Ten guidelines for medicine-life balance

Right now, this month, seven years out of residency with a part-time position at the refugee clinic and three and three-quarters children, I have work-life balance. It's somewhat precarious, something that could be toppled by illness or an unbearable colleague or a newborn, but I would rate my current satisfaction with both career and home life as high. Here are some philosophical and practical guidelines that I follow:

1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.

2. Be clear about your boundaries and don't apologize for them. I work Mondays, Tuesdays and Fridays. I can't start any earlier than 9AM due to school drop-off. I've had potential employers rework schedules and change clinic start times when I tell them my availability.

3. Don't compare your finances to others'. Recently, my six-year-old son asked me, "Where do you and Daddy get money from?" He was taken aback when I explained that we are paid for our work. All this time he had assumed we were going to work for pleasure and to help others. This pleased me no end. I don't want money to be the prime consideration in my decisions.

Every year the BC Ministry of Health puts out the "Blue Book", which lists what every physician in the province billed the Medical Services Plan. I've perused it before, but no good comes from seeing that my family physician neighbour bills more than five times what I do. I start to gauge the wrong things in terms of money; what are quiet days at home puttering in the yard with my four-year-old worth?

4. Say no. This may be the most important skill I've learned in the last five years. If I feel awkward saying no to someone's face, I say I'll consider their request. Then I say no by email. I don't bother with reasons or excuses. I came across a quote from one of Dr. Gabor Mate's books a few months ago that I think of almost daily: "Always choose guilt over resentment."

5. Write. I take ten minutes once or twice a week to document for myself what was memorable. This has a magical way of allowing what's important to rise to the top while the irritations of daily life drift away, affording perspective. Here's something lifted directly from a journal entry this summer:

Playland yesterday, Leif smiling as he soared through the air, Saskia looking non-plussed even when having a great time. It felt wonderful to give them a day of whatever they wanted, unlimited rides, mini-donuts, cotton candy, a snowie despite wasps hovering over the syrup spigots, eaten cross-legged on concrete in makeshift shade. They were good as gold. Felt strange to see legs dangling from a great height, delighted screams, ferris wheel buckets the colours of candy against the North Shore mountains, and think that the same world has refugee camps.

6. Consider exhaustion the state of having given, rather than having been taken from. A few months ago, as I rounded the bend to approach the Second Narrows Bridge on my way home from work, CBC's Rich Terfry on the radio and Ariana strapped in the backseat, I thought with dismay how overwhelmingly fatigued I was. I felt drained, spent, exhausted - and reflecting on these words I realized that resenting others having taken from me was passive and inaccurate. I had given what I had by my own choice. When considering Dr. William Osler's words, "Let each day's work absorb your entire energy and satisfy your widest ambition," anything short of collapsing into bed completely spent each night feels a waste.

7. Travel lightly. I try to apply minimalism to every aspect of my life. People remark on how tidy my home is, but the truth is that we have very little stuff. I decided two years ago to leave the HIV clinic to focus my part-time work at the refugee clinic only. We eat simply. Any commitments are carefully selected and for a defined period of time.

8. Hold an AGM with your spouse. Once a year, Pete and I hire a babysitter and take an evening to take stock of where we're at in every major area of our life: his work, my work, finances, church, where we live, parenting, friendships. We identify what's working, what needs to change and when we need to reevaluate. We like to feel that our choices are deliberate; we don't want to float up to our forties to say, "Huh! So this is how we live." I have such fond memories of these evenings, full of gratitude and brainstorming and collaboration, and everything recorded in my notebook.

9. Three projects. At any given time, I have three projects on the go that require one to two weeks to complete. One relates to work, one to home and one to something creative. For example, I might apply for a research grant, order a coffee table and frame some of my photos for our front entry. No new projects can be tackled until all of the original three are completed. (See zenhabits for more.)

10. Marry well. Pete (who works full-time in a non-medical field) is supportive, a non-complainer, hands-on with the kids and flexible around gender roles. We've both made sacrifices. He is undoubtedly the linchpin to my current contented state of mother-doctor.

