Guest post: Trust me, I am a mother

I never went into medicine to become a better mother. I never became a mother to become a better doctor. But, the two journeys merged in 2013 when I knew something was seriously wrong with my almost six year-old son. My son is like any other boy his age, other than occasional mild irritability that is slightly over the average and incredible creativity. He usually springs out of bed ready to tackle the day, excited about all the projects he is going to do. For about ten days, I noticed that not only was he not interested in any activities, but he was incredibly irritable at even the most minor setbacks. He has always had a high pain threshold, yet we started noticing an increase in his frequency of "got hurt" episodes. There were no focal deficits on physical exam. I sent an email to his teacher asking if she noticed any limitations at school. She said no. I didn't know if I should go to a pediatrician or a psychologist. Then, he developed a minor unprovoked pain in the shin. I jumped on it as now I had a reason to take him to the pediatrician. I reasoned with the pediatrician that given the irritability and mild low grade temps at night time for two days, his shin pain may have been an indicator of something systemic. After an exam, she ordered some blood work and X-rays which came back normal, other than a slightly elevated WBC and platelet count. She told me to trend the fevers and to come back if there was no improvement.

The same night, I noticed a slight temperature and called the on-call doctor. I explained that I was concerned about the low grade temperatures without an obvious source, and that the shin pain might point to a musculoskeletal or neurological issue. She also told us to "trend" the fevers and call her back in the morning. Completed unreassured, we took him to the emergency room. A full day waiting in the emergency room led us again to blood tests that were mildly abnormal but not convincing for any diagnosis. An MRI of the leg was done which was read as normal. I pulled the pediatric ER physician aside and told her my concerns: was there something systemic? As an adult critical care physician, I was not the kind of parent to seek attention unless I was truly concerned. I alerted her that I was concerned regarding the elevated white count and thrombocytosis without an obvious source and even more concerned that the MRI was normal. We were told to "trend" the fever, and if it became more than 101.5, to seek attention. We were also to give scheduled ibuprofen to suppress any synovial inflammation that may be happening in the hip from a viral infection two weeks before. After a dose of ibuprofen, they tested his walking, and said that it was noticeably better, so it must be Transient Synovitis, a diagnosis of exclusion. One caveat to this "give the drug, and see if this gets better, if then, it must be this" argument is that it is absolutely flawed. If the participant knows that "he or she is supposed to get better" then the free will overcomes any pain and of course, he is going to walk better. It may or may not have anything to do with the drug. We walked out of the Emergency Room still concerned.

I continued to give him ibuprofen over the next day. He continued to limp. The ibuprofen suppressed the fever, so now we had an afebrile child who couldn't walk. After no significant improvement, we took him back to the pediatrician office the next day and asked for a neurological exam and, bingo, over the course of a few hours my child developed cerebellar ataxia, clonus, and inability to stand. All of this happened within the time we saw the pediatrician, got him back to the emergency room, and a MRI was scheduled. That night as I sat at the edge of the MRI machine holding his leg, I had never been more frustrated with the fragility of the human body. I loathed hospitals. I never wanted to step foot in the hospital again. The doctor inside of me put the differential diagnosis of "epidural abscess, brain tumor, meningitis, encephalitis" on the list, while the mother inside of me put "something really bad" at the top. While the initial scout films started coming up, my husband, who is a body radiologist subspecialized in MRI, stood by the MRI technician with a solemn look in his eyes  -- one that I had never seen before. As he drew his finger in a vertical line across the computer monitor, the heart of the mother inside of me sank, while the doctor inside of me said, "Wait, that could mean it is not a focal tumor or an epidural abscess, but could it be a diffuse tumor? Maybe, it is meningitis."  With one hand on my child's leg amid the deafening noise from the machine, I kept waving to my husband to see if he could tell me something. He asked me to come outside and knowing my child was already asleep in the machine, I stepped out and could immediately notice the flair abnormality that swept across the spinal cord. As the axial cuts were pouring in, we could see the flair signal lit up like two snake eyes pointing to the diagnosis of Transverse Myelitis, which we knew only held very good prognosis one third of the time. There was no Brain MRI ordered as the ER staff wanted to "focus on one thing at a time," and it  seemed that the spine was the problem. Thankfully, the neuroradiologist who was examining the scout images, and who was about to leave in thirty minutes for the night, noticed the transverse myelitis throughout the spinal cord and asked the technician to add a brain MRI. Within minutes we found her and discussed with her and confirmed the diagnosis of Acute Disseminated Myeloencephalitis with Transverse Myelitis, a disease that occurs in my child's age group, typically after a viral infection or a vaccine.

During the hours in the emergency room, my son went from being able to walk with a limp to being unable to move both legs and becoming tachypneic. Prior to returning to the emergency room from the MRI, I told my husband that knowing the diagnosis, they will for sure want to do a lumbar puncture to rule out active bacterial/viral meningitis and this will of course delay steroid treatment if the lumbar puncture was not done in an expedited manner. We were already in the emergency room for twelve hours by the end of the MRI and given the progressive course of his symptoms, further delay could have caused him to progress into a coma and the risk of hemorrhagic encephalitis existed. Upon return, we asked the team to be present at his bedside, and we made our concerns open to them. The on-call ER physicians were skillful and quickly performed the lumbar puncture. We soon knew that there were no alterations in protein/glucose/gram stain and that we had the right diagnosis. The ER team hung the bag of 600mg of IV solumedrol before we were transferred up to the ICU and every successive day resulted in more return of neurological function. Within five days, we were at home recuperating after this nightmare of an illness. The neurologists repeatedly told us that they have never seen a child with such degree of MRI severity not have the physical signs to reflect the changes; it is likely because we sought attention right in time. The mother inside of me was strong during the five days, and the doctor inside of me was quick to decline any unnecessary blood draws and made sure that he got out that hospital as quickly as possible. For if anyone knows how deadly hospitals can be, it was the doctor inside of me. We were welcomed at home by a supportive community and his return to school and activities was a breeze because of the love and support from family and friends. When I bought my son a couple of youth basketballs to help his recuperation phase, he jumped out of the sofa, ran to me, gave me a big hug and said, "Mommy, how do you know me so well?"

I said, "Trust me, I am a mother."

Guest post: Fewer patients, more friends

On the face of it, a day at the clinic seems very social. I see patients, one after the other, from nine until four, with a break for lunch. Most of my patients I've known for a while now. I get caught up on their their lives - school, family, work. "How are your spirits these days?" I ask almost every time, patting my right hand over my heart, using the most effective cross-cultural mood elicitor I know.  It doesn't get much more personal than this. It's just me and the patient, our knees almost touching, in a small exam room with the door closed and an interpreter behind my left shoulder.

I leave work after a day of this, drive the five minutes to pick up my three-year-old from preschool, and begin the commute home to Deep Cove. Suddenly I'm ravenous. I ask Ilia what's left in her lunch box and she hands me some carrot sticks and cubes of cheddar from the back seat. Ten minutes later, around Grandview and Nanaimo, I bottom out, utterly exhausted. The idea of having to shepherd four kids through meal time and bedtime chores after this feels impossible.

If Pete's not away on business, I come home to sous-vide salmon and curried cauliflower, and we divide up the after-dinner work. If he's traveling, we eat the lasagna my thirteen-year-old put in the oven when the big kids came home from school. Then I oversee homework and lunch making, brushing teeth and laying out tomorrow's school uniforms.

I cut corners. I pick the bedtime book with one sentence per page. I move up the bedtimes of the kids too young to notice. I want the noise to stop, even the singing. They're getting shortchanged, I think, but  I'll make it up to them later in the week.

