Me Too

I went to the hospital at 4 p.m. yesterday. Instead of getting home at my usual 2 a.m. and climbing into bed next to sleeping Son, I flew through the door at 7 a.m.. Son and Husband were busily zipping up their coats, ready to hit the road for school and work.

Home about 30 seconds, I saw that something was missing.

I picked Son up and plunked him on the kitchen counter and stuck the patch to his eye.

"Kiss," Son said. I reached up to the cabinet for the daily-after-eye-patch Hershey's reward and put it in his hand.

"No, kiss," he said, puckering his lips.

Duh. Soft, wet, four-year-old lips on mine.

"I really missed you today," he said.

"Me too," I said, swinging him to the floor and patting his bottom as he ran out the door to his father's waiting car.

Me too.

Generation M--what would Abraham Lincoln say?

So I was driving to work the other day, listening to NPR while checking voice mail on my handheld cell phone and eating a banana with a glass of OJ balanced on my thigh (and driving, remember) when I heard a story about Generation M. The M in this case was for multitasking. The story was about teenagers who do online research for their homework while listening to music on their iPods, surfing around on Facebook, and instant messaging up in the corner of the screen with a couple of friends. I pictured the kids in this story like those computer-game-addicted adolescents I see everywhere these days and thought to myself: "I am not going to let my kids do that." And then I looked down, noticed the steering wheel, the banana, the OJ, the cell phone, the radio, and the patient chart I was about to open on the passenger seat so that I could return a phone call from a referring physician during my drive...oh no, I am ONE OF THEM! My fruit and juice and cell phone are the low-tech, old-fashioned version of Generation M, Generation M for the not-quite-middle-aged.

I have to say that I love multitasking. On the one hand, I resent being so busy that I have to do 4 things at once to have any chance of getting a solid night's sleep. Kind of. The truth is, though, that I love that feeling of productivity, knocking 5 items off my To Do List simultaneously during my commute, getting a day's worth of errands done in one big sweeping geographic circle with no backtracking and no dead time. I might even be addicted to it. I suspect that many physicians share this perverse enjoyment of multitasking, and if it wasn't in their blood when they started med school, it certainly has been beaten into them by the time they finish their internship. Add to that parenting as a physician (or maybe parenting period), and it's easy to see how multitasking gets reinforced in all of us. We multitask, we get rewarded, we multitask more, we get rewarded more.

So, I'm not the only one addicted to multitasking and thinking about it. NPR apparently can't get enough of it, either. They have had 3 stories about it in the month of October. And they are alarming. One segment reported that multitasking on a cell phone while driving reduced reaction time and driver attention to a degree similar to driving while intoxicated. Another talked about the results of functional brain imaging showing that we really don't multitask even if we think we do. We just switch quickly from one task or thought to another and back. But, in so doing, we really cause a kind of "brown out" in our brains. The electricity doesn't go out entirely, but it dims noticeably, enough to be an irritation to those in the environment. In one experiment, a highly accomplished professional musician was noted to make several mistakes while playing familiar pieces of music if asked to perform simple mathematical calculations in his head simultaneously. There were several other experiments, all with similar results.

Once I began paying attention, I realized that it was true; I really wasn't keeping all the balls in the air, as I thought. I was remembering to gather up the overdue library books and a shirt to return to the mall as I dashed out the door to my physical therapy appointment, which is on the same road as the library and the mall, but I was leaving the house without my car keys, then my wallet, then the library books, then the receipt, rushing back to the front door over and over. I was dealing breakfast dishes onto the table like cards in Vegas and unloading the dishwasher and throwing the laundry into the dryer and packing up my breast pump and absentmindedly putting a halt to the sibling bickering at the table, but I wasn't really listening to the kids or even noticing anything around me. I was missing a golden 10 minutes of making a real connection with my kids in the morning, hearing them say something goofy or precocious that would bring me joy repeatedly over the course of a long workday, or (God forbid!) eating breakfast while not in a vehicle. I had come up with creative questions for patients whose answers would provide multiple essential bits of history and also serve as ice-breakers or social chit-chat, but I wasn't really engaged in the process. I was missing the body language and the pauses. I was always one step ahead, trying to pick up a few minutes here or there because I was so overcommitted. I was being a mechanic, diagnosing and fixing a problem, instead of a doctor.

