Days and Days of Day Care

It is amazing to see the variety of available child-care options that are available to working parents. For our family, we carefully considered all options when I was pregnant with CindyLou. I was a resident, with very limited maternity leave (unless I wanted to prolong my residency training...I didn't) and my husband was moving up in the finance industry. We had no family immediately available, and, I am not sure if I saw one too many "Hand That Rocks the Cradle" -type movies, or what, but I was not comfortable bringing a stranger into our home to raise, shape, and mold our precious young child. What can I say (the lady tried to *breastfeed* that kid!!!)? I'm an alarmist, but Mr. Whoo felt the same way. So, we settled on out-of-home care, or, the dreaded "day care." I felt that the group setting held certain safety and social advantages over home care. For us, looking at certifications like NAEYC helped us to stratify centers, then we carefully would visit and observe. CindyLou's first day care was in a church-run facility. They had NAEYC accreditation, individual door codes for each child and family, and an "open door" policy. We loved the staff, and, as much as a small infant could, CindyLou thrived there.

After residency, we completely lucked into a top-notch facility, meant mainly for government workers, but they would sometimes open slots to the slovenly masses if they moved far enough down the food chain. This place was like Fort Knox, and you needed 24 hour security clearance (with armed guards at all entrances to the property) just to get onto the campus. Needless to say, we felt she was safe there. In addition, we were really impressed with the facility, staff, and, get this, curriculum. Who knew that day care could have a *curriculum?* We fell into the habit early of calling day care "school" and her care providers her "teachers." She was learning so much, it was easy to do. Socially, we felt that the exposure to different children and personalities was a plus for our outgoing child. Academically, we felt she was always challenged and she came home talking about things that she had learned we would have otherwise thought beyond her level. There were daily progress reports and periodic "parent-teacher" conferences. We always felt well informed about her day to day life in "school." Some downsides were the strict regimentation of protocols, and, as a Gubment agency, an inordinate amount of "days off" that were not necessarily days off for me. Fortunately, once the Bean came along, siblings were given priority, so he was also placed in the same center. We never felt badly leaving them in the care of the staff of the center, and over the 4 years we were there, they, the other parents, and other children came to feel like more of a family. It was a sad day when we had to leave them.

Now, here in Newville, CindyLou is in Kindergarten (for which I feel she was well prepared due to her day care "curriculum") during the days, and after school goes to a private program in the same pre-school in which the Bean is enrolled full time. In her after-school program, she has structured homework help, a place to go on those odd "holidays," and, in the summer, a fun, camp-like experience with lots of activities and field trips. This facility prides itself on being called a "school" rather than a "day care" so it gelled well with our overall philosophy. However, it is quite a bit more expensive (to the tune of $300 extra a month, and that is without CindyLou being enrolled as a "full time" student), but we can also attribute that to the area of country to which we have moved.

After several unstructured weeks off, and being out of the routine, the structure of the school-like environment was a welcome change for all of us. After a week or so of separation anxiety, we have finally gotten back into the daily groove. Bean can't wait to tell us each day how he loved reading books, playing outside, Spanish class (!!), and, most of all, playing with his friends. So, for us, careful research and quite a bit of good luck have lead to an all-around favorable experience with out-of-home care. For our family, the social interaction, structured learning, varied daily experiences, and caring staff members have made leaving our little ones behind as we make our way in the world just a bit more bearable.

The Difference

So, I made it! I survived the last few weeks of overdrive at the old job, moved halfway across the country, and started my new position a couple of weeks ago. The differences are amazing. The practice I came to is a much larger one, with several doctors and several locations. The offices run like well oiled machines, and the staff is top-notch. Everything is also on EMR, which makes it an interesting learning curve. The work is the same, but I always loved the actual job. The biggest difference, however, is the impact on my family and life.

Instead of having only 4 days off a month, I now average 4-6 calls a month (and this month there are only 3 calls...breaking me in easy). No longer am I mentally dividing myself between work and home every night. I get to come home at night and turn off my brain. When I am not on call, I am free to make plans...go out with friends, take the kids for a walk, go to my little girl's swim lessons. I no longer feel as though I have one foot out of the door at all times. I'm not obsessively checking the hospital census trying to spy potential labor patients. I'm doing what I love to do again, playing with my kids, reading books, going to movies, and seeing live music. I have a life again, and life is good. Mr. Whoo remarked, unprovoked, how happy he was to have "me" back. I had no idea how much of myself had been squelched by my lifestyle. I see the difference with my children, as well. CindyLou exclaimed to me just yesterday, "I love my happy mommy!" I love *being* a happy mommy. It was a scary leap to make, but so far, so good. May the scales of work and life balance tip more favorably for us all going forward, it makes such a difference.

Worried

I really, really don't like to post about political topics. Mostly because it is inflammatory, but also because, to me, it is extremely personal. However, based on recent media coverage, and President Obama's recent remarks to the AMA, I feel that I cannot keep silent on this subject. In his recent speech to the AMA, he downplayed the importance of tort reform in decreasing rising medical costs (such as unnecessary, expensive tests, ordered primarily to CYA and keep the lawyers at bay). More disturbing, however, was the notion that, in a "public option" (aka Government-run plan) he would base physician rating and reimbursement based on their personal health outcomes.

So, wait a minute, what's wrong with that? You ask. I mean, it is the doctor's *job* to make you *better,* right? It doesn't seem so horrible...you have a cold, you visit your physician, s/he diagnoses you with a viral infection, you get better, life goes on. But, what about this? As a physician, your patient population is obese. Despite your multiple attempts and counseling and lifestyle change recommendations, your patients continue along their unhealthy lifestyle, becoming even more obese. Guess what? You get a pay cut. Your patient that has smoked a pack a day for 50 years, and laughs in your face at your attempts to counsel smoking cessation develops COPD. Sorry, that is coming out of your hide. You did such a *bad* job of taking care of this patient! Your diabetic patient doesn't fill their medicine for a month, and then comes in to the hospital in frank DKA. *Your* fault for a negative outcome. Then, to add more fun, your ability to order laboratory/imaging tests will be limited (in the interest of keeping costs low), but if you miss out on a diagnosis? Your *fault,* and here come the lawyers for their piece of your livelihood. Where is the personal responsibility?