Where I live. And why I live here. © Martina Scholtens. Deep Cove, BC

For years, I've seen patients Monday, Tuesday and Friday. Mid-week I'm home with my youngest, grateful that Deep Cove is off the beaten path. We can't see our neighbours from our place. Looking up from the laptop now, I see a stand of waving cedars, the gunmetal grey winter waters of Indian Arm, and the dark bulk of Belcarra rising from the opposite shore. The solitude is perfect. No play dates, thanks. No community centres or meeting up for lunch, either. I might be up for something on the weekend, but it'll take until Saturday evening to recover from Friday's walk-in clinic.  I need a respite from human contact, and I prefer as much solitary time outside the clinic as four kids will give me.

I forget, though, that seeing patients isn't at all a substitute for catching up with friends over drinks.  At the clinic, the topics of conversation, the confidences, the complaints - they're all one-sided. It often strikes me that family physicians are professional friends: non-judgmental, accessible, reliable, skilled listeners and excellent secret-keepers. There's pleasure in seeing patients, but really, it's business.

If you had told me that I'd have four kids and eight hundred patients, and feel lonely, I'd never have believed you. But my work drains me to the point that all of my spare time is spent trying to recuperate. Pete would love to have people over more, and vacation with other families. I always imagined a noisy, boisterous home with friends and family coming and going, but with my work commitments, I don't have the psychological reserves to make it happen.

Then I had an epiphany. Clinical work exhausts me with the people lineup, and my social life is extremely thin because I need stretches of alone time to recharge from work. I ought to reverse this. I need to implement more solitary time at work, and more people-time in after hours.

I've started on this. In October I gave up my Friday clinic. I've worked Fridays since I finished residency in 2003. Now I finish the week with administrative work and other projects instead, alone in my organization's secret library. Just me, a row of computers with access to our clinic's EMR, shelves of journals on paediatric nutrition, and a yellowing poster on Boolean operators. I can do this very happily for much of the day, and still have the energy to go out with Pete at night. It's been life changing.

I knew from residency that I couldn't see forty patients a day, five days a week. I find it hard to do half that. Maybe it's that my patient demographic, refugees with trauma histories and multiple barriers to care, are particularly challenging. Or maybe it's the demands of four kids. Maybe our clinic needs to use a different model of care. Maybe an office with some natural light and a view of the North Shore Mountains would help. There are probably other changes I could make to bolster my psychological fortitude and soldier on, even thrive, in this setting. But for now, I've reduced my work hours devoted to direct patient care.

Three months in, and no regrets. Before, I felt like I spent everything at the office. Now I've got this feeling of having a bit of pocket money. There's the promising jingle of spare change.


-Martina Scholtens, cross-posted at www.freshmd.com

Guest post: Loneliness

Cross country move to start a second residency, otherwise known as a long fellowship. Getting pregnant in residency. Health issues in the family. Yearly in-service exams. Patient care. Having a baby. Board certification for the first residency. Learning curve. Conference presentations. And now there is job search. I get by in most of these situations. I must say I have excellent family support, but a physician spouse can also only help so much. I find myself exhausted, sometimes nervous, mostly looking forward to the days going to work and coming home. But I also find myself extremely lonely. There is no time or energy to go meet other mommies. No time to hang out with your single or non-parent colleagues. (They don’t invite you anyway) No time to form new friendships. Hardly some time to hang on to the old ones you have left behind in another city and another country. I love my husband, who is also a hus-friend! But, a girl needs some girl friends.

I find myself making awkward attempts at trying to set up playdates with other moms, who apparently have their baby’s social life all dialed in.

Do any of you other mothers in medicine experience this loneliness? Or is it just me? Should I even allow myself to feel lonely when I have a lovely child and husband. Can you be busy and lonely?

Guest post: United we stand, divided we fall

Editor's note: MiM contributor juliaink came across this blog post and thought it would make a good guest post here. The author was gracious in sharing it with us.


I was going to write about how new parents need to come together to create a “united front” when it comes to how they’re going to raise their baby, but because of a great thread I’m following on Facebook, my focus is beginning to soften and is more inclusive. There is a need for new parents to really hash out all the key points on how you intend to raise your children – before the baby arrives. If there are any big differences in your parenting styles, it would be best to know before your little person comes into the world to shine a spotlight on them! And if there are challenges between the generations, and there almost always are, it’s important for the couple to unite together for the sake of their own relationship. If a particular issue with a grandparent comes up, their child should speak directly to them about it – not the in-law child. This is just basic information that you’ve probably already figured out as a couple, but has special importance when you become new parents.

Having acknowledged all of this, the thread I’m following on Facebook talks about how grandmothers might experience postpartum mood disorders as their own daughters become pregnant and give birth. This was nothing I’d ever considered before, but makes complete sense to me upon hearing it. What a woman experiences during her birth will remain with her for always, her whole life. As a woman’s own daughter begins her journey toward motherhood these emotions and feelings from so long ago might begin to resurface. This can cause strain in the mother/daughter relationship as the soon-to-be grandmother revisits her own experience. If it was negative or traumatic for her, than there will be challenges that come along with this remembered event. If there were no real issues at her birth, there can still be some challenges or feelings of judgement if her daughter decides to do things differently from the way she did in her early years of mothering.

The same can be said for fathers and grandfathers. We live in a very different time with new research and lots of ideas about best practices during pregnancy, birth and parenting that just simply did not exist when our own mothers and fathers were on their journey. It’s no wonder that we have plenty of families having discussions with soundbites like this:

“When we were having babies, we just did it! What are you so worried about?”

“Well, that’s not the way we did it when you were a baby, and you turned out just fine, didn’t you?”

The health care system I work for has a fairly new class called “Grandparents Today” and it’s geared toward softening these conversations between the generations. It’s taught by a retired L&D nurse of 35 years on the floor who also happens to be a grandmother herself, so this is peer-to-peer education. The class brings to light all of the current information we have on how to keep babies safe when sleeping, why there is such an emphasis on breastfeeding, how and why it makes such good sense to wear your babies and have them skin-to-skin as much as possible, etc. The grandparents who take this class absolutely love it! They come back to their own children and school them about these best practices and everyone lands on the same page – at least about the things that are taught in the class.

I’d like to propose these two generations take this opportunity of bringing the newest family member on board as a chance to unite the whole family around raising this little person to adulthood. It’s a ton of work to do this job well – if you’re lucky enough to have your parents nearby and can count on them to assist with the day-to-day care of your newborn, this can be a lifesaver for you and your relationship. But even if they’re far away, relying on the wisdom that they possess – just from having more years on this earth than you – can be so helpful.

When talking with them about your challenges, try hard not to compare your situation to theirs. Yes, you might be going back to work full-time and they stayed home, but every parent works – just in different locations! Include your father in this new stage of his life without resentment – it was a different time and he was not encouraged to take part in parenting the same way you are today. If your mother never breastfed you, remember that as she’s learning right along with you, her words don’t mean to be unsupportive, she just might be feeling a little guilty about not doing this when it was her turn.

Having a new baby means stretching, growing and making room for this little person. Everyone examines who they are in relationship to this new life and it brings up stuff for each member of the family, some of it good and some of it not so good. Don’t assume anything in communication with one another. If the words you hear sting, instead of getting defensive, pause and try to imagine where their hurt might be coming from. Ask lots of questions. Look for understanding and common ground.

