Reasons to Wear Lipstick.

It's a peculiar thing being a single mom, 30, and a first year medical student. At the med school parties, I'm 8 years older than everyone. In the hospital, I'm 8 years behind on my training than physicians my own age. At my kid's daycare, I am that parent that hasn't a clue it was my turn to pay for pizza Friday, or it's the teachers birthday. The other non-traditional parents in my class live with supportive spouses, so it is hard to fully relate to anyone. I like the uniqueness of my life, and on multiple occasions do classmates and strangers tell me how inspiring I am. But, I also admit it is quite lonely.  I moved into a new apartment with my 2 and 3 year-old last year. It was the first time I had to live alone with two toddlers. My life was study, change diapers, study, take the kids to beach, study, clean, study, yell at toddlers to stop drawling on the walls, study... It was a crazy adjustment, but I rocked it, mostly, after I found a good balance between those two heavy identities of mum and med student. (Finding that balance took a lot of tears, complete break downs, sleepless nights, fits of being woken by crying toddlers at 4am before a final, lots of use of a babysitter etc. etc). After three months of nothing but late night study sessions in the library, alternating with being Mom, I wanted an escape. Something fun. Something easy. Something to take my mind off of my chaotic life and make me feel like a normal human again. So I got on Tinder. Yes, that awful addicting dating app/hook up site for people like me who are incapable of meeting someone the old fashion way through mutual friends or some serendipitous moment in a coffee shop. The swiping happened, the chatting started, and the harmless fun of it was a light and easy way to wind down at the end of the night. Like how normal people watch TV, I ask completely random attractive men about their lives. I finally got ballsy enough to meet these completely random attractive men in real life. Of course only on weekends after tests when I didn't have to study as much. My basic day to day attire was messy bun and yoga pants, so it was so nice to wear real clothes again! I went Salsa dancing on the beach with a CT surgeon, played board games at a bar with a teacher, picnicked by the water with wine and a book with an IT guy, watched a play with a lawyer, drank more wine and watched the sunset with a pediatrician. It had been 5 years since I dated, and the timing of course is terrible as being a mom and med student makes an impossible girlfriend. But the experience, fun, and connections are just what I need to take me out of my diaper/molecular biology bubble.

Turns out some of my classmates are also on Tinder, so now study breaks consist of swiping and comparing baes (yes I started saying bae, I hang out with 22 year olds). Definitely no Mr. Right in the near future, but I will update y'all if anything crazy happens. Not crazy like the time my date showed up hammered after 5 shots of Whiskey. Just hoping for more wine, sunsets, good conversations, and a reason to wear lipstick.

What are y'alls reasons to wear lipstick?

Supporting parent learners in medicine

I recently put together a panel for the AAMC Continuum Connections conference (a joint meeting of student affairs, GME, medical students, and residents) on Supporting Parent Learners Throughout the Continuum. The goal was to discuss the unique needs of our parent learners, identify gaps in support, and share best practices. We had a fantastic panel including a medical student dad, an OB/GYN fellow mom, a student affairs dean, and a former PD/central GME leader.

The 1 hour 15 minute session was clearly not enough time. We could have filled 2 days with the discussion. I loved that so many people had chosen to come and think about these issues and the panelists' personal experience and perspectives were insightful. 

Some key areas that were brought up:

• communities of support for parent learners to connect with each other
• childcare
• stigma/bias
• parental leave
• breastfeeding (particularly with regards to culture/time and certain rotations)
• parental leave

One institution holds spots in a local daycare for incoming PGY-1s since the process can take so long and there can be too little time to secure ones after Match Day. Love this idea. One school holds a welcoming event for medical student parents and their families to get to know each other right from orientation.

And I shared the upcoming event at my house: babysitting for medical student parents so they could have a nice night out together --Parents' Night Out. It was so difficult for my husband and me to share any alone time without a baby on our lap, and it's expensive to hire babysitters, so I wanted to give our student parents some wellness. 

