A day at the refugee clinic

I get up at 6:40, always reluctantly. I shuffle downstairs to eat a bowl of granola with yogurt while checking email. Ten minutes later Ariana shouts from her bed, "I want to wake up now! Time to wake up!" and forty-five minutes of prodding three kids through the morning routine begins. If they are dressed and seated at the table by 7:30, I make them tea in a white elephant teapot.

We wind our way out of Deep Cove, dark waters to our left and hulking mountains to our right, with CBC Radio 2 playing. I adore Tom Allen's voice and think how my patients would benefit if I could speak in such kind, good-humoured tones. Forty-five minutes later and I've dropped two kids off at school, the youngest at preschool, and parked the van in a neighbourhood five blocks from the clinic.

As I walk to work, I often dread a day of seeing patients. I wish desperately that I were a pathologist working at VGH, looking up from my microscope periodically to gaze out over a view of False Creek. I feel immense pressure to be fully present for each of my patients and in the moments leading up to the start of my day it sometimes feels unbearable.

I am one of five part-time family physicians at the refugee clinic. I typically have five 30-minute appointments booked for the morning.

9:00 My first patient is a 27-year-old Ethiopian woman with a new diagnosis of HIV. I break the news through the interpreter, who is clearly shaken. The patient is distraught. I explain that HIV care and prognosis is different in Canada than it was in her village. Grim though this task is, the face-to-face, front line provision of care to this crying woman seated before me strikes me as an incredible privilege on my part, and any longing for the detachment of a pathology lab slips away.

9:30 The next patient is an elderly Afghani widow with hypertension and depression, well-known to me. At the end of the visit she tells me that when her son was severely wounded in Afghanistan years ago he became a pastry chef. She produces two Ziploc bags of cardamom-flavoured pastries, one for me, the other for the interpreter.

10:00 A 42-year-old Burmese woman comes in for her first well-woman check. I do a pap smear, bimanual exam and breast exam. She had never heard of these exams before I introduced the concept at her last visit. The idea of screening for disease, rather than treating it as it presents, is a novelty to her.

10:30 An elderly Bhutanese man, illiterate in his own language, presents with symptoms of prostatic enlargement. I pull up a diagram of the prostate on Google images and he stares at it. I am not sure how effective my teaching is.

11:00 A Congolese woman comes in for follow-up of her PTSD. She also needs documentation of her torture scars for a medicolegal report. She weeps as she describes how each wound was inflicted. I make detailed notes and feel ashamed of the human race.

The morning is not quite that orderly. One patient brings her two children, and because they've spent ninety minutes getting here on public transit, I feel compelled to fit them in. Two patients are late. The other physician and the psychologist tussle with me over the Farsi interpreter. An infectious disease physician calls to discuss my patient with echinococcosis. The nurse taps on the door to ask for a signature on a parasite medication prescription.

I leave for a quick lunch with my colleague at the Indian place a block away. We head out the back way, bypassing the waiting room that's already filling with the afternoon patients. The clinic is so busy that taking time to eat or pee induces feelings of guilt.

I see prenatal patients on Tuesday afternoons. I have a medical student today. I let her palpate fetal parts and find the heartbeat with the doptone. She is thrilled; I can tell she's going to tell her classmates all about it tomorrow and I feel nostalgic for those fresh and glowing medical student days.

I'm ravenous with hunger by the end of the afternoon, and briefly consider the Fibre One cereal samples, Tums smoothies and chocolate Caltrate Soft Chews in the cupboards. I resist and head out into the December cold to pick up Ariana.

Forty minutes later we pull into our driveway. The cedars are stirring from the wind blowing up Indian Arm and the docks across the water are decorated with Christmas lights. Deep Cove is serene and worth the commute.

I open the front door and the entrance way is strewn with backpacks and toques. We head up to the kitchen where Pete - who cooks every night - has prepared a meal of grilled salmon, asparagus and French bread. Everyone tells anecdotes from their days, including me, but the story I attempt to tell Pete is interrupted so many times that it fizzles out and doesn't seem worth finishing.

