Pictures….Not!

A fellow Peds resident took his dream job on the North Shore of Oahu. In our former lives, we enjoyed windsurfing together the sounds of the East Coast. He dreamed of bigger waves, and he found them. He sends me pictures from time to time of his beautiful and expanding family. His last set was taken along the shoreline of Hawaii. I want pictures like that, I thought. Serene. Idyllic. Outdoors.

Then I saw KC’s pictures of her family. Sweet pictures to be regarded for years to come. Happy baby pictures. Sibling enchantment (however brief). Glowing parents. I want pictures like that!

So I’m on a quest for some visual memento of my seven and eleven year olds. How else can I freeze them in time? I want to capture Harry’s tossed salad blond hair, and Will’s prepubertal glow. Not only would pictures satisfy my mommy-lust for holding back the sands of time, I could use them as Christmas gifts for family and Husband.

One of my office staff showed me her Christmas pictures. They were urban and modern, and I loved them. Her website showed pictures of playful kids in old chairs outside. This photographer, like KC’s, had the gift of not only catching the image of the subjects but their spirit as well. Sign me up!

So we were all set Tuesday afternoon to meet this photographer after school. The rendezvous point was a field of wheat on the other side of town. Prior to this meeting, I had run all over town looking for the right wardrobe. I had settled on solid color sweaters and t-shirts, and had tried hard to pick items that the boys would wear anyways.

Will, Harry, and I piled into the car for the 20 minute drive to this field – my rough directions in hand. We dodged traffic lights. The boys muttered about interrupted play time, but understood that surprising Daddy was part of the adventure. I chatted them up about how much fun this would be – trying hard to keep the atmosphere light. We found the field on the side of a road, and pulled over to park and wait. We were a couple minutes late. No problem – we had 30 minutes of daylight left.

My first clue to impending failure should have been that the wheat was actually weeds – a disaster for my allergic seven year old. The second clue was waiting for 20 minutes with two antsy boys in the car. I’m not sure I would have wanted the pictures of that afternoon. Surly Will. Pouting Henry. To be honest, I was pouting like a toddler, too. The photographer left us in the field. No show. Nadda. Disappointment is an understatement because then I had to explain to Husband why the boys were so moody when we returned home. Surprise revealed. Ta dah!

Maybe a trip to Hawaii for pictures is not such a bad idea after all. Hmm….

Seriously, I wanna know...

Do you have a favorite memory of gift-giving? What has been your favorite gift to receive? Any favorite gift-giving tips for the holiday season?

Seriously, I wanna know...

What are your plans for Thanksgiving? Do you cook the turkey, stuffing, potatos, greenbean casserole or do you eat nontraditional fare? Have you tried a prepared dinner from a grocery store?

Twisted for Twilight

As an avid reader, I pick and choose across the genres of fiction and nonfiction. I am an equal opportunity consumer of the printed page. When looking up my member card at Barnes and Nobles, the cashier says "Oh, I see you come here often." Basically I'm looking for a good story - the kind that is hard to put down, will make me schedule my lunch hour in a quiet location just to get through a couple of chapters. Now as I write blog posts and dabble in fiction, I find myself asking what makes a good story.

Can't tell you what made me pick up Twilight. Maybe it's the buzz about the movie that I've read on other blogs. Maybe it's that desire to have a reading feeding frenzy. Stephanie Meyer hooked me - through all four books and the trials of Bella and Edward. Couldn't put them down until I finished them all. Went back to Barnes and Nobles on a Sunday night to buy the third and fourth because I couldn't wait for USPS to bring my Amazon delivery. Emersed in this world of "vegetarian" vampires, I find myself having philosophical discussions about the books with my teen patients.

Now the movie is coming out this weekend, and I'm trying to figure out how to get my boys to go see it with me. Movies are a shared passion between my two sons and myself. Husband bows out graciously whenever we go because he says he can nap for free at home. Sometimes finding common ground between the three of us is tough. The oldest likes action, noise, and can follow the twists and turns of plots well. The younger (age seven) son still likes animated films, but doesn't do scary well. I like a clever plot with not too much violence. So I'm thinking that I can sell this movie to my kids as kind of action-adventure and still get my romantic, girly fix.