So, what's the message here, and where is Abe Lincoln going to come into the picture since this post is nearing its end? I haven't stopped multitasking. Sometimes I have to do it. Sometimes we all do. But I have stopped multitasking without thinking about it, and I've realized that we really don't have to do it all of the time to get by. In order to stop multitasking 24/7, I have also had to stop saying yes to everything and everyone, including myself. I just acknowledged that I couldn't do it all anymore--it's too much with 3 kids and 2 physicians in our family of 5--took a deep breath and felt relieved. And so, as Abe said: You can please all of the people some of the time, and you can please some of the people all of the time, but you can't please all of the people all of the time. Amen!

MiM Mailbag

Occasionally, we receive emails from readers looking for advice. With our readers' permission, we thought we'd share some of these here with the larger community for your collective wisdom and thoughts.


Hi ladies!

I'm a fourth year medical student and planning on going into Family Medicine. Thankfully, I think that this is a pretty family-friendly specialty, but right now I'm trying to figure out how children might be worked in for me over the next few years. This past June, I had a miscarriage at 9 wks (had that baby not miscarried, I would be around 6.5 months right now, and would have been due in Jan.) I thought that this would be the perfect set-up, go into residency with a 6 month old. Obviously, (wo)men make plans and the gods laugh. But now, I am having this feeling of being dead-set on getting pregnant, and not having anything man-made (ie residency) interfere with my husband and I being able to have a child (hopefully) within the next year. That means that I would possibly be having a baby during intern year. So mostly, I have a few questions:

Am I crazy in thinking that intern year and newborn are doable?

Should I just take a year off if I get pregnant within the next few months?

I'm getting ready to start interviews, like, soon....should I bring up these issues at the interviews?

Any advice is appreciated, honestly.


Thanks,
A medical student

Future babies

I know a lot of the women contributing to this blog have concluded their babymaking years, but I still am hoping for one more. Just one. Sometime in the not so near future. But not so far either, since my aching back has just reminded me that I'm getting on in years.

Considering I've still yet to finish residency and then will possibly do a fellowship and likely my first real job will not be a permanent one, I worry a lot about having to make a job switch while pregnant. Is there anything more unpleasant than having to tell your new employer that you're X weeks pregnant and will be taking Y weeks of maternity leave in the near future? Surprise! Bet you didn't notice that during the interview, did you? Of course not, or else you never would have hired me!

(A sad truth: my pregnant friends had to dress very creatively during their residency interviews.)

I already had the pleasure of being three months pregnant going into residency, so I'm not looking forward to explaining another baby bulge to a new employer someday. I'm hoping I have the luxury of being at a job for at least a year before the stork pays my uterus another visit (that's how it happens, right??). Long enough for people to maybe get to like me before they grow to resent me.

Or maybe I'll find a job where the people I work with will actually be happy for me and not just congratulating me through gritted teeth. A magical job in Happyland in a gumdrop hospital on Lollipop Lane.

Of course, with the economy being the way it is, maybe I'll luck out and be unemployed for the next 5-6 years.