Who wants to put up with years of rigorous training, difficult study, and mountains of student loan debt only to be stymied in patient *care* at every turn? Surely not our best and brightest. I am worried about the future of our profession. A "public option" (not "free," by the way, more like $62,000 taxpayer dollars per person) for all intents and purposes will likely undercut any private competition (not to mention the tax burdens that will be levied to discourage competition). This will leave us, both patients and physicians, with only one choice. Government Medicine. Just like Government Motors. I don't want to become a government employee. I don't want my health care options to be limited to government employees. I don't even like to spend a day at the DMV!

I do believe that some reform, obviously, is needed, but I think it needs to be more geared to catastrophic coverage. I think we need to go back to fee-for-service health care, even schedule fees on a pro-rated percentage based on income to make health care visits affordable for all. Get rid of insurance for preventative care, labs, and office visits. Competition will then drive the costs down naturally. We, as physicians, can stop shuffling through piles of insurance paperwork and prior auths and get back to doing that which we were trained to do. Something that we love to do....take care of patients! Personally, I feel that "free" = "of little value." I believe we need to give people back a financial stake in their health care, and, perhaps, when they are financially vested in staying healthy, then they will value their health, and their health care providers, once again. Until then, I jump through a few more hoops to get my patients the care they need, and I worry about the future of our profession, and our nation.

MiM celebrates one year: dr. whoo

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

dr. whoo, an ob/gyn and mother of 2, is a veteran blogger with a popular personal blog with an awesome name. I mean, Ob/Gyn Kenobi, is brilliant, no? We were thrilled when she joined Mothers in Medicine as a regular contributor shortly after we launched.

dr. whoo writes:

Hi KC! Favorite post? Hmmmm, I think I would pick "What My Medical School Accpetance Letter Didn't Say..." I also liked "Boys Club" and "How do you do it all?"


Her choices involve a) her contribution to the Topic Day on "Things we wish we knew in medical school" --apparently a popular source of favorite posts for MiM bloggers; 2) a raw look at working in the trenches of medical culture where there is still a difference in treatment between male and female physicians (Boys Club); 3) continuing struggles to balance work and home life (How do you do it all?).

dr. whoo writes from the heart, with a clear point of view. Her love for the work she does is inspiring. We're rooting for her to be able to strike the work-life balance with a better job on the horizon. Thank you, dr. whoo, for being a part of MiM. We're looking forward to hearing all about your new adventures to come.

Role Reversal

Ever since my husband made the decision to stop working in order to balance our family and home life, things have been ever so much more manageable in our lives. Groceries get bought, laundry gets done, dinner gets cooked, and life is a little easier for all of us. It has been a necessary, though not a permanent, change. As my husband has assumed the "traditional female" role with respect to keeping our house in order, I sometimes find myself falling into the role of a 60s sitcom "traditional male." I come home, grunt a few times, stare at the television or the internet until dinner, hug and snuggle the kids, get them fed and bathed, and become basically a zoned-out zombie until the weekend rolls around. It is only then that I awaken to my real "maternal instinct." It is only then that I can interact with my kids as more of a mommy than a "provider." I know that I haven't changed, but, right now, my role in their lives has. I'm the breadwinner. I'm working for our family, and somehow, it is taking a lot from me. Lately, I find myself more sympathetic to those 60s fathers, bearing the weight of the world on their shoulders, but always ready with a bit of wisdom or a pithy saying. I know my husband respects the hard working (not bon-bon eating) housewives, as well. Still, at the end of the day, I know my mother's heart is still alive and well, especially when Bean holds my face close and memorizes every feature, softly saying "nose," "mouth," "eyes," and "hair." My heart just melts, and I feel so blessed to just be "Mommy."

To Get to the Other Side

There are times in life when everything seems to fall right in to place, and then, there are times like now. I can see the shimmering oasis of a new life, just on the horizon. A better call schedule, closer to family and friends, a chance to work in a collegial (not competitive) environment, more time with my precious kids and husband, and a chance to grow as a physician. Between the oasis and where I stand, however, is a treacherous, rock-filled, rapid river, swirling and threatening my ability to ever reach the opposite shore.

Obstacle #1 - Our house is on the market, and we have shown it at least a dozen times. Yet, despite positive overall feedback, not a single offer. I don't mean to boast, but our house is a beautiful house. I love it. I was ready to buy it the second I walked through the front door, and I can't believe that everyone else that sees it doesn't feel the same way. We never thought we would have to sell this house. Maybe we should have thought about selling it before we bought it. If we don't sell before we move, we'll have a hefty house payment, along with any rent payment we need to pay in Newville. This alone will be a financial strain.

Obstacle #2 - Mr. Whoo has yet to find a job, nor procure an interview in Newville. Granted, he has only starting looking in earnest recently. However, he is looking for work in the finance world, which isn't the best place to be seeking employment given the current state of our economy. We have been fortunate that he was able to quit his job last fall when our family really needed it, but now we worry that the employment gap may cause an impetus with new employers. Plus, without an additional income after the move, there will be more financial strain on our family. (See Obstacle #1)

Obstacle #3 - My current place of employment is not letting me go without a fight. There have been veiled and outright threats of lawsuits and damages and liabilities for me leaving earlier than my contract had mandated. There is also the matter of giving back a portion of student loans paid by the hospital. The fact that we would have to pay back was not unexpected, however, the amount that we calculated is about half of what the hospital estimates. We are procuring the services of a contract negotiator and a lawyer, who seem to believe we have a case for inducement, but I'm having angina just thinking of it. Not to mention the fact that, if the hospital's calculations are correct, they want us to pay up in less than 2 months. Add more financial liability to the swirly, cold, and fast water.

