’t even call us. Just go to the ED. If you are worried tomorrow, bring him in again.”

I should have known. It always gets worse.  This kid gets sick fast.  So he got his first dose of amoxicillin, and I waited.  You know that waiting -- the kind of waiting moms do -- where we are so worried, need to be distracted so we don’t obsess, then we second guess our judgement, try to convince ourselves it will be ok, exercise some magical thinking that all will be fine as soon as the antibiotics kick in, and the time can’t pass quick enough.  I put E to bed at 6 pm because he was so tired and miserable, and the next 3 hours were unbearable. He would sleep for 5 minutes, cough uncontrollably, wake up and cry, and then be so tired he’d fall asleep again, and then do the same thing over and over. It went on like this for so long. Did I mention I also was getting my 7 year old fed, showered, ready for bed? Oh yeah, that too!

At 9:30, while holding E in my bed, trying to get him to calm so that he could get some much needed rest, he woke and cried and said “Mama, I need help. I need help.”  So, that’s it.  I sped into action: clothes on, coats, boots, hats, gloves for kids, I woke up M, I put both kids in the car (10 degrees outside!), dropped off M at a friend’s house to sleep over, and drove to the ER.  E’s dad eventually met us there -- another story.

In the ER, E’s room air pulse ox was still 92% but when he fell asleep, he got hypoxemic to the low 80s.  I’m guessing it’s why his sleep was so fitful.  So, we got admitted. And we spent 3 days in the hospital. From the gurney in the ER, I sent emails and texts to my clinic manager, medical director, and colleagues to cancel all my patients and my meetings, and the interviews for the promotion that I’ve been working toward.  The rest of the week was a wash.  In fact, all the stress and chaos of ‘everything else’ just melts away when you have a sick kid. I told myself, “I’ll catch up. It will be ok. Everything else will wait.”  And it did. Time stood still with him in my arms. All I needed was him to get better.

E is fine now. He is back to preschool, and back to his usual self. M had a few days of being bonkers because her routine was off as we figured out how to move all the pieces of the family puzzle while I stayed with E in the hospital (thank goodness for good friends!). But, she was truly a champ during it all. And, we are back to ballet and soccer and swim class and play practice and birthday parties and the crazy of morning school drop off, and I’m back to patients and meetings and interviews. And somehow we are all staying afloat. And we are making sure to do it all with lots of hugs and giggles and a few dance parties mixed in -- the chaos is there, it’s never going away, and we are trying to keep it ‘light’ for now because that’s all this doctor mama can take at the moment.

Guest Post: Finally

I have been tired since May 2015. I am so, so tired. But the sleep deprivation proved to be worth it today. You see, today was Match Day. The results were good. Outstanding, really. Not only did I match to my number one ranked program, but my future institution is one of the most prestigious medical centers in the world.

My journey to get today was not easy. It took me three application cycles to get accepted into medical school. The emotional toll alone of receiving dozens of rejection letters is enough to make anyone go a little crazy. But with application cycles also comes time, and as we all know, with time comes a decline in ovarian function. Women physicians are all too familiar with that line graph comparing ovarian reserve to a woman’s age. I was finally accepted into medical school at 27. By that time I was married to a man nine years my senior who was very eager to start a family. So we decided to have a baby… while I was in medical school.

After a pregnancy complicated by complete placenta previa, studying for Step 1 in the height of my third trimester, and a major placental bleed during third year orientation- my beautiful Ben was born. I have loved my son with every ounce of my being since the second I heard him cry. He has brought our family indescribable joy and not a moment goes by that I am not thankful to have him.

But being a parent is even harder than I imagined (I still have PTSD from the newborn period). Being a parent while in medical school seems like an almost insurmountable challenge. It has been exhausting and challenging and there were times I did not think I would make it to today. But today is proof. When I celebrated the news of my match, I got to share that moment with my loving husband and our smart, wild, daring, and sweet little boy.

Yes, I am still exhausted. And no, I do not believe I will get to catch up on sleep anytime soon. But just as my increasing age correlates to my declining ovarian function (that damn graph), it also represents the passage of time. My grandmother used to say that the days were long but the years were short. So to all the women who wonder if they can be a mom while in medicine... the answer is YES. Do whatever is right for you and your individual circumstance. And if you do have a baby in medical school (or at any point in your medical career), there will be times when it’s awful and times you genuinely don’t believe you can do it anymore… but it is so worth it. And whatever you do, enjoy every second because my grandmother was right. There were so many long days, but these sweet, sweet years are ever so short.