Trying to explain this preoccupation with high school vampires eludes me. Is it the classic girl meets boy story? Is it the element of danger in Bella's longing for a vampire boyfriend with pulsing teenage hormones? Is it the pace? In my second reading of the first book, I tried to look at the writing from the perspective of a writer. The words are not complicated, and the storyline is kind of predictable. Still, I'm hooked.

My Two Cent’s Worth about General Pediatrics

A new doctor on the medical staff of my hospital parks his Rolls Royce in the MD parking lot. It sticks out among the Mercedes, Suburban’s,and Hondas that other doctors park there. It gives me pause to fantasize about the life this physician has and how different it must be from mine – no school loans, kids grown and out of college, retirement nearing with a nice nest egg (or at least decent after the recent downturn of last month’s market.) As a Pediatrician, I know this will not be my life, and I’m absolutely fine with it. As Nancy Snyderman, MD, told Matt Lauer recently on the Today show, “Pediatricians don’t go into medicine to get rich. They go into medicine because they love children.” Lesson #1: Think about another specialty in medicine or another career altogether if money is high on your life priority list. Don’t get me wrong. My family and I are comfortable, but there’s a reason (which is best left to a future post) pediatrics winds up on the bottom of the pay scale every year.

Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.

Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.

Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.

Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.

Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.

Seriously, I wanna know...

Did you change your name after you got married? Do you use one surname professionally and one name socially? Do you hypehenate? How about your children's last names?

Helloween

Husband is leaving tomorrow for his annual boy’s weekend at the beach - Helloween. For the next five days (I thought weekends were two days long?) he’ll let his hair down – what’s left of it – with a group of longtime friends at a house with no heat or A/C. He says it’s perfect for this group of guys. For the past six weeks, this weekend has been his constant topic of conversation. It’s his de-stressor – time to drink cheap beer, play football, inflict bodily harm by paintball, not shave, commune with his fellow man and blow off steam. In more recent outings, they’ve become sort of domestic and actually cook – deep-fried turkey and chili. Our household is not lacking testosterone – I have two sons, a male golden retriever, male cockatiel, and three male African frogs – but the adult male camaraderie and freedom from family responsibilities provides him with a vitamin-like boost.

Once upon a time I dreaded his weekend plus away. My children were young, and with one less parent to supervise them on the weekend, mayhem would always ensue. Single parenting brings out my latent attention deficit disorder as two children, pets, and household compete for my undivided focus. One year my youngest decided to take a bath in my stand-up shower by blocking the drain. He sat happily in the bottom playing with boats and legos in one inch of water. I ran downstairs to grab his towel out of the dryer and noticed that the ceiling fan in the family room had suddenly become an upside down sprinkler – spraying water over the entire room as it trickled down the arm of the fan. I dove for the switch so as not to electrocute us all, and ran upstairs to investigate. The shower was overflowing – tsunami style – onto the floor above the family room as youngest continued to splash and enjoy himself.

Somehow, events that happen while husband is away never happen while he is home. In late July, husband went to visit his best friend in Indiana. During his four day leave of absence, the golden retriever (child #3) decided to do laps in the new pool in the backyard. The fur from the hairy beast clogged the filter as I tried to vacuum the bumper crop of hickory nuts squirrels were lobbing into the water. Upon his return, Husband’s pool expertise solved the mystery of why it took three hours of minimal suction to clean the nuts off the bottom of the pool.

Water seems to be a constant theme to husband’s weekends away – whether it is both children having an unintended water gun fight in 50 degree weather or leaking roof from torrential rains. Experience has improved my outlook on Helloween. I know that Husband will return recharged (hung-over). Most small crises are survivable, and the boys and I can do things that we wouldn’t ordinarily do with dad home – like have a sleepover on the sleeper sofa in front of the fire place. The boys get undiluted mom time, and I look forward to the adventures we have together.

I also look forward to my own me-time. That’s the deal. Husband gets his weekend and I get mine. So in a couple of weeks I’m taking off for a writing conference in Massachusetts –deep immersion into words, character, plot, and all things bookish. In the past, I’ve done beach weekends with the girls, a polymer clay retreat with my mom, bead shows and a solo writing conference to see favorite author, Sue Monk Kidd. These weekends are sanity-savers, a time to pursue who I am besides mom, spouse and physician (not necessarily in that order), so I understand Husband’s enthusiasm for his Helloween crew. So while my crock-pot is my domestic secret weapon, personal retreats – solo or with friends are my trick and treat for self preservation.