I put the kids to bed at 7:00. I crawl under the covers with my five-year-old for a few moments and he suggests, "Hey! How about you move out of Daddy's room and move in here with me?"

I answer any urgent emails and then watch a movie, too often something like Blood Diamond or The Killing Fields or Lost Boys of Sudan, one that turns out to be overwhelming after a day at the clinic. If we've thought to chlorinate the hot tub, Pete and I will spend ten minutes before bed with piping hot water up to our necks, gazing out at the towering spruce trees across the way and the moon on the water.

And then bed, the sweet, delicious coolness of sheets and pillow, and I am asleep in minutes.

Day in the Life of a Middle Aged Full Time Student/Mom/Wife/Friend etc .etc. etc.

I'm Peggikaye 

I'm a 45 year old wife and mother who, after 20 years of being home decided to go back to school. Majoring in psychology with the goal of becoming a clinical psychologist to work with families of children with disabilities (and provide a service that was lacking when I was going through the diagnostic and adjustment period as a mother of a kiddo with disabilities). When I went to school 22 years ago, I'd gained all of 24 credits before I became too ill with Myasthenia Gravis and Lupus to continue. I'm not in remission, but I don't feel any worse at home than I do going to school so ... WHY NOT?

As a wife, mother, full time student (during finals time no less) I sometimes get a bit shocked when normal problems crop up. (like pharmacy misplacing my medication)

My favorite statement when someone is causing me difficulty is "Stop messing with my midlife crisis!"

I've been a reader and occassional commenter on this blog since it's inception. I comment under Dreaming Again.

6:00 AM … wake up even though alarm isn’t set until 9 am. 

Know that if I get up, son #2 (17 years, 11 months and 2 weeks old) will ask for a ride to the bus stop a whole 3 blocks away.  After all, it’s colder than the arctic out there!! It’s all the way down to 27º (he’s really going to not like me when it’s in the single digits, which it will get to)

So, lay in bed, reminding myself that I didn’t go to sleep till 3 AM so it’s just as well. REST PK REST!!

7:10 AM

Hear front door shut and get up to work on speech that did not get quite finished at 3 AM when my body gave up.

7:12 AM Start the coffee (most important job of the day!)

7:15 AM Find all the information that I left on the computer desk at 3 AM that has been moved. Evidently someone got on the computer before school this morning. (it’s ok, he’s allowed. Just wish he’d leave my stuff be!)

7:20 AM Sit down with coffee (yum!) and start to figure out where I left off with the speech.  (and randomly go to Facebook for a distraction)

9:00 AM FINISH speech!! Realize morning is getting away from me and jump into shower.

9:18 AM Grab second cup of coffee

9:22 AM Finally get around to taking my turns on my word games (Lexulous and Wordscrapper, my life would be so tense without you!)

9:27 AM Start to get ready for school : Breakfast, make up, hair, dress. (While doing hair realize that I miss my long hair …wash and go!)

9:55 AM  Realize I’ve got an errand to run (Pharmacy) before school and I need to be at school early to print off report for Personality Theories (10 page paper, developing my own personality theory …while using the text book theories to support my theory. I am still unsure how this isn’t just a review of material as well as still protesting the assignment in general. This is graduate level assignment ...not undergrad and certainly not freshman/sophomore level!)

10:00 AM Leave for school/pharmacy.  Argue with pharmacist about the medication they say they have no record of ever having.

10:10 AM run back home, grab Mestinon Rx bottle and go back to Pharmacy to *SHOW* them that I get Mestinon there every single solitary month, without fail … They tell me it needs a refill authorization.(the bottle clearly states 3 refills) They tell me they can’t help it and it could be Monday before they get it back. I ask to speak to the main pharmacist. I ask him if he knows what Mestinon is and what it’s for. He says yes, I tell him that I have 2 days of medication left and there is no way to wait 5 days. He agrees and finds my refill in the computer. (Amazing!)

10:20 AM Finally get onto school, now running later than planned. Stop at Quiktrip to grab an extra caffeinated Mighty Mocha Cappuccino that I wasn’t going to get but after Pharmacy rigmarole, need it!