I've loved William Wordsworth's poem "Nuns Fret Not at Their Convent's Narrow Room" since I studied it in English 103, particularly these lines:

In truth the prison, unto which we doom
Ourselves, no prison is.

I'm a mother in medicine by choice. I accept any challenges and restrictions inherent to this position, for this is exactly where I wish to be.

Announcing our next Topic Day: Our Mentors

On Wednesday, February 11, we will have another Mothers in Medicine Topic Day, a day where we will feature posts on Our Mentors. Readers are welcome and encouraged to submit stories on this topic. Write about your mentor. The mentor you wish you had. The mentor who inspired you to do medicine / surgery/ research / be a physician-mother / be a better physician / volunteer / (fill in the blank). Share a funny mentor story. Anything related to this topic is game.

To join us, please send your stories to mothersinmedicine@gmail.com by Monday, February 9 to be included. We'll be scheduling posts to publish regularly throughout the day.

To see our previous Topic Days, click here.

Topic Day: The advice we wish we had in medical school

Welcome to our third Topic Day on Mothers in Medicine! Throughout the day today, we'll be featuring posts about the advice we wish we had in medical school. What words of wisdom do we have for entering women students? For our younger selves?

Posts will be publishing at regular intervals today so be sure to check back. Feel free to add your advice in the comments section, or if you are currently a medical student, what you think of our advice!

Scroll down to see the posts...

A straggling piece of advice

I was held up yesterday so my post is late. Straggling, as it were.

People in my medical school did not talk much about life, the universe, and everything. We were concentrating on the cerebral aspects of medicine, not necessarily the humanitarian elements, and not the life outside med school.

So if I did medical school again (and, yes, I absolutely would), I would take this advice back with me: have a human perspective on all things. During my training, we all tried so hard to be professional, but I think that, in the process, we started to ignore or even invalidate our own feelings. Our emotions and reactions may not always need to be open and visible, but it's okay to feel the burden of your patients' experience and not be closed off to it. I think too many people have the fear that allowing themselves to feel too much will cripple their medical ability. I don't think so.

In my years since medical school, I have seen many of the best and brightest doctors from various disciplines getting their hands and their hearts dirty (so to speak). They have an intimate knowledge of their patients, and I see how they are invested in their patient's care. These professionals have taken down the wall that is supposed to exist between the medical brain and the feeling person underneath. I have immense respect for them and the care that they provide. They manage to be involved, yet they don't make inappropriate recommendations or have nervous breakdowns. They just see the patients (and themselves) as the human beings that they are.

These are my role models, from my unique spot from behind the microscope. But if I were a medical student again, I think I would allow myself to feel a little more sadness, frustration, helplessness, and love.

My Two Cent’s Worth about General Pediatrics

A new doctor on the medical staff of my hospital parks his Rolls Royce in the MD parking lot. It sticks out among the Mercedes, Suburban’s,and Hondas that other doctors park there. It gives me pause to fantasize about the life this physician has and how different it must be from mine – no school loans, kids grown and out of college, retirement nearing with a nice nest egg (or at least decent after the recent downturn of last month’s market.) As a Pediatrician, I know this will not be my life, and I’m absolutely fine with it. As Nancy Snyderman, MD, told Matt Lauer recently on the Today show, “Pediatricians don’t go into medicine to get rich. They go into medicine because they love children.” Lesson #1: Think about another specialty in medicine or another career altogether if money is high on your life priority list. Don’t get me wrong. My family and I are comfortable, but there’s a reason (which is best left to a future post) pediatrics winds up on the bottom of the pay scale every year.

Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.

Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.

Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.

Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.

Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.

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

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

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

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

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

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

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

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

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

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

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

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



Future Dr. Whoo

If I were a first year med student right now, I would...

As a third year med student, I was involved in some sort of group discussion session with first year med students. All of us older, wiser third years were offering advice to the first years in the form of "If I were a first year med student right now, I would..."

I had just finished a particularly grueling internal medicine rotation and I was feeling fairly disenchanted. When it came to be my turn, I said, "If I were a first year med student right now, I WOULD QUIT."