Notes from the Parents' Axuiliary

I am a psychiatrist married to an academic. In our family, “Take Your Daughter to Work Day” ranked somewhere between Groundhog Day and National Oatmeal week as a celebration. It was nearly impossible to bring our three daughters into our worlds when they were young. Instead, we tried to enter theirs. Their dad coached them, we devoted Saturdays to swim meets. We never missed a concert or a play, even when a daughter had a non-speaking part as an inanimate object, or had only built the set. I, for my sins, had three painful years as a Girl Scout leader (anything, anything to avoid being the Cookie Mom). I learned to make wax dolls for dioramas, where to buy poster board at midnight, and which thrift store racks have the best fairy princess costumes (sleepwear, hands down). Still, the girls grew away from us, with their own friends, their own media, their own intellectual and academic accomplishments. Their growth left a hole in my world, and I missed my dwindling role in theirs (except for the Girl Scout leader part).
Now the dynamics have changed. Yesterday for me was “Take Your Mother to Work Day.” I volunteered in the campaign office where my daughter is an organizer. She put me through the training program with focus and poise. When I brought back my tallies, she patiently corrected my work, with generous dollops of humor and tact. To my surprise, I found that I am a Jill-come-lately to the mothers’ auxiliary of this campaign. Many other volunteers had brought parents to work with them. It wasn’t cute, like having kids in your cubicle, but it was a statement of loyalty and closeness that warmed my heart.
I guess I should not be surprised to follow rather than lead. My husband dragged me from the world of WhiteOut and erasable bond into the computer age, but it was the children who introduced me to Hogwarts, the internet (from which they still must still untangle me from time to time), and, eventually, to the worlds of opera, competitive ballroom dancing, and now voter organization. Lately, I have even tried to develop some enthusiasm for math and computer science. My daughter has been kind about it.
At one time, my sphere as a parent seemed narrow—medicine was my window into the world outside. A doctor’s experience is both wider and more circumscribed than many. We are involved with people that most others in our social class never see. They are always on our turf, however, and we too often meet them with their clothes off and with the richness of their experience cloaked in a veil of illness.
As the girls grow past college, the time they seemed farthest away, I am entering a wonderful phase of parenthood. My adult children bring back the broad horizons I once had, offering me opportunities to visit and live in worlds beyond my office and the hospital. To see them working, to engage in conversations in which they are the experts, and I the novice—these things bring intense satisfaction that mothers of young children can only dream about. Dream on, sisters, the day will come.
And did I mention that my daughter does a great job at her job?

Helloween

Husband is leaving tomorrow for his annual boy’s weekend at the beach - Helloween. For the next five days (I thought weekends were two days long?) he’ll let his hair down – what’s left of it – with a group of longtime friends at a house with no heat or A/C. He says it’s perfect for this group of guys. For the past six weeks, this weekend has been his constant topic of conversation. It’s his de-stressor – time to drink cheap beer, play football, inflict bodily harm by paintball, not shave, commune with his fellow man and blow off steam. In more recent outings, they’ve become sort of domestic and actually cook – deep-fried turkey and chili. Our household is not lacking testosterone – I have two sons, a male golden retriever, male cockatiel, and three male African frogs – but the adult male camaraderie and freedom from family responsibilities provides him with a vitamin-like boost.

Once upon a time I dreaded his weekend plus away. My children were young, and with one less parent to supervise them on the weekend, mayhem would always ensue. Single parenting brings out my latent attention deficit disorder as two children, pets, and household compete for my undivided focus. One year my youngest decided to take a bath in my stand-up shower by blocking the drain. He sat happily in the bottom playing with boats and legos in one inch of water. I ran downstairs to grab his towel out of the dryer and noticed that the ceiling fan in the family room had suddenly become an upside down sprinkler – spraying water over the entire room as it trickled down the arm of the fan. I dove for the switch so as not to electrocute us all, and ran upstairs to investigate. The shower was overflowing – tsunami style – onto the floor above the family room as youngest continued to splash and enjoy himself.

Somehow, events that happen while husband is away never happen while he is home. In late July, husband went to visit his best friend in Indiana. During his four day leave of absence, the golden retriever (child #3) decided to do laps in the new pool in the backyard. The fur from the hairy beast clogged the filter as I tried to vacuum the bumper crop of hickory nuts squirrels were lobbing into the water. Upon his return, Husband’s pool expertise solved the mystery of why it took three hours of minimal suction to clean the nuts off the bottom of the pool.

Water seems to be a constant theme to husband’s weekends away – whether it is both children having an unintended water gun fight in 50 degree weather or leaking roof from torrential rains. Experience has improved my outlook on Helloween. I know that Husband will return recharged (hung-over). Most small crises are survivable, and the boys and I can do things that we wouldn’t ordinarily do with dad home – like have a sleepover on the sleeper sofa in front of the fire place. The boys get undiluted mom time, and I look forward to the adventures we have together.