Seriously, I wanna know...

Jay Leno needs five. Albert Einstein needed ten. Leonardo da Vinci took his in 15 minute intervals. Hours of sleep, that is. How many hours do you need to feel human? Do you catnap?

Secret Weapon

I have a secret weapon – not a bat mobile, not a web shot from my inner wrist, not an iron suit – think domestic secret weapon.

It’s my crock-pot and in fifteen minutes of prep time – I can create the illusion of having slaved in the kitchen for the last ten hours. Magically this appliance takes raw meat and vegetables and creates a main dish, a side and gravy. This satisfies my meat and potato men (separate sides of the plate, please) and my casserole (one dish, less clean-up) mentality.

I’ve heard the concerns about crock pot cooking: the appliance doesn’t cook hot enough to be safe. What if it malfunctions (which has happened and we ordered take-out that night)? What if it sets off a fire when I’m not home? I’m willing to take the risks as I do with all the other appliances plugged into my house. Thankfully no one has gotten ill from one of my crock-pot adventures, and I have yet to burn the house down.

I own about fifteen slow cooking cookbooks, and always looking for a new take on my stainless steel wonder. One of my family’s favorites is pork BBQ. It is stupidly simple and can spawn multiple varieties. One pork butt roast with bone intact (don’t know why the bone matters but it does). Put the roast in the slow cooker ten hours in advance of dinnertime. If I remember, I try to put a liner in the cooker to ease my clean-up. Pour one bottle of BBQ sauce over the top and cook on low for 10+ hours. I keep this one very simple with just meat – but I usually add vegetables to my other slow cooker recipes such as pot roast, chicken and dumplings, (bastardized) chicken cacciatore, or beef stew.

At the end of cooking time (and this works well overnight for lunch, too), all the meat falls off the bone into juicy, tangy ribbons of pork which are easily draped over a sandwich roll. I like it by itself with vinegar BBQ sauce. Throw together some salad, fruit or baked beans, and I have a meal. Turkey or chicken can be substituted for less time with good results.

The best part ….the whole house smells like I’ve cooked all day. Heroically I can serve dinner at 6PM sharp with clean-up by 7. Not faster than a speeding bullet but according to 19th century French chef and author Urbain Dubois, "the ambition of every good cook must be to make something very good with the fewest possible ingredients."

24/7

Mamapop had a great discussion Thursday about feminism, and how it applies to politics, specifically Sarah Palin. Feminist is not one of the labels I apply to myself (like juliaink). Just don’t consider myself a pioneer in moving the cause of women forward. I also don’t tag myself as a political animal. However, this election has me fired up because I feel that the items the media has picked up and discussed are issues in my back yard.

As women in medicine and specifically mothers in medicine, we have a unique perspective. My occupation is 24/7. I share call with other physicians, now, although I was once a solo practitioner. The ownership part of my practice is still there seven days a week and requires maintenance whether it is employee reviews I need to write, maintenance of the facilities or just a late night security call. Being a physician is a 24/7 job whether I’m on call or not – and I suspect it may be that way for my fellow MIM writers. Have you fielded a phone call from a worried neighbor or family member because you have MD or DO (or RN, PA, NP) after you name?

Mothering, Fathering and Parenting are also 24/7 jobs. Even with my two healthy children, the balance is precarious and dynamic. I can only imagine what adding intense media coverage, decision making for 300+ million citizens, and overlapping passport stamps would do to my stress level. It’s not that the VP (or presidency, for that matter) job isn’t compatible with parenthood. It is. I’m not sure the job that will require 110% focus seven days a week (or at least this is what I expect out of elected leaders ) is balanceable with children that need their parents as much as 2 of the 5 Palin kids will need their parents in the coming months.

What If?

In Eat, Pray, Love Elizabeth Gilbert introduces us to her goons, Depression and Loneliness. They follow her through Rome and Italy as she begins her journey back to herself. I have thugs, too – the What Ifs? They’re a nebulous group of wanderers that pop up as uninvited guests to my thought party.

As a physician they appear as I’m trying to decide how to treat a febrile infant with no source for the fever. “What if,” they poke, “this baby is septic? Will the parents call for more advice, treatment?” “Will this child die in the night?”

