My Mother’s Daughter

My mother is a doctor who started a solo practice in the 1970s when there weren’t many working mothers, let alone working mother doctors.  She worked tirelessly to establish her practice and then became one of the busiest primary care doctors in the area. I think she was happy with her decision to practice medicine but I know she has regrets about working full time.  She often told me that she wished she could have worked part time or taken off time while we were young.  When I started a family, her advice was to spend less time working and more time with my kids.  

I’ve taken her advice very seriously and have tried very hard to find a happy balance between work and mothering, but in many ways, I am my mother’s daughter.  I am a doctor.  I am a mother of three children.  I struggle with issues around work and balance and guilt.  But I am also very driven to succeed and my mother’s path may be a big contributor of that drive.   By witnessing her courage, strength, and perseverance, I knew that women could work and their kids would still turn out to be great.   

That’s why it’s so encouraging to see research that supports what I always knew – that the children of working moms are very likely to succeed.  

A few months ago, researchers from Harvard Business School published findings from a study where they found that daughters of working mothers were more likely to work themselves, have supervisory roles, and earn higher incomes compared with daughters of non-working mothers.  

This is exciting and affirming news for all us working moms.  And in some ways it's not so surprising.  When I think about my kids and who they will grow up to be, I often wonder what will motivate them, what will make them happy, and what will shape their future selves.  There’s no question in my mind that role models play a huge role in shaping their decisions, their paths, and their destinies.

As for my own mother, I shared this study with her and she wasn’t surprised by its findings.  But she still feels sad that she wasn’t always around after school and on the long days of summer and in the classroom as a volunteer.  Those feelings seem pretty universal and hard to shake.  

The good news is that she is now retired, has six grandchildren, and lots of time to enjoy them.  Plus she has three kids who are successful by any definition and who deeply love her and are grateful for her hard work and for the role model that she was to us.

(Don't) Hide your kids!

The first year after my daughter was born, my end of year evaluations digressed into a lot of talk about whether or not I was mommy tracking myself.  The criticism was not about my work ethic or my skills. Apparently, there was an extensive discussion about how overly preoccupied I seemed to be about my daughter.  I mentioned her too often.  The suggestion of part-time residency came up and the sentiment was that I would no longer reach my full potential.  These meetings are supposed to be confidential-ish but I was told afterwards that perhaps I should try to hide my kid.

The instructions to hide my daughter came from a good place.  It came from an attending who had my best interest in mind.  He mentioned that in this world even though I was working just as hard, family issues were going to be looked down upon.  I would be stereotyped.  People aren't used to mom surgeons, especially not as residents.  He told me a story about sneaking off from work as a fellow to pick up his sick son by making up some elaborate story to hide the reason that he had to leave.  “It is more respectable to meet friends for beer than try and pick up your child from daycare,”  he told me.  My response…I would talk about my child incessantly!

So, I did.  I figured, if the world wasn't ready for women to be both surgeons and moms, than I would help to make them ready.  The end result is that I feel this has brought me a lot closer to the other hospital staff who are sometimes more open about recognizing the importance of family.  Being closer to the hospital staff makes my job easier.  I chat with the nurses, scrub techs, office managers about our families.  I feel like it gives me a sense of legitimacy and realness which means we are all on the same team.  Also, an unexpected result was that I became the “mama hen” of the residents.  There are a few more junior residents with kids or husbands and the associated stress.  I try to keep an open door policy for them.  And we have real and frank conversations about how hard this can be.  The supportiveness of being able to have this dialog goes both ways!  Also, I find that many of my attendings take an interest in my family life as well as my surgical development.

This past year’s evaluations had no mention of mommy tracking.  In fact, I was made chief resident.  Last night, as I sat finishing up work in the chief’s office while my baby girl bounced around watching Dora and coloring, I felt I made the right decision.  She knows all the names of the other chiefs and incorporates them into her world.  She loves coming to the office and is well known throughout the department.  She chats with me at night about her day and asks about my day.  She tells me she wants to be a doctor like me when she grows up (well, a doctor and a cowgirl of course).  I’ll never hide this beautiful girl!

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 .

Nicely done?

Went to the pediatrician with my daughter for routine primary care visit.  I thought she (the pediatrician) did such a good job with my daughter in terms of the tenor and content of the discussion, the calm demeanor, the subtle but savvy questions, the listening, and the encouragement.  Promoting wellness, self -esteem, and balance.

