Motherhood changes you: cooking and hair braiding

This is not a story of the profound and amazing ways that motherhood changes you.  Its about two simple ways that it has changed me.

Before I had my daughter I had NO domestic capabilities.  I could read directions from a cookbook but my husband was the adventurous one in the kitchen.  Also, despite having a lot of hair, I was completely incapable of controlling it!  When my family members found out I was having a girl, after the congratulations many of them laughed at me and said they felt sorry for my future child and the ridiculous hair she was bound to have!  However, on this almost last day of my vacation I find myself cleaning the kitchen to prepare for tonights culinary adventure and tonight I will engage in a hair-braiding adventure with my beautiful girl in order to be ready for church tomorrow.

My daughter LOVES food.  She is the smallest child in her daycare class but requires two breakfasts in addition to the one dad gives her on the way to school, gets a double portion of lunch and eats two snacks and an adult portion of dinner.  She is a rail thin ball of energy.  She devours everything I make. She smiles and licks her lips and yells things like "SO GOOD MOMMIE!!!!  YUMMY IN MY TUMMY" and my favorite, "I LUB IT!!!!!!"  She loves all the different cuisines I try, Spanish food, Indian dishes, Caribbean dishes, attempts at French cuisine - and it just fuels me to cook more and more.  Thanks to the Pioneer Woman and my Le Creuset pot (a gift because there's no way I could afford one), I am a cooking machine.  My mom gave me a recipe book of family dishes at my bridal shower, I had barely touched it before my daughter was born, and now I use it once a week and I've added a few dishes of my own.  With my busy schedule its something I enjoy and can share with my daughter and provides her with meals even when I'm away from home.  Motherhood made cooking about love.

My baby girl was born with a head FULL of hair.  At two she has a beautiful head full of soft curly hair that stretches down her back.  My husbands hair wrangling abilities are measly at best so I needed a way for her to get to daycare looking un-hobo-ish in my absence.  So with the help of wikipedia and my dads response to my mom mentioning my hair braiding insufficiencies that "She can do anything she wants to do, no reason it will be any different with hair braiding" - I decided to figure it out!  Now each night after bathtime, we sit and watch Dora and I braid like crazy.  I treasure this time with my baby and when I'm done I tell her to go show daddy her "princess hair" (everything must be princess something right now).  She smiles so big and touches her hair and runs to the mirror.  All love.

Awesomeness

Yesterday I worked with one of our part-time attendings.  She had two cases scheduled.  The first went smoothly.  It was a bit complex and atypical of an operation but it went well and the patient did well. The second case...different story.

Back story: This attending is a part time surgeon, an enigma that you hear about but never see.  She became part time after her second child was born and I've been told I should get to know her ever since my daughter was born.  Now, I've finally gotten the opportunity to work with her.  Mom surgeon mentors are still still nearly impossible to find, especially those that are relatable.  She is a regular person - her husband isn't independently wealthy, she doesn't have 4 live-in nannies and a stay at home dad, she is a regular person, awesome surgeon and a mom.  With a bit of timidity, I've had the occasional opportunity to pick her brain about her career choices when I've taken call with her and she's been an amazing resource.  I also know that she recognizes the career advancement sacrifices that come with her choice to work part time.  She seems a little frustrated by the trade-off but not at all regretful.  

Back to the present: Ok, second case, she decides to try out a different approach she read about to increase exposure.  Unfortunately the change in the approach makes some parts of the operation a lot more difficult.  However, we press on.  Then we hit a key part of the case where a structure needs to be identified to ensure that it isn't injured, and we just couldn't find it!  She called for back-up.  I hear her mutter under her breath: "Can I just get through one case without asking for help!"  One of the senior surgeons came in and helped out.  The remainder of the case proceeded with continual second guessing her every move - "does this look right" "I think I'll go here"  "do you think this looks okay?"  She was reduced to what I like to call 'resident uncertainty.'  We finally finished.  All went well, the patient was fine, the final result actually looked great but I could tell she was defeated. She apologized to me at the end of the case.

Its not uncommon that attendings help each other out and scrub together.  Its one of the things I like about the group of surgeons at this hospital.  I tried to tell her I thought the case was fine that no apologies were needed.  But, I could tell she was disappointed in herself.  I wanted her to know what a great teacher she is, what a great role model she is to her residents and her children.  I wanted to remind her of how her patients gush about how amazing she is.  This attending trained at my institution and I have literally NEVER met a single person - faculty, resident, nurse, administrative staff, who had anything but extremely positive comments about her skill and her judgement.  I wanted her to know that I have operated with senior surgeons who have come to work every day for the past 20 years and still occasionally need to call in back up.  When I think about the two cases we did that day, I think that there are two people that may no longer have cancer because of her.