“What if the eight-year old that hit his head on the basketball court has a subdural hematoma? What if I miss this serious diagnosis? What if I get sued?” They love to spin tornado-like into larger and larger scenarios of doom. Rarely, they bring news of good. There’s no “What if you catch this hip click before it becomes avascular necrosis of the femoral head and needs a hip replacement when this patient is 25 years old?" There’s no “What if you’ve caught this MRSA before it’s an admission to the hospital?”

They bleed into life as a mother, too, where they take advantage of my sympathy and relative novice state as the parent of a grade- schooler and tween. Never having charted this particular course in parenthood – and it’s very different being a parent and having experience and being a physician and having book-knowledge – is perfect fodder for these thugs.

“What if being too tired to read to Harry tonight makes him feel unloved, unintelligent, uninteresting – take your pick? What if my slightly overweight sons don't hit that growth spurt just right to put their body mass indexes into a normal range? What if someone takes my social and easy-going seven-year old? Who will I call? Where do I look first? What would he do?”

Neurosis is part of my hard drive. I was born to worry about something and these goons know that. A good day for them is when they spin me so tightly that I spook when someone drops a pencil or my husband sticks his head into my office to say hello. Sometimes the What Ifs bring their cousins the What’s Next and Whys. Newspaper trivia about lame lawsuits and pediatric listservs feed their hungry mouths, but they’re always starving for more. Sleep deprivation is a neon open sign to my goons, and if they can catch me just right, What Ifs can keep me up all night with their myriad possibilities.

Lexapro is weak garlic to the What If bloodsuckers that leach my energy. Gilbert’s kept her vampires at bay with Wellbutrin. Breathing exercises and meditation return me to now from La La Future Land where these ding-a-lings prefer to inhabit. Running, walking and exercise also repel the monsters that dwell in my head. Maybe they hate body odor and running shoes. Experience locks the door on the What Ifs cage using reason and common sense as arsenal for the grenades they lob at my head.

Do you know the What ifs?

The Orchidometer

“Mom, do you have an orchidometer?”

“A WHAT?” I’m totally in mom-mode lounging and watching television with my tween son, Will.

“It’s in one of those books you gave me.”

“Go get it and show me what you’re talking about.”

He brings me one of his puberty books, and shows me a picture of varying sized beads on a string.

I hadn’t seen one of those since my peds endocrinology rotation fifteen years ago. It’s a gauge to measure the size of a patient’s testicles, and not part of my regular assessment in general pediatrics.

“I think I’m between a 4 and 6. Maybe about a five.” He offers me.

Great – I’m amused and relieved that he would even share this information with me. I am his go-to parent about all matters related to sexual development. My tween is in a very push-pull stage. There are days he’s my shadow, and can’t get enough of me. He strokes my back affectionately, and nuzzles up to my shoulder. I can barely relieve myself without his presence, and I’m mostly grateful that he still likes my company. I know there will be a day soon that my company will no longer be needed or desired.

I’m also horrified that he knows the information that he does. It gives me a small peak into what he is preoccupied with these days. It’s not the video games that I would like to lull myself into false expectations with. Who is he sharing this information with? Have I overeducated him? Is he overeducated in some areas and undereducated in others? (Probably)

“The book says that puberty doesn’t start until your testicles get to be about an eight or nine.”

“Good to know.” I blink hard.

“So I don’t think I’ve started yet.”

“Mmm.” is all I can think of to say.

So the acne, body odor, mood swings, and tiny peach fuzz over his top lip aren’t because of puberty. The frequent visits to my glass shower while I’m in it probably aren’t related to puberty, either. Boy, that’s a relief! For now I’ll continue to watch this surreal movie that is my life with a pre-pubertal son.

Seriously, I wanna know...

T's post about her future career as a daycare owner left me wondering. What would be your next career move? Would you pick medicine again?

Love's labor

The day that my first son was due was also the day that Princess Diana died in France, August 31, 1997. I spent the next week on bed rest crying about the loss of a mother to Diana’s two sons, Will and Harry. Little did I know that I was getting ready to birth my own heir (and later a spare). We had purposefully left the gender of our first offspring a secret to get me through the birthing process. Labor finally came during Diana’s funeral and I got to writhe during the whole ceremony in a hospital bed while the unsynchronized and unorganized contractions did little except flip this baby to the occiput anterior position.

