Planting Bulbs

I love autumn. It's always feels like a time of regeneration and new starts, even more than springtime does. A lot of this probably has to do with school beginning in the fall - we get used to a cycle of starting again each September.

Fall is also a time of planting for me; while many look to the spring to sow seeds and plant annuals, I prefer to put in the bulbs that will become the crocuses, daffodils and tulips that I love to look at in the spring.

It dawned on me as I was planting the bulbs that this is very similar to raising kids. What?

I can prepare the beds and make sure the bulbs are as protected as possible from the environment, including harsh weather and rogue squirrels, but ultimately I have to have the faith that the bulbs will grow where I planted them.

Isn't it the same with our kids? We feed, clothe, nurture them, read to them, snuggle and play with them, and love them. We offer the best environment that we can - but ultimately have to recognize that the final outcome may be out of our control. As someone who is used to directing her environment, this is a tough realization to come to grips with. But, I'll sprinkle a bit of fertilizer and nourish both my bulbs and my boys as best I can. And wait for the outcome.

A

P.S. Have a happy and safe Halloween!

Ahh, sleep

This morning as I awoke, I rolled over and stretched a lovely long stretch. My first thoughts were “I feel gre-“ but my reverie was interrupted by the sudden realization that I HAD SLEPT ALL NIGHT LONG. I grabbed the on-call phone next to my bed and anxiously scrolled to the “missed calls” file. It was empty. And then I was left with the vaguely guilty feeling that I have far too frequently after having a good night’s sleep.

When did this start? Why do I have a problem with sleeping all night long?

My first recollection of this sensation dates back to when I was an intern almost 20 years ago. A resident I worked with was fond of heading to the on-call room as soon as possible during call nights and jumping into an open bed. His rationale was that any sleep was better than no sleep and 45 minutes of sleep at 7PM might well be the only sleep of the night. I still recall the first night of call when I decided to do the same; I headed to the on-call room and tucked into a lower bunk, optimistically setting the alarm in the room for the next morning. I woke the next morning to the sound of the alarm blaring and immediately wondered why I hadn’t gotten called. I frantically paged myself. When my pager went off, I hung up and did it again. Again, my beeper responded immediately. I found a toothbrush and freshened up as best I could, then headed down to the morning lecture. On the way, I ran across the resident who had been on call with me the night before. He grinned at me guiltily and then said, “You’ll never have another night like this. Savor it. But don’t ever talk about it.” His unspoken comments implied that sleeping during a night of call was frowned upon – even if there were no patients who needed the night intern or resident.

I recall the same sensation the first night both kids slept through the night. My initial drowsiness upon wakening abruptly vanished with the realization that I hadn’t heard the baby cry. Stumbling into the nursery expecting the worst, my fears resolved upon the sight of Eldest earnestly holding a conversation with his stuffed bear; a few years later, it was Youngest’s voice singing aloud which soothed my concern after a similar night.

But I still don’t know why I feel guilty after getting a good night’s sleep. Is it because I spend so much of my time fighting fatigue that I don’t know what to do when the feeling is gone? Have I grown so accustomed to chronic sleepiness from interrupted nights that what should be normal for my brain and body is now considered the aberrant?

Even now, after having been awake for several hours, I feel “off”. Is it extra energy, lack of fatigue, hypercapnia from sleeping with my head under the pillow for an additional ninety minutes?

So MWAS, here's a really long answer to your question of the other day: 7 hours to function, 8+ to feel good (but then I feel bad). Does anyone else have this guilt after sleeping well?

A

Time is sanity

For me, time management equates to stress management. When I'm less stressed, it seems that I'm better able to manage my time. To that end, these are the tricks that work for me on a regular basis. I wish I could say that I always use them, but I don't. Perhaps that's why I've been able to recognize just how well they work - because I have so many times when I haven't used them to compare!