Later in the evening, reflecting back on the visit (and talking with my spouse) I realized how similar the pediatrician’s approach seemed to my own approach with my tween patients.  Or at least was what I aim to do.  But then I wondered about how circular this is.  I like the pediatrician because she practices like I do. How self-congratulatory is that?  And yet, perhaps instead it's that she and I are similarly mediocre pediatricians. Regardless, my daughter stated after the visit that her pediatrician was the “best pediatrician ever.” (Present company excluded, of course.)  

Do you learn about doctoring when, as a MiM, you go to the doctors?  I have tried to over the years. And as a MiME (Mother in Medical Education), I teach some stuff too. Actually, we chose this pediatrician in part because she trained with us.  More circularity.  Nicely done!

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.

The high price of motherhood

My little daughter takes violin lessons, typically on Saturdays. This Saturday, we had a conflict, so I took the only other spot available, a 3:00 pm Wednesday lesson. I don't get off work that early, of course, so I figure I will quickly take her and then bring her back to work with me.

The workday was packed. I wanted to back out of this cockamamie scheme that I had somehow let myself into. But I just went ahead and did it. I had heartburn and a mild headache by the time I got back. Having my daughter at work with me proved very inefficient, but by 6:00, we were set to go home, with a little residual work left for the following morning (I came in at 6 am this morning to catch up).

I don't think I have any wisdom to share. If there was a simple answer on how to have a medical career and be a mother, we wouldn't have stress or angst. I think that I have two of the most wonderful kids in the whole world, and I absolutely cherish them and thank God for them. I also have a fantastic career that I love. My payment is stress, both physical and mental. It's also the guilt I feel when I can't devote the time to my career that I would otherwise before I had kids. It's the grating knowledge that others may either resent me and/or think less of me when I have to put my kids first. But these are all payments I am willing to make, because my life is full and beautiful. Nothing truly great comes without sacrifice.

Anyway, nothing this week will top my experience yesterday at work when, during an intense conversation with one of the general surgeons about his patient's biopsy results, Sophie gets right in my face and says "MOMMY, I have to POOP! I have to poop REALLY BAD! (I was trying my best to shush her) Really, I'm NOT trickin' ya! I have to POOP REALLY BAD! MOM-MY! I have to POOOOOP!!!"

Don't worry, we made it.

watching from the sidelines

First swim lessons this weekend for Just Four. As a former lifeguard, current mother and pediatrician, one would think that I could have taught her some swimming basics. But despite our best intentions and her inquisitive nature, my daughter has a hard time learning from her parents. She knows Dr Mommy is the best at putting on band-aids. And that daddy can rock out on the guitar. However, our teacher-centered little girl who is frequently found to be instructing her stuffed animals in all of life's lessons, appears to learn best from Other People. We struggled with which class to choose, one in which we parents could wade in the water too versus one in which we were banished to the sidelines (instructor to parents "Step away from the pool"). Choosing the latter proved to be a wise move, as she made us proud, nervously saying Goodbye and then completing her first lesson, bubbles, floating, gliding with an occasional wave to Dr Mommy, who, behind a glass wall was watching her daughter learn and grow on her own. Needing me but not needing me. Oh, yes, and my needing her.

Worms

The kids know that I'll check out their cuts or scrapes on a routine basis, and I've been known to pull out more than a few chunks of bothersome ear wax when asked. So it doesn't usually surprise me when one will pull me aside and ask for my "professional opinion". The other day was an exception:

“Mom, can you look at worms with your magic* otoscope?” Youngest casually posed the question one morning.

“Yes, of course,” I began to respond. Then his question sunk in. “Um, honey, why do you want to look at worms?” With mild disgust, I pictured some juicy night crawler on the sidewalk that he wanted to look at more closely.

“Can you look at the worms in my head?”

“WHAT?!” Take a deep breath, I told myself. Surely this isn’t what you think.
“Youngest dear, you don’t have worms in your head,” I stated, with far more confidence than I felt.

“I have one of those song worms in my head and it’s making me crazy. I thought maybe you could see it with your otoscope and get it out,” he replied calmly, starting to walk away.

Song worms? Song worms? What the heck is a song worm? I wondered. Then it hit me – he had an EARWORM that was tormenting him. Starting to laugh, I followed him and pulled him in for a hug.

“Even with my magic otoscope, I can’t get out ear worms. You just have to let them die a natural death. Sometimes, if you’re lucky, you can pass them along to someone else. What song is bugging you?”