At the time we lived in BFE and I was a pediatrician in a small group practice. I had witnessed several hundred deliveries in pediatric residency. I hadn’t really given a lot of thought to how I wanted my own delivery to go, but I knew some things I didn’t want. I didn’t want a cesarean section. I have a child-bearing pelvis for a reason. I also didn’t want to be in pain if I could help it. I had seen women cuss at their husbands, scratch, spit, and refuse to push. I didn’t want to be out of control like that. I believe in good drugs and an epidural was part of that picture. I knew I was no hero, and would deliver in the same hospital that I worked in. If the hospital was good enough for the parents of my patients it was good enough for me, but I also wanted to keep it together as best I could. First and last I wanted this baby to be healthy.

Part of my initial Obstetric packet was information about writing a birth plan. At the time, I was pretty naive to how detailed some women write their birth plans. Not many mothers had or followed birth plans in the inner city hospital of my residency training. Those that wrote birth plans in BFE probably delivered at the teaching hospital an hour away. Also knowing what I knew about babies and deliveries, I realized that anything could happen, and it was important not to get too attached to my own agenda. I wasn’t the only one in the picture. That philosophy has paid dividends many times over in my life as a mother. The one thing that I really wanted to experience as a new mom was breastfeeding. All of my exposures to hundreds and thousands of germs would pay off by passing on my immune experience to my new son. That was the least elastic part of any plans I had for this delivery. I would breastfeed, end of discussion.

This baby provided me with excellent lessons in flexibility. The epidural didn’t touch the back labor, but it did a great job of turning my legs to jello. At one point my labor nurse (bless her) had me on all fours trying to shake my OP baby loose so I could deliver him. I lost my balance on the jello legs and tried to fall out of the bed. My quick thinking nurse and husband caught me before I went over the rail and pulled out all of my tubes – IV, Foley, and epidural. More lessons came quickly when my mom appeared at 10 cm. My husband and I had made a tentative pact that the delivery would be just us and any needed hospital personnel. At 10 cm and needing to push, I could have cared less if the whole high school football team had been in the delivery room. With the first push, I quickly caught on that the pain and pressure would be over if I could put the pedal to the metal. While Number One Son didn’t flip out of the sunny side up position, I was able to avoid the c-section and delivered his 8lb 6 oz body with lots of pushing and a third degree tear. He appeared with a lusty, masculine cry, and twelve hours of labor melted away into a memory. We had a son!

Breastfeeding humbled me. Latching on made Will claustrophobic – a personality trait he still has to this day. He would cry every time I tried to make him try which made me a teary mess. Next he turned pumpkin yellow with jaundice, and got sleepy enough that he didn’t care much if he was hungry. My ample chest apparatus (to go along with the child bearing hips) missed all the milk-making memos. Maybe all of the tears from the death of Princess Diana soured the whole system. And with no lactation consultant in BFE, I was up the creek. We tried silastic tubing and supplemental nursing systems, cup feeding and so much fenugreek that I smelled like a pickle. After three weeks of trying to starve my sweet baby boy, my husband kidnapped us both and took us out of town so I wouldn’t have to look at my new breast pump and cry anymore. A formula family was born! A more empathetic pediatrician to new mothers was also born as I labored to learn and relearn my lessons of flexibility.

P.S. Harry’s birth was much easier.

Bees and Birds

“Douche bag!” My tween son hurls at his brother in the car on the way to a picnic.

“What was that?” I counter.

“Douche bag.” He returns sheepishly.

“Do you know what a douche bag is?”

“No, not really.” Will replies.

“Well let me tell you.”

And so continues our snippets of car talk. One would think that talking about sex and sexual matters would come easily for a pediatrician. Conversations about sexual matters and children are a daily occurrence in my practice. Yet a different element exists when I am trying to convey information about sex to my own children.

Trends in our family would suggest that there are some universal truths about sex education. The first is that the topics my children seen to have the most questions about aren’t covered widely in any book I know about. We’ve covered the basics – mostly in the car – about where babies come from and the real words for male and female anatomy. Sometimes it is all I can do to stay on the road. Then there are these other topics like defining a douche bag or masturbation. One time after an Oprah episode my eldest wanted to know what a pedophile was. Okay, where do I begin?