I read an article recently about how motherhood completely and utterly changes your life.  No matter what you have invested in your career prior to having children, being a mom will profoundly change your career and who you are and every decision you make.  This is so true.  I feel like I'm struggling with it every day.  Fulfillment in two places, work and home, often at odds with each other.

As she walked out of the OR my attending told me that she was on call tomorrow night and that unfortunately I would be stuck with her again.

My response ..."It would be my pleasure"

A post for those in the trenches with us...

This post is for my husband and my beautiful daughter.

To my daughter:

Thank you for running and screaming "MOM-MIEEEEE" with complete happiness and joy each time I make it in time to pick you up from daycare.  Thank you for your constant big beautiful smile.  Thank you for thriving despite my many absences and nights on call.   Thank you for telling me "I love you mommy,"" GOOD JOB mommy" (one of her favorites), and "com wit me" with your outstretched little hand.  Thank you for this unconditional love.  Thank you for changing my life and making me whole.

To my husband:

Thank you for coming to meet me as I sob to you through post call tears at the violence I unfortunately sometimes see the results of.  Thank you for coming home for lunch every day I'm post call and bringing me lunch, tucking me in and putting on soft relaxing music.  Thank you for allowing me the complete and utter assurance that my precious baby girl is always remarkably cared for in my absence.  Thank you for going on this journey with me.  Thank you for surviving the many bumps we encounter.  I believe we can make it through.  Thank you for making me whole.

Dear Moms, How do you cope?

I'm currently doing the dreaded stint as the chief resident in the burn unit.  Its a particularly grueling rotation, lots of getting called in from home, crazy sick patients and lots of terribly sad stories.  It is taking an emotional toll on me, and I've been missing out on seeing by little peanut.  For the first time since I've come back from the lab I've gone two full days without seeing her.  I have cried a record number of times after countless family meetings at the end of hours of doing everything we could.  Thankfully, I've had a fabulous and amazing team of interns, nurses, chaplains, social workers and support staff to be on this journey with me.  However, despite the support, the one thing I haven't managed to cope with very well is the non-accidental injuries.

I have always found child abuse unbelievable horrifying, but as a mom, my horror about this has reached new levels.  In particular, a recent child I operated on, who is very similar in many ways to my own, has left me having nightmares every day in which I see her injuries on my precious daughter.  I wake up gasping and anxious and immediately go hug my daughter or go to her room and stare at her while she sleeps.  I've talked to other moms with similar experiences, a pregnant NICU fellow fighting the nightmares about her unborn child mirroring the illnesses she saw each day, the burn unit nurse manager who I sat and chatted with in her office about how this unit makes you so hypervigilant about protecting your kids, but the one thing we fail to come up with is a solution.  How do you make the nightmares stop?  I even talked to my own mom, who doesn't need to be in medicine to understand the disturbing fear a parent feels anytime they see another child harmed.  (My mom is awesome by the way, just want to throw that out there because she is my greatest mentor as I navigate this crazy journey of motherhood!)

So, tomorrow I will go to the spa, and try and lose my thoughts and replace them with relaxing calm.  I will continue to listen to my mindful meditation CD's as I drive home from a particularly horrifying day of work.  I will continue to delight in my beautiful, amazing blessing of a child each moment I see her.  And, I will pray for the beautiful children who have endured hurt and pain and pray that they someday receive the love they deserve.

Selah.

Transitioning

I've been back to residency after my time in the lab for a full three months now.  This transition has been quite a roller coaster.  Here is my reflection of transitioning.

#1 Our lives have totally changed.

Positives:

