Flowers for KC

Our fearless leader KC organized a meet up - first IRL (in real life) for MiM's in DC this past weekend. I can't remember the birth date of the blog because I wasn't here but I've been around for a few years.

It was small - we are a busy group so many couldn't make it but I got to meet T, Mommabee, Juliaink, m, and KC.

KC sandwiched us between two conferences - one in New Hampshire on education and another in Chicago on blogging. She coached soccer Saturday morning for her son then met us at the Smithsonian Museum of Natural History. It's her I want to write about here.

Although I hadn't yet met KC in person, she is an incredibly supportive ringleader for our unruly bunch. If I e-mail her a question at midnight I have an answer waiting on my phone at 6 am. She has guided me in the perils of people trying to pull you in to advertising a seemingly worthy cause just to promote a marketable item. She has listened to e-mail rants I would like to make online about working situations or frustrations, knowing that it would be inappropriate because they were too fresh in my head. It's better to turn that anger into thoughtful pieces once the mood has passed. And she probably does that and more for all the other MiM's here - that's a big responsibility.  She protects us like a guardian angel - she saw too many negative comments a few years back and made the commenting process less anonymous, not only for the writers and guest posters but to keep the community supportive and the commenters accountable.  When I write on MiM I'm writing to an audience, but I also feel like I am writing to KC since she invited me here in the first place.

Mentors are people that you encounter in your life that create a space for you to grow and flourish and learn. I've been lucky to have many, and I definitely count KC as one of them. I had seen her picture in our Big Tent discussion group, but I wasn't prepared for her huge presence. I say huge, but she is a petite beautiful woman whose Chinese roots are evident in her features; dark hair, tea-colored skin. She has a bright smile that made me feel instantly welcome in DC, a city I was becoming acquainted with for the first time. Her fashion sense is impeccable. I learned she grew up in a New Jersey town not far from where my boyfriend, who accompanied me on the trip, attended high school.

My emotions surrounding the weekend were enormous - I imagined breaking down upon meeting her but it was just like meeting the popular girl in high school you were so intimidated by but she turned out to be a really cool person. Her accolades, at a year younger than myself, are astounding. Woman Physician of the Year for creating this space. Three amazing children - I delighted in conversing with her older son about animals and following her daughter through a museum crawl space that took us to a display about common insects we reside with in our homes. Mommabee instantly charmed the youngest boy; if she was here in Arkansas I'd recommend her as a pediatrician in a heartbeat. KC's supportive husband whom she met in medical school was entirely focused on the children and not at all interested in being the center of attention at our meet up at the museum.

Dinner with KC and m Saturday night was incredible - we chatted about posts and long time followers whose comments we loved and future directions and personal goals. KC seemed to take the back stage - she did all weekend - I convinced myself it was by design to let us shine. When drawn out in conversation her words were sparse but invaluable. More substance than fluff. M asked her, "What is your favorite outcome of starting the blog?" Her answer was immediate. "The readers. Whether encountering them face to face, or through e-mail. When they tell me how much it means to them to have found it. How it helped them." It was almost 11 pm when I met my boyfriend at the Metro to head back to our hotel.

I reflected on some of KC's words at dinner on the Metro. "I am invested in creating a space for our contributors and guest posters to write about what they want, when they want to say it. I don't want to control the content, I want to support creativity. A space for people to just be themselves." I must admit, I've been angry at KC. Misplaced anger, derived from guilt over not writing for months when I have had trouble writing. Anger that she didn't hold me to my pledge to post once a month. Then intense gratitude when she welcomed me back into the fold when I was ready to write again.

After some fun spa time on Sunday morning I learned a little more about KC. She has blogged in the past about her husband's year long deployment to Afghanistan when her youngest was two weeks old and her older two were toddlers, but I learned more about the challenges and fears surrounding that time. Another mentor-worthy feat - the insurmountable becomes existence and manageable day to day. Because if you look at it from a distance, how could you handle it? I asked her, "So is it done? Is he home for good?" She replied, "No, he could be called out any time."

When T showed up for brunch Sunday morning with us, she was full of regret. "I wanted to stop by a florist. But it was closed. I wanted to bring you flowers in appreciation for all you've done for us." T lives close to KC - they have published many articles about social media and medicine together since they have met. Juliaink was a pleasure to meet - I got to tell her in person how much I loved a poem she wrote years ago. I couldn't help thinking during the brunch, what a perfect idea for a gift for KC. A flower. A mirror image of her - something that packs a powerful punch with its image and color and strength, all the time belying a fragility that lies within it - within us all.

She is more than a flower, though - she is the gardener here. She planted the seeds. She waters us and helps us grow and find our own voices and learn from all the amazing voices in this community. I have had many mentors in my life, fabulous in their different ways, but none shares the quiet but unyielding support of KC. Now that I've met her maybe I can get her off of this pedestal and be her friend.

Happy birthday KC. You deserve much appreciation. My emotion didn't come out in waterworks this weekend, but hopefully it can be conveyed in this post. You are an inspiration.

A bursting moment

We signed up the whole family to run our school's annual 2K/5K Family run this past weekend. Last year was our first year running it together; despite my protests at the time (I might die, go into rhabdomyolysis, etc etc given my baseline inert state since having kids), I ended up having a really fun time. It even got me into running regularly for the past year. Granted, I've been running short distances, around 2-3 miles at a slow pace, but I'm doing it 2-3 times a week without fail and have come to enjoy it. (Added bonus is watching TV shows while on the gym treadmill which I would never otherwise be exposed to, including Long Island Medium and Hoarders: Buried Alive. Fascinating.)

Being in better shape and actually used to running made me much more excited to run the 2K this time around. Also running it would be Jolie (9), JL (6), our au pair M, and my mother-in-law. I convinced my husband, an Ironman-distance triathlete, to do the 5K instead of running with us since he'd lap us anyway by the end. Our 3-year old would wait on the sideline with my parents.

Now, last year, JL ran with me while holding my hand the whole time. Yes, this was sweet, but making it physically more difficult to run. Believe me, I did not need any added difficulty. He told others after the race that maybe he could have won if he didn't have to run with (running-challenged) Mommy. Gee, thanks, kid.

At the start, everyone took off way too fast. I tried to keep up with Jolie and JL and keep them in my sights. JL, in particular, zoomed off- could not believe how fast he was going. I had to go much faster than my usual pace to catch up and run with him. We were flying and passing people. Probably about 3/4 of the way done, JL started to feel it.

"I need to walk!" he said. "My legs hurt!" "I'm tired!"

