Dandelion poetry

We brought dinner to the beach last week, and afterwards we walked out to the dock and played along the shore. Leif found a cluster of dandelions gone to seed and hunched over, snapping the hollow milky stems and double fisting his prize.

"I'm going to make a wish!" he said. "I wish for . . . " I could see him searching for something extravagant. "A chocolate cake!" he said expansively.

puff puff spit huff spit puff

"I'm not going to blow anymore. I'm just going to whack the wishes off now," he said, striking the fluff balls against the railing, then plucking them apart manually. "Look - a school of wishes!" He watched them drift off in a hazy clump. "Hey! The wishes are all hugging each other!" And then he spotted some goslings and trotted off down the beach.

How wonderful to wish for chocolate cake. To have to think hard for something to wish for, to have all your needs met, to have no cares or sickness or worries to wish away.

For me, my children and their pure, unspoiled interactions with the world are the most potent antidote to the suffering I witness at work and sometimes carry home with me as a little black cloud over my heart.

Baby names

Warning! Your name or the name of someone you love may be disparaged in this post. Read at your own risk.

It boiled down to two possible names for my daughter: Claudia or Ariana.

Pete wasn't keen on Claudia. "Would you name your son Claude?" he asked.

"No!"

"Then why would you name your daughter Claudia?" he asked practically.

Because I love the name. It's beautiful, it's solid, it's got years behind it, it's not overused. And yet, something didn't quite sit right about it. Finally, when I looked up the meaning, it all came crashing together: Claudia means lame. Of course - from the Latin claudus, from the same root as claudication. I was mortified that this hadn't been immediately obvious to me.

As a physician I'm more finely attuned to the medical implications of names than most, and I don't expect others to associate Claudia with vascular disease. But the name had been spoiled for me. Ariana it was.

Having narrowly averted my own baby naming fiasco, I am sympathetic to parents who inadvertently grant their newborns medically inadvisable baby names. By which I mean, I may inwardly gasp but I keep my mouth shut.

I met a little girl recently named Nevis. Maybe to her parents the name conjures up the beauty of a Caribbean island, but to me, well, she was a living, breathing mole.

Then I came across a variant spelling of Kyle, a name which until then I had considered benign. Chyle is a milky fluid consisting of lymph and emulsified fats, formed in the small intestine during digestion - not a preschooler.

Tanner reminds me of the stages of puberty, Addison warrants an endocrine referral, Lance is asking to be incised and drained, and Brady needs an ECG. 

I can medically bastardize most names, but that doesn't mean the general public can. So I don't recommend that parents fret over the medical implications of their name choice. Unless they're planning for a medical career for their child.

Because Melena isn't going to get past round one of the medical school selections process.

My aptitude for family medicine: poor, apparently

I did the University of Virginia medical specialty aptitude test purely for sport recently and was startled to learn that of 36 medical specialties, the one I am least suited for is family medicine.

I'm not surprised that family medicine did not rank first. I chose it only partially because of any natural inclination toward it, and mostly because the training and practice of it meshed best with other priorities in my life, particularly raising a family. What did take me aback was that it occupied the very last spot on the list.

Pathology and radiology ranked at the top.

From time to time I flirt with the idea of returning to residency, but what it comes down to is that I would rank my current job satisfaction as a family physician at a 9/10. Is a chance at boosting that to a perfect score worth three more years of residency, a massive reorganization of family roles, a significant reduction in my time spent with the kids and a hefty kick in the pocketbook? I don't know.

William Maxwell, fiction editor of the New Yorker from 1936 to 1975, said upon retirement: "For nearly forty years I have shaved with pleasure in the thought that I was about to come to this job." How I love that quote. What a gift, such perfect happiness with one's work.

Of course, while he was shaving his wife Emmy was likely frying up the breakfast bacon, readying their daughters for school, preparing for a day of housework and granting him the enviable ability to be single-minded.

That is what I find most difficult about mixing medicine and motherhood: the diffusion of focus.