• I have managed to keep breastfeeding and actually making milk.  I have no idea where my body finds this milk reserve, and I can no longer breastfeed in the mornings because I leave before she wakes up, but this has allowed me to maintain a very precious part of my relationship with my daughter.  With all the change in our lives right now,  I cherish being able to continue our "bu bu" time.
• I truly LOVE surgery.  I love operating and as a more senior resident, it is even more clear to me how much I truly LOVE being a doctor to my patients.  I now get to see my patients in clinic, operate on them, make decisions about their post operative care, and meet with families in a much more meaningful way than I did as a junior resident.  
• Being a mother has CLEARLY made me a better doctor.  I have an additional way I can relate to my patients.  It has enhanced my empathy.  There are so many intangible, hard to describe ways in which I have become a better person, and I can already see this reflected in my work.
• My husband and I have become CLOSER!! Yes, I said closer!  We were struggling post baby.  As my love was exploding for this little perfect human we had created, my husband and I were having a hard time relating to each other in these new roles.  The strain on our relationship was significant.  This is another thing on the list of stuff people never tell you about having a baby (up there with peeing when you sneeze).  One of our issues was me feeling like he didn't respect the work I was doing in the lab. Well, his support of what I do as a resident is unquestionable, he is constantly building me up and teaching our daughter that when I'm away I'm doing something that matters.  We also appreciate each other more because we are both working so hard to make this work.  I appreciate how he takes care of our daughter and our house when I can't be helpful. He appreciates how hard I work to contribute when I am at home.  This has been probably the best outcome of me going back to residency because I seriously worried what would happen to our relationship as I got busier.  

Negatives

• I MISS my baby SO MUCH!!!  I MISS HER, I MISS HER. I MISS HER!
• It is such a struggle to balance.  Trying to study, prepare for work while maximizing my home time with my family involves lots of juggling and making choices to do something less well.  I'm developing strategies.  I sometimes come home after work, have family time, and then set a certain time where I do back to work to finish paperwork and notes and prep and study.  I also have times where I choose to spend time with my beautiful girl knowing that I will suffer tomorrow.  Evidence - this Friday, I BOMBED my case conference presentation - BOMBED IT! But the night before I let my husband stay at his work function because he already gives up a lot for me. And since I hadn't been home before 9pm all week, my daughter literally refused to sleep.  She wanted to play princess with me, watch Dora with me, read books, you name it.  She was literally forcing herself to keep her eyes open.  So after hours of fighting it.  I just let her hang out with me while I tried to prepare for conference.

Transitions

One of the harder things about transitioning back to residency is managing the daily transition from home to work.  With less quality time with my family, I want to try to be the best version of me that I can be when I'm at home.  This can be hard to pull off after a crazy day.  It requires a mind-shift.  It requires me pushing out of my mind the patient who I watched realize his own mortality as he prepared to go to hospice for what will likely be his last few weeks, it requires pushing out of my mind the berating I received at the end of the day from my least favorite attending, it requires forgetting the young moms with cancer, letting go of my mental step my step operating in preparation for tomorrows cases.  It requires me realizing the importance of princesses and shapes and coloring and bath time.  Sometimes I go to Dunkin Donuts, buy two munchkins and sit in the parking lot in silence for 10 minutes just to clear my head.  Sometimes I stop by Krogers on the way home and walk around aimlessly until I feel like a grocery shopping mom (that's when I know the switch has occurred).  Sometimes I listen to breathing exercises on the way home.  And sometimes I fail, and I come home all revved up and worn down and I feel like a bad mom.  

This is hard.  Being a working mom is hard and rife with guilt.  But we have to do it.  We have to find ways to do it our way.  I receive encouragement all the time which gives me the little push I need to keep going.  Yesterday, the coffee cart lady who brings coffee to patient families on the floor just randomly tells me I'm setting a beautiful example for my daughter and that I'm a good doctor, just because she overheard me talking about my beautiful girl.  I had never even really spoken to her before this.  It can be hard to find role models, but occasionally I do and they keep me going, and encourage me to be a role model for those that are to come. 

Thats all for now.

Cutter 

Apparently I’m only worth ¼ of a man

This weekend I attended a surgical conference in a beautiful location.  I had been looking forward to bringing my family with me to enjoy a nice weekend getaway.  I barely got out of the hospital on Friday in order to get there, and as a result I felt totally rushed and nervous about the talk I was supposed to give Saturday morning.  I was slated to give my talk right after the big state of surgery update talk by a surgical big wig.  He talked about the health care reform, the surgeon shortage, the effect of hours restrictions on surgeon proficiency at the end of residency and then he talked about the detrimental effect of the influx of all these pesky women into medical school and now SURGERY!!!! Yes, I’m actually serious.  This dude got up in front of an audience at a major meeting and had a slide that said that four female surgeons were required to equal the productivity of one male surgeon .  Yes, these words were on his slide.  He prefaced the slide with a line about it potentially being controversial, but asserted that it was based in statistics and facts that were not cited at any point in his talk.  One of my mentors was sitting beside me and made an immediate rebuttal in addition to commenting again at the end of his talk.  She made it clear that she was a productive female surgeon and that statements like his are what lead to unfair hiring practices.  I whispered to her that I planned to take one more dig at him when I got up to talk.  And she smiled and told me to “go for it!”