Everyone kind of stared at me in shocked awkward silence, then quickly went on to the next person.

But you didn't come here to read that kind of advice, so I'll give you some revised sagely advice from an even older and even wiser me: I wish I had taken a year or two after college to see what else was out there, instead of going straight through to med school.

It seems like the happiest people in med school were the ones who were in their mid-20s when they started out, instead of 22 like I was. They had taken a few years to see what else was out there and realize that it wasn't for them. Oddly enough, some of the people who were significantly older seemed to be just as disgusted as us young'uns, possibly because many of them had families that med school was taking them away from.

This is my graphic representation*:



I wish I had taken a couple of years off. At least then I could stop romanticizing all the stuff I didn't end up doing. Maybe I would have realized that being an actuary (i.e. calculating insurance rates for companies) isn't such a fabulous career, despite how nerdishly excited I get over making a graph (see above). And I could have written that novel I always wanted to write... about the compelling protagonist with an obstacle to overcome, where some friends become enemies, some enemies become friends, and at the end my main character is richer from the experience... (you get the idea)

*Graph not based on actual data

Answer to lingering questions...

I know you always wondered how preceptors graded you on the rotations. And you always wondered why your grade was less than what you thought it should be for the work and energy and time that you put in. Now as an attending I understand - those that clearly like the rotation, get jazzed about it, do the work in a way that you can trust them and not have to repeat the work, or just do it themselves to get it done right - those are the med students that do well during rotations. BUT SO WHAT!! you did everything you needed to do, studied the way you needed to to pass, slugged out a horrible internship year which made you question going into medicine at all. Then you saw the anesthesia light at the end of the tunnel and you're life only continues to get better from there. You chose the ABSOLUTE right profession. Yes, if someone said I could not continue to practice unless I go through med school again - I NEVER would do it. But now being at the other end, I'd NEVER give it up! My advice? If you've started - get through it and enjoy as much as you can without killing yourself... the results are worth it. If you haven't started DON'T unless you're ABSOLUTELY SURE!! And of all the people in my med school class, those that came with kids, those that had them during med school, residency etc, and those that went straight through - we are ALL satisfied about where we ended up!!

Note to self

Dear KC,

Hey you. I don't mean to blow your mind, but I'm you, writing from the future. No, you are not on Punk'd, I assure you. You don't believe me?

Well, I know you have a crush on that cute guy in your class you went to coffee with the other day. The one you talked to for hours, losing track of time. You are going to be married in 6 years. I know, score! Your wedding day is going to be the most perfect day, ever, complete with birds chirping and a gentle breeze blowing. Don't be scared by the weather forecast. The clouds will literally part that day.

Are you with me?

I wanted to pass on some advice because I think it will save you a lot of stress and anxiety. Listen, all of those years of stress and anxiety about everything from career choice to thoughts about the future and families really can add up (really add up = multiplying white hairs = a return to getting highlights again = major upkeep commitment = $$$). So, in essence, I'm saving you time and money by sending you this note.

1) Go with you heart when choosing a specialty.

I remember how much you wrestle with this. I know it's hard sometimes to imagine what you might like to be in the future, but whatever you choose will have to sustain you intellectually over the years. Do what you love. Do what challenges you. Your career is going to take a few unexpected turns (I'm convinced that it always does), but it will lead you to where you are now, in the future, and it is so meaningful and fulfilling for you. If you love what you do, you'll find a way to have the kind of life you want in that specialty. You'll "make it work," (reference to a show in the future that you will absolutely adore.)

2) Having children does not mean giving up on your career.

You may think now that choosing to have children early on in your career will necessarily mean a hiatus from doing anything productive, career-wise, for many, many years. You may be resigned to not being able to accomplish your career goals because of this. Don't. Because I'll tell you that having time constraints because of your family can make you that much more productive during your other times. You'll have rushes of creativity, of ideas, moving ahead productively in ways you would never have imagined.

3) Having children will make your life unbelievably rich.

It's amazing. It's all that you dreamed of and more. Go for it. (But, no need to rush in - enjoy the alone time with your husband - travel, explore, really solidfy your two-ness. Children are wonderful but you'll miss that two-ness later on.)