The second universal truth is that I am my sons’ go to girl for information. I am the token female in our family and it is my job to educate them about the female gender. Yeah, right. My job has globalized into ISM specialist or Information about Sexual Matters specialist. As I strive to keep these lines of communication open and honest, I am having epiphanies of understanding for all the parents who struggle with these topics. At one point I had aspirations of writing a coaching guide for mothers of boys to tackle some of these topics. I bought as many books about puberty and boys as I could find on Amazon.com. If I educated myself, I might be able to educate others, right? As the project sits stagnant on my bookshelf, the books have provided practical punctuation for Will’s sexual education and fodder for more conversations to come.

Lastly the universe has decided that we will have these conversations whenever and wherever. Car, movie theater, restaurants. No place is excluded. As a new parent, I assumed that “the talk” would take place in the privacy of our home. When my boys ask questions, they seem out of context because 90% take place out of our house. The silver lining to this truth is that the conversations are usually short – literally snippets – and ongoing. This is a key concept I try to share with families in my practice. The talk really should be an ongoing thread woven into daily life. Break off small pieces to feed your kids on a regular basis. It is less overwhelming that way.

“Sorry about the language, Mom.” Will say at the end of the picnic.

“I’m just try to teach you before someone else does.”

“I know.”

“I don’t want you to be embarrassed by a teacher or someone else’s parent. You need to know the real meaning of the words you use.”

“Thanks, Mom.” Will kisses my cheek. Mission accomplished (for today).

Ataxia versus Balance

Balance is a daily quest for me. Juggling the responsibilities of parenthood, being a spouse, pediatrician, practice owner, and other smaller hats requires the agility of an Olympic gymnast. So I read with interest Lisa Belkin’s article in the New York Times Magazine this Sunday, “When Mom and Dad Share It All”. She details parenting duos who strive for a 50:50 split of all childcare and household duties. One family divides parenting into 3 or 4 molds based on their past and present experiences: “mother-knows-best mold”, “involved dad married to the stressed out working mom”, “stay at home dad”, or a newer mold, “equally shared parenting.”

Me: Which mold do you think we fit into? I ask husband who is enjoying his Father’s Day repose in front of the US Open.

Husband: (grins) I don’t know.

Me: Are we the equally shared parent group or the involved dad married to stressed-out working mom?

Husband: I think the latter would be more accurate.

Me: Hmm

We’ve actually tried on most of these molds in our marriage. There probably was a time as a pediatrician and mother that I thought I knew best. My husband and I have certainly butted heads about this – my husband being more of an authority on the male half of our species than I. Time has taught me that I may be an expert on some matters relating to children, but I always have a lot to learn about my own children and their version of human nature. I’ve also learned how capable my husband is at dealing with our family – that at the end of the day if all are fed, healthy, and content that matching socks, extracurricular activities, and thank you notes can go by the wayside.

The stay at home dad experience was our failed experiment. After a challenging experience with a nanny, my husband decided to be the stay at home parent with our then seven month old son. Belkin and Marc Vachon (one of the interviewed fathers) say that this parent is “cooed at for his sensitivity but who is isolated and financially vulnerable as the stay-at-home mom.” That pretty much hit the nail on the head. Living in a small, conservative town worsened the loneliness for my outgoing husband who was used to the daily traffic of his office. Ultimately we moved to a larger community so that we could find support and reinvent our parenting roles.

Our current mold is a hybrid of stressed out mom and 50:50 parenting. Some days are 10:90 when I am on call and my husband picks up, feeds, and completes homework with the boys. Other days are 50:50 when we divide and conquer the birthday party gift-buying, drop off and pick up. The stressed out part comes from my own personal parenting standard getting in the way of just doing it. I don’t always know where these standards come from, but they are very persistent and immediate. This week is a good example. The boys are enrolled in soccer camp, and I have found myself micromanaging the clothes, water bottles, and drawstring bags for each day. I don’t have any idea where this standard comes from that both boys need to have these things and look like they’re playing in the World Cup.

With the exception of reading articles about co-parenting in the NY Times magazine, I think less about the division of labor in our household than I used to. Keeping track of how much work at home each parent does isn’t very fruitful. It either makes me anxious that I haven’t done enough and I overcompensate (read stress out) or I’m resentful that I have so much to do in a short period of time (more stress). Looking at the big picture helps – the important things are getting done and accomplished. What didn’t get done probably didn’t really matter that much.

Father's Day

Happy Father's Day to all of the men that help us do what we do! My gift to you is a heartfelt quote from John Gregory Brown in Decorations in a Ruined Cemetery, 1994.