I then got up to do my talk after my introduction by a very prominent female surgeon leader.   Suddenly, all my prior nervousness was gone - I’ve always been good at making waves!  So, I loaded my talk, got behind the podium and calmly mentioned that I was never one to shy away from controversy and that as a former economist I was well aware that statistics can easily be manipulated to support your agenda.  I then mentioned that I would now present the research I completed while pregnant in the lab and more productive than anyone else with me.

It is ridiculous that we continue to fight against these types of stereotypes and misinformation.  The only reassuring thing about the entire situation was that so many people came up to me afterwards in support of what I had said.  Women add value to medicine in so many ways, we are essential.  I don’t have to say much about it.  I’m preaching to the choir here.

ROAR!!!

Last Day: Part 2

Ok, lets try this again (yes, I'm over posting myself).  I just finally put my daughter to sleep.  Its as if she knows something is up.  She has been adorable all day!  

Today I had a marvelous day with my daughter.  We read books, danced like crazy, had a morning sleepover (which involved playing and jumping around on a comforter and pillows on the floor in her room), slow danced to Miles Davis, belted out some Etta James, played catch in the yard, ate munchkins outside in the Dunkin Donuts parking lot, called family to say "I lu y-ooo" and just basically had an awesome day.  Tomorrow I go back to residency after my two year lab hiatus.

As I held my little munchkin tonight, after breastfeeding her to sleep, I couldn't stop thinking of the meeting with the scheduling chief a little more that two years ago.  During our meeting we discussed the feasibility of me going into the lab.  I remember thinking that if I pulled this off, the little 10 week old peanut inside me would be a year and a half by the time I started back - practically a grown-up.  Well, here we are.  I am the mother of the greatest 18 month old baby that ever lived.  I can't believe I'm already at that year and a half mark.  I look back at myself then and realize that I am UTTERLY CHANGED.  Completely and utterly changed.  She has changed me in every way.  She colors ever decision I make, she is such a huge part of what defines me, what motivates me, what matters.  During my last trip home for my mom's surgery, my husband taught my daughter how to say "Mommy's a doctor"  or more like "Mah-mie uh dahktur."  Tonight as he handed her to me for our bedtime routine he must have given her the sign, because she said it again, in her cute beautiful little voice.  I nearly melted.  I love her SO MUCH.  I pray that through all of this I can be a good mom and a good doctor.

Cutter

Last day

I’ve half drafted about 4-5 entries that still are unfinished in my MiM folder.  I definitely plan to eventually post the ones about my journey as daughter and doctor dealing with my mom’s recent breast cancer diagnosis.  It has been a difficult, emotional, strengthening, family building, strange, roller coaster of an experience.  So far, things are going well.  However, I’m writing just a short entry today.  Today is my last day of “freedom.”

Tomorrow I’m back in the hospital, a resident again after my two year lab hiatus.  I start off as transplant chief.  I am completely terrified and completely excited. My life has changed so much in these two years. My special necklace with a pearl and my daughters name on it just arrived from Etsy yesterday.  I love my beautiful girl so much!!  I hope I’m doing the right thing.  I’m completely motivated to make her proud.  My life these two years has been a roller coaster of emotions.  I’ve gone from loving my anesthesiologist who put in my epidural so much that I was convinced anesthesia was my new calling.  Then I was convinced that I must find a way to be a stay at home mom - otherwise I thought my life would be impossible to balance.  But, now the hormones are fading, the Zoloft is working (prob TMI - but you’ll hear more about that if I ever post the post-partum depression entry I wrote), and I’m amped up to be a surgeon.  Two years of cancer research has given me some clarity.  I feel confident that I want to be a breast surgeon (also one of the entries on file).  So, I have 3 more years to get as much out of all the other amazing types of surgery that I also love.

Wish me luck!

Cutter

A tired American - an angry rant

Ok, so this is risky, and I’m likely to attract plenty of debate but here I go.