Having a baby does not have to be something that divides a family – it can be something that brings you all together. Being aware of these multi-generational challenges can be one way that you get closer to your own parents. Isn’t that something worth fighting for?

When you had your baby, did issues arise between you and your own parents? How did you handle them? Did the baby bring you closer together or drive you farther apart?


-Barb Buckner Suárez, a childbirth educator
Originally posted at Birth Happens

Guest post: It takes a village . . .

...and my village includes a housecleaner, a nanny, a back-up part-time nanny for on-call days, an amazingly flexible husband who works from home and one amazing non-medical friend I've made in this new city. Plus, in really important crunch times, a family willing to fly across the country for weeks at a time to care for my family so I can focus on studying. I come from a family whose resources definitely did not allow for hiring nannies or housecleaners, so I always feel a little self-conscious about it and hesitate to seek help, even when I know it’s needed.

Before medical school, and even during the first two years, I could usually balance the work of school with the work of home. Between studying for Step 1 and then starting 3rd year, with two young children, I realized something had to give! I finally accepted the fact that extra help was necessary, for my sanity and for my success in medicine. While I don't mind cleaning the tub or mopping the floor, I would rather spend that time playing with my children, hanging out with my husband, trying to maintain some relationship with my friends and family, and of course, reading, reading, reading for school!

Since I've relinquished control of keeping up with the cleaning, and since my husband has taken over the cooking (mostly), I'm amazed how much time and mental energy I've been able to devote to school. I'm also pleasantly surprised at how much this extra time to study has boosted my confidence on the wards and subsequently my performance. Meanwhile, at home, I'm actually more likely to tidy up and clean a bit every day, since I don't feel so overwhelmed with the amount of cleaning to be done. This makes my husband, a neat freak by nature, extremely happy. Historically, every woman who could afford to hired people to help manage the house, so why do we try to be superwomen today?

I'm interested to hear how other mothers in medicine have found ways to expand their village of support and if they noticed a difference in their professional lives. I’m also interested to hear if you received any negative responses from your family about hiring help?

Ley is a medical student with two children under age 5. She lives on the west coast and remembers enjoying running, cycling and camping before medical school happened; she hopes to return to those hobbies sometime in the next decade.

Guest post: Taking a year off before medical school

I found MiM while studying abroad, trying to decide between PA and medical school, and being thoroughly terrified of not being able to spend time with my future family if I became a doctor. Reading all of these amazing stories from mother doctors helped erase my fears. I just wanted to give back to the blog, if possible. Also, I thought there might be some other undergraduates out there who can relate. So, here are some recent thoughts:

Had anyone asked me three short years ago what I would be doing after graduation, I would have immediately replied, "going to medical school." After three long, but fun and enriching years at a small liberal arts college known for it's rigorous science reputation, I'm ready for a break.

How did I get from that young, enthusiastic 18-year-old to a 21-year-old who self-professes her exhaustion from school? How did I decide that I am probably going to delay motherhood for an entire year, since I'm planning on waiting to have a family until post-residency? (that was a pretty large factor in my thought process) No, I didn't have a horrible college experience. I didn't have to retake classes, or even get "lost" along the way. Honestly, I just grew up. Needing a break isn't something I'm ashamed of. In fact, as my aunt said, it's probably one of the smartest things someone looking at graduate/professional school can do. I realized I'll have one year in my 20s not in school-- whether I take a year off or not, so why not make it now? A year off will grant me the opportunity after 18 years of education to stop stuffing equations and facts into my brain and fit in some life experiences to look back on and utilize. I will be able to start medical school refreshed and ready to learn, not just going through the motions to add "MD" to my name.

So many people reply, "Oh," when I say I'm taking a year off. I practically have to convince them that I'm genuinely excited to have time to experience more of the world. I believe it's perfectly acceptable to do whatever is right for you, whether that's powering through, or taking a break! However, I think some people need to realize that we don't always need to be in such a rush to get done with something to move on to the next phase. Slow down and enjoy today because tomorrow may be completely different.


From a "traditional" college senior at a small liberal arts university in the Midwest who plans to become a pediatrician. 

Guest post: What's your plus one?

I love the honesty of Mothers in Medicine. I feel compassion for women stretched so thin between two callings. But I’ve got to ask you this: is there more to your life than motherhood and medicine?

I know, I know. For a lot of years, it’s about sleep and survival. But at some point, you’ve got to do you, right? You’re more than a stethoscope, a uterus, and a pair of lactating breasts.

Maybe I’m not saying this right. I definitely don’t mean to act smug. But I know I always wanted to write. I just didn’t want to starve to death, and I liked helping people, so…boom. Medicine. I studied my little heart out. I loved it. Until I lost the residency match, and I had to decide, am I going to keep chasing that ever-elusive subspecialty dream as hard as I can? Or can I do emergency medicine, see my husband sometimes, start a family, and pick up my pen and write again? I chose the second one. Either road would have been fine, but I’ve built a happy life with my childhood sweetheart and two kids, I’m writing, and I want to tell you not to forget yourself, that secret self that doesn’t necessarily earn money or praise or nurture others, it just is.

Medical-wise, I’ve got privileges at four different hospitals now, and one chief of emerg told me, “No. You can’t do it. You can’t work at four different hospitals. It will kill you.” He also limits his staff’s total number of shifts because he doesn’t want them to burn out. Autocratic? Sure. But he’s the only one I know who treats other physicians like human beings instead of widgets who have to see patients faster and more cheaply every day and night and night and day. We’ve been talking about how not to lose yourself, not become suicidal, not treat each other like garbage. Thinking about yourself as an individual and not just a service—I’d say that’s the first step. Plus, I thought it would be fun to talk about our secret selves.


Melissa (aka ACLS)
Emergency doctor/writer, mother of an 8 y.o. boy and 3 y.o. girl, in Canada
http://www.melissayuaninnes.com/blog

Guest post: Doctor guilt

I have been a faithful reader since sometime in med school (6 years ago?) and have so appreciated all of your posts! I haven't found a community anywhere else with as many talented, empathetic, articulate and amazing women. I'm a family practice doc in a rural town practicing full spectrum family medicine. I have been in practice for two years since residency and absolutely love my job, even when it is stressful and hectic. I am a wife to an underemployed lawyer and mom to a beautiful, sweet, developmentally delayed 11 month old girl with tuberous sclerosis. She is the joy of our lives.

Having worked my whole life, I was really looking forward to maternity leave. I thought, finally, time for a break! As any mom knows, maternity leave isn't any kind of a vacation, but it really was a much needed mental and physical break from work. However, it was also disorienting to not have a schedule and frequent social interaction. I absolutely loved maternity leave and I think part of what kept me sane was knowing that I was going back to work. When the time came closer, people warned me about how hard it would be, and that I was going to cry my first day back.

I shed a few tears the day before, but the day I went back to work I was 100% ok. I enjoyed it, actually. I felt like I was back at my second home with my second family. The first night back I assisted with a crash c-section and had a blast.

It's been 8 months and I'm still going strong. I work in clinic on Monday, Wednesday, and Friday. I do 4 to 5 24 hour ER shifts per month. I am there nearly every day rounding on patients, since I almost always have a patient in the hospital. In reality I probably average 40 hours per week even though I'm considered "part time." I love having every other day off. After a crazy clinic day it is nice to have the next day to decompress. After having a day of playing with my daughter and being at home I look forward to the fast paced environment of being at work the next day.