Obstacle #4 - Emotionally, I am wrung out. I am completely exhausted, and barely hanging on by my fingernails to make it to the date I indicated I was leaving. Being on call, continuously, with only 4 days off per month (plus vacation time), has left me completely burnt out. I find it hard to drag myself to work and muster compassion for my patients. They deserve better than the doctor I am right now. My health, mental and physical, is suffering. The remainder of my contract is a mere six months, and by finishing it out, I can alleviate much of the financial burden of the above obstacles...for the price of my very sanity. I want to cry just thinking of it.

So, I sit here on the bank, pining for the oasis, and unsure how to navigate the obstacles that lie before me. Oddly, I am reminded of the "old school" computer game, "The Oregon Trail." When faced with a river, you can try to ford the river, float the river, or hire someone else to help you across. Right now, I am pining desperately for someone to throw me a life line, or at the very least, a strategy for surviving these treacherous waters. The best advice I can relate to our readers is to know what you are getting in to before you sign a contract. There is no such thing as a perfect job, and if it seems too good to be true, it, in all likelihood, *is* too good to be true. Caveat emptor...and pass the caulk.

*cross posted at Ob/Gyn Kenobi

It's A Match

Match Day. It was a day that I viewed with trepidation (Will I go where I want to go?), anticipation (Where will the next chapter of my life begin?), and exhilaration (I would finally be done with medical school!) Match Day was a day that, before you entered medical school, you had no idea even existed. I hate to borrow the comparison to sororities once again, but Match Day does work almost exactly like sorority rush. Your senior year of medical school, you interview at many different programs, searching for (what you think is) your ideal fit for a training program. You have to make decisions about community programs vs. university based programs. Small programs vs. larger programs. City or rural? Academics focused or procedure focused? I'm oversimplifying for the sake of keeping the post a reasonable length, but you get the picture. Then, at the end of the interview season, you sit down and rank, first to last the programs in which you would like to train. The residency programs do the same, ranking applicants from most wanted to least wanted, and yes, they do have meetings where they put your picture up and talk about your pros and cons...just like rush. Then, all of the information from both the students and programs is plugged into some kind of nebulous computer database matrix-type-thing, where the magical "match" actually happens...each student to each program, according to mutual rankings. Thankfully, you are somewhat unaware of the gory details of the process when you are interviewing. All you know is that the decisions that you make when writing your match list will profoundly affect the rest of your professional life. No pressure.

For me, I was fortunate in the fact that I didn't have to worry about a couple's match (trying to match to the same place as your spouse or significant other). Mr. Whoo was delightfully mobile with respect to his professional life, so we didn't have the constraints of specific places that we just *had* to be. We picked a general area of the country in which we knew we would be happy, and concentrated on applying to the programs in that general area. I was also fortunate that I wasn't trying to match into a super competitive residency like dermatology or radiology (or, the "lifestyle specialties," as they are called), and I really had no interest in the rigorous academic programs. I was more concerned with learning how to be a general community Ob/Gyn, could not care less about research or academic prestige. For me, I primarily searched for community based, procedure heavy programs in a large region of the country. I looked at how the attendings and the residents interacted with one another, and I was really interested in finding a program where the residents actually seemed to *like* one another. As far as match criteria are concerned, mine were quite modest. I ranked 8 programs, 2 of which I loved enough to place them interchangeably in rank order.

Match Day itself was rather overwhelming. There was lots of pomp and circumstance, and even more nerves and jitters. There was a big ceremony outside, then we all went into the main lecture hall (where we spent the whole of our first two years as students, sort of poignant). It was there that we received the envelopes which held the direction for (did I mention?) our entire professional lives. To add extra fun, each of us was called individually up to the front of the entire room, filled with friends, students, and families to open our envelope in front of *everybody* to read aloud the program and specialty to which we had matched. The only prior knowledge that you had going up to this point was whether or not you *had* matched, so the reactions ranged from ecstatic, to barely concealed bitter disappointment. It was a little awful and a lot wonderful. On the whole, my class matched well, so many of us were rejoicing together. When it came my time to grab my envelope, I could barely squawk out the words on the paper, I was so overcome. I vaguely remember cheers and applause as I blindly made my way back to my seat. I had matched into my first choice...my path, once shrouded in mystery and doubt, was suddenly, sunnily clear.

After our class had opened the last envelope, there was a cake and punch reception (to which we brought flasks to generously spike the punch). We shared happy and sad tears, and there was a sense of relief that it was all *over,* when, in fact, it was just beginning. I found out that two other classmates had matched into residencies at the same place in which I did. This was kind of amazing, since we were coming from a big, academic med school in a location nearly a full day's drive from the smaller, community-ish program to which we all matched. It was comforting to know that there would be a couple of familiar faces in that new, unfamiliar territory. That night we all hit the town together as a class, and acted decidedly not like budding young medical professionals, but like the kids that we actually still were. For all the toil, sacrifice and tears that we had endured thus far, with even more looming on the horizon, all was right with the world on the day that we found our match.

Why I Do This

Lately, for me, all you have been hearing is bitch, bitch, bitch about how this or that sucks big hairy ones (can't wait to get the misguided google searches on that one). So why, you collectively ask me, either outright or in your minds, do you put up with all that you do? Why not quit and become a garbage collector or something? This list, my friends and frenemies, is why:

~ Bringing babies into the world is, quite simply, awe-inspiring. I love it. It is so special and intimate, that moment when a family is born (and re-born), and I feel privileged to be a part of it.

~ I love helping women. Women are way too busy taking care of every one else to worry about taking care of themselves. It is good to have 15-20 minutes to sit and listen to women, and make suggestions on how they can better care for their own needs.

~ I like to *fix* things. I am, at heart, a fixer. I want to change things for the better, and being an Ob/Gyn allows me to do this more often than not. I find this infinitely satisfying when I can make things better through surgery or medical treatment.

~ I enjoy the continuity of care that being an Ob/Gyn affords. I love being able to deliver multiple babies for the same patient, and then be able to take care of their Gyn needs once childbearing is over. I like the lasting relationships the field can foster.

~ I like to do Gyn surgery. General surgery, to me, was overwhelming, but Gyn surgery affords me the ability to do a variety of cases in a limited area of the anatomy. The perfectionist in me enjoys the focus on one organ system, but there is always good enough variety to keep it interesting.