I switched to rally mode. "C'mon, JL! We're almost there! You can do it!"

He really wanted to walk. I told him he could walk, but that I would keep going and he could catch up to me later. This got him to push it out more. He didn't want to walk alone.

We kept running. He grabbed my hand. We ran for awhile like that. I kept cheering him on - Let's go, JL! Let's finish it! I know he was struggling. But, I also knew we were almost there.  Just a couple of more blocks and then we'd turn and see the finish line.

He was a trooper. He kept pushing it. We held hands. When we turned the corner and saw the end with the banners and the crowds, we dropped hands and he spurted ahead to finish.

We crossed the finish line within a couple of paces of each other - triumphant but totally spent.

We watched as others came through - a couple of his friends from Kindergarten and their parents. We saw Nana come in, we saw my husband come in for the 5K, then M and Jolie.

When the awards were announced, we heard JL's name announced for first place finisher of the 2K for his age group (6 and under)! He ran to the podium to receive his medal, and I could see his heart bursting with happiness. BURSTING.

This is a boy - the middle child- who is often in the shadow of his big sister and more-needy baby brother. He needed this moment.

As I watched him glow, showing his medal to everyone afterward, seeing that smile on his face, I was filled with a special kind of mothering joy. If I wasn't there alongside him, he would have likely given up, started walking, falling behind. And isn't this an amazing part of what we can do as parents? Being there, cheering them on, helping them do what they think they can not. Helping to make the moments that are filled with confidence-growing, heart-fluttering, self-celebrating pride.

For me, helping JL win that medal was the best Mother's Day present I could ask for. I am so glad I was there, helping him have a bursting moment.

Guests of the month

My husband and I made one New Year's Resolution for 2014 together: to have friends over for dinner more regularly. Whenever we do, we love it, and the kids have a blast. However, it has always seemed like a lot of effort to coordinate, to clean ("clean" underestimates the amount of prep our house needs to be able to be opened to the public), and it's just so much easier not to do it. Plus, we're introverts. Now, it's not like we are hermits or anything (although I don't really know what a normal social life with a family is), but we both agreed that having people over more would be good for our whole family. I'd estimate that last year we probably had people maybe 4 or 5 times, but we are aiming to host dinner once a month.

As of April, we've had four families over - including neighbors, good friends we don't get to see enough of, friends we haven't seen since grad school, and new friends from church. We are loving it. We've relaxed some of that need-to-have-a-perfect-house compulsion when entertaining - and no one has run out screaming yet. (Still have some degree of compulsion, I won't lie, but it's definitely less severe that it was. Think: overall order with occasional pockets of entropy. We have a butcher cart in the kitchen that is so hopelessly disordered from top to bottom, we joke about pushing that whole thing out the front door one day in joyful riddance, imagining it dropping off the porch stairs and going straight into the garbage truck. Well, half-joke. At least I'm only half-joking. We also still have zebra streamers up from a wild-animal-themed birthday party many moons ago that will stay up until they degrade on their own. I personally enjoy the added festivity, and will enjoy it until I can't stand it anymore.)

And the kids. They run around screaming like lunatics, chasing each other in pure joy, even with children they are meeting for the first time. (Don't you miss that?)

It has been surprisingly effortless to invite people, and we're always talking about who we're going to have over next.  So far so good. Reward to effort ratio remains favorable, and no sight of inertia setting in...yet. Having the house look presentable for longer than the 1 hour after it is cleaned every two weeks (sometimes the house destabilizes in 20 minutes thanks to 3 very talented children) has the added benefit of keeping me in a better mood. And, if we skip a month or two or three...no pressure. We'll take it as long as the motivation lasts.

On having an au pair

After doing daycare/preschool exclusively for a time (when we only had my daughter), a live-out nanny, and a live-in nanny at various times, we went the au pair route 1 1/2 years ago and couldn't be happier. It's just what our family needs right now. I wish I had known more about it earlier on, since it may have made life easier and richer back then. People may have had different experiences, but here's ours.

We've had two au pairs so far, and both turned out to be great matches for our family. The matching process reminds me a little of residency matching, but without the rank list. You search through au pair profiles, filtering by what's important to your particular family (maybe a strong driver or experience with taking care of multiple children or a particular religion), can read a "personal statement," watch a video they made to tell you more about themselves, scan their letters of recommendation, and their childcare experience. You can select  au pairs to interview (via Skype generally) and have a certain amount of time to render a decision whether you want to match with the au pair. The au pair must accept the match as well, and you agree on an arrival date.  It was a bit unnerving to select our au pairs, not knowing exactly how it would turn out in the end - would she like living with us? Would we like living with her? How would she be with the kids? Like residency matching, you go a lot by feel of a program and projected fit.

What we didn't anticipate was how much our au pairs would be like family to us. They have launched out on their own, excited to see the US - everything is new. You are their host mom and dad, and it does feel a little like that - parental and guiding, showing them the ropes and helping them have a good experience in a new country. Our au pairs have been from Mexico and Brazil; we've learned about their countries. Last year, I made a Mexican Christmas dinner with our au pair at the time N; this year Brazilian.

N was with us for only 6 months. This is not typical. The contract is for a year. However, N's family needed her back home; a family member was ill so she had to break her end of the contract and our au pair company arranged for us to match with someone new. M, from Brazil, has been with us for almost a year. We love her. The kids love her. She loves being here. She's extended her contract for an additional year (the maximum possible) which is great news. There's a ramp up period of about a month when they first arrive for driving lessons, figuring out routines, roles, etc, so having her want to stay longer is a huge plus. Meanwhile, we keep in touch with N who writes me occasionally and updates me on her career and relationships. She's getting married next year and has invited our family to Mexico for it. It's kind of like a mentor/mentee relationship.

In November, M's mom and her mom's friend came to visit, stay with us and travel. They were here for an entire month. This included a trip for the "Brazilians" as my husband and I nicknamed the trio, to Europe for 9 days and a weekend trip to NYC, but otherwise our house was full of warmth and Portuguese  for the remainder. It seems kind of crazy that we had all of these people in our house, but to tell you the truth, it was really nice to have them here. They are such sweet, wonderful people who were the perfect house guests. They made dinner for us all a few nights. We miss them.

An au pair's hours have certain restrictions; they can provide a maximum of 45 hours per week. With our youngest in half-day preschool, this gives us a chance to have a date night each week or coverage on the occasional weekend day I have to work. She picks up the kids from school, drives them to their swim lessons, gets them bathed. We juggle the days and hours when there is an unexpected snow day or sick day. That flexibility has been key. You have to have space for an au pair to have his/her own room and be okay with someone living with you.