10:30 AM Arrive at school and calculate if I have enough time to print off all I need to print off. Decide to try it walk as fast as possible to get to library and pray there is a computer!

11:00 AM get to Speech class, unsure if I have to present my speech on talking about critical care medical choices before the time comes to need them. 

Sit through speech class impressed with my young classmates at the seriousness of their choices as well as the quality of their research. Listen to final speech and about get knocked out of my seat with the offensive nature of her conclusion.

12:20 PM Head over to Personality Theories, more nervous about turning in this 10 page paper than any speech I’ve ever had to give.

1:50 PM Review over, paper handed in, it’s all over but the crying.  (Something is wrong when a science phobic, stage frightened Psychology Major enjoys biology for non majors and speech class above and beyond their psych class!)

2:00 PM Walk into 17 year olds school to check him out early to go to a doctor appt to get toenail removed.

2:45 PM Arrive at doctor’s office and check in. Check in sheet says we’re there to get results of flu test. Um, no, we’re really not. We got those the day we got the test. We’re here to get is very infected toe fixed. (again, this will be the 3^rd time to remove his toenail!)

3:10 PM get called back, they weigh and measure my son who was 6’ tall just 6 weeks ago …he’s now 6’1.5’’

3:30 PM Here a male voice outside the room sounding like he’s in a panic. “I can’t do that! I’ve never done it!!”  While I try to keep my OCD teenager in the exam room till we find out what is going on.

4:00 PM Office manager comes in to explain that we, #1 needed an appt with a doctor, not a medical student (yes, I asked for one …) and #2 it’s a procedure and we had to have and we have to have an appt for the procedure room. (Which had it been booked, the computer would not have allowed her to assign a medical student nor resident to his case) (yes, I know, I specifically asked for a procedure appt, we’ve been through this before) They leave, come back and apologize, give him antibiotic to help infection and reschedule for Tuesday. In the middle of my class … where I must give my speech. Husband gets the honor!

5:00 PM Finally make it home. Work on homework and play on Facebook until time to figure out dinner. Realize we don’t have anything and a grocery store run is in order.

6:45 PM come home with readymade chicken from the grocery store.

8:00 PM Sit back down to computer to work with philosophy portfolio. Wonder if I’m really ever going to finish this. I’m 12 chapters worth of reviews behind and it’s due next week.

8:30 PM Decide to email speech professor about the offensive speech. There is nothing she can do now, it’s already done, but maybe she can keep it from happening in future semesters.

3:00 AM stand up from computer to stretch and look at the clock. Realize it’s 4 hours after I’d planned on going to bed. Shut down computer and get ready to start the whole thing over again around 7 am.

The Family:

Don 54 (hubby and sometimes child)
Samuel 20 (going on 21 going on 12 going on 40)
Benjamin 17 years, 11 months and 2 weeks (I refuse to put 18 and the fact that both my children are leagal adults one moment before I have to!)
Myself ... Peggikaye ...45 years old