~ Procedures are fun. Not just surgeries, but colposcopies, LEEPs, IUD insertions, polyp removals, and endometrial biopsies are all very enjoyable, and the results are often immediately evident. Highly satisfactory.

~ There is a limited amount of pharmacology. For me, it is pretty much antibiotics, hormone replacement or suppression, birth control, anti-inflammatory meds, the occasional hypertension or diabetes med, and some anti-depressants. I loathe polypharmacy, so I enjoy the clean and simple pharmaceutical profiles that Ob/Gyn provides.

~ The patients. That's right, for all that they do to drive me crazy, it's the patients that keep me coming back for more. Be it the infertile woman that I helped to conceive, or the anemic, miserable woman whose ills were cured by a simple procedure or surgery, or even the chronic pain patient who got the correct diagnosis, treatment, and subsequent improved quality of life. I do this for the patients, plain and simple.

~ At the end of an exhausting day, I feel that I am making a difference and an impact for good in people's lives. That fact makes the unbearable actually bearable.

So, look, I love my job. I love it. For all of my whining, I wouldn't do anything else. I hope this answers the questions out there. Thank you for listening.



**Cross posted at Ob/Gyn Kenobi

Just Like Mommy

Earlier this year, my daughter's class was doing a week on "healthy hearts," and her teachers asked if I could donate a stethoscope or two for the class. Since I am on my 5th or 6th stethoscope, it wasn't too hard to fish out the cast-offs from CindyLou's dress-up chest. The day we were to bring them in, CindyLou was sooooo excited. "My class is going to listen with *your* 'stefflstopes??' I'm so excited to be a doctor...just like mommy!" But instead of warming the cockles of my cold heart, these very words struck an odd chord of panic. I mean, what parent wouldn't beam with pride when their child wanted to follow in their footsteps, much less enter the medical profession?

Then, I paused a moment to think about what "being a doctor" really means to CindyLou. To her, mommy's work is hanging out at the nurse's station...checking out the new babies, coloring, eating crackers and suckers, and generally being fawned over by nurses, patients, and visitors alike. Or, perhaps she thinks about time in mommy's office, where SuperNurse plies her with her secret candy stash, she sits on her lap, and "works" on the computer. Being a doctor must seem a pretty sweet gig to a 4 (almost 5) year old. It also gives me hope that, for all my harried feelings about my job, they don't transfer to CindyLou; thus enabling her to feel like being a doctor is a pretty darn cool job. What ever the reason, I did feel grateful and humbled that my little girl was looking up to me, aspiring to be (despite my many foibles) "just like mommy.'

The Student

In the not too distant past, I had the good fortune of having a really great student with me for an "Office Ob/Gyn" elective. When I say "really great student," I mean exactly that. She arrived early and stayed late. She was professional and comforting to the patients. She asked appropriate questions and wrote really great notes. She had a good knowledge base, and she did it all with a smile and no 'tude. Truly, an awesome student. Unfortunately for her, we spent more time in the hospital doing surgery and deliveries than we did in the office. (I think that Whooville is having a serious baby boom. They just. keep. coming.) I do think that I was able to give her a taste of what being an Ob/Gyn is like, at least as far as being a solo practitioner, any way. She is trying to decide between Ob and a couple of other more "lifestyle friendly" specialties.

During the rotation, I really tried to let her form her own opinions about the life that she saw me living. I found myself, several times having to refrain from trying to talk her out of being an Ob/Gyn. A student that any Ob residency would be lucky to have, and I kept wanting to, I don't know, *protect* her or something. Maybe it was her sweet, un-cynical self, not yet marred by years of being beaten down by the establishment. Maybe it was because I wanted her to have a chance at a less stressful life, before it was too late to look back. Or maybe I was just trying to warn her not to make the same mistake that I made when I chose my first job out of residency (an essentially solo practice). I would like to think that it was the latter, because I truly love what I do, I just don't want to do it so, um, *often.*

I want to be able to feel confident in inspiring the best students to follow in my footsteps in a field that desperately needs good physicians. I worry that my first instinct is to tell my students to run, run, run, because I know that I wouldn't have. Even if the attending told me to run, I would have made the same choice. So at the end of the rotation, after we went over her evaluation, she asked for a letter of recommendation (which I will gladly write). When I asked whether she wanted one geared toward an Ob residency, or one for more general purposes, she chose the "more general" category. She's still making up her mind. Perhaps my feelings were telegraphed more than I had realized. I do feel hopeful, though, to know that the such bright rising stars in the future of medicine exist out there. So, to all you bright med students and would-be med students...don't let the disillusioned attendings get you down, y'all. We need you more than you know.

Boy's Club

Being a woman in medicine is not as difficult today as it was for our predecessors, but I'd venture to say that we still haven't gained true equality. My medical school class was the first class in school history to have an equal number of male and female students. The classes that followed ours actually were weighted in favor of more women than men. Yet, as I roam the halls of my hospital, I am acutely aware of how much of a "boy's club" still exists. There are small reminders in the physician's lounge areas of the surgical suites. The lounge attached to the female locker room is the "nurse's lounge." The lounge attached to the male locker room is the "doctor's lounge." In the hospital's general "doctor's lounge" there is a single restroom, in which the toilet seat is always left up.

In the operating room, invariably, it is my rooms that get the fresh new scrub techs that don't know a Kelly from a Heaney clamp, because they don't want to tick the male doctors off. My rooms also tend to run farther behind, "because (I) don't throw a fit." I'm sorry, since when was "throwing a fit" acceptable professional behavior? It happens more often than it should.