My work in refugee medicine is profoundly rewarding; raising three little ones even more so. The two have proven to be compatible. And yet at some point the efforts put into one require sacrifices made of the other. There simply are not enough hours in the day for me to invest what I wish I could into both spheres. I have erred on the side of mothering, and while I do good work at the clinic, my career trajectory has been modest.

I say this cheerfully. So far, I don't regret any decisions I've made. And every day presents an opportunity for new and different choices. Maybe one day, when the kids are a little older, I'll alter my career track or return to residency.

But for now, and maybe forever, a 9/10 is good enough.

(Cross-posted at my personal blog.)

Fired

It was 7:30 AM, the front door was open in readiness for the five of us to brave the morning chill and head for the van, and I was crouching in the front entrance hurriedly attaching boots and mittens to my dawdling four-year-old.

I ushered him out the door, entreating him to pick up the pace as he ambled down the walkway, stuffing pinecones into his hoodie pockets. Once in the van, I had to remind him several times to climb into his car seat, as I strapped in his sister and deposited backpacks in the trunk.

I read once that children have no sense of urgency, that it's a waste of time to try to make them hurry, and I must say that in my seven years of parenting, truer words have never been spoken.

However, from time to time I can't resist trying to instill the importance of efficient house-departing routines into their little heads, and so this morning I told him earnestly, "Mommy and Daddy can't be late for work. If we are, we could be fired!" Unlikely though that scenario is, against the backdrop of today's economy the statement sounded sufficiently grim.

My words seemed to have an effect. I had his full attention. "They would set you on fire?" he asked with real interest.

Five happiness-inducing habits

A few months ago the UK government's science and technology think tank Foresight concluded its Project on Mental Capital and Wellbeing.

The report includes an evidence-based list of five simple daily habits for mental wellbeing. These activities, which are likened to five daily servings of fruits and vegetables, are recommended to every person in the UK:

1. Connect with other people, be they family, friends, colleagues or neighbours.

2. Be active. Go for a run, walk around the block after dinner, putter in the garden or take the kids sledding.

3. Take notice. Be aware of the details of daily life - the beautiful, the humorous, the surprising. Be conscious of the world around you and your reactions to it.

4. Keep learning. Take a photography course. Learn to knit. Tackle a work problem in a different way.

5. Give. Show kindness to others. Volunteer. Support a charity. Donate blood.

The report, the result of a two year study involving over 400 international experts, concludes that making these five activities a part of daily life can have a profound impact on people's happiness.

These recommendations crystallized a few things for me.

First, they offer an explanation for why a day at the clinic is almost always extremely satisfying, whereas a day at home with the kids must be carefully crafted to provide close to the same level of happiness. I'm not talking about long-term gratification or blissful moments, where at-home mothering easily holds its own. I'm referring to my state of mind at dinner time, when I review the day.

Medicine has an advantage in that it inherently ensures that I connect with colleagues and patients, take notice of the details of others' lives, learn continuously and give to others. I tick off four of those five boxes just by going through my day. I check off all five when I hunt for free parking and walk eight blocks to the clinic.

Staying home with the kids, few of those five activities occur spontaneously. When the path of least resistance is followed, a length of time at home seems to naturally tend towards isolation, inactivity, monotony and boredom. Most of my days at home are pleasant ones, but only because of the work I put into making them so. Scavenging in the woods, photographing ruddy cheeks and muddy boots at the beach and meeting up with friends for afternoon tea at Honey's Doughnuts make for good days, but require concerted effort on my part.

Second, the list validates the time I take during the day for pleasurable pursuits. Knitting while the kids nap, bringing The Element of Lavishness along to the beach and fiddling with a setting on my camera during lunch are often accompanied by some guilty twinges. Shouldn't every moment with my children be devoted to them? And any spare ones be spent reading Parkhurst Exchange?

But I see that all of my hobbies include several of the five happiness-inducing habits: photography involves learning and taking notice; writing requires taking notice, connecting with others and learning; and gardening entails being active, learning and taking notice.

Now I can articulate why tucking away pockets of time for these activities during the day is not frivolous: it may quite literally preserve my sanity.

(This is a combination and reworking of two posts from my personal blog.)