I remember one day, during M's first months, she was Skyping with her family in our living room. Her family - her mom, dad, brother, and brother's girlfriend were all there on the screen saying hi to our kids. I looked over at the screen to find all of her family members on the computer screen with their two hands forming the shape of a heart on their chests, and my children mirroring them on our side. I thought:  this is such a good thing.

I drove M's mom and her mom's friend to the airport when they left; I hadn't realized the impression we left on them. They vowed that they would start some traditions back home since they enjoyed them so much while they were here: having wine with dinner each night and listening to classical music. And even though they said their thanks solely in Portuguese, I saw in their eyes what they meant.

We started a tradition last year of including N in our Christmas card photo with the family. This year's card has us all sitting on our local high school bleachers, each of the three kids on our laps - me, my husband and M. This will help us remember the years when our family was a little bit bigger. M cried when she saw the card for the first time, to be included. We couldn't imagine it differently.

The ways we grow

A patient recently eyed me right before a bedside procedure (I was supervising my residents) and asked with one eyebrow raised, “How long have you been a doctor?”

I thought about it for a couple of seconds, doing the math. “13 years.”

His face registered a small shock. Then, he relaxed a little. “Do you have children?”

“I have three.” His eyes widened, and he smiled.

Thirteen years is a long time; many things have happened to me that undoubtedly have shaped who I’ve become since I graduated medical school. I’ve certainly changed in many ways. Which ways were due to medicine and which were due to plain old maturation? My marriage? Having children? Other life experiences?

Upon reflection, I think medicine is responsible for this: more compassion.

There is a belief that medical training may result in the opposite. That because we see so much death and suffering, we have to harden a little to get through it all and come out emotionally unscathed. I certainly don’t think that’s universal and likely some of those observations arise from the development of burnout, the dampening of resilience.

As a hospitalist, I witness suffering from illness regularly. I am, not too rarely, the bearer of bad news – the cancer we found, the poor prognosis, the decline in function that is unlikely to be gained. I see people at angry, vulnerable, hurting points in their lives.  I’ve seen illness stem from poor choices. But just as often, I’ve seen illness strike with absolutely no provocation, turning someone’s life into a nightmare overnight.

Being a doctor has not made me numb to the suffering of others, despite sometimes feeling surrounded by it. On the contrary, it has made me more acutely away of what makes us human and connected. I think this has altered my approach to the universe. Probably, choosing to work in the veterans health system has something to do with that. I’m driven more by service now than when I was younger. I did community service in college, more because I felt I had to rather than because I wanted to. I do it now because it fills a need to serve and sustain.

The man who cleans my office is my favorite person at work. He is a wonderful soul, kind, generous and thoughtful. One day, after reading a column I wrote about emergency research done without consent, he said to me, “KC, I have observed that you have a deep, abiding compassion for those without a voice.”

I didn't know what to say.

Is that me? That wasn’t me before medical school, but if it is me now then I am grateful that becoming a doctor has made me so.

Pump hero

I needed to meet with a team to grade their students and had set up a time to meet them in their team room. This is one of the best team rooms we have in the hospital. It's spacious, with a wall of computer stations on either side, and windows lining the opposite wall from the door, filling the room with natural light. When I'm bringing the third-year students around to their team rooms after orientation, I always deliver this team's students last since it's kind of like closing the curtain between first class and coach.

I walked into the room and saw a medicine intern with her back to me, working at her computer. At the other wall, the senior resident was reading some papers before him. They greeted me as I sat down with my folders and took out my forms for grading.

"I hope you don't mind, but I'll be pumping while we do this." In the sudden quiet, I heard the telltale rhythmic sounds that I knew so well. She was pumping. Right there. In the team room. I didn't notice earlier, but she apparently had a hands-free set-up going, and was typing away, doing her notes. I glanced back at the senior resident, nonplussed. This was routine business.

I was filled with...joy. Admiration. So impressed.

"I think it is so awesome that you pump in the team room!" (Could I have?)

"I've lost all modesty after 9 months," she said with a smile.

We graded. She finished pumping, cleaned up, stored the milk, and I could not stop smiling.

Mother's Day, MiM-style

Mother's Day this year was my favorite one to date. It involved working for 7 hours at the hospital, so maybe my expectations were low that it would be one for the record books. (I had traded teams with another attending in order to get the weekend before - daughter's first communion - off, but that meant being on for Mother's Day.) Instead, I was pleasantly surprised.

8:00 am. Enter post-call team's room  - an all-woman team with resident, 2 interns, and 1 third year medical student - bringing breakfast (nothing worse than being post-call, hungry, and not having food) - and I'm met with a chorus of "Happy Mother's Day!" None had families of their own yet, but they knew about mine. Before we launched into patient presentations, they wanted to know about how my family fun 2 K run went the day before since I had warned them that if I didn't show up that Sunday, it would be because I had died from attempting to run that thing (Not a runner. Usually break things when attempting to run.) We round, take care of our patients. I write my admission notes and head home.

4:00 pm. At home, Girl (8) and Boy (5) have prepared a Mother's Day show. Boy2 (2) is an unpredictable assistant. There is a ticket booth with tickets and an information sheet informing us that we should expect to arrive between 4:00-4:15pm and the last time to get there is 4:15pm.

We all go upstairs into Girl's room and me, husband, and our awesome au pair M are seated in a row of office and desk chairs facing Girl's bed. She reads from a script.

"Ladies and gentlemen, boys and girls, before we start the 3 songs, I would like to talk to you. Over there near the bounce area, you can get raffle tickets. There are only 27 raffle tickets. You just ask for a number of tickets, I hand them to you, you sign your name, and hand them back. Then at the end of the show, I will pick the winner, give them artwork and they will keep it. I also have artwork for KC because it is Mother's Day. Now, if you are wondering where the bounce area is, it is there. (points to corner with many random pillows and blankets). You cannot get all the tickets. The most you can get is 6 raffle tickets. Boy, '1' please."

Boy runs to the CD player and starts the first song of the Holiest Kid CD Known To Man, a CD given to Girl by her first grade teacher at the end of last year - very holy bible songs in surprisingly catchy tunes - this CD deserves a post in itself. Girl, Boy, and Boy 2 stand on the bed and sing and perform. It is achingly cute. (and holy).

"Thank you, thank you. (bow)" repeat x 2 other very holy songs.