Strangely enough, I never experienced the mommy guilt that is so prevalent among working moms of every profession. I love both of my jobs. I know my daughter is in good hands. (My husband is with her most of the time when I'm at work, and we have a wonderful neighbor who helps). I miss her when I'm working a 24 hour shift but that's not the same thing as feeling guilty that I'm not there. I don't know if it's because I'm the primary breadwinner or some other reason. I am 100% at peace with my decision to work. How many men who are breadwinners feel daddy guilt? Is mommy guilt something that is part of our genetic makeup or something that we are told culturally we are supposed to experience?

What I have felt sometimes is doctor guilt. I think part of this is because I was 32 when I gave birth so working is what I've known my whole life. I wonder if I should be working when I'm playing with my girl. I wonder if my colleagues are jealous that they don't get more time off to spend with their kids. (They never say anything - I just wonder). Maybe we'd all be better off as doctors, moms and dads, if we had the flexibility to have more time with our families.

Anybody else have doctor guilt, rather than mommy guilt?

Guest post: The whole truth

"Tell all the truth but tell it slant" (Emily Dickenson)

Much is written about how women, and mothers in particular, hurt each other by only showing their competent and successful side. I agree. This isolates us. I’ve had people ask me: “How do you do it? How do you manage being a doctor and a mother at the same time?” Most of the time I say “I don’t know," and that is true in part. I am just doing the best I can and it never feels good enough.

But here is the whole truth. I have a LOT of help. An insane amount of help that I feel embarrassed that I need and for which I feel undeserving. Particularly here in Utah where many women have a lot of children and do a darn good job taking care of them all while looking fabulous in the process, I admit that I feel guilty that I don’t measure up. I feel silly that I have a hard enough time taking care of two.

So here, in a nutshell, is a list of all of the help that I have: a housekeeper a morning per week. And in addition, gulp, a lady who comes two times a week to help with laundry. I shop online and save most errands this way. As if that weren’t enough, I am fortunate enough to have my parents here in Utah. In addition to watching Adelyn during the day, if we are late for school pickup, or if I have a late meeting, my mom is there for backup. Oh, and since we are in full confession mode, also a therapist to help me deal with all the damage done to my psyche by medical training. Have I suffered any real trauma in my life that would actually merit a therapist? Nope. Yep, I am a spoiled white WASP (I’m not actually sure what that is but I think that that is the category people would put me in.) So what am I doing with all this help? Am I volunteering for humanitarian causes? Am I the PTA president? Nope and nope. Here is what I am doing with that time: spending it with my kids mainly. All this help allows me to spend a lot of quality time with my girls. I hope it is doing them some good but I am never quite sure. I desperately want to volunteer to help disadvantaged kids but right now, I have all I can do to take care of my own children. And so I am an armchair do gooder, making donations and all that other useless stuff. I cook several times a week. I sometimes have people over for dinner if the house is presentable enough (though I should do so no matter the condition of the house…foolish pride). I read I bit. I run. When I am feeling brave I take the girls to church on Sunday. I garden and putz around our property. I sit on the front porch and drink iced tea. I occasionally get together with friends or talk on the phone with them or write a letter. Oh, yeah, and I'm a doctor. A decent one most days, and some days a downright good one. If I didn’t have all this help, none of this would be possible.

What are my kids doing while I write this? Watching a dumb cartoon with negative educational value. It’s 90 degrees and in the heat of the day and we already read, and done 2 crafts and some homework pages and eaten and cleaned up and attempted naps and I have no more tricks up my sleeve. And darn it my husband has just arrived home early and caught me ignoring the children while they watch TV.

There you have it. Judge away. Or maybe, just maybe, cut me some slack. Cut other women some slack too. And if you do more than me with less and get by without any help at all, I am truly happy for you. But it's okay that I'm not that way.

I realize that sometimes women take offense when you say things like “I don’t know how you do it.” But when I say that, I am being genuine. The woman with 5 kids--you are my version of a rock star. If I have a lot of questions for you and ask you how you do it, it is because I admire you, like some people might do when they meet a world class athlete or a famous author. To me, you are doing the impossible. The woman staying home with 1, that’s a huge job too. The woman with no children-- wow you must be able to accomplish so much, and gosh it must be so nice to be able to read the paper in bed or join friends for cocktails at night or have a glass of wine on the plane without a small person dumping it out and making the whole aircraft smell like a vineyard and good for you for knowing yourself well enough to make that choice (and if it is not a choice but one that has been forced upon you by infertility, I am sorry and this is why I try not to ask women if they have children lest I hit a sore spot). The woman who has made it to the top of her field? Thanks for paving the way. The woman doing important work to end social injustice? You are ALL my heroes. And I’m grateful to have so many of you in my life.

-a geriatrician and mother of 2

Guest post: Pregnant during residency (and not feeling the love)

Prior to becoming pregnant I thought there were no women's rights issues in today's day and age. It was only after I became pregnant that the struggles became all too real. One of the first questions I received from my program director upon announcing my "good news" was...will you take all 6 weeks? Soon afterward a colleague proudly told me he once worked with a resident who was back to work 2 days after delivery. He was hoping my pregnancy would be uncomplicated so I could do the same. Approximately 25 weeks into my pregnancy my physician said I could no longer work solo 24 hr in house calls or 80 hr weeks and that although I could continue my rotation duties, hours should be limited to 12 hr shifts, 5 days a week, maximum of 60 hours. This restriction came after early contractions, shortness of breath and tachycardia had set in.

Although my colleagues weren't pleased with this decision, they agreed to accommodate me of course with the assumption I will be heavy back loaded on calls when I return from maternity leave because each and every hour of call I miss needs to be made up. Made sense to me since caring for a 3 month old should be easy peasy right?

In the meanwhile I continued to work, study, do research, present at national meetings. Pregnancy brain hasn't always helped while being pimped or taking my yearly shelf exam but I have dealt with it as best as I can.  After receiving  two offers for prestigious interviews at two of the top programs in the US for my subspecialty my program director kindly contacted me to recommend that I not go to these interviews and postpone them in the interest of my health and since my schedule was already so "limited". I thanked him for his concern but went to the interviews anyway while 29 weeks pregnant and was accepted by both, able to have my choice!

Now with only 4 weeks of pregnancy left, my physician has recommended no more calls. I of course have worked with my colleagues once again getting them to cover my remaining calls with the promise that I will owe them all back.

I feel a bit like an outcast of the program right now all because I am trying to balance work with a future family. I hesitate strongly to say I am discriminated against but in some senses, I can't help but feel this secretly as well. I keep telling myself that this too will pass in hopes of things returning to "normal" after the pregnancy.

Has anyone else had similar experiences in pregnancy and if so, how did you deal with them?


-An ophthalmology resident 

Guest post: Two points for knowing what you don't know

I’m driving the kids home from school, winding along Dollarton with afternoon sun glinting off Burrard Inlet, and Saskia’s telling me about the Gauss Mathematics Contest she wrote that morning.

“I left one question blank,” she begins. It’s a confession: a perfect score is off the table. She doesn’t add up test scores, she works back from 100. She goes on, “But I did that because of how the scoring system worked. You got six points for a right answer, two points if you left it blank, and zero points for a wrong answer. I wasn’t sure about the last question, so I just left it.”

I make her repeat that, making sure I have it right, because I know I’ll be chewing on this for days.

They were rewarded for leaving alone what they didn’t know.
Making a wild stab at an answer was worth less than no response at all.
For once, it wasn’t about doing one’s best, but about acknowledging one’s limitations.

* * * * * * *

I was assigned to a family practice when I began residency in 2000, for several 4-week blocks over the two year program, and callback every Thursday afternoon. It was an established practice on Broadway and Granville, and a good group of doctors, but I dreaded seeing the patients, mostly well-heeled reproductive aged women.