There's something like a line of gold thread running through a man's words when he talks to his daughter, and gradually over the years it gets to be long enough for you to pick up in your hands and weave into cloth that feels like love itself.

Top Ten Pearls

This is a shameless plug for an excellent writing conference that I attended this spring in Boston. Publishing Books, Memoirs and other Creative Nonfiction (aka Harvard Writers) is a classy conference directed by tireless and enthusiastic Julie Silver, MD. Authors, agents, editors, and publicists gather to teach the medically minded about the publishing world. I even got 25 CME credits for attending!

One of the standout presentations, and there were many, was Pauline Chen, MD. Dr. Chen's first book, Final Exam: A Surgeon's Reflections on Mortality, is a New York Times Bestseller. She shared with us her Top 10 Pearls about writing in David Letterman style.

• 10. Study for your boards - attend writing programs and conferences. Dr. Chen went to the UCLA writing program


• 9. Practice your knots - write. write, write


• 8. Go through rotations with an open mind - be prepared to be surprised about where this writing journey takes you


• 7. See a donut/Eat a donut - Eat for free - Read as much and as widely as possible especially in your own genre


• 6. Better is the enemy of good (Voltaire) - Make the jump! Sometimes you have to stop writing and try to publish


• 5. Don't apply to just one program - Find someone with similar interests and meet them (personal thank yous to Fat Doctor and KC for getting me started)


• 4. Make a list of 10 most important things in life - sometimes it takes reestablishing priorities to write/blog - For Dr. Chen: Sleep when you can, eat when you can, write when you can and don't mess with the pancreas applies


• 3. Remember your residency - You survived/are surviving residency - you can write a book/blog


• 2. A good senior resident is a good team player - publishing requires same set of skills: be polite (give credit where credit is due), be prepared, be punctual


• 1. Trust no one - trust only your voice and find it by reading and lots of writing.

And in case you think I've lost my mind and forgotten that this blog is supposed to be about mothers in medicine, writing makes me a better parent and I hope a better physician. Maybe it's the political climate, maybe it's too much JennyMcCarthy's rant on vaccines and autism, but medicine seems to be taking a beating. It's important for those of us in the medical trenches to have an outlet to be heard. Honor and integrity still exist in medicine, and we are uniquely positioned to tell that part of the story by wearing our mom and doc hats simultaneously. Write with abandon!

Warped

To say that pediatrics has altered my outlook on life is the understatement of the last general election. Take my children, for example. Most of my parenting decisions come from 1) gut response 2) experience from pediatric residency 3) pediatric practice or distant #4) indoctrination from my own parental units.

For several years William and Harry have requested some type of reptile coming to reside at our house. I have a difficult time calling a reptile a pet since they are neither cute nor cuddly.

Gut response says “Hell, No. No slithering critters with tails who can escape from minimally-lidded glass aquariums.”

The joint Pediatric camp says “Are you crazy? Turtles, lizards, geckos, etc. carry salmonella and shigella and can give you bloody diarrhea just to start.” Flashback to PICU patient seizing with generalized shigella infection.

Finally the Parental/Growing up experience has no comment because I grew up in a house full of girls who had nothing to do with reptiles.

The issue of “heelies” has also come up with the two boys in my life.

“They’re fun.” Says Harry

“We won’t get hurt.” Says William

“What about the classmate with the two broken elbows from last week?” The Pediatric Camp volleys.

“We’ll wear pads.” H and W say simultaneously.

“Yeah, right.” We’ve already paid a small fortune or at least a couple of house payments to our friend the orthopedist. Let’s not add our friend the ED doc to the family payroll. Another flashback to PICU patient with head injury seizing in the unit – maybe I just have Pediatric Post-Traumatic Stress Disorder.

And then there are the video games which are heavily regulated by the Homeland Parental Unit (HPU). E rated and the occasional T rated games only. Every now and then the HPU catches Harry sneaking next door to play M rated games with the neighbors. Gut response wants to know how long it will be before William or Harry go postal and wind up on E! television as a True Hollywood Story about serial killers. The Pediatric camp wants to know how much weight they’ll gain from playing 2 hours a day instead of being outside. The Growing up response again has no comment because I’m a girl and too old to have dealt with this issue in my own childhood.
Ok, I’ll admit it. My career has warped me into an overly neurotic, lizard-hating, heelie-avoiding, E-rated un-fun (but safe)parent that I am today.