~Maria

Itty bitty ones and screen time

Screens! There are so many. And they are everywhere. Even AAP relaxed their screen time recommendations in recognition of the ubiquity of screens. I remember when my little one was born, AAP recommended no screens for children under 2. Current recommendations relaxed the no-screen age from 2 years to 18 months. Like many other things related to parenting, I have been flying by the seat of pants, and experimenting as I go along. Here are some observations from our ongoing screen time adventures.

Under 18 months? No screens for you: We did not adhere to that. Part of it has to do with very different approaches that me and my husband take to screens (and parenting in general). I was the stickler in the beginning, determined that my child would view no screen until 2 years. Husband is several notches more laissez faire than me, felt screens were fine birth onwards. After several battles, a compromise was reached. I don't recall the exact age, but it was somewhere between 12 and 18 months.

So many screens and so little time: At first, I didn't distinguish between different kinds of screens and let the toddler do as he wanted. TV? Sure! iPhone? Why not! Laptop? Here ya go! But then I dialed it back quickly after seeing him flip from one video to another at a dizzying pace on the touchscreen phone. My toddler has pretty good attention span for doing tasks, but watching him with that level of stimulation gave me future ADHD nightmares. For now, I have stuck to less interactive screens like TV. Watch a show. Finish viewing. Turn it off.

Screen as a pacifier: Kids and restaurants don't mix well together. "Twenty minutes in a high chair is about all you can reasonably expect from a toddler... Little bodies need to move" When he was having a meltdown, initially a smartphone seemed like a very effective pacifier. Avoid the angry stares from other patrons. Enjoy our meals in peace for a little bit. But then our child became Pavlov, and we were his little rats. When every meltdown was rewarded with a phone, they just became more frequent. Eating out is an important social skill. Sowing seeds for that ineptitude so early didn't quite sit right with me. So I stopped caring about strangers stares. If the meltdown was too intense, one of us walked out with him until he calmed down. Now instead of playing with a phone at a restaurant, he plays with his food. Baby steps!

Screen as babysitter: AAP recommends against using screens like electronic babysitters. Easier said than done! As I discussed some of my childcare challenges with limited financial resources in a previous post, this is the rule I feel guiltiest about breaking, but I continue to break it anyway. In AAP's ideal world, "parents should co-view media with children to help them understand what they are seeing". In my real world, while my child is glued to the front of a TV, that is some precious time to hastily get stuff done. However I did find a workaround through a loophole for that AAP recommendation. Toddlers love to view the same thing over and over. We cut the cord and watch most of our TV via Netflix/Amazon Prime etc. I watch a few episodes of some shows with him, and then play the same ones over and over for him.

All programming is not created equal: I have found PBS to be the highest quality, though even with PBS, not all shows are equally good. By far my favorites are Sesame Street, Daniel Tiger and Peg+Cat. There was a even a study showing correlation between Daniel Tiger viewing and children's emotional intelligence. Adding anecdotal evidence, I have taught my son to apologize using the episode where Daniel Tiger learns to apologize. And to clean up after himself using Daniel Tiger's jingles "Clean up, pick up, put away. Clean up, everyday".


Practicing the preaching: All this fussing about my toddler and his screen habits have made me rethink my own screen time. Excluding unavoidable screen time (work/school related), I tried to take an inventory of the my avoidable screen time. I am not much of a regular TV watcher, my biggest avoidable time sink was checking social media on my smart phone. A strategy that I have had moderate success with involved creating extra hurdles to view social media. You can read about it in greater detail at my blog here. Less time with my face in a screen meant more time being present (actually present) for my munchkin.