And now, Miley Cyrus’s “The Seven Things I Hate About You” has given an ear worm in my brain new life…

A

*Magic because it only turns on when a child blows gently on it – with a little help from Mom’s fingers on the rotary switch. And for more on worms, check out the post here.

Enjoy the moment

Having spent a few weeks off with my kids this month I feel renewed.

It has been an interesting time - My kids are 3yrs and 22mos so not quite independent, rather being with them is quite tiring. And while I still have to escort my 3 year old to her room several times a night, and my 22-month old has started having night-terrors...I feel ironically refreshed and rested.

It's because spending time with the kids requires me to be in the moment. They require my attention physically and emotionally.

Throughout my work day, I am usually multi-processing. Driving to and from work I am carefully planning how to use my time effeciently. While in a room with a patient, I am busy trying to cram their agenda in with mine while simultaneously typing their note. In between patients I'm usually checking labs while keeping a window open for my two email accounts...my usual routine is hardly restfull.

I'm not sure I need to do so much multi-processing, but from the time I spent this month at home with the kids, I am reminded of how important it is to enjoy and stay in the moment. I also feel blessed to have children to share these moments with.

Normal Incompetence

This blog is useful. Yes indeedy. Because all of you, I'm sure, will understand the emotion behind this post.

I can run a code. I could, if forced to, put in a chest tube, intubate, throw in a central line. I've delivered over 100 babies and I've taken care of countless numbers of people in the ICU. I can and do coordinate the care of patients when they are circling the drain. I can and do make life and death decisions every single day.

But put me in the room with my 4-year-old and I'm weak. He throws a tantrum (or eight) and I break. I yell. I threaten. I have no control over him, and no control over myself. I've never hurt him, but that's because I put myself in time out when things get really bad.

Yes, I occasionally lock myself in the bathroom to get away from my son.

Today, while sitting on the toilet in my locked bathroom, I thought, "What am I doing bringing another child into our family?"

_______________________________

After I typed the above, my phone rang. It was my adoption coordinator. I think perhaps God dialed the phone for her. I told her about my day and my feeling of utter incompetence. And then I wept on the phone with this woman who has the power to make our adoption happen or not.

She said I'm normal. She said she's glad to hear that I'm scared and feeling overwhelmed. The adoptive parents who have it all together, she said, terrify her. Like the mother I want to be, she soothed me with her kind words and lifted my spirits.

I'm normal. Incompetent, but normal.

So I went to peek in on Son, who is asleep in my bed. Angelic. I lay next to him and he snuggled in, his hot breath brushing against my neck.

And as I type the second half of this post, I'm starting to feel better.

Normal, if you will.

Tucked in

As a resident running the family practice ward, I would come up to the unit in the evening to finish dictations and complete paperwork. At the end of the evening, I'd ask the nurse if there were any patients she was concerned about or orders she wanted written. Having tied up all the loose ends, I'd head to the call room.
I distinctly remember how I felt walking down the corridor at eleven at night. The ward was hushed and still, with the patients' lights off and just one or two staff at the nursing station. Heading back to the elevator, past rooms of four beds apiece with patients curled up under blue cotton blankets, I felt maternal. Or how I imagined maternal would feel, as I hadn't had a child yet.
It was a powerful emotion, a combination of affection and respect for my charges, the satisfaction of having managed the day's problems, the weight of responsibility, and humility and gratefulness for my own position.
These days, as I round on my own children every night before bed, the flood of feeling as I adjust the covers over small sleeping bodies is remarkably similar.
And I realize now that those late nights walking down the corridor of 7B, the sense was of having tucked the kids in for the night.

Backfired

Years ago, I heard my sister tell her then 2-year-old son that she was 'so excited' to go to work. I questioned her motive behind that statement, as I knew she would rather spend time with him.

"I don't want him to think I would ever leave him to do something I don't like," she said. "If he believes I love going to the hospital, it won't hurt him as much when I walk out the door."

Now that I, too, am a mother, I see the logic in her little white lie.

A few days ago, Son was quite upset when I left him at preschool to go across the street to my own hospital. I stooped down so I was at his level and explained to him that going to work was fun for mommy, that sometimes I need to have fun like he needs to have fun.

Today, we are staying home. I told Son our plan to meet our friends (a nurse I work with and her son, who is in Son's preschool class) for a picnic in the park. I suggested it would be fun for us both.

"No, Mama," he said sternly. "You go to work to have fun," he explained. "The park is not fun for you."