We had it this past weekend and it was a ton of fun. Students dropped off their kids at our house and I had a small crew of student volunteers who wanted to help. There were five kids total, ages 3 months to 3 years old. We adults outnumbered them -which turned out to be a very helpful ratio to trade-off and allow helpers to eat and take a break. I loved loved loved seeing our medical student parents and their kids. When one couple came to drop-off wearing nice going out clothes and mentioned it was their first date since the baby was born, I think my heart grew two sizes. I also enjoyed getting to know the students who volunteered their time to help on a Saturday night.

At the AAMC panel, the former PD/central GME speaker said to the audience: to the younger generations, I'm sorry my generation could not figure it out (in terms of parental leave). It's still an issue after all of these years. But, what I would add to that is that we have certainly made progress. More of us are thinking about how to support our parent learners better, as well as all of our learners. Just having a dedicated session to that during a conference is a start.

Looking back, looking ahead

As I hang up my short white coat after my last clinical rotation of medical school, after the celebrations of commencement week subside (I have had more than my fair share of these), and before the reality and terror of starting as an intern starts to set in, I find myself looking back and looking ahead. What a wild ride these past years in medical school have been! Spending all these years preparing for the first day of internship. Along the way, also learning on the job of raising a child. As I enjoy the lull of these last few carefree days between completing medical school and starting internship, every now and then I feel like I should brush up on my clinical knowledge to allay intern year anxieties. Then I remind myself that no amount of preparation could have really "prepared" me for being a parent or a medical student, and nothing will really make me feel "ready" for intern year. Best to savor this time with family and friends.

Recently I came across this article in the New York Times titled "The Gender Pay Gap Is Largely Because of Motherhood". It goes on to discuss not only the impact of motherhood on income, but also career decisions made by mothers to give up job opportunities, inequitable distribution of household and parenting responsibilities. Looking back at that experience of mixing parenting and medical school, I have reflected on how things would have been different if I didn't have my baby during medical school? How would things have been if I had gone through this experience without being a parent? I may have done better in some rotations, or gotten better grades on some tests. In the end, those things didn't matter as much as I thought they did. I ended up matching to what and where I wanted to end up for residency. Even if I had a perfect application for residency, my desired outcome wouldn't have changed.

I am pretty early in my career to measure the impact of motherhood on my career and quantify it in terms of lost opportunity or income. In some ways, I can't imagine the alternate reality of going through the medical school experience without my son, my experience as a medical student is so completely intertwined with being a new parent. Sleepless nights dealing with baby eating into precious few hours to sleep during clinical rotations. Being in a perpetual rush to pickup or drop off my toddler from or to daycare. Dealing with meltdowns in the morning struggling not to be late. Preparing for tests while distracting my toddler without distracting myself from studying. However dealing with the responsibility of raising a little human taught me patience, empathy and humility, which I like to believe, made me a better human being and will make me a better doctor.

Money and mothers in medical training

Children are expensive. So is medical school. Children take up a lot of time. So does medical school. Unfortunately time and money are two things in considerable shortage during medical training. Mixing children and medical school can be an unhappy combination. We had our baby halfway through medical school (me) and residency (the Mister). There has been lots of discussion regarding the timing of procreation in medicine (eg here and here and on this blog). My general takeaway can best be summarized with this license plate.

I have found some serious life wisdom on vehicle license plates.

My general takeaway 1.1 regarding the subject of timing babies in medical training is that there is no perfect time. Each time is good in some respect and not so great in others. Having spent my 20s in pursuits of other advanced degrees, I didn't want to wait until I had a "real doctor job". But that meant that financially it was not such a great decision. Residents stipend is not enough for supporting a family, especially when one member of said family is incurring expenses of medical school. More than a third of our income goes to childcare expenses, and that's not even including food, diapers, and a multitude of other child related expenses. We are always worried if we'll be able to pay all our bills at the end of each month. I am in debt up to my eyeballs. Financial worries are always lurking in the background of my thoughts, and money has been on my mind even more as I am looking into taking out more loans for upcoming residency interviews.