It's been a bumpy ride but I feel like we have reached somewhat of a steady state with our relationship with screens... for now. But these pesky children keep growing up, ensuring that the steady state will not stay so for long. Screen time for kiddos has been in recent news, with stories of links between increased screen time and diabetes risk and teens replacing drugs with smartphones. Even without those scary stories, I am dreading navigating the whole wild world of smart phones, video games, internet and social media when my itty bitty one is no longer so little and outgrows PBS Kids. Mothers in Medicine with children of all ages, share your own screen time adventures. What has guided your approach to your children and screens? What screen related rules do you use in your house? Did you have it all figured out or do you fumble around like me?

The Request Case

One of the things I really enjoy about being an anesthesiologist is the wide variety of patients that I see. You never know who you're going to have the privilege to care for on a given day. Although my group is large, I will occasionally be assigned to a patient that I personally know. And occasionally, someone I know will request me as their anesthesiologist.

Last month I took care of a friend who requested me for her surgery. It was a very straightforward case, everything went smoothly, and she expressed abundant gratitude at the end of her experience. I was also asked to do anesthesia by a friend for a surgery that, knowing her history, was going to be fairly complicated. That one gave me pause, but I did it and everything turned out well.

Gizabeth recently wrote about being a doctor to her friend, and I'll bet that some of you have also taken care of friends (or have become friends with some of your patients). I would venture to say that being an anesthesiologist or surgeon to a friend adds an even further layer of complexity because there is an immediate "life and death" aspect to what we do. However, either fortunately or unfortunately, patients don't usually appreciate this.

On the "pro" side, patients can feel a great sense of empowerment in choosing their own anesthesiologist. A good attitude and sense of empowerment going into surgery can translate to less stress on the patient and better overall recovery. During my residency, I had a scary brain surgery. At first, I thought it would be awkward to personally know my surgeon and anesthesiologist, but out of convenience and timeliness, I chose to have the surgery at my own institution. I was able to choose my anesthesiologist - who at the time was one of my supervisors! In the end, I felt great comfort in personally knowing my healthcare team.

On the "con" side, there is a phenomenon in our specialty called VIP syndrome. Taking care of a VIP subconsciously makes people pause and do things slightly differently than they would normally do, rendering the whole process vulnerable to errors. What if your friend suffers an adverse event under your care? And are your decisions objective enough in the situation?

What do you think? Would you and/or do you take care of friends? How about family members? Let us know your experiences with requests for care by friends, acquaintances, or family.

The doctor self-diagnoses again (a delightfully disgusting story)

Genmedmom here.

I've posted about my own recent miserable illnesses on my own site so often lately, I'm afraid to post anything else about being sick there. People will start to think I have some underlying issue, like an undiagnosed immunocompromised state.... or hypochondriasis.

But I have to share the gross details of my latest medical problem! I have to, because it's so disgusting, it's entertaining.

So my kids and I have been SO sick this winter. There was Norovirus at Christmas, and then the flu three weeks ago (despite being vaccinated), which for me, then triggered a horrible asthma exacerbation...

But last week, I was finally feeling better. I remember thinking, "Gee, I finally feel better..."  and probably jinxed myself.

By the end of the week I was really congested and feeling run-down. "Great, a cold coming on, this sucks," I thought.

Then Saturday afternoon, I was more congested, and the mucous was really green. I felt kind of woozy, with mild chills. I ignored it and went for a four-mile run in ten-degree weather. Weirdly, it was invigorating, and the hot shower afterwards was heavenly! The mucous drained and drained.

"Ha! I beat that one!" I congratulated myself.

But, Sunday: worsening congestion, thicker gray-green mucous, facial pressure... and then there was this smell.

I smelled it first in our kitchen. A warm, dirty dishwater smell, like when you open an old dishwasher before the heat cycle is done and all that steam with the hot-moist-food-particle odor hits you full in the face. WTF? I peeked all around trying to find the source.

Then at church, I smelled it again. The kids were running around and I was distracted, so I didn't think about it too much other than, "Yuck, what's that?"

Later, at home, still soooo stuffed up, I blew my nose for the millionth time, and got a huge glob of nasty slimy mucous. For some reason, I thought to sniff it.

And there it was. That smell. It was reminiscent of when I worked part-time in our college cafeteria and there was an immense sink for soaking all the pots and pans and serving dishes in super-hot water with some kind of toxic detergent, and the clouds of steam would waft up with the odor of all those food scraps: leftover meatloaf, cherry jello, brown gravy, pea-soup, and harsh industrial-strength cleaning solution all mixed up together in one nauseating and assaulting aroma...