4) Take calcium supplements now. Hello, peak bone mass?

5) When making your residency rank list, remember that it is MOST important to be around people you love who can support you, not the fine details of the program.

6) Dream big.

Don't stop setting high goals for yourself. Don't settle. As a woman in medicine, as a mother in medicine, you can do great things. Dream big.

See you in the future,

Me

Years from Now

Dear Fat Medical Student,

You worry too much. It's gotten you this far, but enough is enough.

Years from now, it won't matter if you get a 92% instead of a 100% on an exam. You won't care if a resident thinks you are lazy for wanting to leave just two hours late. You won't even remember your step one score, but you'll remember the hangover from the celebration upon passing the test. Years from now, your patients will love you because you care. They won't care if you don't know all of the answers as long as you know how to find them.

You'll be a family doctor, a combination of all of your "favorites"...internal medicine, pediatrics, obstetrics/gynecology and psychiatry. You'll know a little about a lot of problems but not a whole lot about any of them. You will be comfortable referring to specialists. People will tell you their deepest secrets and will care about your opinion. Don't let them down.

Years from now, a lot of your "hero" teachers will seem emotionally immature to you once they are your colleagues. You'll watch them be cruel to ancillary staff, students, their families and, heartbreakingly, some patients. You'll feel superior to them in all ways other than raw knowledge. Don't put them on a pedestal until you are sure they deserve it.

Don't be so desperate to find a mate now. You will marry your best friend and have happy children. You'll see.

Years from now, you'll be sorry you quit walking the dogs when you got a fenced yard. You'll regret those drug-rep bagels, too. Stop when you are 15 pounds overweight and you'll never be 140 pounds overweight.

You will hurt many patients...not with malice but with honest mistakes, misjudgments and quirky fate. Decide now how you will handle it so it doesn't kill you. You'll cry about these circumstances because you are a good person, but don't let the bad outcomes make you jumpy.

Years from now, you won't care about money because you'll have some. Save for retirement and live below your means. Your loan payments will be a small part of your overall salary because you borrowed wisely.

Years from now, you'll find yourself wanting to snap at people in "ordinary" life. Practice now how to manage fatigue so you don't become an ass. Medical students will turn to you for a kind word or emotional support and you should give it. Always.

You'll be glad you spent time with your nieces and nephews even when finding time was difficult because the children make your life whole. Invest love in them and it shall be returned when you are back in diapers.

Years from now, you'll be a generally happy person. Of course, you'll wonder what might have been in you hadn't chosen medicine. You'll consider chucking it all and going to cosmetology school. Don't let your mind go there. On the day when you decide you are in the wrong career, a patient will tell you that they credit you for helping change his or her life. It will feel good.

Enjoy the success...it's what you wanted.

XOXO,

Future Fat Doctor

Express Yourself

Most medical schools have satirical student productions. The most rewarding thing I did in medical school was to be deeply involved in ours, called the second year show. I can still remember classic skits: the first year student doing a physical on a cadaver and missing that the patient was dead, for example. The accompanying song still runs through my mind whenever I teach phyisical diagnosis. Playing music, singing and dancing with classmates is a tremendous counterweight to both the isolation and the competitiveness that seem to be a leitmotif (or maybe I mean heavy motif) of medical
education.

Oh the Places You'll Go!

8/ 01/1997

Dear RH+,

Well here you are…. All grown up and getting ready to start Medical School. The things you are going to experience are going to blow your mind. No matter how hard things get I want to let you know its all worth it. In the future you are happy and love your profession. But, there are just a few tidbits you should know:

Those student loans are really hard to pay back. Don’t take out any more than you need. Also read the book “The Millionaire Next Door” as well as “The Richest Man in Babylon” the summer before you start med school.

Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship. (This is not meant to spark controversy. I feel my Osteopathic training was outstanding and I love the profession. It was however detrimental to applying for residency positions and I was mislead on this issue when I entered school)

It will all work out. Don’t freak out when you realize that you want to be an OB/GYN. Do what you love. YES, you will be able to have a family and a somewhat balanced life.