A friend offered me wisdom from her interview experiences, telling me about some common interview questions, one of them being "Tell me about a difficult experience you had in medical school". I said (almost half jokingly), urrmm pretty much the entirety of medical school since having a baby has been one incredibly difficult experience. It is difficult to separate the experience of being a parent from that of being a medical student, and money has been one of the connecting threads between the two.

Daycare was the only affordable childcare option for us, and we are lucky to have hospital subsidized daycare. It was amusing (not really) when one of my classmates thought that "hospital subsidized" meant that all costs were covered by the hospital and it was free of charge. No, it just means there is a small discount. Though it is a "hospital affiliated daycare", but like most other daycares, it is not a 24/7 facility. Having both spouses in medical training means that both of us have very little control over our schedules. There are plenty of times that we are both working outside of daycare hours. And trainees may have an 80 hour a week work limit, but a child requires care 168 hours a week.

This same classmate who thought that daycare was free, was also surprised to learn that I hired baby sitters to study for medical school exams. "Wait, so every time you have to study, you have to pay someone to watch your kid? Can't you just put him in a playpen and do your studying?" Before I had a baby, I envisioned this picture of getting home from the hospital and spending daily finite hours of "quality time" with the little one and then he would, I don't know, put himself to bed or maybe I'd read him a little bedtime story at the end of which he'd dutifully doze off and sleep through the night, and I'd get more hours of "quality time" studying. Or just like my classmate I assumed that I would be studying while the baby/toddler would be happily playing by himself on the side with his toys, of course, without interrupting me. Those fantasies/assumptions disappeared pretty fast when a real baby (who is now a toddler) showed up.

Talking to other people in our situation (two medical trainees with no family close by) most options I heard of were not financially viable alternatives for us. I have heard people say to not worry about money and keep taking out loans because when I have a "real doctor job", I'll be able to pay it all off. Maybe there is truth to that. But when I look at the enormous amount of debt that I have already accumulated, and when I think about the uncertainty with future physician compensations, I don't feel comfortable taking out loans to whatever amount.

Things haven't always worked out great with this whole arrangement. I have less than perfect grades in medical school. I feel like if it was just the hours in the hospital and then I could come home and eat, pray, love or something, it would be fine. But because work just gets started after getting back home from work, is what makes it so hard. After a particularly rough rotation that had lots of nights and weekend shifts (read: "when daycare is not open" shifts) and an end of rotation exam, I bombed the exam. The course master told me that he was really surprised about my exam performance because the clinical portion of my grade was stellar and there was such a discrepancy between the clinical grade and the exam grade. I didn't know how to explain that for me studying for exams cost money. Whatever little savings we had, had recently disappeared after a family emergency, and as interview expenses had drawn closer, I had scrimped on getting sitters to study for tests.

As a minority it is sometimes difficult to explain or convince people even in the face of overwhelming evidence that social factors control how you experience your life and the color of your skin can change the opportunities and travails you encounter. At some point it is tiring to keep going through the explanations over and over and knowing that unless someone has actually been there, they really won't know what you are talking about. I feel that way about the experience of being a mother in medicine too. I could go blue in the face with my explanations but it is exhausting.

Trading fake patients for real people

MS2 Terrible Twos here. New to MiM, so here is a quick introduction. I am mom to a sweet nineteen month old boy who is into everything and lacks even the faintest inkling of self-preservation. In a former life I received a Bachelor's of Fine Arts from an art school here in the Bay Area, and worked for over a decade in advertising, marketing, corporate event design, apparel, and retail packaging design until I decided that pursuing a career in medicine was truly my dream. Thanks to a lot of hard work, a loving and patient husband, and tons of emotional support from friends and family, that dream has materialized and I am (as of last week) a second year medical student in the Bay Area in California.

Having just completed MS1, one of the most challenging aspects of the medical curriculum this year has been seeing through the text books, algorithms, power points, Quizlets, acronyms, mind maps, case studies, and patient vignettes and remembering that the purpose of all this learning is to support real, actual people with rich histories and complex emotions. The majority of my patient interactions feel so forced and so awkward – so robotic, scattered, and disjointed. I hear standardized patients describe their symptoms and feel myself responding stoically, without empathy to concerns like, “is this serious?”, or "am I going to die?" as I systematically wade my way through OLD CARTS and FED TACOS and remember what a relevant ROS might include for the few differentials I know to consider.