Sigh.

I guess I need to rethink that line.

You stink!

Another day in the life with kids:

Ooooh that smell
Can't you smell that smell
Ooooh that smell
The smell of strep surrounds you
(apologies to Lynrd Skynrd)
A few days ago Youngest spent some time with a family friend, returning home several hours sooner than expected. Coming in the door, he complained of a headache. Our friend explained that Youngest hadn’t seemed quite his perky self during their outing, adding he was surprised when Youngest abruptly asked to return home.

I put an arm around Youngest and he leaned in for a hug. I was initially repulsed at how warm he was – but shrugged it off to the heat of the day and the time he had spent outside. But what did I just smell? Only a quick whiff, gone before I could really say with certainty I had recognized it. Nonetheless, after our friend left, I put Youngest on the sofa and got the thermometer. 101.3 – not a typical temperature after spending time outside, no matter how hot it gets. Ergh. Let’s keep a close eye on this, I thought.
“How’s your head, bud?”
“It’s OK, Mom.”
“Any sore throat?”
“Uh uh.”

Maybe I was mistaken about that smell…

The next morning, Youngest was still febrile. Leaning close, the smell was unmistakable.
“How’s your throat today?”
“It hurts when I swallow, Mom.”
*Sigh*
“Open up. I want to look at your throat.”
“AAAHH” Youngest has an amazing ability to open his mouth when he wants to be cooperative. I was able to see almost down to his larynx, so I had no problems identifying the pustules along his tonsils. As he exhaled, the scent was overpowering. Strep. Unmistakable. I could have waved a rapid strep screen in front of his face and obtained a postive response.

“OK, time for some medicine for you.”
I knew he was really sick when he responded with “Can I have the pills instead of the yucky liquid?” instead of his usual protests against any type of medication.

So now we’ve been on antibiotics for 48 hours. The pustules are going away. Youngest is back to his usual bouncy self. And I’m hovering around Eldest on a regular basis, waiting for him to exhale, waiting for him to develop that smell.

A

photo from Medscape.com

Bittersweet weekends

"You're going to work?" says my three-year old daughter, taking a break from the business of a blueberry waffle and yogurt. "Why?"

("Why?" is the most repeated word in our house for the last few months.)

"Because there's a lot of sick people and I need to help them get better, " I say, as I kiss her on the top of her head and give her a hug from behind.

"Oh," she says, unfazed, her focus again on the waffle.

I slip away, blowing kisses through my lowered car window. Trading "air hugs." Just like any other day.

But today is Sunday. I also worked Saturday.

Today, it stings to drive away, as it always stings on a weekend day. You would think I'd be used to it by now, after three years. But, no.

Working on the weekend is by far, the hardest part of my job. It feels so anti-mother, leaving my babies on a day that is supposed to be time off with the family. I think of families everywhere, doing the usual weekend things. Brunch. The park. Even running errands. Do they realize how special uninterrupted weekend time is? Do they have any idea?

My job, while it does require some weekends, allows me flexibility at other times. During those other times, I really appreciate the flexibility as it relates to mothering. I can head into work a little later, after fitting in an extra nursing session with my 7-month old. I can get home earlier if I need to, to meet with my daughter's teacher. This flexibility, I often reason, makes the occasional weekend day tolerable. But, always, my reasoning and appreciation evaporate the instant a working weekend day rolls around. Poof. Like magic.

I always just want to be home. Like a "normal" mother. I always feel a twinge of guilt. Like a "bad" mother.

Yet, I love what I do. I love every other aspect of my job. I can still find joy in talking and joking with my patient's wife on a Sunday afternoon as we all talk about his progress, his recovery.

I think my daughter understands her mother is taking care of sick people and sick people need help, even on the weekend. I think she knows how much I love her, and how much I miss her when I'm away. Hopefully, my son will know this too, one day.

And when I have the luxury of an entire weekend to drench with family, it is all the more precious.

I soak it up.

The Orchidometer

“Mom, do you have an orchidometer?”

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

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

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

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

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

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

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

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

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

“Good to know.” I blink hard.

“So I don’t think I’ve started yet.”

“Mmm.” is all I can think of to say.

