Expectations and Realities

I will finally sign out that last autopsy that is due in 9 days so that this time I don't wait until day 60.
*I call my husband on day 60 and tell him I'll be staying really late to finish an autopsy, but I'll be home for Punky's bed time, for sure; she gets to bed 30 minutes late.

Tonight I get home from work before 6:00pm and I'm definitely going to wash my makeup sponges and re-order whatever stuff I'm low on from Sephora.
*A friend texts with a work crisis and I write back-and-forth for 45 minutes until I have to break for bath time.

For sure this time I will buy our plane tickets for our holiday travel at least three months ahead of time to save money.
*Three weeks before the trip I'm scrambling for the last three seats on the plane, surely paying at least $200 more per ticket. Again.

After Punky's bath tonight, I am definitely going to change her sheets and thin out her clothing that she's outgrown for donation.
*I spend that 25 minutes recording (for posterity) the funniest conversation that she and I had about unicorns vs. mermaids while she was in the bath.

Today will be such a good day at work; I have been off for a week and I am back and refreshed with an empty queue to start.
*43 new cases in the queue, Pedi GI calls and asks for a stat run on a liver biopsy for possible atresia, three separate colleagues come in with "sorry, I have a few quick cases that need review, and they're kinda old" and then the outlying problem hospital calls to say that a surgeon is screaming about a lost specimen and I need to call him NOW.

I will be the first one to sign up for what to bring to the next pre-K class party; I will definitely get paper plates or napkins this time!
*The list comes out when I'm on call and can't bring Punky to school or pick her up for a week; I cut an array of colorful fresh fruit for 1.7 hours at midnight and arrange them into an appealing rainbow configuration in an act of self-flagellation.

I will schedule a nice, easy play date with Punky's school friend that has the really nice and friendly mom to bolster my only child's social skills.
*I finally text her 14 weeks after I first committed to it in my mind, schedule them to come to our house for the upcoming Saturday, spend three hours the night before cleaning the house,  and then drink a mimosa beforehand to ease the path to small talk. It goes fine. The anxiety regarding the next play date begins immediately after the front door closes behind them.

I will work extra hard to keep up efficiency today and just work on my cases, one after another, until they are all completed before I do anything extra because I know that I'm too far behind already this week.
*I work steadily for 45 minutes, then make a doctor's appt for myself that I've been putting off for two years, make sure bills are paid, finally order Christmas gifts for my oldest friend's five kids so they get there in time (converted from birthday gifts, because I decide to face it, remembering five extra birthdays annually is essentially never going to happen), and make that rage donation to Amy McGrath (because Moscow Mitch did something heinous *again*) so I don't forget to do it later. Only half of my cases are signed out. Crap.

I really want to spend the 20 min of Punky's bath time doing color-by-number on my iPad.
*I fold two more baskets of other people's laundry and force myself to put away the clothes.

Tonight I will definitely clear off the clutter from the kitchen table that we never use for eating, because I know that my husband hates this state of affairs.
*I put approximately four pieces of paper into recycling, photograph 16 pieces of artwork for Keepy and throw them away, then realize that I need to answer my MOC quarterly questions now since the thought just popped into my head and if I don't do it I'll miss the deadline.

This year, I will wrap presents as they come in to keep caught up.
*I place gifts in reusable cloth bags on a random midnight a few days before Christmas in place of sleeping.

I will definitely complete all four of the reminders I set on my phone for internet errands today.
*At 1:23 am, I sigh and change the dates on all four phone reminders to tomorrow's date. Well, technically *today's* date.

I will work on that amazing wooden puzzle tonight after putting Punky to bed and eating something.
*I scroll thru my Facebook feed for 1.75 hours reading the news, getting angry; I see a couple of cute kids and I feel a little better.

It's been weeks since I've had a work day off with the kid in daycare, I will definitely knock out at least four of my running to-do-at-home jobs off the list I keep on my phone, including setting up the Roomba that I bought two months ago which is sitting in it's box in the corner of the utility room.
*I drop off Punky, "stop in" to World Market for 1.4 hours, then head over to Target to wander around for another two, finally getting home at 1:45 pm and folding laundry/hanging clothes in the closest while listening to podcasts and scrolling Instagram until I have to pick up Punky at 5:30pm; the Roomba remains unopened.