At the end, I won the raffle AND got special Mother's Day artwork. Score!

"The show is over. You can play on the bounce area or leave. Thank you for coming. You can also take one of the dolls on the floor, but not Rebecca or Baby Boy, they are my favorite. Thank you!"

7:30pm.  I am walking into Verizon Center arena with Girl for her very first concert. Taylor Swift. This is a birthday present for her, but I am secretly very psyched. It's been ages since I've been to a concert. Girl is a Daddy's girl through and through. I'm usually assisting our boys (very much Mama's boys) and the husband, her. This time with her feels very special. She is BEYOND EXCITED. Half walking-half running ahead to find our seats She screams and sings along to the songs. Watching her experience the concert fills me with joy.

Taylor Swift is fantastic. Such a great, entertaining show. The best concert I've ever been to by far. (OK, maybe not saying much given my track history - not telling - but let's just say the concert that's a distant second was Madonna's Blond Ambition tour, complete with her torpedo bra outfits. Much less family-friendly.)

11:00pm. We finally get home after the drive in from the city (and leaving before the encore - tomorrow is a school day) and get her quickly ready for bed. It's going to be a rough morning.

It was a full day, a  day of work-life on steroids. And completely awesome.

And many more

In honor of Mother's Day, I was interviewed for Radio Rounds about Mothers in Medicine - why it was started, how it's grown, and whether I thought mothers in medicine could "have it all." (An enthusiastic Yes.)

Mothers in Medicine will turn five this month - 5 years of stories from amazing women who I am honored to write with and share this space. Some have been writing here from Day 1; others have joined in along the way. All have shared openly, these thoughts and feelings that could easily be kept private, for the benefit of this community. The blog's growth has been staggering.

This blog is still my favorite "extracurricular." I list it on my CV under "Service to the Community" because I think that's what it is: service. It's community. A labor of love. And definitely, not a business (note: we do not, nor will we ever have ads. Advertisers, please stop emailing.).

So, MiM writers, thanks for writing. You are all fantastic, and I still hope for the day that we'll hold a MiM conference somewhere tropical. I'm buying you all drinks. MiM readers, thanks for reading and commenting and liking and sharing. You're why we are all here.

To 5 years and to many more.

Less than perfect

I admit I’m not a perfect mother.

I wish at the end of the day, I can see all the bathwater that has sloshed out of the tub and likely making its way down cracks in tile and through the subflooring, and not angrily bark at the kids (who are at least in the tub and getting clean). After I bark and they are settled into their beds as I read their bedtime stories, I imagine how I could have handled it differently: with less anger, more love, and more humor.

I wish I could make them do things that they don’t want to do without the aid of bribery or sheer parental authority force. Like being creative and using Jedi mind tricks. Like being a positive shaping force instead of a strong-arming wet blanket. I manage to do this well sometimes, and others…well, I default to those methods which take the least time and energy.

I wish I could always be 100% attuned to them and their needs when we’re together, instead of being preoccupied with what I’m doing on the computer or the laundry or the person on the other end of the phone line. I realize this sometimes only after they raise their voice to tell me something again. Or act out to get my attention.  This always makes me feel guilty, vowing to try harder.

I wish I could put aside all of my stresses – and there are many big ones I deal with every day –when it comes to taking care of them, instead of letting those stresses spill over messily into my precious family time.

I have friends whom I think are better mothers. I imagine: what would she do in this situation? Or how would she handle this? Probably with more patience, I think. Less frustration, most likely. More accepting, I bet. This helps me be better in the moment, or sometimes the moment has unfortunately passed, but I’ll try to remember for next time.

I’m not a perfect mother. I’m a work in progress. But, I hope my children know how much I love them, and how much I think of my own imperfections, so that one day, we all could not be prouder of the mother I have become.



Posted originally on Momicillin.com.

Women leaders in medicine

Last week, I went straight from the hospital to the Washington DC Convention Center for the AMSA National Convention. I was there to receive the 2013 Women Leaders in Medicine Award, along with 4 other women; part of the award reception was a panel discussion on the significance of women leaders in medicine. We had received some questions to ponder ahead of time that the moderator would ask us, and then it would be open to the floor of mostly women medical students.

The award came as a total surprise. I had no idea who had nominated me (nominations came from medical students across the country), but was excited to hear that we would be each introduced and a brief excerpt shared from the nomination letter. I’ve been really proud of my career so far, but after seeing who my co-award winners were and the list of prior award winners (including Surgeon General Regina Benjamin and former CDC Director Julie Gerberding), I was feeling a tiny bit which-one-of-these-things-is-not-like-the-other.

I was up first, alphabetically, and the excerpt mentioned how well I’m able to balance an academic career with motherhood. My internal response: Well, I’m glad it seems I’m balancing it all! I guess it always feels like a work-in-progress to me. It’s always “trying to balance” and not, “Oh yeah! I’m balanced!” But, if I can send a message to others that doing both – having a successful academic career and family life— is achievable, then I’m glad.

The other award winners were Carolyn Clancy, head of the Agency for Healthcare Research & Quality; Sophie Currier, the woman who took on the NBME to allow time during the exam for nursing mothers to pump (she won!);  Petra Clark-Dufner, Director of the Urban Track at U Conn; Laura Tosi, orthopedic surgeon and director of bone health at Children's National Medical Center.

We represented a spectrum of ages and stages in our career, and I think this made the panel discussion richer since we complemented each other. We talked about leadership – how there’s not just one style but a range, and how you need to find the style that works for you. Sometimes, it’s about standing up for what you believe in, despite the consequences. Sometimes, it’s being the first and paving the way for those behind you. But, it’s also about caring for those you lead. It’s about being generous with your talent and time, and putting the needs of the people you lead ahead of your own: to help them grow.

We talked about mentors, and how you need to look beyond the traditional 1:1 model of mentorship – those traditional models are rarer today –you may have many mentors, people who can offer you pieces that will help you with the whole. And, great mentors may be actually peers, perhaps within a few years of you. Don’t be afraid to approach someone you admire and ask them for their advice or time. The worst they could say is no – and we need thicker skin than that.

We talked about challenges as women in medicine, and what we did to overcome them. For some, it was being the first, being a rarity: a female orthopedic surgeon starting many years ago. I thought having children was the biggest challenge I had faced – from  the guilt of leaving work at a reasonable time to catch my daughter before bedtime, to the mania of pumping.  My solution: I wrote about it. I also started MiM to form the community I wish I had around me (at the time, none of my colleagues had kids and didn’t really understand).