Making a diagnosis and treatment plan on my surgery rotation, or in the emergency room, wasn't a problem, but these women kept presenting with issues that weren’t in any textbook. One couldn’t interpret her baby’s cries; another needed advice on dealing with strangers’ remarks on her child’s birthmark; the next had discovered her teenage son’s porn collection. Working at this family practice was by far my least favourite rotation, and I was doing a family medicine residency. That worried me.

My preceptor and her partners took the entire clinic out for Christmas lunch that first year, between morning and afternoon clinics packed with patients wanting to be seen before the holidays. I remember Sarah pausing during the meal and saying to me congenially, “You know when we knew you were okay?”

I had no idea, but I was relieved they’d arrived at that conclusion.

“Remember that rash?” she asked. “The four-year-old with the vesicles on his legs who’d just come back from camping?”

I remembered. Yet another patient that had had me stumped.

“When I asked what you thought it was, you said ‘I don’t know,’” she went on. “That’s when we knew we had a good resident.”

The other physicians agreed. “We don’t care what you know,” said Joan. “We care that you know what you know.”

* * * * * * *

I teach residents myself, now, and it’s true - I don’t pay particular attention to how comprehensive their knowledge bank is, but to whether they recognize what’s missing. Nothing raises a red flag like a learner who already has all the answers.

And then there are the patient encounters where you can’t turn to UptoDate for backup. Sometimes there really isn’t an answer, in that brisk bullet point way that physicians love. Sometimes the P of SOAP feels terribly inadequate; writing ‘counseled’ or ‘conservative’ or ‘follow’ feels like a fail. Physicians get the God-complex jokes all the time, but from where I sit, we're keenly aware of our limitations. Medicine teaches you how very much is unknown.

That's using the Gauss scoring lens to look at one field in one profession. Imagine if we approached everything from a place of humility.

I read comments on news articles on refugee matters, vociferous ones, that are ignorant of the basic facts of the system. I’ve heard someone predict the eternal destiny of another person’s soul with the same degree of certainty that they state their summer vacation plans. I’ve seen someone with no more than Biology 11 comment with the authority of an immunologist on vaccines.

I can't say that those lessons I've learned in medicine have overflowed into every other part of my life, either.

So how about each of us, the next time we’re in a conversation - with a client, in a staff meeting, on social media or out to dinner - consider whether we truly know the answer to the question at hand.

And if not, take two points for keeping our mouths shut.


Cross-posted at www.freshmd.com and www.mothersinmedicine.com

Guest post: Everything changes when you become a mother

It’s a cliché, and I hate clichés. But it’s also a truth. And it beats me over the head on a daily basis.

I never wanted to be the type of person who thinks, let alone says or writes, that there are things that people without children just don’t understand. And I won’t pretend to know what anyone else feels or understands. But I can say with absolute certainty that my own understanding and experience of life has changed immeasurably since I became a mom. And I’m still trying to learn to navigate not just the logistics of life with a baby, but a very new emotional terrain.

My son was born in February after a healthy, uneventful pregnancy. At three months old, he is thriving – sleeping well, eating heartily, and smiling and cooing in ways that melt my heart anew every day. My husband and I try not to make assumptions about the future, but like all parents, we have high hopes for him. And we look forward to every day that we will spend together as a family, watching him grow and learn and discover the world.

Yet today I am sitting on the living room couch sobbing while my baby naps peacefully in the other room. Why? I am no longer painfully sleep-deprived, no longer terrified that he and I will never master the art of breastfeeding and that he will not gain weight and grow. My hormones seem to be back in check and I have largely adjusted to being back at work and away from him, although it is still hard to leave each morning. I am sitting here in tears because I just read a blog post written by someone I don’t know, someone whose story I came across when it was shared by one of my friends on Facebook. It was about a woman who just lost her little boy to cancer. And I am feeling another mother’s pain.

I can’t imagine what it feels like to lose a child. I couldn’t before I had my own baby, but now whenever I encounter such losses, all I can think about is how, once upon a time, that child’s mother had high hopes for her baby, had her heart melted by each smile and coo. Which is not to say that I would not have cried at the same story before I had my son, or that people without children would not shed tears over it. But the feelings behind my tears – the fiery, gut-tearing pain that churns within me when my mind even dances near the edges of the real question that arises with every story of loss: What if it were my baby being taken from me? – are awful and new.

So with my newfound understanding of motherhood, and the attendant capacity to imagine maternal grief, I face a new challenge. Since medical school, I have wanted to be a pediatric oncologist and treat children with cancer. I adore children, I love working with families, and I am fascinated by the science behind the diseases that afflict them. Back in medical school, one of my classmates confessed that she would have become a pediatrician if she hadn’t already become a mother. “I can’t,” she said, shaking her head and looking pained at the thought of caring for sick children. “I just can’t.”

I did not have children at the time, and although wondered how I might be affected once I started a family, I thought that perhaps I would gain some degree of immunity by entering the field before my own children arrived. When I began my pediatrics residency, I certainly felt sad when children were sick, and extremely sad when they died. But I was able to let go of that sadness and move on.

Then, during my second year of training, my own baby arrived. And after my brief maternity leave, I returned to work on the pediatric oncology ward, a place that had always gripped and excited me. And suddenly everything changed.

I still loved the strictly medical side of things: working up a new diagnosis, puzzling over the best ways to manage the side effects of chemotherapy. But the family meeting to discuss a little boy’s grim prognosis nearly sent me into a fit of sobs. I had to look away and sing songs in my head just to get through it. All I wanted to do was to cry with this mother. For this mother.

Which leaves me in a confusing state. Everything that I have always felt about caring for children, I feel much more strongly now. The uplifting and the soul-crushing both resonate in ways I could never have anticipated. Will this effect wane with time, or intensify? Will it render me better able to care for my patients and their families, or become a barrier to pursuing and surviving the emotions of this career about which I once felt so sure?

It’s hard to know anything for certain, other than, finally, what it feels like to be a mom.


Becky MacDonell-Yilmaz is a second-year pediatrics resident at Hasbro Children's Hospital/Brown University and mom to a three-month-old son. She blogs at The Growth Curve .

Guest post: Gaining More Than Just Weight

Twenty pounds into my pregnancy with no end in sight, I began to dread stepping onto the scale at my Ob/Gyn appointments. Even more, I began to dread that moment in the exam room when my doctor would review my numbers for that day. My blood pressure was invariably okay and my urine dip was normal, but my weight continued to bound upwards in increments larger than what was apparently advisable. I would nod with shared concern as she read out the new tally – seven pounds since my last visit? Oh, my – and with determination as she listed suggestions to watch what I ate and try to get some exercise. Even just take a walk a few times a week, she said. The implication being, how hard could it be?

I would leave the office with new resolve to pack healthier snacks for work and to make time to go back to the gym, or at least to start taking the occasional evening stroll. The snack resolution I met with reasonable success, but the exercise portion proved difficult. Now in my second year of residency, I had stacked my schedule so as to complete my months on certain services – those with the greatest intensity and the longest hours – in the fall and winter prior to my delivery in exchange for a reasonable stretch of call-free maternity leave in the spring. As a result, I left the hospital each night in darkness, exhausted. I stopped even pretending that I might stop by the gym or venture out along the icy sidewalks near my home. Besides, I spent at least half of every shift on my feet, rounding on the wards or hurrying between emergencies. Surely all that activity must count for something.