Throughout every standardized patient interaction, every practical exam, and even every time I have performed an H&P on a "real" patient in my school's student run free clinic, I feel as though what limits me from truly developing any sort of rapport with the patient in front of me, actual or standardized, is the tunnel vision that comes from trying to dot every i, cross every t, and check off each and every box on the syllabus.

I understand that there is a learning curve with all of this. As with many professional practices, the only way to get better at them is by doing them over and over again and I recognize that I'll be working toward that for the rest of my medical career. I suppose that what worries me is the fear that throughout my medical practice there will always be a syllabus to consider, be it a QI evaluation report, an insurance audit, filling in every blank on the EMR, or tending to some other system to which I am held accountable.

I would like to believe that all the the awkwardness of MS1 will start to subside as early as this summer when I volunteer at the free clinic -- that the relief of having completed one full year will allow me to relax a little and try to integrate the systematic thinking of MS1 into just another part of my experience and knowledge. My hope is that the breadth of my other experiences prior to coming to medical school, including being a mother, will begin to materialize within those interactions, allowing me to truly connect.

When did it happen for you? When do patients, even standardized ones, cease to present solely as a collection of their signs and symptoms and emerge as actual people, and what tools have you used to transcend the awkwardness of your early medical training?

Things I wish I knew before starting med school with kids

1. That tired drinking out of a firehose analogy...unfortunately true. I remember being appalled when I read that med students study multiple hours a day on top of going to class. I foolishly thought on my days that end at noon (Monday and Friday) I can pick my daughter up from preschool / go to the gym / twiddle my thumbs. Instead, I am thankful for an afternoon with no class so I can hole up in the library and study. The endless studying is not death, falling behind is.

2. Wearing a half-face respirator during anatomy lab makes me look like Bane from Batman. But hey, that's a pretty good trade-off for formaldehyde-free breastmilk. And the puzzled looks I get when people see the lingering lines on my face after removing the mask -- extra giggles.

3. The lactation room is the mecca of multi-tasking. Pumping can be accomplished while eating, studying, napping, crying, making phone calls, etc. Bonus points for attempting three things at a time.

4. Whatever makes your life easier, and if you have the means, do it. Examples include ordering food, dry shampoo, a breast pump car adaptor, skipping a bath or two for the kids (hey they could have dry skin?).

5. GET YOUR CHILDCARE SITUATION FIGURED OUT AND SET (x10000000)

6. You will be older than some of the MS2s-MS4s, the same age as some residents or even attendings. Bless your eye cream and good genes, although four years of this will probably negate all of that.

7. Saying no is okay.*
"Want to study together at extremely-far-from-my-house coffee shop at extremely-inconvenient-hour?" - No.
"Want to go rage after block exam and stay out all night?" - No.
"Want to join a thousand interest groups and shadow everyone possible in the hospital?" - No...maybe second year?

8. *It is also okay to say yes.
"Need help?" - YES!

9. Your classmates will be amazing people who have done amazing things. Everyone is incredibly supportive and no one is trying to sabotage you unlike the undergrad premeds.

10. And now, a visual representation of your life:

still smiling though!!! 

If you're a mother, you've done a lot of research

You're drawing on the literature, you're weighing the risks and benefits of various protocols of parenting, and you're conducting the all important experiment called being a mom, confirming hypotheses and identifying new areas of uncharted territory for exploration.  I'm co-parenting a middle schooler presently, so you can imagine that the data is incredibly hard to interpret.  And the participant has many questions about the plan.

And then there are the other people in my life, the medical students.  They have a lot of (great) questions too.  One thing that many medical students universally ask is why, whether or not, and if so how should they do research in medical school.