I also look forward to my own me-time. That’s the deal. Husband gets his weekend and I get mine. So in a couple of weeks I’m taking off for a writing conference in Massachusetts –deep immersion into words, character, plot, and all things bookish. In the past, I’ve done beach weekends with the girls, a polymer clay retreat with my mom, bead shows and a solo writing conference to see favorite author, Sue Monk Kidd. These weekends are sanity-savers, a time to pursue who I am besides mom, spouse and physician (not necessarily in that order), so I understand Husband’s enthusiasm for his Helloween crew. So while my crock-pot is my domestic secret weapon, personal retreats – solo or with friends are my trick and treat for self preservation.

My kids hate me (and I'm sure it's because I work)

pI'm convinced that there are parents out there whose kids do not talk to them the way my kids talk to me. My son has, of late, been lashing out (usually when he gets in trouble for something), and he will tell me that I am "mean" and he "hates me." It does wear you down after you hear that too much.

Last week was bad. My head was spinning after trying to compensate for short staffing at work. Then not only my son, but my 3-year-old daughter starts in on me. She throws a fit, gets in trouble, and has to go to her room without stories that night. I go in to talk to her. Through her tears, she tells me point blank that she 1) doesn't love me and 2) wishes I would die (!). I told her "you don't mean that." Of course, she says "yes I do!!"

I told her I wasn't going to let her be mean to me, and I retired to my bedroom, where I promptly burst into tears. I told my husband "ss-ss-ssophie s-s-said she...she wanted me to DIE..." Friday night is not a good night for anything emotionally taxing to happen to me.

As I said, I know there must be kids who don't say these kind of things to their parents. Which makes me think, "what am I doing wrong?" Bingo-I am a full-time career woman! Of course my kids hate me, how could they not? Maybe I shouldn't work, then my kids would be awesome to me and really appreciate me all the time.

As soon as that thought crossed my mind, I realized how ludicrous it sounded. My kids will hate me (at times) no matter what. I'm not naive enough to think that spending more time with them will make them hate me any less; I may just be around for them to express that to me more often! Pathology may be a thankless job at times, but being a mom is in a thankless league of its own!!

I told a friend Saturday that what surprised me most about being a mom was not the work involved, but how ugly the ugly times could get. And I had to screw up my courage to write this post, because it is really hard to admit how awful your own kids can be sometimes. Those of you who read this will belong to one of two camps: those who have, either by virtue of their much younger or infinitely better behaved children, are aghast at the events above; or those who read this, laugh, and say "oh yeah, sister, been there! In fact, that's the tip of the darn iceberg!!"

Weaning guilt

My 9 month old is on a nursing strike. He refuses to nurse even before bed these days, unhappily wriggling out of my arms, trying to use those floppy abdominal muscles to snap into an upright position like a fish flopping on the boat's deck.

It is killing me. Nightly.

What kills me more is what happens when I dutifully trudge back downstairs to the kitchen to fix him a bottle of expressed milk and give him the bottle.

Party time.

He grabs the bottle with both hands, shoves it in his mouth, and proceeds to twist and fondle the bottle like he has just been reunited with his best friend. He slaps it with one hand. Giddily moves it from side to side. He drains it, then.

I should be happy, right? He is providing a prime opportunity for me to finally wean him, just as I planned months ago. Six months was my goal. Nine months was my reach. I'm under doctor's orders to stop at 9 months (osteopenia, long story). He is a champ at eating solids and is very close to walking. But, even though the time appears to have come, I still don't feel ready.

Last night, I searched "nursing strikes" to reassure myself that this new rejection was due to him actively teething (hello bite bruises up and down my arms) and yes, the articles reassured me that nursing strikes happen for all kinds of reasons. (My bruises suggest teething, or perhaps my involuntary screaming when he bit me last week was poorly received.) They also emphasized the transient nature of these strikes and to push through.