Hoping that my mediocre efforts had paid off to at least slow the accumulation of pounds, at the next visit I would slip off my heavy Dansko clogs, get back on the scale, and watch as the medical assistant slid the little weights ever further to the right in order to balance my growing mass. Then the entire scene would repeat.

Eventually I gave up.

My new attitude was a mixture of It’s no use, I can’t, and Why bother. I was doing what I could, I reasoned, and if I gained some extra weight, so be it – I would work extra hard to lose it after the baby arrived. I continued to attend every check-up, only now when I nodded at the numbers, my concern was only mild and my determination feigned. I left the office feeling a combination of relief and resignation, already dreading my next appointment.

And suddenly I was not so different from my own clinic patients and their families: from the children and teenagers whose growth curves make me cringe as they surge skyward, brazenly crossing percentile lines, and from the parents (often overweight themselves) who grimace when I show them this evidence of too much intake and too little output – it’s that simple, I explain. They nod earnestly as I outline a plan of attack: cut out soda and juice, add vegetables, find time for exercise. And they look abashed when they return months later to find the curve inching ever onward in the wrong direction.

I’ve been lucky in terms of weight for most of my life. Sure, I’m a fairly typical female; I have certain body parts that I find too loose or jiggly or poorly shaped and I’ve spent too much time staring from different angles in the mirror, obsessing over these flaws. I have gained and shed pounds according to my level of stress and just how hard – probably at times too hard – I have worked to lose them. But I have never been truly overweight, never begun to dance with the complications of hypertension, diabetes, sleep apnea. Never before had a doctor grow concerned about the number on the scale.

And because I had never been in their position, I had never understood how difficult it is to try to get out of it. My belief and the implication of my advice had always been: how hard could it be?

Now I knew. The specifics of our challenges aren’t exactly the same –many of my patients can’t afford to join a gym whereas I pay for a membership and don’t go – but if neither if us is working out, what’s the difference? We’re both gaining too much weight too fast and have been unsuccessful at making the changes our doctors push for. And we’ve both felt bad about it.

I didn’t suddenly develop a grasp of how to move past the roadblocks in my life or theirs. If anything, this new knowledge makes my job even more frustrating and my motivational interviewing less motivational; how can I enthusiastically pitch ideas that, given the backdrop they are set against, are so unlikely to work? What I did gain was new understanding and empathy. And while I don’t have any brilliant solutions to offer to busy, tired people with potentially limited resources who are struggling with the trials of diet and exercise for themselves or their children, I hope that I am better able to partner with them to search for solutions or simply provide support now that I have stood in their shoes . . . on the scale.



I am a second-year pediatrics resident and mom to a 2-month old boy. I blog about my experiences at The Growth Curve (www.thegrowthc.wordpress.com).

Guest post: Post Partum Pearls

An IM Hospitalist's perspective

I’ve heard that the rigors of medicine prepare women for the arrival of a newborn, and to a certain extent that is true, but there is definitely more to it than that. Our great work ethic, patience, and calmness in the midst of a storm do give us a great base. Also, we tend to “freak out” less over any minor baby medical issues. Despite those similarities, taking care of an infant is quite an unique experience.

It’s been four months since the birth of my adorable baby girl (in my completely unbiased opinion), and I’ve stumbled upon some of my own truths that I felt like sharing.

# First few months are all consuming…kind of like Intern Year

Preparing for childbirth and care takes you only so far, just like prepping for intern year cannot get you ready for the real time situations of the wards.

I was exhausted both mentally and physically in ways I didn’t know I could be. I learned the hard way that keeping my goals simple was key. Feeding, consoling, bathing and carrying an infant is enough for the day. Squeeze in some personal hygiene and eating time and feel good about yourself.

# Infant care is the ultimate roller coaster ride

I recall at the end of my 12 hour day or night of work, my husband would ask how the it went, and in my head multiple thoughts would race, but it was too mentally taxing to convey everything to him, so I’d end up saying “ it was good…” This type of response is quite similar to my days during maternity leave.

There was a mixture of highs and lows and in between. Capturing the entire experience in one sentence seemed unnatural.

# Self-sufficiency is overrated

Though in our profession we are encouraged to ask for help every step of the way, what I’ve found more true with my few years post training, is that most of us strive to work out issues on our own. Asking for a consult every time a question pops up is not an enticing option unless absolutely necessary.

Well when it comes to infant care, support and help are key. The truth is you need your “own time” off from your infant to maintain a healthy relationship. Sure there is satisfaction in bathing, feeding, and nurturing your child all by yourself at times, but not all the time!

Take up your family and friends’ offers to help out. Learn to separate your attending/resident hat from your mother hat! Oh and single mothers, you completely deserve a lifelong standing ovation.

# Don’t feel guilty about not doctoring

As my baby has grown up over past month or so, I have found more free time during the day. At first I immediately thought (after catching up on sleep), that I should do some medicine related things, so my brain doesn’t decrepitate with time. So I filled the hours with intermittent medical reading and reviewing some stuff here and there. I even created my own blog regarding hospital medicine, but as time wore on during my maternity leave, I still found it hard to keep up with everything, and then the guilt trip started. So what I have concluded is to give up pseudo doctoring unless it truly invigorates me, like writing this article. Don’t worry, the skills will not disappear. I realized that after doing a few shifts here and there. You have the rest of your life to doctor away, no need to do fret over it now.

# Embrace your free time, it’s okay to be domestic!

If you’re blessed with more just six weeks off, you will find that your free time will actually increase (not dramatically but noticeably so). I found myself cleaning up the clutter in our apartment and going on an organizational binge. There were moments when I’d stop in the midst of my activities, and think “ oh god, what am I doing?? Did I study, train, work all those hours, and accrue all that debt to only be doing this right now…? “ And then, after bouncing these thoughts off my husband, I slowly snapped back to reality. And reality was pretty great if you are willing to accept it within the context.

For once in my life, I was not working or studying. My hours were completely dedicated to my child and to myself/family. I’d never had this type of time before, except maybe the two months between medical school and residency, except now I was more settled in my life, and that was comforting.

What did I use this time for? Well, to be honest, at first, I binged on TV. Then I started getting into social media especially all the medical related stuff. I’ve also been exploring my creative side again – doing DIY projects for décor, learning lullabies on my acoustic guitar to sing to my little girl, and learning to cook different dishes. It’s been quite refreshing.

Take Away

Overall, it really has been an internship of sorts, and this “learning how to be a parent” is going to continue for the rest of my life just like perfecting the art of medicine never stops. I do hope that my experience will make me a more caring physician when I jump back into the field. I have much to learn, and I’m looking forward to it. To all the other mothers in medicine, I applaud you. I’d love your advice and comments!

@psanyaldey is a 34 year old internal medicine trained hospitalist. She is married and has a mini siberian husky along with her newborn girl. 

Guest post: I'm more like the night-time babysitter

Sometimes I feel like the night time babysitter. I am an Ob/Gyn resident and leave every morning before my 16 month old wakes up (she's a great sleeper, I should be happy). I come home and feed my daughter dinner and supervise the bath, zip up the PJs, watch a cartoon and cuddle while she drinks her bottle, and then its "night night time" and I'm done being a mommy for the day. I could keep her up later but she's tired, and I don't want her being on a special schedule just because her mommy is a doctor.