The reminders extend to the floor, as I round on my patients. At times I have to search high and low just to find the nurse that is taking care of my patient. I see my male colleagues, without lifting a finger, get a nurse to round with them. No kidding, these nurses, with whom I have a very good rapport and professional relationship, will snap to attention, grab the physician's charts, and follow them on rounds writing verbal orders as they go. Boggles the mind. I am friendly with the nurses, but in high stress times, I tend to bark orders just like any other physician. I have been called out for being "too harsh" in certain circumstances, and made to sit down with the nurse in question to apologize. I tread very carefully in my tone of voice, in order to not be misconstrued. In contrast, there was an incident in which a male physician grabbed a nurse and *shook* her because she did not complete an order that he requested (in the best interest of the patient.) Today that doctor and that nurse were laughing and joking together like it never happened. I have to wonder if I would even be working if I had dared pull such a stunt.

In the office, the fun continues, as my front office staff gives me hell for cancelling patients for a delivery, but will turn around in a heartbeat and croon "Aw, poor OtherDoc (my male colleague) has to go for a delivery. Of course we'll take care of it!" When the office orders lunch, they serve it to him in his office! You know, because he has "important doctor stuff to do!" Not to mention the varied and sundry insults that seem to happen on a daily basis. Patients that call me "sweetie" instead of *Dr.* Whoo or refer to me as "that nurse right there." Office patients that insist on calling me by my first name (which I never gave to them). The visitors that come up to me at the desk while I am working on charts to ask me to go fetch them some ice. This never happens to my male colleagues. It just doesn't.

We've all covered, in detail, how the difficulties extend into our home lives as we struggle to wear the mother, wife, and physician hats simultaneously. Women in medicine may have come a long way (baby), but from where I stand, we are the Thursday's children of medicine. We have far to go.

A Day Off

What do you do when you get a day off? I always imagine that families in which the mother isn't working weekends are always up to some great adventure. Taking the kids to the petting zoo, or picking berries on the farm, or just inventing clever games at home. You know what I want to do when I finally get a day off? Not a damn thing. I don't *want* to do anything. I want to sit. I want to veg out with a book or movies or my laptop. I don't want an itinerary or an adventure. I just want to be. So of course, then I feel incredibly guilty. Here I get a precious few hours with my darling children, who are growing up faster than I can believe, and I don't want to *do* anything with them.

How are my children going to remember me? Mommy, finally home from work, lying listlessly on the couch, book in one hand, computer near the other? This isn't how I want to be remembered. When I try to go and do kid-friendly activities, I find myself incredibly short tempered and longing for the comfort of home. I know that 4 days off a month is just too little down time, and things will get better once my job situation changes. In the meantime, what do you do with your little ones when you have the time to spend? Any suggestions for low key activities for 5 year olds and 18 month olds? I want to start making some good memories for my kids that don't involve the movie theater. Thank you in advance!

Reflections

The beginning of a fresh new year always seems to inspire grandiose dreams and aspirations of what we may want to do or who we want to be in the coming twelve months. I also try to take this last day of the year to reflect on all that has happened. I'm finding that my more generic "lose weight, get organized, attain perfection" resolutions are always at the forefront of the year, whilst the unexpected and mundane moments seem to occupy the latter portion of the year. This year my daughter turned four, my son turned one, I stopped breastfeeding, I found a new job, my husband quit work (for the better of the household), I delivered 120 babies, and I passed the board exam. I didn't lose much weight, I didn't stop drinking wine, and I didn't stop being snarky (go figure).

In the year 2009, I will have been graduated from high school for 16 years, graduated from college for 12 years, graduated from medical school for 8 years, married for 8 years, and a mother for 5 years, and graduated from residency for 4 years. I can't believe it. I turned around, I blinked, and the time was gone. I read once that as we get older, one year of life statistically becomes shorter. For example, at 2 years old, 1 year is half of your life, at 50, I year is 1/50 of your life. I do know that the coming year holds a big move, hopefully a sale of a house, the start of a new job (and with it a new lifestyle), kindergarten for CindyLou, and a multitude of other wonderful things that I couldn't even imagine. And it will feel like just a minute ago, but 2009 will be over, as well. My father always says that "These days *are* the good old days." I know one day I will look back at myself at 33 and laugh at how "young" I sounded. So my resolution for 2009 is to take each moment, the stressful and the relaxing, the harried and the hopeful, the highs and the lows, and remember that it is but the most fleeting moment in time, and from that, may I, may we all, find peace in truly living each moment in the coming new year. Happy New Year, Mothers in Medicine!

Slacker.

"You're a slacker, McFly!" is exactly what I hear in my head when I look at the blank screen of a new blog post template. Yes, I have been a slacker (sorry, KC, gentle nudge acknowledged!) I do have a good excuse, though. I was only studying for one of the scariest exams of my life to date (and that's a pretty big deal for a physician!) I recently took my oral board examination for board certification. It was like no other test that I ever had. I would not care to experience it again, though I fear I may. There is something really humbling in studying like a college student cramming for a final exam when you are in your mid-30s. I am not going to lie, I felt a little bitter and resentful about it. I mean, I do this work every day. I feel fairly competent, and, if I don't have all the answers, I do know where to look for them. I also have colleagues to which I can refer, so I really resent that I am not deemed a "good enough" physician until I go through the hazing ritual.

Truly, as I looked around the room the day of the exam, I felt as if I were in the inner sanctum of a (not so) secret society. The testing center was the house of the brotherhood. The examiners were the brothers/sisters, and I was the lowly pledge, so desperate to be on the other side of that imaginary line between junior fellow and fellow. It was all rather unsettling. I have been beating myself up since the test has concluded, and I'll have to wait a little longer until I discover whether I am "in" or whether I am "out." My family has been grounding me since my return home. To them, I *am* their inner circle, and, whether or not the brotherhood deems me worthy, I know that I can count on their radiant smiles and open arms to welcome me into our own little cozy inner sanctum. It puts everything in perspective, of which I am in great need. So, no more slacking, at home, work, or the blogosphere. The test is over, and life moves on.

What My Medical School Acceptance Letter Didn't Say (but maybe it should have)

Congratulations! You've made it to medical school. All of your hard work, community service, pretending to be interested in anesthesiology in order to be able to shadow a physician (any physician), over-involvement in extra-curricular activities, long nights spent studying whilst your English major roommate goes out and enjoys the college experience, and never, ever getting to schedule all your classes on only Tuesdays and Thursdays (so the better to enjoy a 4 day weekend) has finally paid off. Well, sort of. We'll get to that "payment" issue in a minute.