One question from the audience was, "Do you have any regrets?"  None of us did in terms of what field we chose to go into, and I didn't think I had any until I remembered one incident where I assumed people knew I wanted a certain position. I was too modest to directly voice my interest in the position, but many told me I was a shoo-in for it, and I believed it would happen. I wanted it to happen. However, I didn't get it, and when I finally had the nerve to ask why, I was told, "You wanted that? Why didn't you ever tell me? I thought you weren't interested." I was devastated. And I learned to be vocal about what I want. If people, your supervisor, those in positions of power, don't know what you want, you're unlikely going to get it.

One woman asked what would we tell our younger selves? I couldn't think of an answer to this off the top of my head, but did remember we did a topic day on this way back in 2008! (See here and it starts a few posts down: The advice we wish we had in medical school; just re-read mine and agree 100%.)

Another asked, "What's the one piece of advice would you give you women entering medicine today?"
Answer: Do what you love. We can’t predict the twists and turns our career path will take when starting out, but following what you love is the way to having a fulfilling life and keeps you going. There were several themes along this line. The room got quiet and I, who had been silent for this question, said, "Marry well." The room erupted into laughter. But, I explained that my decision to marry my husband (sitting there in the crowd, now getting slapped on the back) was the best one I had ever made for my career and otherwise. Without someone in your corner who supports you, who is an equal partner in life, it's going to be very difficult to succeed in both spheres. (I'm not the only MiM who has said this!)

Our last charge was to leave the audience with one final piece of advice. I said, "Follow your passion," which fulfilled the pithy criteria I was thinking was most important, but now looking back, I wish I had said:

We women need to stick together. We need to support each other. We need to come together and celebrate what makes being a woman in medicine special. We need to lift each other up.

Thank you for being here, lifting each other up.

Hard, but worth it

I love being a medicine attending in July. It's often more intense work since everyone's in a new role. Bright, fresh interns. Excited new R2s and R3s. And the medical students- the new third-year students who have toiled in the classroom finally get to focus on patient care. Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it's a bit of a vicarious thrill to be re-living that excitement again  - the realization that we have such a privilege to care for patients and to make a real difference in their lives, of being empowered by knowing and understanding, and being consciously aware of our own growth as physicians. As a medical educator, July is a highlight of the year. Hard, but worth it.

On a recent weekend day, I was rounding with my residents and students. Working on the weekends is my least favorite part of attending on the wards. These are days that belong to the family unit; I always feel an anticipatory dread leading up to a weekend work day. Of course, once I'm there and working, it's all about teaching, about patients, and it goes by quickly.

Well on this day, I had finished rounds with the team, but had something important I felt I needed to do before I could leave for the day and catch up with my family. There was a patient whose struggle with his illness had moved me, and I wanted to make sure he knew I had heard him, that I understood. So, I wrote something for him: his story, as told to me, as received by me. Not his History of Present Illness, mind you, but his real story - his loss of his identity due to his illness. This was his suffering I needed to acknowledge. I asked him if I could read something I wrote him.

That moment, of reading those short few paragraphs, was filled with light. There were tears. There was an opening of wounds. There was sharing - so meaningful and real and deep -that it nearly blew me away. Nine years of being an attending and I am still able to be blown away by the absolute honor of doing this work. It didn't matter that it was the weekend. That I was at work. I was simply filled with gratefulness for this moment and for the job I am so lucky to have.

It's moments like this that remind me it is entirely worth it, weekends and all.  It is a gift.


*This patient gave me his permission to share this moment.

Parenting in medicine mentoring panel

I just attended the annual Society of General Internal Medicine conference - a conference that always inspires me. You can tell the values of an organization from its meeting. SGIM is understated (no commercial sponsors or huge pharma-dripping exhibit hall) and the work presented is largely focused on health disparities, improving the health of our society, and education. The opening plenary session was titled "Does the Moral Arc of the Universe Really Bend Towards Justice?" (The answer was a heartening yes.)

One of the sessions I attended was a Parenting in Medicine Mentoring Panel, a wonderful idea with an unfortunate acronym. Nancy Rigotti, who directs the Office of Women's Careers at Harvard and a past President of SGIM, led the panel. Mothers in medicine of various stages of their academic career shared their stories, much like we do here. There was also time for questions in the packed room of mostly women and a handful of men (including one division head who spoke about his support for work-life balance in his department by budgeting maternity leaves and family leaves, into his yearly FTE equation, and contracting with emergency child care services- awesome.)

Some key points that were made by panelists and the audience:

• Being a physician makes you a better mother. That quality of being calm under pressure comes in mighty handy when you’re faced with a teenager who announces, “I didn’t go to school today.”
• Make your partner a partner. Many women echoed this. Some split the weekdays in terms of who was responsible for making dinner for the evening
• Get help to do things you don’t want to do to spend that time with your kids. If you can afford housecleaning help, it is worth it.
• If you find yourself working in an unsupportive environment, find a peer group who all have kids to help cover each other when needed.
• Take risks - in your career path, in life
• There is no one way to do it. We each find ways to make it work with our families and choices.
• Don't delay having your family. Unintentional childlessness or having fewer children than desired happens to mothers in medicine.
• On-site childcare can be a godsend.
• Make family dinners a priority.
• Share our stories, form communities of support. (See: MiM byline)

Finally, this thought was shared: Kids are a gift, not an achievement. In all of these ridiculous Mommy Wars and trying to decide who is doing it better, why not just focus on the gift?

Listen to Susan

As I sat at the funeral of a friend this past week - a brilliant former NASA astrophysicist and mother to two sweet boys, 5 and 7 - I felt the collective reverence emanate like an aura over the pews for a woman who was truly extraordinary. Susan and I met through blogging years ago and though we were writing in a medium that engaged distant audiences, we happened to live within miles. For as long as I knew her, she carried a diagnosis of inflammatory breast cancer (diagnosed in 2007). With courage, grace and honesty, she blogged about her journey through chemo, mastectomy, remission, recurrence, hospice, and too much pain. Yet what defined her was not this; it was a true joy of living, of living each breath, of tremendous advocacy, that made her luminous beyond the normal range of our ordinary mortal existence. She was the type of person that if you met her, you loved her. Simple as that.

In the homily, I learned something new about Susan: she had undergone an accelerated Rite of Christian Initiation of Adults (the process by which adults convert to Catholicism) to develop a deeper relationship with God and to draw strength from this relationship through her illness. Seeing her and her family at church each week, I had assumed her faith and religion were constants in her life equation - not something so new and dynamic. I thought about my own RCIA experience 9 years ago and how much that has meant to who I am today.