Good doctor qualities can be liabilities in family life

"These are attributes of physicians that serve them well professionally," said the presenter,* flashing a list onto the giant screen:

• control
• perfectionism
• competitiveness
• dedication
• perennial caretaker
• emotional remoteness

The family medicine conference attendees nodded and murmured in recognition, and he continued, "And these are the attributes of physicians that are liabilities in family life." He flipped to the next power-point slide:

• control
• perfectionism
• competitiveness
• dedication
• perennial caretaker
• emotional remoteness **

As the audience burst into appreciative, rueful laughter, I was struck by how neatly my domestic difficulties had just been explained.

I've often noticed that the very qualities that enable me to do a good job at the clinic frustrate my efforts at caring for my family and our home.

My days at work are organized exactly as I like them, from the length of patients' appointments to their medication lists to the position of the stapler on my desk. I interview patients, I examine them and I write prescriptions, requisitions and orders. I don't determine what walks in the door, but I manage every aspect of the problem once it's presented to me.

My life at home is an unpredictable, distracted mess. Much as I'd like to slot in a toddler bum wipe at 10:15 and keep the school backpacks stowed in the hallway closet, urgent requests and displaced things greet me at every turn. I may be the one guiding the day in a general sense, but the thousand details are determined by three messy, spontaneous children.

The satisfaction of measuring performance by objective standards at work cannot be achieved in the same way at home. I can pick up the faintest of heart murmurs, I can suture a laceration beautifully, I run my clinics on time, but how do you grade yourself on raising a daughter well?

At the clinic, I take on challenging work, complete it, and turn to the next diagnostic puzzle. But at home, I repeat menial tasks thousands of times, while others undo them.

Like most physicians, I thrive on competition. It's always motivated me, and winning is powerful affirmation. But motherhood is a different beast from the MCAT, pharmacology prizes and residency applications. No one's going to come out on top, and comparing yourself to other mothers is futile and dangerous ground. The competitive mother after gold stars is the one no one wants to be around.

The only item on the list to which I can't relate is emotional remoteness at home. My problem is the opposite. Because I am so emotionally controlled at work - probably because I hear the very moving stories of refugees every day - I tend to let any restraint slip away when I walk in the front door in the evening. I can be extremely irritable, though no one at work would ever believe it. Once, when I was being particularly foul, Pete gently suggested, "I think you should try to treat us like you would your patients."

I want to be a great doctor, and even more, a great mother. But if the qualities of one can be the undoing of the other, no wonder it feels such a struggle some days.

*Dr. Paul Farnan, St. Paul's Hospital CME, November 2008

**Ellis and Inbody, 1988

You know you're a physician-mother when . . .

. . . your first inclination after diagnosing your child with fifth disease is to photograph it for your private collection of pediatric exanthems:

And your next thought is gratefulness that the diagnosis does not preclude daycare attendance. Alarming though that will be to the non-medical parents.

(For the uninitiated, I posted a summary of fifth disease here.)

A full day's work by 9 AM

I start work at nine. I get up at six.

Even though we make lunches and lay out everyone's clothes the night before, we need that much time to get all five of us packaged and delivered to our respective places of work and play in good spirits.

I shower, dress and oversee the kids pulling on play clothes or school cardigans while Pete makes breakfast. There's a flurry of smoothing hair into pigtails, stowing rain boots in backpacks, pouring coffee and hunting for library books. We drive Saskia to before-care at her school. Then we head over the bridge and into the city, where we bring Ariana to daycare and Leif to preschool. Finally, Pete swings by my clinic and drops me off on his way downtown. I use the half hour before my first patient to review lab results and catch up on work email.

At two minutes to nine my colleague flies through the door, unstrapping his bike helmet. He's forty and single. His hair is a mess, he's out of breath and he seems exhilarated. "I woke up ten minutes ago," he announces. "I just rolled out of bed and out the door!"

Watching him hang up his reflective jacket and rummage in his briefcase for a granola bar, I vaguely recall a life where my only real responsibility between waking up and presenting at work or school was to put on clothes.

Now, I can hardly remember what it's like to show up at the office without feeling like I've already done a full day's work.