Right now you are, no doubt, a very "big fish" in a little pond. You are probably known as the smartest, most ambitious, and most masochistic, ahem, of all your friends. In medical school, you'll be surrounded by 100 + of people just as smart, ambitious, and masochistic (if not more so) than you. You will probably be, maybe for the very first time in your life, average. And as much as that may give you angina right now, you need to know that "average" is actually ok! No, really!

You thought you studied hard in college, but you are in for a surprise. You *did* study harder, relatively, than anyone else you knew. You also routinely got paid off in As. In medical school, you will sit in the same position for 8-9 hours a day, pausing only for bathroom breaks and pasta, reading, re-writing notes, and reading again, only to score an 80% on your exam. You need to go to lecture, but if you don't go to lecture, then you need a good note service, and, unless you are a hell of a good transcriptionist, if your medical school employs a lot of professors with thick accents, then you will probably need to ante up the cash for someone else to transcribe "your share" of note service lectures. Take some time to go "off campus" for lunches with your friends, and allow yourself to skip a lecture for a mental health hour every now and then. It will be worth it.

The first two years of medical school, you will work, and study, and take tests, and drink copious amounts after tests, and wonder why in the world you ever wanted to go to medical school. Keep the faith. The MD/PhD candidate that sits next you in the third row and your gross anatomy lab group will likely form the core of your best friends throughout your four years together, even though at times you want to throttle all of them. Familiarity breeds contempt, but you are all going through the same hellacious experience. You will value these memories, even if you don't believe it now.

You will have a med school fling. It will be fun, but won't last (and you'll be totally ok with that.) You will make mistakes. You will fail (yes, I said FAIL) a test. You will cry, a lot. You will feel like everyone else smarter than you. You will wonder, more than once, if you have chosen the wrong path. You haven't. You will eat too much, drink too much, and exercise too little. Try to take better care of yourself, that extra hour of studying probably won't make a difference, but that hour of exercise could mean a healthier you four years from now. Don't forget about your family and friends. Try to stay in touch with the people that mean the most to you. Their support is important. Life is going on outside your little microcosm, and you'll be sorry that you lost touch with the friends that knew you before you became a med bot.

Once you start clerkships, you will remember why you started doing all of this in the first place. Taking care of patients! You will *like* what you are doing again, and, all of the sudden, some of the lectures that seemed like absolute nonsense will actually begin to become more clear. No matter what you think you may want to do, clerkships will change your perspective on everything.

Be a good student. Know your patients. Have the patient seen and the notes written before your (overworked) intern hits the floor. Keep a running list of scut that needs to be done on *all* patients on your service (not just *your* patients, remember, you are working as a team) and be sure it is done before you leave the hospital. Check in with your resident/intern often, they are too busy to page you, but you may get to see (and do) some cool stuff if you stay visible. Learn how to write orders and practice whenever you can. Do everything you can to make your resident's life easier. Write prescriptions, skeletonize discharge orders ahead of time, and offer to get them food if you notice they haven't eaten. Stick close to your resident on call, but *go to bed* if they tell you to go! Don't try to show off how much you know, it is obnoxious and will likely come back to bite you. One of your patients will likely die, and you will never forget it.

Once you find out what it is that you want to do when you "grow up," be sure to make yourself known to the residents and attendings in that specialty. Ask lots of questions. Find a resident that needs help with research and offer your data gathering skillz. If it is a surgical specialty, make an effort to scrub in on as many cases as you possibly can. Center your fourth year electives around the specialty early in the year, so you can make the proper connections for letters of recommendation. Make yourself invaluable to your team. It will serve you well no matter what specialty you choose.

Even if you have met the love of your life, and think that January is a wonderful time to get married, think twice about planning a wedding in January of your fourth year. That is right in the height of interview season, and you will cause yourself undue stress trying to plan interviews around your wedding! The good news is, it is quite possible to nurture a fledgling relationship through the stresses of medical school (and it will prepare your spouse to be twice as awesome as he supports you through the worse stresses of residency!)

When you finally finish medical school (it is a marathon, not a sprint!), you will not be the same person that you were. You will be in debt up to your eyeballs, literally. It will take you years (some as an indentured servant) to pay off hundreds of thousands of dollars just for the privilege of being tortured, erm, learning for these last four years. You will realize that you will never be "rich," like your classmate that quit second year because he was making more money day trading stocks than the average family medicine attending. However, you will be a physician...fallible, over-educated, and under socialized, and you are going to help patients in ways you never even considered when you first sent in your application.

All the best of luck (you could use a little of that, as well),



Future Dr. Whoo

"But aren't you a doctor?"

It's funny how in medicine, you fall into your own little niche. In medical school, you start out "learning it all." Eventually, you find yourself gravitating toward a certain area of medicine. Once you decide what it is that you want to do "for the rest of your life," the rest of the schooling tends to fade into the background in favor of learning the intricacies of your chosen field over the broad generalities of medicine. Of course you still have to know enough to pass the tests, and often you can cram that information into your brain for the whole of 24 hours, only to happily empty it out once the exam has concluded. You become a doctor, and you forget more than you have ever learned, but you still hold the title of doctor of medicine.

In residency, you become even more specialized. No more prostate exams or interpretation of peak spirometry tests for me! Of course, that doesn't keep people from asking you medical questions to which they think you should know the answer. Why do I hear rushing in my ears when I lay down? (I'm no ENT, but, um, probably just your blood circulating?) Could you tell me what this rash is? (I'm no dermatologist, but I'll bet if you put hydrocortisone cream on it, it will go away!) I'll never forget the day that Mr. Whoo and I were witnesses to a pretty bad car accident my intern year, and as we pulled over, I panicked "What am I going to do, check their *cervix*?" (Everyone was ok, thankfully, and neither my meager first aid/BLS skills nor my advanced cervical checking skills were needed.)