I hate being a doctor these days. I don't feel important or empowered like people say I should. I know my daughter will one day look up to me as a role model and feel proud of my career, but right now I think she just needs a mommy at home. I don't envy anyone except my stay-at-home mom friends. I wish I knew what it was like to be totally frustrated after a long day of cleaning up plastic toys and missed naps. I wish I knew what it was like to be lonely from lack of adult interaction. Instead I'm stuck taking care of people I don't know all day and getting yelled at by attendings.

I know I'm a "grass is always greener" type of girl, but many days I think I could walk away from this job and never look back. But what would everyone else think? What would my father, who paid for medical school, say? I'm "almost done" with residency-1 year and 2 months left to go, but it feels like forever. I'm already counting down until the day I graduate, so I can take a few months off, and then start whatever Hospitalist job will let me work the least amount of hours. Exactly the kind of career I used to think was an unambitious waste of a medical degree. 

I don't give myself a break or a pat on the back for managing everything. I make sure my house is fully stocked at all times, I sign my daughter up for all of the best classes and lessons (to go to with her nanny). She has an impeccable wardrobe and fresh cooked vegetables in the fridge at the start of most weeks. But I torture myself that I'm not home enough. I cried when my daughter had food poisoning for the first time and I was stuck at work overnight. I refuse to sleep during the day post-call -- what a waste of bonding time. Being a working mom is hard. Being a resident and mom is even harder, but I don't regret having my daughter, she's the best thing that's ever happened to me. I guess I'm crazy, because despite what I've been through these past 16 months, we're trying for baby #2 right now!


Sara, Ob/Gyn Resident (PGY-3)

Guest post: Coming home

I come downstairs after grabbing a few hours sleep in between busy night shifts. I can hear Rose crying in frustration at once again trying to grab the key from the back door. I walk into the chaos in the kitchen. My husband is absorbed in the  newspaper surrounded by the toddler carnage. Why is there breakfast still on the table? Why have the pots and pans been pulled out of the cupboards?  Has she really got porridge still stuck on her forehead and what on earth is she wearing? Oh and why is she chewing hay from the barn?

I open my mouth to say something but hesitate and hold my tongue. I remember that it's his turn to look after Rose while I am in work mode. We do things differently- I'm the surgeon with the perfectionist streak wanting everything to be tidy and clean; he is the artist and is happy to let Rose run free and wild. I smile to myself. 

"Family hug?" I pick up Rose and we all collapse on the sofa together in a warm embrace. A memory to take with me to work that night. Invaluable.

Lotte is a 33 year old general surgery registrar in the UK with an 18 month old daughter Rose and a non medical husband. She works full time.

Guest post: Tales of a hybrid doctor/stay at home Mum-- Part II

April, 2014.

That day five years ago, was the lowest point. (see Part I) Today I work “full time” (whatever that means!) in what is probably my dream job: a perfect mix of innovative clinical care, cutting edge research, medical education and being a leader in my chosen specialty. I am on faculty at one of the most prestigious medical schools in the world and get to work with the brightest and the best, in an environment that is intellectually rewarding and super collegial. …and I feel this is just the beginning!

My husband (who got a raw deal in part I—sorry babe) and I have never been closer and more happier in our marriage—we are both fulfilled in our careers, but most importantly, feel like we are reaping the rewards of our hybrid parenting model now: family life is fun, filled with endless bliss and joy.

Our kids (now 10 and 6) are doing fantastic: healthy, happy and thriving at school and play.

Don’t get me wrong-- it’s a juggling act, for sure, but we are juggling joy and I have never felt more balanced in my life.

Still, the reason I wrote part I is that I never wanted to minimize (or forget) the complicated journey (and decisions) I endured to get me to where I am today.

I only wish my 2014 self could have whispered in the ear of my 2009 self and told her the following:

#1. It will get easier as the kids get older; there will be new parenting challenges and hurdles but the physical dependency will be less and that will give you more freedom. Be patient.

#2.You (as Mum and Dad) have to do what feels right to you (as parents).  This is unique for every single family in the world.You have to decide how best to work to your strengths as a team.Never compromise on your childcare beliefs and preferences.  Do what you think is the right thing to do and everything else will fall into place with time. Your husband is your biggest supporter of your talent and career.  This is, in part, because he is equally passionate, ambitious and talented in his own career.  It’s hard to have two parents be ambitious at the same time when there are two young kids at home.  Right now, you have both agreed it makes sense that it should be his turn, one day it will be yours.  Be patient.

#3. Whatever you do, don’t “opt out”.  You will get deskilled and limit your future career options.  Keep up the hybrid model—it will work to your favor in the end.

#4.  Think of work as a career not as a job.  Keep investing in yourself. When the kids nap/sleep engage in scholarly activities that will keep your CV looking attractive.  You feel like a tortoise right now (and I know you hate that, because you are not a tortoise type of gal) but slow and steady will win the race (one day).

#5.  Stay connected to the reasons you became a physician in the first place.  Don’t’ let anyone distract you from that—these are crucial reasons that are core to your identity as a human being.

#6. Your ARE privileged. Your job entails you coming up with creative solutions to some of the world’s most difficult problems—you impact humanity every time you work.  You also get paid better than most, have societal respect and a “voice” AND have the option to work “part time”.  Many working mothers do not have that type of job. Be GRATEFUL

#7. Don’t become a hovering parent—you have seen them, overeducated parents with time on their hands creating projects in the school so that they can get called to implement them!  Be a good citizen in the school but better you put your skills to use in a zip code that needs your specialized skill set, not the zip code where your kids are lucky enough to live and go to school.

#8. Always DELEGATE non- essential tasks (it will be money well spent) and use that time for love, laughter and being in the moment.  Take care of those who take care of you.

#9. Learn to let go (a little)—it will all be okay.

#10. Don’t pay too much attention to labels, “working mum”; “stay at home mom”; “part time physician”.  Don’t be defined by these terms, they undermine the complexity and power of who you are as an individual. You are unique, you will find a way to make it all work.

Above all remember:

Becoming a mother has made you a better physician and remaining a practicing physician has made you a better mother.


Dr. S is a married physician and mother of two.

Guest post: The morning departure

The whole drive to work I relish in the wet spot left on my cheek from the sweet goodbye kiss of my two year old son.  It was tough to leave today.   Never wanting to just disappear on my little one I always say goodbye and explain I'm off to be "Dr. Pohl" for the day. This is a funny concept that my two year old disputed at first, saying "You're not a doctor, you're a mommy!"  Well I'm both.

This particular morning everything about my little guy was endearing and I wanted to capture every cute phrase and silly look. It was a "this is it" morning - ordinary and wonderful. Aiden running around in his footed pj's and his baby sister lounging in the boppy. I'm in the kitchen packing up my breast pump and he yells to me "She smiled a big one at me!"

When it is time to finally depart he clings to me, giving me the cuddle I desperately try to get from him when I have the time to enjoy it. He follows me to the door, and against my better judgement, I lift him up again. He then contorts his little body so I can't put him down.  I plead with my husband to come help me. I say, "My heart is breaking," because it is.  He takes him from me and each kisses me goodbye. Then they wave from the window.  I put on a show of waving wildly back but I'm close to tears.

I carry the feel of that kiss all the way into the hospital, cherishing it-  until I finally wipe it off, crumbs and all, to put on my mask.


Dr. Pohl is an anesthesiologist with a 2 year old and a 4 month old.

Guest post: Tales of a hybrid doctor/stay at home Mum-- Part I

11pm, January, 2009.

I stare at my face in the bathroom mirror with the magical belief that the reflected version of myself might, if I stare at it long enough, offer my real self an answer to the predicament I find myself in.  My bare feet are rooted to the frigid laminate tile, obstinately clinging to that spot and holding my reflective self hostage until she offers up some guidance.