SUPPORT you fellow female students/residents when they say they are being sexually harassed. Never just think they don’t have a sense of humor. Never look the other way when people say sexist or racist comments, even if they are your superior, stand up for what is right.

When you are an intern you will be convinced that your Chiefs are evil (well one of them is, but she will get fired). They are not. They really are trying to help you and they are just trying to survive as well.

Don’t eat so poorly as a resident. If you eat a second “dinner” at 3 am, you will, in fact, gain 20 lbs in 6 months.

Nothing I can tell you now will prepare you for having a baby. Just a hint, there is nothing better in the world than seeing your child for the first time. Your heart will grow in the most dramatic way. The nausea, constipation, Mag….. all worth it.

Shave your legs with your left hand. This will help improve your dexterity and surgery skills.

Don't wish away your life (except intern year. It will be awful and life will be significantly better when its done). Enjoy each stage as much as you can.

You husband, family and friends are amazing. Don’t ever take them for granted.
Enjoy the ride!!!

Love,

RH+ 11/2008

Things I wish I knew in medical school

Things I wish I knew in medical school (and beyond):

-When starting, I wish someone would have told me that the daily grind of medical school would be the hardest thing that I’d ever done to that point.

-The smell of the anatomy lab will eventually fade. With luck, everything you learned there won’t.

-It’s OK to not know what you want to do with your life; spend your time during rotations and clerkships learning as much as you can. Likewise, it’s OK to be completely grossed out by sputum samples.

-Learn to listen to your gut regarding patients and yourself. It’s part of the art of our profession.


-Every once in a while stop to thank your support systems: parents, siblings, friends, significant others, spouses. Med school is a tough row to hoe (so to speak), and they’ve got your back while you’re cramming for yet another exam. Don’t get crazy - you haven’t got that kind of time.

-You’ll never know it all, so don’t panic when you realize you don’t. This profession is built upon learning regularly, so learn to learn quickly and efficiently. And teach what you’ve learned – it’s the best way to reinforce your knowledge and pay back those who you feel were good teachers.

-Above all, remember that you're never alone. Don't be afraid to ask for help.

A

Guest Post: You can have a child (or four) during medical school

I recently read an article in Newsweek by Dr. Nancy Andrews, Dean of Duke Medical School encouraging students and faculty to "go out and do whatever they want to do." And that reminded me that I wanted to echo that sentiment here by writing about having babies in medical school. A few months ago, I read a funny yet less than positive post on here outlining how really there is no perfect time to have a baby in medical school. There is a lot of legitimacy to that type of post: It is hard. True enough, there may not be a perfect time but that is not the same as saying there is no time. And for the nontraditional female student who feels trapped and conflicted about whether to do medicine or do to a family, there are fulcrums to that tension. You can have a child in medical school and you can do it with assurance that that baby will turn out just fine.

As I reflected on what might be helpful, I came to the conclusion that some of the best support I received along the way was hearing other women's stories. For me, it helps to have anecdotes of success to reassure me along the way. Nothing has been more uplifting than knowing that I am not alone in this journey of motherhood and medicine. It has been other women's random stories, hodgepodged together, that have given me strength, motivated me, and given me ideas on how to improve: do it differently, do it better.

The other day I was at my pediatrician's office with one of the boys. I encountered another pediatrician who was substituting that day in the clinic. "Dr. K, I'd like to introduce you to MSM, she is a med student with three boys and another baby on the way." Dr. K looked up from her chart and flashed me a huge smile. She pulled me aside and immediately introduced herself and gave me her story.

"Oh, I started medical school 8 weeks postpartum with our third child. In the summer after second year, I gave birth to our fourth. I wanted to take a year off to be at home with my kids. I suggested to the dean that if men were allowed to take a year off between second and third years to 'find themselves' that I was already 'found' and needed to cultivate it. I took the year off and returned to school; subsequently, I matched into a peds residency on a part-time basis for the first year and then finished full time."*

She then continued on as I stood there with my mouth open. Rarely do I encounter women with stories quite so similar to mine.