In my internet searching, I also came across many sites that basically pounded The Guilt into me for even contemplating weaning before 12 months. About how no child would self-wean before 12 months, possibly not before 18 months. They talked about earlier weaning would only be for Mom's benefit (read: you are a selfish hog) and could result in less secure children. They said that mothers often misinterpret a nursing strike or normal developmental changes in the child to mean that they are becoming disinterested in nursing (read: you are ignorant and should not be allowed to procreate).

Poison in my eyes!

I thought of my 3-year old who I started weaning at 9 months during a very similar nursing strike. I remember feeling similarly sad and rejected, solemnly repeating the words, "It's the end of an era," to my husband and anyone else who would listen. Was I wrong then too?

Here, I was, thinking that I was almost deserving of a medal for working full-time, pumping 3 times a day to keep up, and downing Mother's Milk Tea every single day (I'm not a tea person, and definitely not a nasty tea person) to feed my son exclusively with breastmilk for 9 months. And then I read this article which makes extended nursing sound so beautiful and bonding that I'm left feeling inadequate.

I think it might be time. But, no one makes this easy.

First day of school

Tomorrow is my 2 year-old's first day of school. We're all excited, fortunately this includes her. As I was watching her today, she looked so little to be going to school. I wondered if I will look back on this phase of life and feel content that we started her in school so young (which is largely because of my interest in working) or if I will regret this decision and wish to have spent more time with her while she was young. Hindsight is 20/20 and I have terrible foresight so I really struggle with this.

My father-in-law once told me (regarding parenting) to remember that we know better than them. (he said this as I was struggling to force antibiotics down)...but I often recall this phrase. I know that my 2yr old will enjoy and benefit from the socialization and learning she will get at school. And most days I'm sure that even if I was home I would want her to go to school for her sake...but then I'm not entirely sure I'm being objective.

I guess for now, I'll enjoy the moment, her excitement to go to school and hope that when I pick her up tomorrow she has a smile on her face because it will surely make it harder if she's not happy.

First degree burns

I've probably burned myself while cooking more in the last year than I have in my entire life.

And they're all kind of stupid burns. Like when I explain what happened, I'm actually embarrassed. Not that there's any smart way to burn yourself. But some stories are dumber than others, like when I burned myself while trying to move a boiling pot with my bare hand. SMRT.

(My father actually has the stupidest burn story I've ever heard from a real person: he burned his chest while trying to iron the shirt that he was wearing. He's a doctor too.)

I've theorized that the reason I keep burning myself is that I'm cooking under very pressured conditions. Admittedly, I don't have some British guy yelling curses at me, but I've got a two year old who alternates between standing at the gate to the kitchen and screaming or toddling over to my bookcase and throwing books all over the floor. So I'm feeling a bit rushed to finish up dinner before our house is ripped to shreds.

Plus I'm just a wee bit tired from working all day so I'm not at peak performance.

Just because I'm a doctor, my husband thinks I know the best way to treat a burn. I don't. Last time, I tried everything that The Great Internet had to offer before the pain eventually faded away on its own. I seriously had toothpaste smeared on my hand at one point.

I get very frustrated by these burns because they keep me from doing what I need to do. I can't take care of the baby (change her diaper, give her a bath), I can't concentrate on studying, I can't wash the dishes or clean up. I can't be Supermomdoc anymore. I usually end up in tears over these burns, even the really tiny ones. It makes me realize how little breathing room I have in my life. Sometimes I worry I'm just two or three burns away from the edge.

My Grass Has Always Been Green

How do you keep going with a juggling act after losing one hand? I am a doctor married to a doctor. I am fortunate to possess the holy grail of mothers in medicine: a part-time job that is (mostly) really part-time. Somehow though, much like getting a raise and then finding yourself saving no more money than you used to a few months down the road, I have the same issue with time. The extra TWO FULL WEEKDAYS OFF per week I reveled in two years ago have somehow become the new norm, and we are again wishing for more hours in the day, more days in the week. Somehow my daydream that the busy work of our three small kids--the doctor’s appointments, grocery shopping, haircuts, laundry, trips to return library books, etc--would be accomplished in those two days with hours of quality time to spare, leaving evenings and weekends for nonstop family fun, was popped in a matter of months. We are in no better shape than we were before. We feel like we are just barely keeping our heads above water again.