First, why am I writing about this?  Because I took an oath to be a healer.  To me this means tolerance, justice, acceptance in order to achieve a greater good, in order to promote a healthy society.  So, I am just a little irritated today as I look at my country which appears to be at odds with itself.  My anger started while listening to NPR on the drive to work this morning and hearing about all of the discussion resulting from the TIME magazine cover of a model-like mom breastfeeding her three year old standing on a chair.  Criticisms flying everywhere about extended breastfeeding and self-important moms. There is the typical sexualization of breastfeeding with lots of reference to the attractiveness of the mom on the cover, and the usual “if they can ask for it” type comments.  (side note: newborns ask for it too - its called crying!!)  So funny, that anyone who decides to formula feed their infant gets nearly stoned for not going the “breast is best” route.  Then we flip it around and hate on the moms who keep breastfeeding.  I realize I’m using the proverbial “we.”  If this doesn’t apply to “you,” then feel free to ignore.  But for all the rest of us: Lets STOP THIS!  Mothers are always criticizing mothers - breastfeed or not breastfeed, work or stay at home, work a lot or a little, nanny or daycare or grandma, etc, etc.  Even Fizzy’s post last week, illustrated how quickly we jump to judgement.  As clinicians we do know the literature and the evidence, but the first step in being able to do no harm is gaining the TRUST and RESPECT of our patients, and in order to do this there needs to be more tolerance and listening.

Anyway, I’m just all revved up.  I live in the Amendment 1 state.  Justice, tolerance.  I won’t say anymore than that.  Our political system is full of polar opposites, butting heads and refusing to compromise.  We’re arguing over reproductive rights of women... AGAIN!  WHAT IS GOING ON!!!

Can’t we all just get along?

Trayvon

Mothers in medicine is my refuge, my voice and my forum. So today, I am going to post about Trayvon. Today I will go to work with a hoodie on, I plan to do this every day until Trayvon’s murderer is arrested - AT LEAST ARRESTED. I’m sure some will wonder what this had to do with being a mother in medicine, and although it may not specifically apply, being a mother in medicine is pervasive in every part of my life. My heart aches for this innocent little boy and for his family because I now understand what it feels like to have a child. My heart aches because I have a little brother, who is my heart, who I love so much, who at age 17 wore hoodies all the time and he LOVES Skittles and Sour Patch Kids, and he is a brilliant, beautiful person, and I shudder to think that could have been him. My heart aches because the hoodie I will wear to work today is my husbands. It is the hoodie he wears home from the gym or basketball games after work. The hoodie he wears at night, in the dark and I know he is also no different from all the Trayvon’s in the world. My heart aches because I have seen first hand the violence of a bullet on human flesh. I have found the offending bullet in bodies that have, in an instant, been destroyed by a tiny yet destructive force. I have walked to the special room outside the ICU to deliver news of this destruction. My heart aches because every loss is huge and at the very least, when facing these huge horrible losses, every family deserves justice.

Legacy

A few weeks ago my grandmother died. She is the grandmother I grew up with, who babysat me, picked me up from school, fed me, encouraged me and was there for me my entire life. She was an amazing woman. At her funeral I was asked to read a poem, and after hours and hours of searching for something perfect, I decided to write one. Writing this poem has caused me to reflect so much on her life and what she meant to me. When I think of who I am now, what I have been able to accomplish, I know that many pieces of me are pieces of her. My grandmother was a sharecropper. A sharecropper! To think that this small quiet woman once worked under the hot Tennessee sun picking cotton with her beautiful delicate hands. To think of the doors that were closed to her, a brilliant mathematician despite only reaching the eighth grade. She raised six professional children - two doctors (one the first black medical student at his school), an aerospace engineer, a math teacher, an economist, a homemaker. She seriously came from nothing and her legacy is enormous. She helped instill in me the importance of education. This generation is leaving us - the generation of sharecroppers whose grandparents actually remember slavery. So much history! In reflecting on my grandmother, I reflect on my history and the fruit of her sacrifices. I am part of her crop. I have grown up in a world where opportunities are open to me. We do not live in a country of true equality and tolerance, but it is a country where a black woman can be a surgeon, when only 60 years ago blacks and whites in the South lived utterly separate lives. I look at my daughter and I know that I must bottle up and save each bit of this legacy so that I can pass it on to her.

This past October my husband and I took 5 days and took our daughter on a “legacy tour.” She met all 3 of her great grandmothers. Two have since passed away. I am so thankful for the pictures and memories we created. So thankful that we drove over 1000 miles to make it happen. So thankful for family and legacy and my beautiful child.

Topic Week: brief thoughts...