Stains

Pete and I were getting ready for work when he set down the iron, inspected his pants, and said, "Not these ones too! All of my pants have grease stains across the thighs."

"So do mine!" I told him. "Grease stains, mid-thigh."

We puzzled over the consistent appearance and placement of the marks for a few minutes, and then it dawned on us. The range of the stains exactly matched the heights at which our two- and four-year-old plant their little hands when they grab us.

I've been a mother for seven years, and I don't think I've ever gone into work wholly clean in that time. I've had breast milk spit up on my shoulder, crusted rice cereal on my shirt cuffs, teething biscuits cemented to my pant legs, apple juice splash marks on my shoes and now a tideline of grease across my thighs.

Maybe I should go back to wearing a white coat. Do they come in floor-length?

(Cross-posted at www.freshmd.com)

Doctor, you are hot!

I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:

Zardari then called her "gorgeous" and said: "Now I know why the whole of America is crazy about you."

"You are so nice," Palin said, smiling. "Thank you."

And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."

I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.

I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?

I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.

But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.

The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?

What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?

To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.

But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.

I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.

Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.

None of this is to say that I am as gorgeous as Sarah Palin.

Decluttering

For me, the key to productive, contented living is decluttering.

Life seems to default to an excess of possessions, activities and pursuits. It takes intention and effort to organize a distracted state of living into one that is simple and peaceful. Decluttering involves making do with the minimum required to achieve your goals, and systematically winnowing out what isn't earning its keep.

I apply decluttering to every aspect of my life. Working at two clinics had introduced unnecessary complexity to my week, so this summer I resigned at the HIV clinic to exclusively practice refugee medicine. I focus on three hobbies: gardening in summer, knitting in winter and photography year-round. No one looks inside my closet without remarking that it's the most pared down collection of clothes they've ever seen. My kids have a modest selection of thoughtfully chosen, well-loved toys. I thin my patients' charts ruthlessly. My blog has the cleanest layout possible and I haven't added any extra applications to my Facebook page.

Learning to say no is a major part in decluttering the calendar. (I was 30 when I finally learned to do this well.) When I do make commitments, I make them for a defined period of time. I'll join a knitting group for one winter, for example, or keep a blog for one year. When I take on a new position at work, I quietly decide up front for how long I'm willing to commit. At the end of the given time, I reassess. That way every obligation has an expiry date and can be renewed or replaced.

To use my time most efficiently, every weekend I plan the week ahead, including penciling in activities for my downtime. My kids are all in bed by 7:00, and that's three full evening hours for me - if I can escape the call of the Internet, probably the most distracting, time-wasting, mind-cluttering force out there. Some useful tools to make Internet use efficient are feed readers, which eliminate the need to visit blogs to check if they've been updated, and Firefox's pageaddict, which monitors the time you spend at different sites and allows you to set restrictions on your visits to inane, yet compelling sites.

Decluttering is a way of life. This method agrees completely with my personality, and I purge, streamline and consolidate with pleasure. Cutting out the extraneous allows for the clutter I do enjoy: a house overflowing with kids and a slate full of patients.

(For more on productivity, visit blogs zenhabits, unclutterer and 43 folders.)

Tucked in

As a resident running the family practice ward, I would come up to the unit in the evening to finish dictations and complete paperwork. At the end of the evening, I'd ask the nurse if there were any patients she was concerned about or orders she wanted written. Having tied up all the loose ends, I'd head to the call room.
I distinctly remember how I felt walking down the corridor at eleven at night. The ward was hushed and still, with the patients' lights off and just one or two staff at the nursing station. Heading back to the elevator, past rooms of four beds apiece with patients curled up under blue cotton blankets, I felt maternal. Or how I imagined maternal would feel, as I hadn't had a child yet.
It was a powerful emotion, a combination of affection and respect for my charges, the satisfaction of having managed the day's problems, the weight of responsibility, and humility and gratefulness for my own position.
These days, as I round on my own children every night before bed, the flood of feeling as I adjust the covers over small sleeping bodies is remarkably similar.
And I realize now that those late nights walking down the corridor of 7B, the sense was of having tucked the kids in for the night.