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

Fracture

My three-year-old broke his arm this weekend.
Technically, he fractured his left radius and ulna, but when I saw him running toward me with a sickeningly unnatural curve to his forearm, I said only, "He broke his arm." I immediately noticed that I didn't use medical language, but at that moment I was solely a mother.
We were visiting family, and Leif had fallen from a four-foot slide. As we headed to emergency, minutes up the road, he kept insisting through his sobs that he needed nothing more than a band-aid. "That always made it feel better before!"
Lying on the gurney in the emergency bay, much more comfortable now with his arm draped carefully over his chest, Leif's chief concern was that the IV not interfere with the (temporary) tattoo on the back of his hand. "Why don't you put it here?" he suggested to the nurse, gesturing to his shoulder.
Hooked up to the monitor, he announced cheerfully, "That's my heart. Did you know it made that little beeping sound?"
I don't think he's ever been cuter. Of course, at home his running commentary has to compete with his two sisters', and we're often distracted by making dinner or driving the van or whatever activity we're engaged in. But lying on the cot, with both his parents directing their full attention and concern at him, the kid streamed charm.
The physician arrived and asked Leif what colour cast he preferred: "Blue? Green? Soccer balls?"
Leif considered the options and replied, "Pink." The lad doesn't have two sisters for nothing.
"Your father will be relieved to hear that we are out of pink casts," replied the physician. "But we do have red."
Leif had to be put under conscious sedation to have the fractures reduced, and as they prepared for the procedure the nurse measured a tiny blue airway against Leif's jaw. "Do you like the colour blue?" she asked him pleasantly.
"What's that for?" asked Pete.
"In case he stops breathing," she replied matter-of-factly.
Once Leif was sedated, hooked up to monitors with on oxygen mask on, his little arm being manipulated by the doctor, I heard Pete make a small distressed sound behind me. I was thinking purely medically at that point, watching the effects of the ketamine and noting the doctor's technique.
I didn't volunteer that I was a physician, as I didn't see how it would influence Leif's care, and there was no natural way to do it. But eventually the physician asked casually, "So, are one of you in health care? Nurse? Doctor?"
"I'm a physician," I admitted.
There was a chorus of Aha!'s, and the remark that we were unnaturally calm.
In fact, I felt grateful throughout the visit. Grateful that in six years of parenting this was our first emergency visit; that the injury was relatively mild; that there was no one to blame for the accident; for the family that visited during our short stay and took care of the girls; for the availability of excellent medical care (working with refugees makes me especially appreciative of our system).
As for Leif, he disregards the cast completely. He's not the least bit frustrated to be constructing forts with one hand, and has been climbing the furniture as usual and threatening to break the other arm.
When I gave him his grape-flavoured ibuprofen this morning, his baby sister asked for some.
"This medicine isn't for you," Leif told her, "It's only for little boys with busted arms."

When I retire perhaps I'll be a daycare provider

I took a vacation day from pediatric practice a few weeks ago to accompany Just Four (and 15 classmates) on a trip to the National Zoo. My daughter and I (and 15 classmates) walked that whole zoo up and down. Fun but tiring, and I still crazily fantasize that someday when I retire from general pediatrics I'll be a day care provider. Assuming I receive the proper training, of course.

But for some time until I retire, I'll be a pediatrician and have children in day care, so I will struggle with various options when it comes to hiding or sharing a vast array of pediatric (and other) medical knowledge. Do I let them know that teething isn't the cause of the 102 fever? That one doesn't actually get a cold from being in the cold. That diarrhea is usually contagious but eczema is not.

Do I show them my technique for reducing a nursemaid's elbow? Perhaps it's best to just do it myself--on my own child yes (twice) but on a classmate? I'll presumably gain some cred in the process, as an unintended but welcome side effect. That cred can go a long way when I assure them that my child who was sent home yesterday vomiting raisins is actually fine today and able to stay and play.

And in preparation for my retirement position, I'll take note of all that I can learn from the day care providers. How do they get my children to nap, everyday, let alone getting 12 toddlers to do so, at the same time, under one roof? When I asked, they laughed it off. And when I asked again --it wasn't a rhetorical question-- they explained, "Oh we just tell them it's nap time and turn down the lights and read a quiet story." Ah, that's how they do it. I'll think I'll try that at home.

Someday I'll "retire" and become a day care provider so I can continue the teaching and learning cycle. I'll greet the parents in the morning and late afternoon with information about their precious children. I'll read books to my class, tell them stories, and hear their tales. I'll feed them healthy food. There will be no potato chips in my day care. They learn not to bite each other. I'll teach 16 preschoolers to skip and 12 toddlers to jump. They'll all know how to dance. I'll be tired, but I'll nap too. When I retire.