I struggled about what to post for topic week. I feel like I should post as a voice of one of the “not family friendly” specialties and a resident, but also I feel like I’m still so much in the middle of training that I don’t have perspective yet. So, all I have to say is this - It can be done. Its hard for all of us - pediatricians, anesthesiologist, OB/GYN’s, surgeons, residents, medical students (I’m just naming some specialties that I know mom-docs). In all honesty, I think its hard just to be a working mom of any type. But, people do it. Children survive and succeed. I love medicine and patients and surgery and I LOVE being a mom. I’m just going to keep doing my best, using my support systems, asking for help and praying that I do this right.

Also, I welcome any specific questions!

Rescue

I knew something was wrong. I knew I was a little more wound up than I should be, but I figured it was normal and that I should just keep powering through - no complaining, no asking for help, just keep moving forward. Meanwhile my thoughts were CONSUMED with thinking about how we were going to manage as a family in 7 months when I leave the lab. We still only have one car, we have no family here to help, my husband’s work has gotten more demanding and I am doing so much stuff now for my daughter - how could we manage if I did less. I thought and worried about this constantly. I even had dreams about it (when I got to actually got enough sleep to have dreams!). This in addition to my constant running thoughts of what to cook for dinner, laundry, when the next feeding is if we’re out, if I packed enough snacks, if the yogurt caused the diaper rash, etc. Then, this weekend, at a medical student mentoring function the wife of one of my attendings pulled me aside as we were headed out, and after about 5 minutes of talking to me she took my diaper bag from my hands, handed it to my husband, and asked him to take my daughter home.

“White or red?” Red.

Sit down, drink, breathe. These were her commandments to me. She saw something in me - a crazy, hormonal, new mom look. Apparently I literally was no longer fully inhaling and exhaling. She saw in me what she remembered in herself just a few years ago. “Don’t quit your program” she told me. I had been seriously considering this over the past week. Even looking at jobs online.

Then came the questions. When had I slept more than 4 hours in a row? - no idea. When had I taken an hour to do something for myself? - couldn’t remember. Do I let my husband help me enough? - nope. Things have to change. Together we sat down and made a plan. Figuring out exactly what help I will need and finding ways to get it. She gave me resources, insight and direction.

I spent a few hours at her house and watched a light and silly movie while eating oreos and ice cream. No one was allowed to bother me.

She is a surgical subspecialist and her husband is a surgeon. She knows what I am facing. She put into words so many of my frustrations and fears. The next morning on my Sunday walk with my daughter I felt like I could finally breathe.

Dear American Board of Surgery (a rant that may get me in trouble...)

NOTE: The communications manager for the American Board of Surgery responded to the post below with an assurance that the leave policy for medical or maternity has not changed. The quotation below was sent to program directors yesterday which lead to the misinterpretation. I decided not to delete the entire post however because I think it still brings up relevant points about leave during residency. I apologize for any problems caused by the post but I am happy that the issue has been cleared up.

Today, after having a nice conversation with a fellow mom/surgery resident about trying to achieve life balance and how much we are committed to being surgeons, I went back to my desk to find this in my inbox:

“48 Weeks of Full-Time Experience Required. We require all residents to complete 48 weeks of full-time experience in each clinical year. No more than four weeks of time off is allowed per year, regardless of the reason.”

Now this is an amendment to the previous rules that allowed 46 weeks in some years for different reasons - illness, maternity leave, etc. However, apparently the almost exclusively male American Board of Surgery has decided that in 2011, the most progressive move for them is to make surgical residency even harder for women if they are crazy enough to want to have a family! Seriously! I own my choice to be a surgeon. I love it, I can’t imagine myself doing anything else. But I am also 31 years old, and I own my choice to have kids. I will do both, it is hard but it can be done. Women surgeons are a valuable and necessary asset to the practice of surgery and as a result of biology, many of us who would like to have children have to do it during training. I do not apologize for my desire to both be a surgeon and a mom. I will take my call and operate and do whatever. Is it too much to ask that I be given a remotely appropriate amount of maternity leave while forfeiting my vacation and any travel to meetings. Many residents already take less than 6 weeks of maternity leave just because they may have to fly to interviews and only have 5 or 4 weeks remaining. This new rule will leave women with 2 or 3 weeks of maternity leave. We would never ask a patient to perform the tasks we do 2-3 weeks post op. LEAD BY EXAMPLE!

be better, be innovative, be smart, be equitable, be accountable. This is ridiculous. Stop being unrealistic about reality. I will make a great surgeon. So will/do lots of women with kids and people who have to interview for jobs and present at meetings and would also like a week of vacation or who may just once need to stay home with a sick kid so as not to destroy the career of their spouse in order to meet your rules. Grow up ABS. Figure out ways to train surgeons more efficiently. We work 90 hours a week (yes, I said 90, 100, 80, 60 pick your number), we care about our patients, we care about being good surgeons - figure out a way to make that happen with humanity and 2 less weeks.