Fracture

My three-year-old broke his arm this weekend.
Technically, he fractured his left radius and ulna, but when I saw him running toward me with a sickeningly unnatural curve to his forearm, I said only, "He broke his arm." I immediately noticed that I didn't use medical language, but at that moment I was solely a mother.
We were visiting family, and Leif had fallen from a four-foot slide. As we headed to emergency, minutes up the road, he kept insisting through his sobs that he needed nothing more than a band-aid. "That always made it feel better before!"
Lying on the gurney in the emergency bay, much more comfortable now with his arm draped carefully over his chest, Leif's chief concern was that the IV not interfere with the (temporary) tattoo on the back of his hand. "Why don't you put it here?" he suggested to the nurse, gesturing to his shoulder.
Hooked up to the monitor, he announced cheerfully, "That's my heart. Did you know it made that little beeping sound?"
I don't think he's ever been cuter. Of course, at home his running commentary has to compete with his two sisters', and we're often distracted by making dinner or driving the van or whatever activity we're engaged in. But lying on the cot, with both his parents directing their full attention and concern at him, the kid streamed charm.
The physician arrived and asked Leif what colour cast he preferred: "Blue? Green? Soccer balls?"
Leif considered the options and replied, "Pink." The lad doesn't have two sisters for nothing.
"Your father will be relieved to hear that we are out of pink casts," replied the physician. "But we do have red."
Leif had to be put under conscious sedation to have the fractures reduced, and as they prepared for the procedure the nurse measured a tiny blue airway against Leif's jaw. "Do you like the colour blue?" she asked him pleasantly.
"What's that for?" asked Pete.
"In case he stops breathing," she replied matter-of-factly.
Once Leif was sedated, hooked up to monitors with on oxygen mask on, his little arm being manipulated by the doctor, I heard Pete make a small distressed sound behind me. I was thinking purely medically at that point, watching the effects of the ketamine and noting the doctor's technique.
I didn't volunteer that I was a physician, as I didn't see how it would influence Leif's care, and there was no natural way to do it. But eventually the physician asked casually, "So, are one of you in health care? Nurse? Doctor?"
"I'm a physician," I admitted.
There was a chorus of Aha!'s, and the remark that we were unnaturally calm.
In fact, I felt grateful throughout the visit. Grateful that in six years of parenting this was our first emergency visit; that the injury was relatively mild; that there was no one to blame for the accident; for the family that visited during our short stay and took care of the girls; for the availability of excellent medical care (working with refugees makes me especially appreciative of our system).
As for Leif, he disregards the cast completely. He's not the least bit frustrated to be constructing forts with one hand, and has been climbing the furniture as usual and threatening to break the other arm.
When I gave him his grape-flavoured ibuprofen this morning, his baby sister asked for some.
"This medicine isn't for you," Leif told her, "It's only for little boys with busted arms."

Where on earth is the head?

When I was 37 weeks pregnant with my second child, we moved one block up the street. The day we moved, my husband flew to London on business. This, my friends, is the formula for induction of labour.

I spent the next few days hauling boxes around and arranging furniture. After a particularly vigorous session wrangling the couch, contractions began. When they persisted for six hours, I called Pete and he arranged a hasty return flight.

Once he was back on Canadian soil, the contractions ceased. I was embarrassed and hoped desperately that the baby would arrive in the next day or two so that I might redeem myself. I didn’t want Pete showing up at his office on Monday without something to show for cutting short a business trip.

I was relieved when labour began in earnest two days later. We headed off to bring our three-year-old to our friends' place, but I was so uncomfortable in the car that I asked Pete to swing by the hospital and drop me off first. I brushed off his offers to assist me inside and made my way up from the parking garage alone, stopping every two minutes to lean against the wall and breathe.

Now, I’m a polite and reserved person, even in labour. I don’t scream, I don’t curse and I take pains not to let anyone else feel awkward witnessing my discomfort.

As I made my way into the maternity ward, I ran into my obstetrician, with whom I had an appointment that day.

“I don’t think I’ll be able to come in to see you this morning,” I told him apologetically.