"If you ever feel like quitting, if you just have one of those weeks and everything feels overwhelming and not worth it, if you feel like your babies don't know who you are and you're stressed, call me. I can guarantee that I have been there. Many times, in fact. But I can tell you, for me, it has been worth it. And I would be more than happy to help if it ever comes to that for you, too."

She then handed me her number and went on to see the next patient. I have to say this made up for all the times that people have looked aghast when I tell them that, “Yes, we are having a baby. And no, it's not our first or even our second, but our fourth.” I feel like a rare irresponsible bird, which I loathe. I suspect they think I must have slept through the reproductive medicine lecture on IUDs, and what a wonderful contraceptive device they are. But ultimately, I've learned not to say anything. I often hear from fellow classmates, "I don't know how you do it. I can't even take care of myself." Despite the desire to retort, "I don't know how you go out drinking as often as you do and still make it to class, functioning no less." I decide not to. Since it's rhetorical anyway. Right?

But here's my long winded point: so far I've experienced a pregnancy in every year of medical school. I had an infant when I started first year. Halfway through that school year, we started trying for number two and ended up with a bonus (I got pregnant with twins). At that point, I took a year off to do research and to care for the babies. The following year, I returned full time and got pregnant at the end of second year. I passed step 1 and started my third year with my surgery rotation. There have been good and bad points along the way. But for me, it has been an extremely rewarding, incredibly busy, but amazing period of my life.

The chaos that accompanies four small children (or even the kids themselves) is not for everyone. I’m definitely not recommending this path to everyone- but to the women out there contemplating entering medicine but hesitating because they feel overwhelmed by the impossibility of family, school and medicine, I can finally return some of that reassurance I have received over the years. Follow your dreams: their individual paths diverge less than you fear, and you can always problem-solve ways to bridge the divide.


*I didn’t have the chance to ask Dr. K’s permission to share her story so I changed any identifiable details, though, I don’t think she would mind inspiring or reassuring anyone out there.

MSM is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.

Topic Day: It's About Time

Welcome to our second Topic Day at Mothers in Medicine. Throughout the day, we'll be featuring posts about Time Management. How to juggle motherhood and a demanding profession? Here we share our tips, secret weapons, philosophies, and choices.

Scroll down to find the posts...

Time is sanity

For me, time management equates to stress management. When I'm less stressed, it seems that I'm better able to manage my time. To that end, these are the tricks that work for me on a regular basis. I wish I could say that I always use them, but I don't. Perhaps that's why I've been able to recognize just how well they work - because I have so many times when I haven't used them to compare!

1. Exercise. This is the best way that I've found to bust stress and keep me going. When I exercise regularly, it seems that I'm able to be more efficient in almost everything I do.
2. Write it down, write it down. Make a list, check it twice. I write down everything, from things I want to get done to gift ideas for the kids.
3. Everything has a home. This is the best way I've found to keep track of items.
4. Make use of duplicates. How many pairs of reading glasses does one busy doctor need? um...at last count, six. I have them in the car, in my office, in my bag, and 3 pairs at home (bedroom, kitchen and family room). Yes, each pair has its own home in all of those locations; the upside is that I never spend time looking for glasses. I do the same thing for scissors and office supplies (kitchen, bedroom, office).
5. Hug my kids or husband. No matter how busy I get, a hug always regenerates me in a way nothing else seems able to.

Even though time isn't my friend on too many occasions, using these tricks makes me feel like I have at least a little control over my life - and that's always a good thing.
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Guest Post: Recipes On The Run

I try to cook healthy, fresh meals at home whenever possible. I have found that having my recipes available wherever, whenever helps me get this done more often and more efficiently.

For those who have an iPhone or are considering one, it’s been a huge help with this. I have an application called “Folders” that allows me to keep my recipes, organized neatly, at my fingertips at all times. I typed in each recipe as a word doc and uploaded them onto the app. I created folders for main dishes, crock pot dishes, side dishes, soups, etc.