Not just us anymore

I had planned to write about my first post baby overnight call which occurred a couple of weeks ago. Long story short, I survived, hubby survived and my little peanut survived. I felt good to be back in the hospital and thankfully it really was like riding a bike, everything came back to me (FYI - I actually can’t ride a bike, but that’s another story). I may still write about it later, because I did gain some nice insights, however, now as I get ready for my next overnight call and a potential procurement call, I decided to write about this new feeling of accountability.

I have one more year left in the lab and I just started taking overnight ICU call twice a month in order to keep my feet wet. Last week I was asked if I would like to to cover some organ procurement calls as well. Initially, I wanted to jump at the opportunity (I’m interested in transplant surgery). However, when thinking about the burden middle of the night procurement puts on my hubby (especially with one car), I decided to table it unless they were really in a bind. Then, I kept thinking about it. And suddenly I was paralyzed about the thought of getting on a random, unregulated jet in the middle of the night with a baby at home. I’ve flown on a number of procurements in the past and I love riding in the jet. I love the free meal we get on the ride over, the much needed nap on the way home, and the urgency of getting organs back to help save someone who has been desperately waiting for them. However, now all I could think of was the danger of these jet journeys. What if I crashed? How could I be so frivolous with my life and safety? Even while on call, I find myself being a LOT more diligent about wearing my PPE and more being careful when putting in lines. A fellow resident is currently suffering on antiretrovirals after being stuck with an open bore needle of an HIV patient - one of my biggest fears. Now, these fears which were sort of trivial, in the background, part of the job fears have moved promptly to the forefront of my mind. I now feel as if I’m not just taking risks for me and my grown adult husband. Now the risks affect my innocent child.

I don’t really know how to deal with this new feeling of accountability. Specific to the risks of being a transplant surgeon (flying and Hep C) I plan to follow one of my husband's suggestions of finding Pauline Chen and asking her! (Yes, he, the non-medical one, knew about Pauline Chen!) I enjoy my work and I fully understood that there were some occupational hazards when I signed up. However, in the meantime, I wonder how others feel about the things we expose ourselves to at work and how that affects our children.

Triggers

The first time it happened I was an intern. I was starting the first day of a week of vacation after a 6 month straight spell of no vacation and few full weekends. I had just finished one of our more demanding services and had been up until 1am finishing up notes. I woke up late Monday morning - after the sun was up - and got in the shower. It was a bright, beautiful sunny day! Then, about 5 minutes into this glorious long shower I started BAWLING!!!! Just the day before I heard about a patient that I’d taken care of off and on all year - she had died in hospice earlier that week. She was a patient who I got to know well. I got to know her family. I was devastated but never really felt it because I was just way to busy. Well, five minutes into my vacation shower I started to feel it. I started to think of all the patients who had died - oncology patients who fought hard to the end, sick kids in the PICU, bad trauma patients, EVERYTHING!!! I cried for like an hour! Then I got myself together, and went out for breakfast.

Well, this morning, I was driving to work. I had just dropped my super cute daughter off at daycare and I was having a good morning. Then, on npr there was a story about poet Dean Young who had just received a heart transplant. In the interview he talks about what it means to receive a heart from someone - in his case a 22 year old college student - and suddenly I start crying. A patient I took care of died over a year ago suddenly and very dramatically after being totally stable from his heart transplant. It was a heart I helped procure. He was one of the kindest patients I had ever had. He was young and so happy about the new life he was about to begin. I had a hard time with his death last year but I thought it was behind me. However, here I was, in my car, crying for this patient. I knew I needed to write about this, the thought of writing it out is part of what got me to stop crying so that I could get out of my car and go to work. How do we deal with the crushing losses we are a part of? How do we stay human and also stay sane?

What do we owe?