I will make sure that this year, we get our family photos done in October so that I can get the cards completed in November.
*I panic and realize that the weekend before Thanksgiving is the last of the semi-decent leaf color and implore my husband to check out that spot that he's been meaning to look at for photography; cards are completed on December 8th and mailed on December 15th.

I will definitely go to bed in the 12:00 hour tonight; I really need a couple extra hours of sleep this week.
*I jolt awake at 2:34am, scroll back through the Schitt's Creek episode list to figure out exactly how many episodes I missed on auto-play, and finish cleaning up the kitchen before brushing teeth and falling into bed.

I will set a recurring reminder in my phone to write a blog post for MiM at some point so they don't kick me off the site.
*I sit at my desk at work at spew this out instead of signing out cases or validating immunostains, because, well, it's just time.

What my toddler is teaching me about growth

In the last couple of weeks, my son has been learning to identify colors. Mama and Dada are bursting with pride that he's so verbal and learning new things so quickly (he's not quite two years old). For the first few days, he would try to identify a color and be right maybe ten percent of the time. When we'd gently correct him, his little brow would furrow for a fraction of a second, and then he'd try again. He's been persistent, and now a few weeks in, he names the colors of the flowers and the cars that we see walking around our neighborhood. And he's so excited when he gets it - just bursting with pride that he's learned something new.

I have a lot to learn from my son. He is curious and eager to learn, and he doesn't give up when he struggles. He's not embarrassed to admit that he doesn't know something, and why should he be? It's all new to him, and he's learning so much! He's having fun, even when he doesn't know the answer.

In just 7 short weeks, I'll be a brand new intern, and I will struggle. I will be wrong often. I will try my best and still fall short. Obviously, the stakes are drastically different for me than they are for him. But if I can approach the next phase of my training with half of my son's enthusiasm, joy and persistence in learning, I think I'll be ok. 

Disney, food poisoning, and a podcast

My husband took our son for his first trip to Disney for his birthday. Alas, sans me, I was working. But this post is not about any mommy guilt for missing his epic birthday Disney trip. My ideal vacation consists of laying on a beach and gazing into the blue ocean and blue skies. Minimal planning required on my part beyond transportation and lodging. I was happy to skip on the byzantine planning of Fastpasses and Mouse Hacking, and let my son make memories in the magic kingdom with daddy.

Father and son brought back lots of memories. But also food poisoning. On the drive back home, my husband was so violently ill, he didn't feel safe driving back. So instead of waiting a few hours to rest and recover, he suggested I drive several hours to meet him halfway and pick up our son. And he continue driving himself home. Because he must get to the hospital in time to get signout for his patients. Over the years of being married to him, I know better than to suggest logical alternatives to his crazy plans, especially if he is in any state of distress. Luckily that particular day was my day off. So off I was, driving in his general direction, hoping for their mutual safety.

On this drive, I tuned into an episode of one of my favorite podcasts, Hippocratic Hustle. And what a pleasant surprise to hear our very own PracticeBalance, talking about blogging in medicine as her side hustle. I very much enjoyed listening to your voice and your story, just as I enjoy reading your posts!

As a Disney ending to my absurd story, we all got home safely, everyone regained their health and lived happily ever after.

Doctor-Moms, This Is Our Job

Finally, a cause we can all agree to take action on. We means everyone: Liberals and Conservatives, Democrats and Republicans, Christians and Jews and Muslims and Atheists and everyone in between. Follow to the end for specific, easy actions you as a physician and a mother can take to help stop this morally repugnant horror.

The issue? Around the world, we are seeing a horrific trend: children are increasingly being used as tools in political conflict. In Syria, children are used as human shields. In Afghanistan, children are recruited and used as soldiers. In Nigeria, children are recruited as suicide bombers. In Myanmar, children are tortured to send a political message.

Here in the United States, we take children as political hostages.

This is no exaggeration nor overstatement. This Saturday, our President stated that he is using  migrant children taken from their families as a political bargaining chip. Despite his repeated insistence, there is no law nor policy in place stating that migrant families should be separated at the border, only President Trump's personal mandate.

How could such a horrible thing happen here, in our democracy? In Spring 2017, Trump's Homeland Security Advisor John Kelly proposed separating all children from their parents as they sought shelter, “in order to deter more movement along this terribly dangerous network”, as reported in last week's New York Times.

More recently, Trump's senior policy advisor Stephen Miller reiterated that this is all Trump's doing: 

“It was a simple decision by the administration to have a zero tolerance policy for illegal entry, period. The message is that no one is exempt from immigration law.”
 