Since her death, so many who loved Susan have written about her and about how they will honor her. Encouraging their children to love science, to practice present-parenting, to support breast cancer research, to schedule their mammograms. For me, she will inspire me to have more faith, less doubt. Yes: More faith. Less doubt.

Because, I doubt. I worry. In the almost-year that my husband has been stationed in Afghanistan, the anxiety has ebbed and flowed, with occasional spurts of outright fear. I play mind games with myself, practice superstition, believing that the course of events could hinge on a mental misstep. In everyday life I worry too. Small things that shouldn't matter. Small things that wouldn't matter if I had Susan's perspective and her faith. Why not practice more faith, more optimism, more belief in the goodness of others? Because life is too short to worry so much for things beyond our control.

A friend on Facebook shared this recently: Worrying is like praying for what you don't want. I never thought of it that way, but how true. Why devote such time and energy to such negativity when there is living, loving to be had? Why not allow one's faith to carry some of the burdens?

Susan was good at many things but perhaps what she was the very best at was loving others. This was evident at her funeral - her love reflected in all those who came was evident. Radiant. Uplifting. Her best friend, a professional musician, sang the Gospel hymn "His Eye is on the Sparrow" in a voice so pure and clear - quite possibly the most beautiful thing any of us have ever heard. We were rapt. Silent. Reverent.

If we all could believe and love a fraction of what Susan could, imagine how many more breaths would be filled with joy instead of fret. Hope instead of worry. Striving towards this is how I will remember Susan. She is the cheerleader I'll hear on the inside. The hug from within.

In a wonderful interview last year, Susan was asked, "you're a role model for finding beauty and joy in life no matter what happens - what are your top 'little things that count?'"

Her answer:  Children’s laughter. Soap bubbles on a summer afternoon.  Reading books together in an easy chair.  Family meals.  Cuddling.  Taking time for a night out with friends — even when there is other work to be done. Stargazing or watching the clouds pass by. Asking a child a question, and listening — really listening — to her answer.

We said goodbye to Susan this week but her inspiration lives on inside us all.

Overheard in a MiM car

[On the way to 4-year-old son's doctor appointment]

MiM: We're going to the doctor's! Do you want to be a doctor when you grow up?

Son: I can't.

MiM: Why do you say that?

Son: (Pause)...are there daddy doctors?

MiM: Yup. There are daddy doctors.

Son: OK, (with glee) I want to be a doctor!

A Hospitalist in Academics

I fell into hospital medicine rather unexpectedly. I knew I wanted to stay in general internal medicine, but I thought I would be a primary care internist. Then, in residency, I discovered how much I loved the inpatient setting - not for the actual medicine part - but for the educational part: I loved teaching and the ability to do so with scale with the large learner-heavy teams on the wards.

A lot of people equate hospitalists with shift work, and in many cases, this is true. Working within well-defined and pre-scheduled shifts may be very alluring to mothers in medicine: predictable hours, a defined schedule, potentially no call, and the flexibility to easily work part-time.

However, for my particular job as a hospitalist in an academic setting, I don't do shift work. Most of my clinical time is supervising resident-run teams (the other clinical time is spent doing consults or supervising a PA-led "non-teaching" service without residents), which means longer or shorter days depending on team census, the acuity of our patients, whether the resident or interns are in clinic for the afternoon, call-days, and how independent my resident is (new R2 very different supervision time than a seasoned R3). I'm available by phone to my teams when they are on call at night. I work many weekends and holidays. And although I can take compensatory days off in lieu of working the holiday, which is great and something I put into action as chief of the hospitalist section, my kids will be home without me.

Parts of my clinical job are absolutely draining, mentally and emotionally. There's the family meetings to discuss goals of care in dying patients who may or may not have decision-making capacity. There's the bearing witness to tremendous suffering -like those with difficulty coping that they have a chronic disease that brings them in and out of the hospital so frequently. But, these parts are also what give me pause - I have a job where I can make a difference. I can make someone's suffering heard, metabolized, and given meaning. I can lead a difficult family discussion and make sure everyone's needs are identified. Hard but good.

I'm in my 9th year as a full-time hospitalist and in that time, have had three children. I've taken on more administrative duties and my weeks on the wards have accordingly decreased. I have the flexibility to do research, to do committee work, to teach. I'm meeting my personal goals of academic success. I feel like I am compensated fairly for my work and the requirement to work some weekends and holidays. This scaling back of clinical duties has been critical to achieving the balance I need as my family has grown. Granted, I worked my butt off in the beginning doing a much heavier clinical schedule, starting a family, and establishing my ability to take on these non-clinical duties and establishing a research agenda to be able to scale back these last few years.  On admin time, I have major flexibility. Flexibility to linger after school drop-off and chat with the other moms. Flexibility to help out with my daughter's art class. I know I have a really good thing going. And it works. Like others, key to this working for me is: 1) an amazing husband who shares the responsibilities of our home and family equally (minus this last year when he's been deployed to a war zone but that's the topic of another post...); 2) supportive and nearby family; 3) great childcare (which currently is synonymous with number 2); 4) having a flexible enough work environment and an awesome boss; 5) I try hard not to drink the Working Mother in Medicine Guilt Kool-Aid, no matter how tempting it looks some days. (Note operative word is "try.")

Hard but good. I think that about sums it up.

The MiM Risk Score (MRS)

In honor of the Labor Day Holiday...

This evidenced-based risk score was developed to help predict overextending of Mothers in Medicine. The goal is to prevent burnout, stress, and associated unpleasant psychological states by monitoring weekly risk, and following guidelines for treatment accordingly.

To calculate risk:

MRS =          age/2 * number of dependents + k [C + Lu + Na]
             _______________________________________________
                             Number of spouses/life partners * + 1

where....

Age = Age of MiM in years

Number of dependents = number of children, care-requiring parents, exceptionally ineffective spouses/life partners, very large and needy household pets. For pregnancy,  multiply total by factor of 1.5.

k= work constant. For full-time work, k=1. For part-time work, k= 1.5 * % of full-time worked (e.g. ½ time = 0.75 since hours worked is always more and uncompensated)

C = number of times you have to call your cell phone to find out where you put it in the past week.

Lu = number of times you are too busy to eat lunch, forget to eat lunch, or accidentally bring a Tupperware with a half ear of corn and half of a large white onion by mistake instead of the lunch you packed the night before. Hypothetically speaking.

Na= number of times you have called your children the wrong name in the past week.