I recently had a discussion with fellow residents, their spouses and friends at a dinner party. We ended up discussing the difficulty of balancing family and a surgical career which brought us to a discussion about two recently graduated female residents who both have young children. They both started out residency very similarly. I had the pleasure of working with both of them and they were awesome leaders and had great technical skills. Both were ironically interested in the same very demanding subspecialty and had done everything necessary to secure top fellowships. Then they both had kids during residency. One went on to pursue her very demanding fellowship and is currently doing well and loving her job. The other finished residency and is now a stay at home mom and also very happy. When we brought up these very divergent career paths it started a discussion about what doctors owe society. One person commented that there is a significant societal costs of training a doctor. In addition, there is a surgeon shortage and therefore a responsibility of those trained as surgeons or any type of doctor, to actually practice medicine. I was surprised by the strong feelings about this issue and felt that personal and family decisions are based on more than these large scale societal issues. Yes - the resident that is not currently practicing as a physician represents some loss to the society. But, I didn’t feel she owed anything to society. She worked hard through medical school and 7 years of residency. She took care of many patients during that time and devoted much of her life to it. In my opinion we all have a right to choose.

What do you think?

Opportunity Costs

As a trained economist before I started training to be a doctor, I often think in terms of “rational decision making.” In economics, all of the basic models are based on free markets and rational decision making. One key component of making rational decisions is determining the opportunity costs of one decision versus another. After picking up my daughter from daycare yesterday, I (for some odd reason) started thinking about opportunity costs and the difficulty of actually quantifying it in real life - if only I could assign a real value to what I give up with the decisions I make.

Other people may not have such a hard time with this. My husband and I actually started hanging out because I took 30 minutes to make a vending machine selection. I headed down to the basement with a definitive plan to buy twizzlers, but once I realized that this particular vending machine also had sour straws (a blast from the past), I simply could not decide if buying twizzlers was really worth giving up sour straws. As I agonized over this very important decision, my future husband had time to sort two loads of clothes, put them in the machine and wait to add fabric softener. When he saw I was still standing in front of the vending machine, he asked if I was okay, suggested sour straws, and the rest is history! Obviously, my inability to assign a value to sour straws has little consequence in real life, in fact it worked to my advantage since I got a husband out of it. However, when it comes to big decisions I am often paralyzed in trying to decide if my decisions are worth what I lose.

I can’t decide what specialty to pursue, I can’t assign value to the time I will give up with the additional training or the additional demands of one specialty over another. I can’t decide if I honestly think I can finish my surgical residency or is the cost of the time I will lose with my daughter too great. I can’t decide when and if I should have more kids. I can’t decide if my husband should really go for that higher paying job in a city 2 hours away, and I know there is no need to make all of these decisions all at once, but I can’t stop thinking about what I’m giving up.

One of 'those' moms...

I just got back from a trip to the ER. In my defense, it is our first trip to the ER, although not the first time I’ve freaked out about the health of my little one. My daughter is a “happy spitter.” She literally goes through about 8 bibs a day and spits up with a smile on all of our clothing. My weekday morning routine involves leaving my clothes by the door and walking around in a t-shirt until she’s in her carseat in order to avoid multiple wardrobe changes before getting out of the door. So, this weekend, as my baby spit away I didn’t think much of it. However, she was having an unusually cranky day and flipping out every time I tried to breastfeed her. Then around 3pm, while my husband was walking around with her, he called me over suddenly to see her bright yellow copious vomit!

I initially tried to be cool. I specifically try hard not to flip out in front of my non-medical husband so that I don’t freak him out. However, I was pretty sure I just witnessed some bilious vomit in my already fussy child. To add to this story, she also hadn’t had a BM in 2 days! I sent a quick text to a friend and fellow resident to make sure I wasn’t being a crazy mom - and she quoted to me one of our surgical mantras - “bilious vomit in a baby is a surgical emergency until proven otherwise.” Off we went to the ER.

Being the doctor in the family before my daughter was born, wasn’t too hard. I get calls from my parents or in-laws about aches and pains and mammograms and colonoscopies. I feel happy to be able to help them navigate the sometimes confusing medical landscape. However, as a mom, this knowledge is clearly both a blessing and a curse.

My daughter was fine (after being subjected to an upper GI series complete with a stream of radiation and a belly full of barium). I watched the study as it was done. The radiology resident and attending reviewed everything with me on the spot. The pediatric surgery resident and attending on call stopped by to check on us and also looked at her films, and again assured me that I wasn’t crazy to bring her in. But all I felt was guilt as I looked at my little peanut strapped to the table and whimpering. I thought of her poor little irradiated ovaries courtesy of doctor mom.

I cried a little on the way home as my husband tried to comfort me. Although he didn’t know initially why her vomit was yellow, he assured me he was just as worried about it. He held my hand as I told him I felt like a bad mom. I was so happy that she was fine, but felt instantly silly for being so worried. I just hope in some way my knowledge will benefit her, not just cause her to be subjected to extra probing and prodding.