So, picture the scene. It’s Wednesday, my late day in clinic. I get home at 7:15pm. Bedtime is officially at 7:30pm. The kitchen looks like a still shot from Storm Stories. No one is in the tub yet. A quick survey of the kids’ bedrooms alone foretells at least an hour of “pre-cleaning” for our once-a-week housekeeper visit. I breastfeed “Fig,” our 7 month old, on my lap while attempting to eat a petrified bagel that I actually toasted YESTERDAY morning and never managed to get out of the toaster because at least, it’s ready to eat, lunging simultaneously for 4 year old “Munch” who is begging to be tickled over and over in the next seat, all while nodding and listening to precocious not-yet-3 “Iggy” describing random events of her day in what has to be the world’s longest run-on sentence ever, except this one. Everyone eventually gets washed, combed, toothbrushed, pajamed, read to, and tucked in. The house is returned to some semblance of order. Finally, after 2 ½ hours of the parental version of running uphill on a treadmill backwards, it’s 9:45pm and we collapse in bed to say hello to each other for the first time. Then my hubby drops the bomb. “The Comfort is leaving on Sunday.” The Comfort is the Navy’s hospital ship. I am too tired to wonder why this would be the first thing out of his mouth when we haven’t seen each other all day. “Oh really?” I say. “This Sunday,” he adds hesitantly. “Wow, where are they going?” “Georgia…ex-Soviet Georgia.” “That’s really short notice,” I note with vague disinterest. At this point, he obviously can’t take my dementia of exhaustion another minute and says, “I’m on it.” “WHAT?!?!?!”

And, in that moment, the juggler lost her left hand in mid-act. Suddenly I had 72 hours to figure out how to swing being both the “drop-off” and the “pick-up” parent, who was going to get my son to his weekly PT appointments which were right in the middle of my late afternoon clinic, how I could even register our kids for the preschool they have been so excited to restart which required being in line outside the school by 5:30 am the day after he was leaving, what I would do if we had a childcare crisis since I had just used up every iota of my vacation and sick leave and then some from taking 4 months of maternity leave, and on and on. My mind raced. The list grew. The punctuation vanished.

Ok, I told myself, you can do this. You have done this before. He had been deployed for 19 weeks while I was pregnant with our third child, just gotten back only 10 months prior in fact. We already knew he would be deployed again in April 2009. But for those, we had time to prepare ourselves and the kids, time to make arrangements, time to exhale and come to terms with it. This time, it came out of nowhere. Well, it wasn’t entirely out of nowhere. There was a moment, I think, during my commute two days prior when I heard on NPR that Russia had just bombed Georgia, a fleeting moment when I thought to myself: “Uh-oh”. But I put it out of my head, reasoning that we couldn’t be in Iraq AND Afghanistan AND Georgia. Our military was stretched too thin as it was. And there was an election in a matter of months. No, nothing to worry about.

The next week after that Wednesday night bombshell went by in a blur as I attempted to cancel and reschedule our lives, make contingency plans, prepare the kids emotionally when I wasn’t even prepared myself. The miraculous news that the entire US deployment to Georgia would be canceled came several days later, not from the US Navy, but rather from a Baltimore Sun reporter and new personal hero named David Wood. That is a saga in and of itself for those who are interested: http://weblogs.baltimoresun.com/news/militarywatch/2008/08/post_45.html. But this is one long preamble for the real topic of this blog.