I realized (with a shudder) that the source of that nasty smell was my own face, my own mucous. SO GROSS SO GROSS SO GROSS!!!!

Of course I googled this, trying to figure out what was the principal bacteria responsible for this gray-green discharge with the very particular odor... No luck. Needless to say, I'm on Augmentin and I feel alot better. 

Early dementia

"We have a problem," my daughter's kindergarten teacher recently told me during a parent teacher conference.

"What's the problem?" I asked.

"You forgot to pack your daughter's snack today," she said.  "Also, you forgot it one other time.  I don't know what's going on there."

I pay a small fortune for my kids to get school lunch (which I'm convinced they don't actually eat), but in addition to that, we have to pack a snack.  I don't remember having snack time in elementary school.  I think we got lunch and that's it.  But regardless, snack time is the convention.  And on two occasions in a three month period, I forgot to pack it.

The thing that surprised me is... am I really the only mom in the whole class who forgot to pack a snack twice in three months?  Is that really something that should make the teacher look at me like I'm irresponsible?  I have a lot of things to do in the morning and I just forgot.

I used to have a great memory.  

I don't know what happened.  I can't remember anything anymore.  I have alarms in my phone to remind me to tell my daughter to pack her clarinet on band day, to remind her to study for her Friday exams, because I'd never remember otherwise.  I put reminders and alarms in my phone about every appointment, every social event, everything I do.  

And it's still not enough.  My kindergartner is totally incapable of remembering her backpack in the morning if I don't remind her, and yesterday, I forgot to remind her.  So we got to school and.... no backpack.  I had to call my husband and beg him to bring her the backpack on his way to work, which he did, but I forgot to put her dance clothes in the backpack, which was practically the only thing she needed in the damn thing anyway.

But at least her snack was in there.

On Family Medicine

I wondered during undergrad if I could do medicine and "have a life". I didn't have a lot of first-hand contact with physicians, and had just started to consider a career in medicine, so I really didn't know what a medical lifestyle was like. I knew it could be incredibly demanding and busy, but I wasn't sure how much flexibility there would be. In the end I suppose I still didn't really know, but I figured if others did it, I could figure it out too.

We had the chance to get early clinical exposure at my medical school. I had always planned to do family medicine, so every Wednesday afternoon in my first year, I would take the bus to the family medicine clinic of Dr. B. Dr. B's patients adored her. She truly listened to them, and was clinically excellent too. Seeing patients -- real people with real problems! -- was thrilling. I get a reminder of this from time to time in my office when I have early medical students join me. Looking at a tympanic membrane is exciting to them! It's a great boost. 

During medical school, I went through the "cardiology! neurology! infectious diseases!" rotation in my mind, until it was clear that being a generalist was what I wanted. Internal medicine was tempting, as I actually enjoy learning minutiae, but I loved women's health, pediatrics, and doing preventative care. The flexibility of a career in family medicine was unmatched in my eyes. So from clerkship onward, I continued to feel that family medicine was the right fit for me. 

I now have a family practice of about 1200 patients in a small group practice, and see patients for about 30 hours per week.  Charting, results and other paperwork takes about 8-10 hours a week.  I block one day off every month for self-care or catch-up time - with young kids, if I have to cancel a clinic due to their or my illness, it’s nice to have a day available to re-book patients. I can book off in advance for appointments for the kids or myself, or fit in local CMEs or meetings related to some community health work I do. The demands of my practice - and of home - fluctuate from week to week, but generally it feels like a good balance. 

I ran into a lovely, well-meaning non-medical friend a little while ago. "How's work going?" she asked. "Ah, it's been a long week." I said. "Lots of coughs and colds?" she mused. "If only!" I thought. I tell this to students a lot: family medicine can be very challenging, medically, and very draining, emotionally. So rather than things like a chest cold or plantar wart being boring and mundane, they can be a very welcome break from the challenging things we see at times.  The medically complex cases are invigorating, and the emotionally draining cases, highly meaningful; the "mundane" cases act as a much-needed foil. And above all, when you know your patients like you do in family medicine, it becomes much more about caring for the person in front of you than about the particulars of their issues.