This tumultuous day had started at 2.00 am, that morning, when my 18 month old daughter sat up and, with eyes still heavy in deep sleep, started vomiting. I rushed to her side, watching in dismay as projectile puke, mixed with bits of basil green pesto pasta, erupted all over her bedding and nightclothes, seeping through to her skin and trickling up to matt her brown curls. When her vomiting subsided, I cleaned her up, changed her sheets, took her temperature and gave her the once over: any skin rash? Is she limp or listless? Does she have tummy tenderness or diarrhea? Having ruled out the presence of a more sinister cause for this jarring episode of vomiting the nocturnal drama appeared to be over.  I settled her down back to sleep and then lay down myself and was asleep all of 15 minutes when the puking started all over again. It was a long night filled with five cycles of vomit, clean up, sleep; vomit, clean up, sleep…

At 7am I had forced myself awake and got my son ready for school. I layered him up with sweater, ski jacket, snow pants, scarf and gloves: a mandatory ritual to protect him against the harsh winter morning. I reached for my own coat but was stopped, in my tracks, by the look on his face. He was standing, rooted to the spot, shoulders hunched over when his face became suddenly pale. In a second, undigested milk and cheerios, splayed onto the wooden floor of our hallway and so began another cycle: puke, clean up, wait; puke, clean up and wait…that consumed the whole of the morning.

I had hoped to spend today having quality time with my children, catching up on errands having coffee with my neighbor and, if time permitted, even putting finishing touches on a research paper.  But the day had taken an unscheduled turn and the situation demanded that I submit to the more unpredictable task of caring for my sick children. Patiently, I nursed them and offered them comfort alongside hydrating fluids.  I gave permission for Barney and Blues Clues marathons to take pace whilst I did pile after pile of laundry. As my children sat, huddled together under a blanket, their glassy tired eyes transfixed to the screen projecting their colorful screen heroes, I scrutinized them for signs of more serious illness.  I watched and waited, waited and watched quelling bolts of maternal anxiety with reassurances by the, more objective, physician in me.

Now, in the still of the night, they are both asleep. Our house has been vomit free for the last eight hours and the situation appears to be under control.  Yet, as I stare at my face in the bathroom mirror, I feel surges of anger gathering up from within me. My children being sick had demanded that I be home with them all day, a duty that I fully accepted and was also loathed to delegate to anyone else. Still, hour after hour of not being able to eat, pee, or shower without being interrupted by a child’s need or demand combined with the lack of sleep and extra chores, generated by the sudden vomiting attacks, has all taken its toll.

Most of all, I resent my husband’s absence from today’s circus. Why was he not here to clean up at least one of the 10 vomits?  To comfort our children when my patience was wearing thin? To watch them so I could eat one of the day’s meals seated? Like so many of the husbands that lived on our manicured suburban street, travel had become an integral part of a work life that took place in a global village where competition was omnipresent. One week New York, next week London, a month later a 3 day meet in San Francisco. I had come to dread this time of year for, along with the short days, bare trees and snow storms, his travel schedule became intense and filled with a cycle of conferences, sales meets, deals to close and budgets to spend. Business at the speed of thought, frenetically taking place in four different time zones all whilst he chalked up thousands and thousands of air miles and airline loyalty points.

Years before, shortly after our son’s birth, I had taken on a hybrid identity as both a doctor and a stay at home Mum.  I had returned to work within weeks after birthing both my children, but never to a full schedule. Our profession demanded a doctor be available and on call at all times, so I eagerly offered my services to cover evening, weekend and holiday duties as these were times when my (mostly) male counterparts, who had already put in a long work week, preferred to be home with their families. During the week, my days were filled with diaper changes, making baby food, cooking meals, school drop off and pickups, baking batches of homemade biscotti for the PTA fundraisers and staying on top of the pediatrician appointments, homework, play date and activities schedules. On the days and evenings that I worked my husband took over the child rearing and I headed to the hospital to give expression to that other part of my core identity, that of being a physician.  For the most part, our childcare arrangement worked well and I not only felt centered as I juggled these two joys in my life but had come to feel both these identities, being a mother and physician, were actually complimentary: that becoming a mother had made me a better physician and remaining a practicing physician had made me a better mother.

I did not know many women who had opted for this model of parenting. My friends either stayed home full time and planned to take a long hiatus from their professional careers or, on the other extreme, worked fulltime and had employed a nanny or involved another family member to be the primary caregiver for their children. For the most part I felt I had the best of both worlds but today, amidst the fatigue, anger and the stench of vomit that still lingered in my nostrils, I felt trapped.  My own Mum had never had a professional career and Dad had always begun and ended his day at home. On days like this, our hybrid parenting model along with having a travelling spouse seemed unnatural to me and it made me doubt our parenting plan. I wondered if we were tempting fate by taking on a lifestyle we were not primed to pull off.

In the bathroom mirror, my reflection reminds my dejected self that I have plenty of resources: an education; every possible modern convenience; domestic help; kind neighbors; a tight knit circle of friends and a pediatrician who is only a phone call away.  All of these facts were supposed to ease the anxiety and physical burden inherent to child rearing and I knew, all too well, that such resources were denied to many.  Still, on this particular night, none of this “pull yourself together talk” could keep me from an overwhelming urge to sulk and stew.

My stewing is interrupted by my vibrating cell phone, twirling on the marble countertop, as it heralds my husband’s return.

Landed. Home by midnight. Caught a stomach bug :(  Need TLC.

     ***

Dr. S is a married physician and mother of two.

Guest post: Making a career shift to leadership

A few months ago, when I was contemplating a shift in direction in my career, I happened to google 'women leaders in medicine'. Among the websites and blogs that google search generated was 'womenmdresources', and through that, the 'mothersinmedicine' website. Reading through current and old posts was like finding a community of friends I had not known existed. In fact, one of the first blogs I read was from 'anesthesioboist' and the post was about her experience with her child having surgery at Boston children's where she had been a resident. I found myself smiling as I recalled a very similar experience at the very same hospital some years ago with my son needing surgery for a fracture while I was a resident there! It made me feel connected to this entire community out there of women in medicine, especially the unique community of mothers in medicine.

Fast forward a few months, I have made the career shift, which involved going from being a staff anesthesiologist at a small community hospital to being the chief of my department at another small community hospital. It required a lot of thought on my part and discussions with my husband to go after this opportunity especially with one child being almost ready to go off to college in another year and another entering the tween diva stage. Did I want to take on this challenge at this juncture of my career (and challenge I knew it would be) especially with my husband's job needing him to be traveling for most part of the week? It would have been so much easier to stay where I was and go to work and come back home and not have to deal with all the issues involved with taking over the running of a department.

10 years ago, when I was finishing my residency with 2 young kids, if I had had a crystal ball, I would never have seen myself in a leadership position down the road. I thought I would be content with a staff position in a small department, enjoying my work, but leaving it at the hospital when I left in the evening and focusing on my kids and family. And that's what I did. However, few twists and turns in the last few years changed my direction and I feel now, for the better.

I had had some experience with the running of a group without the title of chief in a previous job so I knew the trials and tribulations it would involve.

Ultimately, we decided I could not pass up on this opportunity. That previous experience had whetted my appetite to be in a position to be able to make some changes, to problem solve. I had found it very satisfying when I was able to make some changes to make processes run smoother than they had.

And so here I am, 2 weeks into this new role. It has been a challenging couple of weeks. And I find myself looking forward to more.

-Anesthesia Mom