This weekend I was at the American Academy of Pediatrics national conference (a local national conference, and so I shall at some point post about the ups and downs of big annual conferences that happen to be in one's own home town).  Before a packed house of medical students from around the country and the world, I served on a panel where we were asked question after question about preparing for residency.   

In the ramp up to the panel, the AAP's young peds network launched a new forum for tackling these kinds of questions and I was asked to write about research during medical school.

• Why is research looked upon favorably by residency programs?  (Is it?)
• Why would it be a good thing to gain research experience? 
• How do you go about getting started?   

Should you get involved in research on the way to residency?  For my take on these questions, see Research for Residency here.  Bottom line, whether you are in middle school or medical school, it's great to search for answers, to delve into a given topic and set about to gain a systematic understanding.  Especially if you are enriching yourself and serving others.

MiM Mail: Maternity leave policies during medical school

Hi Mothers in Medicine,

I am a medical student, a mother, and I am working with a team at my university to further develop its policies on maternity leave and flexibility for mothers in the medical program. Currently women have to withdraw from the year and repeat it the following year, or are allowed only a few weeks off after the baby is born. Surely this can be improved! Part of my role in this initiative is to research the policies that other medical institutions have in regards to this issue. If you went to a medical school that had a great policy in regards to taking time off, being flexible etc would you mind leaving the university information and possibly a contact in a comment on this post?

Many thanks,
A.


*Anyone is also free to send mothersinmedicine@gmail.com your contact information to be forwarded if you don't feel comfortable leaving it in a comment.

Attention all gunners

I met with my small group tutor today who leads our case-based learning sessions. I knew she was going to say I need to take more risks during our sessions and throw my ideas out there even if I'm not totally sure they are correct. I am admittedly suffering from some form of imposter syndrome; given my finance background I sometimes feel inadequate among my gunner science major peers who have spent years in the lab. I know I just need to get over it and I'm making a conscious effort to do so. My tutor did bring up a good point though, that now is the time to get all these insecurities and hesitations out of the way before the clinical years, residency and so on and so forth. She mentioned that she's seen many students, especially quieter females, miss out on various opportunities because of this. I think I'm a true ambivert; extroverted in most social situations, but especially introverted in academic settings when I feel like I don't know every single thing I need to know. And while I don't think I'll ever be that person who loves to contribute anything and everything even if not particularly relevant, I definitely do not want to lose out on opportunities because of it.

I know medicine is about being comfortable with some uncertainty because it's impossible to know it all. And I realize some of this will come with time, but all you lovely aggressive types, please share your ways. And those who had to work at it, how did you eventually get there?

From premed to med

So in the last two months I managed to do most of the things on my list. We moved nearly all our stuff down and unpacked while I was 37 weeks along. SK's birthday bash went smoothly. Our house is rented. Baby #2, SE arrived and is happy and healthy. We waited until she was two weeks old, packed up our remaining items in a U-haul and made the ten hour drive to our new home. (It's really only supposed to take six hours, but every 30 miles someone either needed to be fed or had to pee.) And now we are here, adjusting to life with a new family member, in a new city, with new schools and jobs. Everyone I've told about our moving experience has thought we're completely nuts, which we are, but we had a plan, stuck to it as much as we could and anything else that came up, we decided to just roll with it. In fact, these last four words have really become my motto as of late, so much so that I can basically take a picture of our crazy lives at any moment and have #justrollwithit be a fitting caption.

My first week of school was packed with such moments. No one to drop off or pick up SK from school on Monday? Just stay home with grandma and do some crafts, eat lots of treats and watch too much TV (#justrollwithit). Get to school and realize I brought my pump but forgot all my pump parts at home? Use the lactation room's backup pump and try to ignore the idea that others have used the same pump (#justrollwithit). Motion-sensor lights turn off in lactation room while pumping, leaving me fumbling around in the dark? Dance like a mad woman in the chair, still attached to my pump until the lights turn on (#justrollwithit....ok there might have been some expletives here and there).