In the same vein, I still find myself overwhelmed with uncertainty when it comes to medical knowledge about my children. In fact, I am certain that my kids have been to the pediatrician more in their young lives than most kids are in all of childhood. I can't help it. It is the best example of a little knowledge being extremely detrimental. A high fever? What if it isn't just a virus? What if they have MRSA that I brought home from the hospital? Bean isn't wanting to bear weight on his leg after a fall? What if it is a bone sarcoma?? This week I had Bean to the pediatrician for a freaking cold. Even though my pediatrician is too kind to say it, I'm sure she is thinking, "Um, hello? Aren't you a doctor, too?" Are my diagnostic skills so shoddy that I cannot distinguish between a common cold and pneumonia? I guess, when it comes to my children, they are. Ever since I became a mother, I am better able to understand why physicians should not even attempt to treat their own family members. Not only are we too emotionally involved with the outcome of their care, those very same emotions cloud what little medical prowess we may have. Do you find your medical education a help or a hindrance when caring for your family?

KIT (Keep In Touch)

Isn't that what everyone would write at the end of the school year in their yearbook entries, peppered with inside jokes and other, long forgotten acronyms? I used to be the queen of correspondence; usually by phone if not by post (cards, letters, etc.) I did all that I could to keep my few close friends apprised of my oh-so-very exciting life. Once email came along, it was even easier to dash off an email. I have always been sort of the "counselor" in my friendships, so I enjoyed trouble-shooting and discussing things with my friends. It was an important part of who I was. Things started to shift a bit once I entered medical school. I was so focused on my microcosm, sometimes months would go by without talking to my high school and college friends before I would even realize it. A well placed phone call, or two, and all was right in the friendship world once again.

In residency, I fell off of the proverbial friendship map. In the pre-80 hour a week era, I could work up to 120 hours a week (every other night 24 hours on call). It was in residency that I developed an odd social phobia involving the phone that I have to this very day. I just stopped answering it unless it was my mother or my husband. I stopped making simple calls like for pizza or take out entirely. I think that it stemmed from the fact that I *had* to answer the pager. I didn't have to answer the phone or call anyone if I so chose. It wasn't that I didn't *want* to talk to other people. It was that I *couldn't* talk to them. I just couldn't give any more of myself away. As a result, I slowly lost touch with friends that I loved very much, but to which I couldn't be a very good friend at the time. Next came parenthood, a new job with little time off, and another baby. There was not much time for extra socializing, though I realized that I needed adult friendships badly.

As I take the steps toward a new job, closer to friends and to family, I have also begun to reach out to old friends in an attempt to reconnect and apologize for being such a crappy friend to them. A rather recent discovery that has been great for this is facebook. I have gotten back in touch with old sorority sisters and my college roommates through this networking tool, and for that I am grateful. I've arranged a few tentative visits with important friends in my life that I haven't seen in 3 years or more. I feel like I am on my way to rebuilding these relationships, due in part to a few easy clicks of a mouse. So facebook worked for me, how do you stay in touch with your close friends that don't live near you?

Role Modeling

As parents, we are the shining (and often, not-so-shining) example of who and how to be for our children. Our food preferences, our political preferences, our jobs, and our recreational preferences shape the way that our children see the world. If we are doing our job, then our children grow up with the ability to decide whether or not they share our preferences. Who we are affects who they will be...good, bad, or in between. Despite the fact that in the last 20 years the medical profession is regarded more often with fear and mistrust than with respect and value, I still find myself in the role of role model and mentor for my patients, as well.

Lately, I've been thinking a lot about how one area in my life is absolutely out of control, and how it affects both my patients and my children. That issue is lifestyle, and more specifically, my weight. When I started medical school, I took care of myself. I ate well, exercised, and got plenty of sleep. Not coincidentally, I was also a healthy weight. In the 11 intervening years between the start of medical school and now, this has all fallen by the wayside. I eat a terrible diet, often rewarding myself with food, rarely exercise, and sleep is inconsistently 6 hours a night, at best. I look at myself now, 14 months after my second child was born, and I know that I no longer have any excuses. I am obese with a BMI of 36. I didn't "just have a baby." It was over a year ago!

Day in and day out, I give weight loss, diet, and exercise advice to patients. Prior to medical school I was also a weight loss counselor. I *know* what to do. How can I expect them to listen to my advice, as a role model, when it is obvious I do not practice what I preach? Worse yet, how do I model a healthy lifestyle for my 4 year old daughter? I can't keep fixing her fruits, veggies, and healthy dinners while I eat a pound of pasta night after night. I can't encourage her to keep active and fit when I come home at night, exhausted, and plant myself on the couch. Soon enough, the questions will start.

In my quest for a better work lifestyle, I am also embarking on a personal lifestyle change. Mr. Whoo and I are taking the kids for walks before or after dinner. This week I have started a weight loss regimen that requires me to track what I put in my mouth. I've started over and over again in the last 3-4 years down this road. I need this time to be the last. I'm doing it for myself, for my family, and also for my patients. It is time to realize that *my* health is important, too. I want to be able to tell my overweight/overworked/overstressed patients "I did this, this is how I did it, and you can do it, too!"

How are you being a positive role model in your patients' and families' lives?

A Body in Motion

In my younger days, I was a veritable whirlwind of activity. "The busier, the better!" was my personal little motto. I did feel as though the more that I had to do, the more that I could get done. In high school I juggled studying, cheerleading (yes, I was a cheerleader, hush), multiple extracurricular clubs, honor classes, a 20 hour a week job, and a steady boyfriend with relative ease. Every minute was scheduled to the hilt. Every weekend was planned in advance. I buzzed from one activity to another like a frenetic hummingbird, and honestly, thrived on the pressure of keeping it all going. Granted, all of my activities were very self-centered. I did what made me happy. I didn't have to worry about cooking or doing a lot of chores or taking care of anyone else but myself. The money I earned went for fun stuff, gas for the car, and clothes. I did get to sleep all night every night, and exercised very regularly and would periodically skip lunch to keep my (I imagined) plump 112 pound figure in check.