“You have a woman in labour to attend to? No problem, we’ll rebook your appointment,” he replied pleasantly.

“I’m in labour!” I corrected him.

As he looked at me skeptically, a contraction began and I excused myself and turned towards the wall.

He gave me a keen look, murmured, “The leaning-against-the-wall sign,” and directed a nurse to show me into the assessment room.

I lay on the exam table, in the standard light yellow gown, waiting for the resident, with the contractions steadily becoming more painful. When a junior and senior resident stepped into the room, I asked politely for analgesia.

They were busy manoeuvring a portable ultrasound. “First the ultrasound, then the exam, then we talk about pain control,” the senior replied briskly.

“Ultrasound?” I asked.

“We had two undiagnosed breeches recently,” she explained. “So we’re doing an ultrasound on every patient to establish presentation.”

She ran the probe over my belly. With supreme effort, I kept from writhing in agony with each contraction.

She began a detailed teaching session with the junior resident, reviewing the operation of the machine and the findings on the screen. “There’s the back,” she explained, gliding the probe down my abdomen and over my pelvis. Then, muttering to herself, “But where’s the head?”

The nurse, who was clearly annoyed by the residents on my behalf, noted that my face had turned white and announced that she was going to fetch the obstetrician.

“Could I please have something for pain?” I asked the resident again, more urgently.

“Ultrasound, exam, analgesia,” she repeated, irritated. Then, swooping the probe over my belly once more, “Spine . . . where on earth is the head? That is just the strangest thing.” The residents were puzzled.

I knew exactly where the head was. Crowning. I had no choice but to be rude. “I have to push,” I announced. At that moment the obstetrician walked into the room.

“How dilated is she?” he asked the resident.

“I haven’t examined her yet,” she replied. “We can’t find the head on ultrasound.”

He berated the resident for not doing the exam first, and she defended herself, “But I had no idea she was so far along!”

“I’m going to push,” I warned.

As I was rushed down the hall on a gurney to a labour room, I was so focused on refraining from pushing, that it only briefly registered that Pete was not among the mass of people swirling around me. Frankly, that was the least of my concerns at the moment. In Room 11, the nurse fumbled with the nitrous oxide, only to announce that the mask was missing.

Then, with not even a Tylenol on board, with my husband missing in action, I pushed out my son with two pushes.

Ten minutes later, as I lay with a bundled 6-pound 5-ounce Leif Jacob nestled in my arms, blissfully happy that baby and I were well, Pete tentatively entered the room. If he hadn’t said anything, I would have assumed he had had trouble with traffic. But he felt compelled to admit that he had thought he had time to spare, and had popped into Starbucks for a latte and a chocolate croissant as his son entered the world.

(Cross-posted at www.freshmd.com)

Fathers and parental leave

"Working at the downtown east side clinic was a walk in the park compared to being at home with the kids," I commented to someone recently, referring to my experience when Pete took parental leave a few years ago.

"Your job must not be that hard, then," he responded.

That is exactly why I think it is so valuable for fathers to experience being the primary caregiver to their children, if only for a few weeks.

When our second child was born, Pete took ten weeks of parental leave. "I'm going to take Saskia [the three-year-old] to the beach every day," he told me happily as he planned his time off.

"What about the baby?" I reminded him.

"Oh, yeah." Pete paused to consider this. "He can come along too."

I couldn't fault his ambition. I was the one who had planned to learn to play piano, take up sewing and audit an architecture class during my first maternity leave.

After two weeks of caring for an infant and toddler, laundry, cleaning and meal preparation; of cycling through endless menial tasks, Pete began the countdown to his return to work.

"Five weeks down, five to go," he announced one night.

I did a mental calculation. "No, four down and six to go," I corrected him.

He was crestfallen.

Meanwhile, I was having a fantastic time at work. I clocked in at 8:30 and left at 4:30. It was civilized. I dealt systematically with one issue at a time. It was stimulating, an academic and clinical challenge. Every day I spent an hour eating lunch with a book in hand at a local eatery. I enjoyed the collegial atmosphere of the clinic. Nobody questioned the value of my work. And I was getting paid.