1. Exercise. This is the best way that I've found to bust stress and keep me going. When I exercise regularly, it seems that I'm able to be more efficient in almost everything I do.
2. Write it down, write it down. Make a list, check it twice. I write down everything, from things I want to get done to gift ideas for the kids.
3. Everything has a home. This is the best way I've found to keep track of items.
4. Make use of duplicates. How many pairs of reading glasses does one busy doctor need? um...at last count, six. I have them in the car, in my office, in my bag, and 3 pairs at home (bedroom, kitchen and family room). Yes, each pair has its own home in all of those locations; the upside is that I never spend time looking for glasses. I do the same thing for scissors and office supplies (kitchen, bedroom, office).
5. Hug my kids or husband. No matter how busy I get, a hug always regenerates me in a way nothing else seems able to.

Even though time isn't my friend on too many occasions, using these tricks makes me feel like I have at least a little control over my life - and that's always a good thing.
A

Worms

The kids know that I'll check out their cuts or scrapes on a routine basis, and I've been known to pull out more than a few chunks of bothersome ear wax when asked. So it doesn't usually surprise me when one will pull me aside and ask for my "professional opinion". The other day was an exception:

“Mom, can you look at worms with your magic* otoscope?” Youngest casually posed the question one morning.

“Yes, of course,” I began to respond. Then his question sunk in. “Um, honey, why do you want to look at worms?” With mild disgust, I pictured some juicy night crawler on the sidewalk that he wanted to look at more closely.

“Can you look at the worms in my head?”

“WHAT?!” Take a deep breath, I told myself. Surely this isn’t what you think.
“Youngest dear, you don’t have worms in your head,” I stated, with far more confidence than I felt.

“I have one of those song worms in my head and it’s making me crazy. I thought maybe you could see it with your otoscope and get it out,” he replied calmly, starting to walk away.

Song worms? Song worms? What the heck is a song worm? I wondered. Then it hit me – he had an EARWORM that was tormenting him. Starting to laugh, I followed him and pulled him in for a hug.

“Even with my magic otoscope, I can’t get out ear worms. You just have to let them die a natural death. Sometimes, if you’re lucky, you can pass them along to someone else. What song is bugging you?”

And now, Miley Cyrus’s “The Seven Things I Hate About You” has given an ear worm in my brain new life…

A

*Magic because it only turns on when a child blows gently on it – with a little help from Mom’s fingers on the rotary switch. And for more on worms, check out the post here.

You stink!

Another day in the life with kids:

Ooooh that smell
Can't you smell that smell
Ooooh that smell
The smell of strep surrounds you
(apologies to Lynrd Skynrd)
A few days ago Youngest spent some time with a family friend, returning home several hours sooner than expected. Coming in the door, he complained of a headache. Our friend explained that Youngest hadn’t seemed quite his perky self during their outing, adding he was surprised when Youngest abruptly asked to return home.

I put an arm around Youngest and he leaned in for a hug. I was initially repulsed at how warm he was – but shrugged it off to the heat of the day and the time he had spent outside. But what did I just smell? Only a quick whiff, gone before I could really say with certainty I had recognized it. Nonetheless, after our friend left, I put Youngest on the sofa and got the thermometer. 101.3 – not a typical temperature after spending time outside, no matter how hot it gets. Ergh. Let’s keep a close eye on this, I thought.
“How’s your head, bud?”
“It’s OK, Mom.”
“Any sore throat?”
“Uh uh.”

Maybe I was mistaken about that smell…

The next morning, Youngest was still febrile. Leaning close, the smell was unmistakable.
“How’s your throat today?”
“It hurts when I swallow, Mom.”
*Sigh*
“Open up. I want to look at your throat.”
“AAAHH” Youngest has an amazing ability to open his mouth when he wants to be cooperative. I was able to see almost down to his larynx, so I had no problems identifying the pustules along his tonsils. As he exhaled, the scent was overpowering. Strep. Unmistakable. I could have waved a rapid strep screen in front of his face and obtained a postive response.