I'm starting to realize that my med school experience is going to be a little bit different than what I had envisioned. I missed out on most of the socializing opportunities my first week because I had to run down to the first floor lactation room to pump while everyone else ate lunch. In fact, it is lunch time right now as I write this and I'm being serenaded by the gentle pff pff pff of my lovely pump. When our social calendar first came out I foolishly rsvp'd to several different events which I'm now realizing was a tad bit ambitious. I guess having a preschooler made me forget what newborn schedules are like; I forgot about the eating every 3 hours thing and the getting up multiple times at night routine. I am feeling a little bit left out, but I know the social aspect of med school will come with time, especially when the little one is a bit older. My biggest struggle right now is trying to figure out when I'm going to find time to study and I'm hoping with some trial and error I'll figure it out. Yesterday an assignment took me 5 hours...maybe 1 hour of actual work in total, 1 hour playing DJ for SK so she could perform dance routines in the living room, 30 minutes of reading Fancy Nancy books, 30 minutes of redirection, timeouts and talks, 1 hour of snuggles and cuddles, 45 minutes of breastfeeding and 15 minutes of accidental sleeping. By the time everyone else is actually in bed and I can study without distraction, I'm about to face-plant into my laptop.

I am loving what I'm learning though and I'm thankful to be in a great program. It's the logistical part that's scaring me right now. I can feel the dreaded "what have I gotten myself into" question creeping into my mind sometimes, but I'm pushing it aside for now. I'm rolling along and I'll be rolling with it for the next 4 years and probably thereafter.

Hello from CaliMed

Hello MiM!
I'm excited to be joining this fantastic community that has helped me tremendously from the time I started thinking about medicine to now, 12 weeks shy of starting my first year of medical school. A little bit more about me, my background is in finance, but after a few years on Wall Street I knew I was going down the wrong career path. After having my first daughter in 2011, I realized if I really wanted to go for medicine, I had to get on it. I am extremely lucky to have a supportive husband and thus started my post-bac when my daughter, SK, was 1. Because I was a finance major in college I had to take all the pre-reqs and although I've always loved school, I learned that studying with a toddler in tow was a completely different experience than my undergrad years. (Like that time SK accidentally locked me in the garage like a prisoner before my organic midterm...)

Now said princess is turning 4 in June and we are expecting another in a matter of weeks. It was my plan all along to squeeze another child in before the start of school, but the window was limited and tricky. At one point I was clearly delusional and considered being a "little bit" pregnant for the MCAT, but thankfully came to my senses. I am sad that baby #2 will still be tiny when school begins, but I know I am luckier than most to have the flexibility that comes with being a student.

I am really looking forward to sharing my journey through school with you all. I have to confess, I feel like quite a newbie - I've done the mom thing for a while now, but I've just started the medicine part. And with so many wonderful members in this community who are much more advanced in their careers than I, I am curious what others would like to see from me. Please let me know!

And now I will leave you with my brilliant plan for the next 12 weeks before I take the plunge into medicine:
1. Pack up house and move most of our stuff to new city.
2. Rent out current place.
3. Host fantastically awesome Rapunzel birthday party for SK at 38 weeks pregnant.
4. Pop out baby #2.
5. Move the rest of our stuff and drive down to med school.
6. Get situated (make sure SK likes school, find nanny (!), get to know area, figure out transition from life with 1 kid to life with 2, oh and unpack)
7. Start school and balance marriage, 2 kids and student-life like a boss*

* TBD. May need help with this one, but absolutely thrilled to be pursuing my dream.

Cheers all!

Edit: I wrote this post before I saw Cutter's post from yesterday. After reading it and all the comments below which seemed to offer a resounding and unanimous "no" to her question, I realize my post may sound slightly manic and also maybe naive. But I am honestly very excited for this new experience that lies ahead and think it would be wrong even, to make such a drastic change in my life and not put everything into it. I have so much respect for Cutter and all the women in this community who have taken the path that I am just now embarking on. And I would be lying if I said I was not affected by some of the comments. But I was also very encouraged by the fact that many of you absolutely love what you are doing. I know I have a lot to learn and I may feel differently down the line, but for right now, I can't look back and can only look forward and say yes.