In college, it was more of the same; harder classes in a biology major, more studying, way more partying, leadership positions in extracurricular activities and my sorority (again, hush), the (required) volunteer work and physician shadowing in preparation for applying to medical school, and a long distance relationship. I bemoaned the woe of having 8 am classes, keeping me only able to go out 4 times a week instead of 6. When I found I had gained the dreaded "freshman fifteen," I dutifully trudged to the gym every afternoon after my 3 pm class, and found the will power to decline dessert with my meals. I lived in the sorority house where meals were cooked three times a day during the week, there was a housekeeper, and my idea of shopping was sneaking in a box (yes, I said box) of contraband wine to hide under the bed and drink with my roommate on the balcony. "A body in motion tends to stay in motion!" I would chirp, and be on my merry little way, padding my resume for medical school applications.

In medical school, things got a lot harder. The classes weren't easy any more. I actually had to go and study, a lot more than I ever had. I was living on my own for the first time in a really big city. I doing all of the chores, laundry, cooking for myself (lots of ramens, rice, and pasta), shopping for myself, and really starting to live like a responsible adult. All of the sudden, all of the extra stuff just wasn't so appealing. I dodged requests to join the AMA, and AMSA, and more volunteer work, and med school committees. I was too busy! I joined the note service for the benefit of not having to take notes during class, but dreaded my transcriptions. It was all I could do to keep my clothes clean, my brain plugged in, and my fledgling relationship thriving. I still made an effort to get to the gym, but the nearest one was a 30-45 minute drive in traffic both ways. This coupled with the pasta, after exam parties, and late night study snacking packed on about 20 pounds. In the last year of medical school, I planned a wedding, got married, interviewed for residency, matched, moved across the country, and bought a house. All of the sudden, I didn't feel like I could do it all.

Then came residency, the mother ship of having no healthy life at all. No sleep, terrible eating habits, 120 hour work weeks, and the *pressure* of being a neophyte physician. Hobbies outside of surviving residency? Surely you jest! It was all I could do to stay awake long enough to speak briefly with my new husband, eat a piece of pizza (cooking just didn't happen any more), and maybe occasionally bathe. Fortunately for me, the 80 hour work week was passed 2 years into residency. I celebrated my new found "time off" by getting pregnant...immediately. Then it was triple the laundry, triple the chores, and triple the responsibility. I began to lose who I was, other than doctor, mother, and wife. I stopped taking care of myself, in order to get everything else done. I was constantly in motion, and constantly wishing to rest. During this time an additional 50 pounds of weight crept on gradually, then not so gradually.

So here I am now, still working ridiculous hours. Still eating like I did when I was in medical school and residency. Still not quite keeping up with the chores. The focus of my life has completely shifted from myself to everyone else *but* me! I stop to look around, and I realize that with as much motion as I have experienced in my life, I have been standing still for years. During a recent interview, someone asked me what I did for "fun" when I wasn't working, and I couldn't come up with a good answer! Um, reading? Blogging? Trying not to pass out whilst my children crawl all over me in the evenings after work? I was shocked to realize that I am not really living, I am merely surviving. In all of my constant motion, that once started out so self-centered, I have lost contact with what exactly it is that I would *want* to do, should I have the time.

I want to cultivate in my children a love of something that makes them uniquely them, be it sports or music or dance or chess or reading. I realize that it is my responsibility to be an example for them, and I don't want my legacy to be only a strong work ethic and keeping very slightly ahead of chaos. I want my children to live in motion, like I got to do, once upon a time. I now realize that to help them live in motion, I've got to find a way to get some rest.

How do you take care of you, and still take care of your families and patients? I welcome your advice.

Moving On

I grew up as the daughter of a Naval officer. I have never, in my life, lived somewhere longer than 6 years. We would typically move every 2-4 years, finally settling once my father retired from the Navy when I was 12. I then went to college at 18 for 4 years in one location, and medical school for an additional 4 years in a different location. Mr. Whoo's childhood moves were similar. Since Mr. Whoo and I have been together, we haven't stayed in one place more than 4 years. To be quite honest, I really disliked moving so much. Starting over got more and more difficult each time we had to make a move. The leaving of friends, the packing, the unpacking (torture), the need to learn everything about a new area wore thinner and thinner with each new beginning. Once I finished residency, we agreed to make a concentrated effort to find a place to "put down roots." We thought we had found that in our current location, and we were so excited to settle in and become fully immersed in the community.

Then, slowly, it became obvious that my job was not as lifestyle friendly as it had promised. Instead of a 1 out of 3 call, I became a default solo practice Ob/Gyn physician (something that I never, ever wanted to be). In the last 3 years, not much has improved. I have managed to eke out 2 weekends off call every month, but it seems this is all the leeway with lifestyle that I am going to get. Our family life is severely affected by my call schedule, and I always feel like I have to have one foot ready to run out the door. It is time for a change, and, for us, that means moving....again.

Of course, all of the joy that comes with moving is expanded with small children, especially in the arena of finding reliable child care. Then I worry about putting them through a move and how it will affect them emotionally. For Bean, I am not so concerned, as he is small yet and likely won't remember the change. For CindyLou, this move is going to be hard. This is the only home that she knows. She loves her house, her play set, her room, her teachers, and her friends. I remember all too well the hurt of having to leave my friends and everything that I had known behind for the unfamiliar. Most of all, we want to have a stable place where our family can grow and thrive. As long as I am on call as much as I am, we will never be able to pursue extra curricular activities for the children, and I really can't bear the thought of not making it to baseball games and/or dance recitals.

Logically, I know that as long as we are together, we are home. A house and a town are just places, but a family is your true home. I just wanted to give my children the opportunity to graduate high school in the same place that they went to kindergarten. It is this little fantasy that I have entertained ever since I was a girl, having to move time after time. I am starting to worry that my childhood and schooling has triggered some kind of wanderlust, set to go off every 4 years or so! I never pegged medicine as a nomadic career, but I am taking careful steps to try to make this next move our last one for a very long time. How do you ease the transition of a move on kids that are old enough to understand?