It is now well-documented for the world to see and judge. In using children as political hostages, our country has stooped to the same lows as terrorists and dictatorships in Syria, Afghanistan, Nigeria, Laos, and Myanmar.

Of course there is growing outrage against Trump's disgusting agenda. Many Republicans leaders are stepping forward to condemn this administration's inhumane actions, and not only moderate stalwarts like former First Lady Bush and Senator Susan Collins of Maine. Even Senator Lindsey Graham of South Carolina has gone on record, stating "President Trump could stop this policy with a phone call",  as Monday morning's New York Times reports.

While he is unlikely to take any action, we can.

We are mothers and doctors. We are uniquely positioned to comprehend the psychological damage inflicted upon children who are forcibly removed from their caregivers. The American Academy of Pediatrics has vehemently opposed this as policy since it was first mentioned by Trump's administration last Spring, based on the known grave consequences to child development. Pediatricians are speaking out. AAP president Colleen Kraft described the heartbreaking grief of a toddler she witnessed at one detention center, and explained the effects of harmful toxic stress on children.

As the AAP's formal statement on The Detention of Immigrant Children recognizes:

"In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings."

The American Psychological Association has also written a letter to the Trump administration in opposition to the policy:

"Families fleeing their homes to seek sanctuary in the United States are already under a tremendous amount of stress. Sudden and unexpected family separation, such as separating families at the border, can add to that stress, leading to emotional trauma in children. Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

Yes, it's pretty clear that ripping innocent, frightened children from their parents and locking them in chain link cages is not in accordance with internationally accepted rights of the child. So what can we do about it?

As little or as much as you want. This can be simply clicking on a link to sign a petition or donate to a vetted charity, to calling your representatives, to writing an article for a local newspaper or blog... It's up to you. Here are some suggestions (and I personally did every single one of these this lovely Monday morning before my clinic started):

SIGN: 
Petition to Donald Trump to stop separating families at the border: https://actionnetwork.org/petitions/where-are-the-children

Petition to the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/department-of-homeland-security-stop-tearing-families-apart

Petition to Secretary of the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/keep-them-together-stop-separating-children-from-their-families-at-the-u-s-border

DONATE:
KIND (Kids In Need of Defense) is a nonprofit that provides legal assistance children who would otherwise stand in court alone. 

The Florence Project is a nonprofit that provides legal assistance to political detainees, including children, in Arizona.

The Asylum Seeker Advocacy Project is a nonprofit that provides legal assistance to refugees feeling violence seeking safety here int he U.S.

RAICES is a nonprofit that provides legal assistance to detainees and refugees, including children, in Texas.

Al Otro Lado is a binational nonprofit that provides legal assistance to families who have been separated, navigating the legal systems of Mexico and the United States to bring them back together. They also help deportees who have been abandoned in Mexico with resources including medical care.

PROTEST:
Families Belong Together is organizing rallies and protests in opposition to separating families at the border. Check out their website to see what's happening next near you.

CALL:
This is actually one of the most powerful things you can do. Call your representatives using any of the below easy methods. You'll probably get an answering machine, but if you get the machine or a person, say "My name is (your name) and I am opposed to separating families at the border. I am from (your zip code) in (your state). I do not need a response.":

Find your representatives in the House and then find their office phone number, and call.

Find your representatives in the Senate  and then find their office phone number, and call.

Or just call the Capitol operator: 202-224-3121. This number will direct you to the Capitol switchboard. When you call, ask to be connected to your senator or representative. The operator will direct your call to their office.

Pending Legislation on this includes The Keep Families Together Act and The Help Separated Children Act . 

SHARE: 
Whichever of these relatively small actions you take, TALK about it, SHARE on social media, PUBLICIZE the cause. This is really powerful.

WRITE: You are a doctor. You have a platform. Your voice is heard. Please consider writing a letter to your editor, even if it's a small town newspaper. Consider writing an op-ed for a news outlet. Consider posting on a political website, as Sanjiv Sriram, MD did. Consider writing a guest post for a blog. I accept guest posts at my own personal blog www.generallymedicine.com , and the editor here at Mothers in Medicine does as well. Kevin, MD is another great place for physicians to share their educated, intelligent thoughts.

Whatever you do, DO SOMETHING. The policy of using children as a political tool is morally repugnant, and we as doctor-moms know this better than anyone. Please help to stop this moral slide into evil.