Now, with my folders of recipes on my phone, I can decide what to make before I leave the office. I can then stop by the grocery store on my way home and get the ingredients, since I have them all listed in the recipe. When I get home, I make dinner using the recipe on the phone. I know when the dish is done by using my iPhone as a kitchen timer!

I can even find out what the half-price specials are at the grocery store while I’m at the office deciding on a recipe for that night. I pull up the store website on my iPhone, and if ground beef is half price, I’ll pick a dish that uses it.

The iPhone may be a bit pricey, but for everything it’s helping me do (including acting as my pager), it’s been worth every penny.


gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.

Under pressure

As a resident, it's important for me to put aside time for studying while I'm home, so that when I graduate I'm not just a huge malpractice suit waiting to happen. Having a baby has in some ways made that more challenging, but in other ways has actually helped me (believe it or not).

My typical evening prior to having a baby:

6PM: Arrive home

6:30PM: Leisurely dinner

7:30PM: Watch television, think about studying.

8:30PM: Surf the web, usually while watching television

9:30PM: Consider studying again.

10PM: Bedtime snack

10:30PM: Consider studying again, but figure I'm too tired to absorb anything. I'll study tomorrow.

11:30PM: Bedtime

My typical evening now:

6PM: Arrive home

6-9PM: Baby care

9PM: Get out book and furiously study, write presentations, whatever

10PM: Collapse into bed, totally exhausted

The difference? When you have a kid, you know free time is scarce, so you take your studying when you can get it. You can't afford to postpone work till tomorrow, because god knows what will come up tomorrow.

As a result of all the studying I've been doing lately, I've become one of the most knowledgeable senior residents (in my very modest opinion). Sometimes I forget how it used to be and I wonder why the residents without kids seem to never have time to read like I do. I mean, what do they DO all night?

Choices

I chose a job where I had control of my schedule.

I chose to have Mondays off.

I chose to work out of 1 hospital only (God bless you crazy OB ’s that work out of multiple hospitals and have people in labor all over town)

I chose a good man.

I chose a low maintenance haircut.

I also try to start most days with a run and some time in prayer.

I finish my charting before I leave the office, but I keep a small stack of paperwork that can be procrastinated. I keep my journals in this stack. Then, I go through them when I’m stuck at the hospital waiting for someone to deliver (My office is down the hall from L&D).

I’m a optimist. I don’t let myself wallow in self pity when I have to work late or don’t get any sleep. I try to focus on what an honor it is that people let me into their lives so intimately. To deliver a baby… even at 3 am …… is still the most amazing experience in the world.

I also drink a massive amount of coffee.

Commute time is not more fun than time with the kids

Like the dog year to people year conversion factor (what is it 7 to 1? I'm no vet...), there is something funky about the commute time to kid time equation. Even though I can listen to my favorite radio hosts who catch me up on local, regional, and world events, even though I can unwind after a rough day seeing pregnant teens who didn't know they're pregnant, and even though I can make cell phone calls (hands free) to friends I don't get to see that often anymore, I will unequivocally say that time spent commuting is not more fun than time spent with my kids. A simple fact. The commute is a time-sink. And commuting in traffic is negative time. At least if I were in the car with my kids for the bulk of those travel minutes, then it wouldn't be too bad, as we talk, listen to music (on my rockin' cassette player), discuss what we see on the side of the road, and make stops at farmer's markets (always a winner) and gas stations (fun because Mommy washes both rear passengers' windshields a few times) . But commuting without either rear passenger is painful indeed. I recently obtained a navigational GPS that I thought would help me Get Places Sooner, but I find it actually gives me more choices that I can now fret about... will it be faster or slower to turn onto this side road, and why does it say "no outlet?"



One good option which serves to add precious moments to the standard 24 hour day, when I can swing it, is to skip out of work early on administrative days or light clinical afternoons, avoid traffic altogether, and surprise my children with an early pick up. And, on a typical trafficky commute, what makes up for those negative minutes are the positively huge smiles, cheers, and hugs when we all meet up again at the end of the day. And I don't dare let thoughts of tomorrow morning's commute intrude on our fun-filled evening.