*for polygamists, add only 0.5 for every successive spouse after primary spouse; for work spouses, add 0.25 each; only spouses/life partners currently living with you for the majority of the week count in full.


**** Risk score interpretation ****

MRS > 50 = High risk for overextending. Schedule child-free vacation, delegate projects, get a babysitter for a night out, add another spouse/life partner (or increase efficiency of current one), for the love of God say no to new commitments. Wine.

MRS 41-50 = Moderate-high risk of overextending. Schedule spa date. Say no to new commitments. Delegate projects. Possibly add another spouse/life partner (or increase efficiency of current one). Adjunct retail therapy.

MRS 30-40 = Moderate risk of overextending. Schedule coffee with girlfriend(s). Say no to new commitments. Delegate projects.

MRS < 30 = Low risk of overextending. Good job! Offer help to your MiM friends in higher risk categories.

n.b. Risk score prognostication has not been scientifically validated.

Don't Give Up on Women in Medicine

The Mary Elizabeth Garrett Room lies off a busy corridor on the main floor of Johns Hopkins Hospital. As a medical student and later an internal medicine resident at Johns Hopkins, I often treated the small women’s lounge and adjoining locker room as a sanctuary amid my hectic days and nights of studying and call. Its namesake, a philanthropist who was one of the wealthiest women in the US in the late 1800s, used her financial power to provide opportunities for women to gain independence and autonomy.  She and her friends offered to raise a badly needed $100,000 for the endowment of the Johns Hopkins School of Medicine if the trustees agreed to admit women on the same basis as men.  The rest, for future women in medicine, was history.

In her New York Times opinion-editorial  “Don’t Quit This Day Job” (June 12, 2011), anesthesiologist Dr. Karen Sibert argues that women physicians, who increasingly work part-time or leave clinical medicine altogether to find better balance between work and family life, have a moral obligation to practice medicine full-time. She rightly points out that there are limited medical school and residency slots in the face of a growing physician shortage, particularly in the primary care fields that attract women in high numbers. However, Dr. Sibert’s envisioned ideal would be a great loss to patients and the profession, and a major step backwards for women in medicine.

Historically, the practice of medicine had required a selfless devotion to the profession at the cost of personal and family life.  Turn of the 19^th century legendary physician Sir William Osler is credited for saying, “Medicine is a jealous mistress; she will be satisfied with nothing less.” These roots are evident in the harsh training environment that prevailed for so many years, requiring super-human work hours, rare days off, and expectations to work through personal illness. Slowly, medicine professional culture has made progress, realizing that the care of its members—in all senses of that word—helps physicians (men and women) lead more balanced, healthier, happier lives and helps patients by improving the quality and safety of their healthcare experience through physician work-hours restrictions.

For women physicians, who continue to perform the lion’s share of household duties and child-rearing despite a more progressive society towards the division of household labor, this has meant the increasing availability of part-time positions, job-sharing, and other creative solutions to allow them to continue practicing medicine while fulfilling commitments at home. Achieving work-life balance means greater satisfaction for one’s career and keeps women (and men) physicians in medicine. Indeed, it is this flexibility that is possible in certain specialties such as primary care, dermatology and radiology that makes medicine an attractive career for many women, despite the years of difficult training and medical school debt.

We are, after all, talking about a profession that is built around caregiving, with the parallels between caring for patients and families undeniable.  Women physicians spend more time with their patients, up to 10% more, and have been shown to have a distinct style of doctoring from their male counterparts: more encouraging, supportive and patient-centered. The contributions of part-time women physicians are no less in quality to the lives of their patients; shouldn’t such devotion to caregiving at work and home be traits encouraged in physicians? 

Invoking the predicted physician work shortage as a reason why women physicians should not work part-time or leave clinical medicine places undue guilt and blame on them.  The main factors driving up physician demand is the growth and aging of the US population and health care reform.  While women physicians do work fewer patient care hours compared to men, what kind of profession would we have if women who might decide to work part-time later were denied admission?  More reasonable (and humane) answers to the physician shortage lies in lifting the residency training caps to train needed physicians and creating new models to increase efficient use of the existing workforce.

Besides, women (and also men), who choose to spend a portion of their medical careers working part-time or who take an extended leave, may return to full-time work at a later time, for example, after their children reach a certain age. Thus, there is a need for effective physician-reentry programs that help prepare any previously trained physician to return to the workforce, providing education and re-training as well as portals to reenter medicine.

Let’s not forget about the men. Besides early to mid-career women, men approaching retirement age are the other fastest growing segment choosing to join the part-time physician workforce. Survey data show that today’s medical students and residents, both men and women, say achieving a balance between their work and professional lives will be the most important factor when establishing a fulfilling career in medicine. Medicine mistresses are going out of style all-around, much to the dismay of the medical henchmen: Burnout, Stress and Dissatisfaction.

To be sure, medicine is a public good. Federal dollars support physician training, and certainly, it is imperative that medical school admissions committees select applicants, male and female, who show a strong commitment to medicine. Yet after training, men as well as women may decide not to practice clinical medicine. Is it more problematic when the reason is because a woman wants to raise a family versus a man who takes a job with a consulting firm? I hope not. These are difficult personal decisions, emphasis on personal.  Like everyone else, doctors need to make decisions for the health of themselves and their families. Life happens.

I am a mother, and I am physician.  These two roles are complementary in more ways than they are not. The increase in flexibility for women physicians in recent times has been a boon to those of us who have found a calling in medicine but do not want to sacrifice having a full family life. Isn’t that what Mary Elizabeth Garrett had in mind as well? Independence and autonomy for women to practice what they love, to be empowered by having choices.

Katherine Chretien is founder/editor of www.mothersinmedicine.com.

Twitter to Tenure: My (parenthetical) story

I'll soon be heading to the 2011 Society of General Internal Medicine's annual meeting. As prelude to a workshop called "Twitter to Tenure," I, and several fellow academicians are blogging about how social media has helped our academic careers. See bottom of post for the other posts in this series. And if you'll be at SGIM, please come and say hi!


If I had known that starting a personal blog in 2006 would eventually result in such great things for my career, I would have started one a long time before that. The truth is, I was simply trying to capture the moments of new motherhood that I didn't want to forget. (Also, before 2006, I was like, what's a blog?)  In the process, I unknowingly set wheels in motion that would eventually help shape my future personal and career pursuits. (Bonus!) This is what you call a win-win. Win-wins in life are the best.