Being the one coming home to the kids, in time for dinner, gave me a new view of domestic chores. I came to greatly appreciate two things in particular: a path cleared from the front door to the kitchen, and a meal of any kind on the table. These days, on the three days a week that I stay home, I strive for that minimum, and some days I achieve it.

In many ways, Pete's stay at home wasn't comparable to my own. His was for a defined period of time, a matter of weeks. Mine is indefinite, making it more difficult to keep perspective. And postponing a career for a decade or two obviously has greater implications than a brief leave from work.

Still, those ten weeks gave him an empathy for stay-at-home parents that only time in the trenches can.

(Originally posted at www.freshmd.com)

Goat farming, return to residency or the status quo?

I work two days a week, and I'm home with the kids for three. Apart from a full-time stint when Pete took a ten-week parental leave in 2005, I've never worked more than three days a week since I finished residency five years ago.
You might assume that if I've maintained the same pattern for years, I must have found the perfect balance, requiring little review.
But a typical week of end-of-day comments to Pete looks like this:

• Monday: "I've been thinking of doing another residency. What would you think of staying home for three years?"

• Tuesday: "Let's move to the Island and take up organic goat farming. Think how much the kids would love it."

• Wednesday: "Work's been great lately. Maybe we should pick up another day of daycare and increase my work to three days a week. We could use the extra cash to pay for a cleaner and meals."

• Thursday: "I've been thinking maybe I should be home full-time while the kids are this young. These years will be done before we know it."

• Friday: "Why don't you apply to medical school? You could go into family medicine, and we could share a practice. One of us could always be home with the kids."

• Saturday: "I'd love to throw myself into work full-time, even just for a year or two."

• Sunday: "Our current arrangement really is ideal. I'm so grateful that I get to spend this much time with the kids. What other career would offer this flexibility?"

These suggestions, and many others, are never offered out of dissatisfaction, but out of creative optimism. An afternoon seeing prenatal patients makes me want to return to the clinic the next morning. But a morning spent hunting for crabs at the beach with the kids makes me wish for a long, uninterrupted string of just such days.
I don't consider the constant consideration of alternatives pathological. For one thing, when you're a physician mother, being yanked in several directions is the norm. For another, I think it's healthy to live with intention, frequently reviewing one's choices.
Before getting a new haircut, my personal rule is that I must want that cut for seven consecutive days. I apply the same basic principle to life changes. When rapidly cycling through ideas, best to sit tight with the status quo, unless an option eventually emerges as the better one.
My fantasy pendulum swings equally in both directions - increasing time at home and at work. The average of all ideas I toy with is exactly what I'm doing now.
Looks like for the foreseeable future I'll continue seeing patients on Tuesdays and Fridays, and spending the rest of the week sharpening pencil crayons and picking berries in the woods.

You didn't tell me you're a doctor!

Our painter, a fifty-something fellow, has done many jobs for us over the years. He works hard, grunting and thumping and wheeling the roller around whatever room he's working on. I commented once on the superb quality of his work. He responded kindly, "I'm sure there's something you're good at, too."

Months later, touching up our living room, he caught sight of my medical degree tucked in a corner of a bookcase. "You're a doctor!" he said accusingly when I saw him next. He felt deceived because I hadn't volunteered that information.

This has happened to me on many occasions, where someone who has known me only as a mother discovers that I am a physician. A neighbour is seated in the clinic waiting room and is shocked to see me with a stethoscope around my neck. A mother at the playground asks why I'm carrying a pager, and is taken aback when I explain that I'm on call for the clinic. The response is usually dismay, and I know it's because they are madly working to mentally recategorize me. They're disconcerted because they realize they've been using the wrong set of assumptions.

The response to both occupations bothers me. I resent being patronized as a mother, and I feel embarrassed when I'm congratulated for being a physician.

While doling out hot dogs and orange drink to my kids at the school barbeque recently, I remarked that the energy and enthusiasm of students made teaching look attractive. A teacher grasped my arm and replied earnestly, "And I'm sure you could do it, one day!"

What was I supposed to say? I just nodded and thanked her.

Cross-posted at www.freshmd.com.