“OK, time for some medicine for you.”
I knew he was really sick when he responded with “Can I have the pills instead of the yucky liquid?” instead of his usual protests against any type of medication.

So now we’ve been on antibiotics for 48 hours. The pustules are going away. Youngest is back to his usual bouncy self. And I’m hovering around Eldest on a regular basis, waiting for him to exhale, waiting for him to develop that smell.

A

photo from Medscape.com

DoctorMom, revisited

I've been asked about how being a doctor affects the way I'm a parent; in review, I'd have to say there are probably some things I have done differently because of my background: I probably worried less about a runny nose and productive cough when my kids were younger. I'm more annoyed than concerned about the occasional bloody nose that Youngest gets, especially after he's admitted he hasn't been taking his allergy medication. My kids have known anatomical terms for their most private parts since before they could talk, and the "toy" medical kit they used to use contained the stethoscope I received when I was a medical student. And dinner table conversations are as likely to include a discourse on why cocaine can lead to a stroke (even in first time users) as they are to include a review of the school day.

More important, I think, is the question about how being a mom has affected the way I practice medicine. I see a great deal of "carry-over" as I interact with my patients. See the way that lady with Alzheimer's disease grabs my hand and won't let go? In residency we learn about "frontal releasing signs" as an indication of deterioration of the brain; as I speak with families I can describe how this is similar to the grasp that an infant has, because I've experienced that same grasp when my babies were born. Similar to the way I don't shy away from explaining the concept of "you get benefits out of something proportional to the effort you put into it" to my kids, I'm not afraid to tell a patient who has refused to participate in the home program component of physical therapy that I'm not surprised that he hasn't seen any lasting benefits. And (I know that this is not at all politically correct) if one of my patients has shared with me fears or concerns about the future, especially as it relates to the illness I treat her for, I'm not hesitant to give her a hug at the end of the visit any more than I would hesitate to hug one of my children after they've shared their most recent fear or worry.

I'd like to believe that being a doctor has made me a better parent in many way; at the same time, I'd like to believe that being a parent has made me a better doctor.

Have any of you experienced similar experiences with your patients?

Artemis

Moms in Medicine

When I was in medical school a male attending physician told me that no matter what I did, things would always be different for me because of my gender. His words rankled - this couldn't possibly be a good thing - so how I tried to prove him wrong! Anything that a male medical student could do, I could do better - and was rewarded by all of the "perks" that came along with great performances. When it came time to match, neurology was my program of choice and I started my program with the same gusto I had shown as a student. Oh, there was one exception: right after graduation from medication school, I got married.

But being married didn't seem to put too much of a damper on my enthusiasm for throwing myself into my work and I continued to shine, collecting various awards and accolades through the first 3 years of residency. As my final year of post-graduate training approached, it became time to name the new chief residents. By then, I had an announcement of my own - I was almost 3 months pregnant. I had told only my program director, believing that he should be able to schedule around the time I'd need to be away from hospital duties as early as possible. Shortly after giving my news to the program director, the chief of neurology summoned me to his office. As I sat down, he greeted me warmly and spoke in glowing terms about how well he thought I had performed during my residency. Then he said this: "Artemis, I think you should be chief resident. Everyone that I've spoken with thinks you should be chief resident. But I'm going to name John Smith* chief because you're pregnant."

You can be angry for me because of this. I'm not (anymore). I'm not sharing this story because I've carried a grudge through the years; I'm sharing it because it was this event that brought me full circle, depositing me right back at the attending who stated that things would always be different for me due to my gender. Ultimately, he was right: I'm a woman, and I'm a mom - and this will always color the way I practice. The stories we share here have a common thread, but are unique to us because we're moms. You won't find these same stories on a blog written by men, even if they're up for Father of The Year award, because things are different for us. And that is a good thing.
Thanks for sharing our times and our stories.
A
*name changed