Writing leading to...
In my early days of blogging, I posted feverishly, to my 3 readers, one of which was my husband. We're talking practically everyday (I sigh when I think about how much more time I had when there was only 1 child to contend with). In the process (of talking to those 3 people), I developed my writing voice. It became like nothing to write a post- I could whip one out in 5-10 minutes, honing my story-telling, organization and my writing got better. (Please do not use this previous sentence as an example.) Malcolm Gladwell talks about this 10,000 hours phenomenon to achieving excellence in anything--I haven't come close to that but blogging so frequently was a start.

Writing opportunities...
An amazing thing happened in the midst of blogging feverishly (now over 3 readers): people found my blog and offered to pay me to write about parenting --humor writing. Paid! To write! This was a huge boon since it felt like I was an actual writer who could (occasionally) make people laugh. Meanwhile, the blogging (on multiple blogs now) continued, more hours under the belt. I networked with other bloggers, went to blogging conferences (after at first scoffing at them--who would go to a blogging conference??? Lame. I've realized, since, how much I love eating my words, or at least, embracing being lame.). I am not sure when my affinity for using parentheses developed.

And medical education applications...
I now appreciated what blogs could offer (discussion, community, feedback, support, to name a few) and while studying adult learning theory and the theoretical underpinnings for reflection in medicine, started a reflective writing blog for internal medicine clerkship students. Students' writings blew me away as they wrote frankly (amazingly frankly) about professionalism, doctor-patient relationships, empathy, and the struggles and anxieties of being a medical student. This led to workshop presentations at conferences, a paper in an academic journal, and networking with some pretty awesome collaborators.

And research....
Having had a blog where I occasionally mentioned issues that I saw in the hospital, as well as developing a (vaguely, on good days) humorous writing voice, I could appreciate the line that physician-bloggers had to manage between privacy, humor, disclosure, and professionalism. I became interested in the intersection of professionalism and physicians on social media and had an idea for a study on medical students and unprofessional online content. I also got involved with other forms of social media - Facebook and Twitter - and more ideas for studies came. This research has led to plenary talks, media interviews, grand rounds invitations, national conference workshops, and has defined a career path. Not to mention it's just fun to do these studies. Note: I would have never imagined I would be doing research when I was a resident! Thoughts of doing research in the past had always been accompanied by images of pain and suffering, like having a fork stuck in an eye.

And staying up-to-date with news from my field...
I've become a Twitter convert, thanks to Twentors (sorry) like Vinny Arora, an amazing academic rock star and Star Tweeter (ST). It has become my go-to source for breaking news and keeping up with my areas of academic interest --medical education and social media in medicine. I do not follow anyone like Paris Hilton ("I'm sooo tired! Need a nap!"), and instead follow those who have similar interests (as me, not Paris--pretty sure our interests don't overlap) or provide interesting perspectives and links. See Vinny's post for more resources about how to use Twitter professionally.

And Mothers in Medicine...
And of course, blogging led to the birth of Mothers in Medicine. Enough said.

So, social media has been good to me. It might also be good to you too.


Also see the following STs:

Alex Smith's (@AlexSmithMD) intro post on Geri Pal.
Vinny Arora's (@FutureDocs) post on FutureDocs.
Bob Centor's (@medrants) post on DB's Medical Rants.
Eric Widera's (@ewidera) post on Geri Pal.

Speaking out about kids, football, and traumatic brain injury

I attended a Grand Rounds on Chronic Traumatic Encephalopathy (CTE) and the NFL earlier this year given by neuropathologist Dr. Daniel Perl. It was eye-opening for me. Despite all the recent media attention given to cases of NFL players being diagnosed with the disorder post-mortem (usually following untimely deaths due to suicide or bizarre "accidents"), it hadn't really penetrated my consciousness. But to see the actual images of abnormal tau protein staining in these relatively young brains - heaps and tangles similar to Alzheimer's but in slightly different locations - well, it was chilling. Even more chilling was hearing about these findings in younger players, those without years and years of professional-level play. Including those without many (or any reported) concussions. I started thinking about all of the children in the US who play tackle football and wondering: When are these changes happening? Why aren't we talking about this re: children? How many mothers might not realize that their children could be sustaining irreversible injuries that only manifest many years later? This. is. huge.

I debated whether or not to write about the issue. On the one hand, I felt passionately that discussing these issues was a matter of public health. Yet, I also weighed this against the likely backlash from football supporters and the kinds of personal attacks that commonly happen on the comment pages of online media forums.

In the end, I decided that this was too-important of an issue not to write about, stick and stones notwithstanding. My op-ed is in today's USA Today. Would love to hear your thoughts (including dissenting!), mothers in medicine, about this issue. Do you (would you) allow your children to play football? Do you think developing CTE is a reason for concern in kids? What do you think should be done to protect kids who play? Pediatricians, do you discuss this with your patients/parents?

This one's for the girls

At the risk of exposing my musical tastes (and innate sappiness), I have a confession to make. Whenever I hear Martina McBride's This One's For the Girls, I tear up. I'm so not kidding. I'm not even a country girl--I prefer The Killers to Carrie Underwood --and I couldn't tell you another song that Martina McBride sings. But, this song has always made me want to link arms with women everywhere, celebrating how much we share in common: the broken hearts, the high dreams: reality ratio period, our struggles to find ourselves. You're beautiful the way you are. See. There I go again. (NB: for all of you who have never heard this song, I suggest playing the YouTube video linked above but just listening; the video kind of weirds me out. Who directed that thing?)

It's with this background that I write this post, a post I've had in mind for awhile now and directed to all of you in your 20's.

What I wish I knew in my 20's: it gets so. much. better.

When I was in my 20's, I remember thinking that this must be my peak age. Bone mass and fertility peak...it must all go downhill from here. I had no reason to believe it shouldn't. I steadied myself for a future of decline in all respects.

Now, comfortably past the mid-way mark of my 30s, I would never trade being in my 20s again for now. Now is awesome. With time, the insecurities, the not knowing myself, have gradually slipped away. I feel more powerful, confident, and, yes, comfortable in my skin than ever before. With time, I know me, accept me, in ways that the younger, more stronger-boned and fertile me could never have imagined. Plus, now there is a growing family - and the joy and richness that brings, a more mature (and ever stronger) relationship with my husband, and a satisfying career on a path that I'm setting, not anyone else. The 30s rock.

And, I have a suspicion, and a hope, that it just keeps getting better. Perhaps "all you girls about forty-two" could chime in...

There's no need to fear growing older, MiMs. Look forward to it. The best is yet to come.