The next woman I saw in clinic was a new patient, 34 years old, a mother of 4 kids ranging in age from 1-7, widely metastatic breast cancer, a recent move from out of state for her husband’s high-travel job, no immediate family on either side, and no friends to speak of yet for 800 miles in any direction. She reported in a perfectly matter-of-fact way when I asked about her meds that she takes an extra dose or two of Oxycodone to control her bony pain enough to be able to make the kids dinner and do their baths. I was paralyzed by awe, by shame, and by the perfect storm of awe and shame: humility. As I sat wringing my hands over my husband’s unexpected, uncertain, and slightly risky deployment of probably a few months—maybe six at most—here sat this woman in constant pain, facing her own certain mortality, juggling despite having lost both arms, knowing that if she even blinked or faltered ever so briefly, it was over. Permanently. And her husband. What would he do? When she was gone, he would be on his own until the last baby was grown. And he worked full-time. Traveled several days a week. Seventeen years. It was an eternity. It was incomprehensible to me. How would he ever manage? How did he even lift his head off the pillow every morning? Here sat this young couple in front of me, and I was supposed to be the wise one? The doctor? And, in that moment, I became a medical student again. Suddenly I was the same young woman who years ago stared wide-eyed as patients gave their spouses a last kiss before being wheeled in for their liver transplants, wondering if they would make it, wondering how they managed to smile, wondering how they could be so strong, wondering whether I could ever be so strong, hearing that disquieting voice that told me I knew the answer and it was no.

It’s been over 6 weeks since this all happened, but I am think I am permanently that medical student again, if a bit more wrinkled these days. I realize now that every patient I see is living some variation of this story. She is trying to get her chemo and get home after dropping off her son at preschool and before her daughter gets off the bus and hoping her nausea medicines will work well enough that evening for her to cook dinner without the smells making her sick. She is terminally ill and desperately wants more time at home but cannot quit her full-time job because, without it, she will lose her health benefits and therefore, the treatment that may give her another month or two with her children. These people are all juggling more than I could ever comprehend and with so much more at stake.

I finally got it. After so many years focusing on whether the grass was greener on the other side, I finally realized that my grass has always been green. I just never sat still before long enough to notice.

The Mothers in Medicine Challenge: Giving back to public schools

Getting into medical school is competitive. We're hoping that competitive streak in you will help us in our goal to raise money for a great cause: our public schools. Many public schools, particularly those in poorer school districts, can't afford the materials they need.

Have you heard of DonorsChoose.org? It was started by a former teacher as an experiment and now is an alternative funding source for teachers nationwide. Teachers upload projects they want sponsored such as Biology Lab basic equipment for a Mississippi high school where students have never had an exposure to a real laboratory ($818). Donors can contribute as little as $5. DonorsChoose purchases the supplies and ships it to the classrooms, along with a disposible camera. Donors receive thank you notes from the children, as well as photos.

According to Fortune magazine, "Donorschoose.org has raised $24 million to get support to 1.4 million students in 50 states. Nearly 60,000 projects have been funded."

Now, to the competition.

Starting October 1st, bloggers around the country will be competing to see who can generate the most donations to DonorsChoose classroom projects. Last year, blog readers donated $420,000 toward books, art supplies, technology, and other resources, reaching 75,000 students in low-income communities.

Mothers in Medicine in joining in and we're hoping that we can show the internet who wears the pants. Please visit our giving page and see what projects we've selected to raise funds for. You can also get to our giving page via that nifty widget in our sidebar. After donating, you can leave a message for the students you are helping. Since the giving account is under Mothers in Medicine, leave your name, if you wish, in your message and where you are from.

Give if you can!

KIT (Keep In Touch)

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

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

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

Doctor, you are hot!

I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:

Zardari then called her "gorgeous" and said: "Now I know why the whole of America is crazy about you."

"You are so nice," Palin said, smiling. "Thank you."

And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."

I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.

I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?

I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.

But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.

The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?

What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?

To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.

But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.

I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.

Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.

None of this is to say that I am as gorgeous as Sarah Palin.

Patient was a furry, red-haired monster in moderate distress

I was watching Sesame Street with Melly this morning. Elmo was sitting on the curb, clutching his left foot and crying out in pain.

Gordon: "Elmo, what's wrong?"

Elmo: "My feet hurt!"

Gordon uncrosses Elmo's legs as he again cries out in pain.

Me: [thinking] "Oh my god, is it an ATFL sprain? Is it plantar fasciitis?"

Gordon: "Elmo, I think I see what the problem is."

Me: [thinking] "Tibialis posterior tendonitis? Achilles rupture? Talar dome fracture??"

Gordon: "You put your shoes on the wrong feet!"

Wasn't even in my differential.