One day in my clinician-educator internist's life, last week

2:15 am Daughter appears in bedroom doorway. Blanket has fallen off bed. Why she is unable to replace is a mystery, otherwise very capable 4 1/2 year-old.
2:15:30 am Back to my room, door slightly ajar. I fear the worst. The cat has infiltrated the sacred sleeping space. Allergic to cat.
2:15:35 am Back into bed.
2:17 am Cat jumps on bed. Turn on the light and spend next 5 minutes looking for him. (Husband away on business - am alone dealing with cat highjinx.)
2:45 am Never found cat. Can't sleep. Thinking about 1,000 things. Eventually fall asleep.
6:19:30 am Wake preemptively to 6:20 am alarm, then set it for 6:40 am. So tired.
6:40 am Awaken to alarm.  Let cat out of room - he is peeved to have been trapped inside all night. The nerve!
6:55 am Daughter enters my bathroom as I'm getting ready - she hangs out a bit then watches some Super Why while I finish getting dressed.
7:10 am Son awake and summoning me with a pressing "MAMA! MAMA!"
7:20 am All are dressed for school, head downstairs for breakfast.
8:00 am I'm out the door after goodbye kisses. Nanny will take kids to preschool.
8:50 am Walk into office, answer emails etc
9:10 am Arrive at Team room - first day back as ward attending. Start rounds, we are on-call. Take advantage of teachable moments. Only gentle, encouraging pimping.
10:30 am Done with rounding, resident and I meet with interdiscplinary team for discharge planning. I love my social worker and case manager.They are the greatest.
10:45 am Back in office. Starving -skipped breakfast - eat grapes, saltines. Wonder how early I can eat my lunch. More emails. Do some writing for a manuscript. Multiple, multiple emails with various collaborators on different research projects.
11:45 am Start calling ward teams to find good patients with physical exam findings for physical examination round teaching session for third-year students at 2pm.
11:55 am Eat lunch (leftovers) in between calls to teams to find patients, writing, email, and 28,471 other things.
2:00 pm Meet students, show them picture of Osler and have them guess who it is. Need hints. Introduce him as the Father of Modern Medicine and read an inspiring quote about the art of observation as segue to physical exam rounds.
Divvy up students into 3 groups to go with 3 faculty mentors - I have one group.
2:15 pm See first patient together. Student notices his great example of clubbing. Discuss causes, pathophysiology, correlate to current patient.
2:35 pm See second patient with interesting heart exam. No one else can hear his murmur. Have them all listen multiple times in same spot but 2/6 systolic ejection murmur continues to elude. Patient is wonderful with us, wants to help, has fun.
3:02 pm Call in two minutes late to conference call with collaborators (who are also friends) for a research study.
4:45 pm Finally done with very productive call - head to team room to see how call is going.
4:55 pm Leave- with husband out of town, have to pick-up daughter at school.
5:45 pm Pick up daughter
6:10 pm Dinner altogether, made by godsend nanny
6:45 pm Up for daughter's shower, read story to both, changed into pajamas. The two roughhouse a bit until someone ends up crying.
7:10 pm Resident calls with run-down of admissions so far. Son and daughter chant her name over and over, much to her delight.
7:15 pm Son tucked in with bear and lullaby - he is starting to sing along - I've sung this to him since he was a wee bug.
7:20 pm Do daughter's Stars for the day - I'm generous and she gets all 5 today (say please and thank you; try not to whine; share; clear your plates; make bed). Daughter tucked in. Same lullaby by demand.
7:35 pm Curled up on couch under throw blanket, writing for leisure and work. Miss husband.
10:00 pm Call husband. Then stay up working on side project (essay on health policy) --my usual routine when he's away (otherwise asleep by 10:30).
11:20 Done. Sleep. Hope blankets don't fall off beds tonight.

Which Day?

I have no adequate way of selecting one typical day to post about, as part of the joy is the variation inherent in a career of education, research, and clinical care, and two ever changing kids and a supportive husband. If I was a better writer, could be a memoir instead of a post!

Morning:
Awoken by happy child, other child wakes, was happy but she wants more snuggle time, downstairs for breakfast, play some music, make some music, move lunches from refrigerator to car, socks on, brush teeth, pee, finish getting dressed myself, get in car. I take one to school, husband takes other to daycare. Off to fight traffic.

Or, should I describe a typical day where I take the whole morning to go on a class trip with one of my children? Or take them to the dentist? Or pick them up early for a special concert performance?

There’s the occasional day where I have to leave so early to lead a morning meeting that the kids are just waking up as I kiss them goodbye.

And the day that where I use my “administrative” time to be academically productive, surfing PubMed, online journals, checking personal and professional emails, catching up and making plans scholarly and otherwise? Attending noon conference, meeting with trainees.


And when I spend the afternoon at our pediatric health center with (in 5 to 30+ minute intervals):
· a teen who doesn't think she’s pregnant and is;
· a teen who thinks she’s pregnant and isn't;
· a newborn, it’s his first visit but we know the family as the 8 other siblings come to our practice as well;
· a mother who wants H1N1 vaccine for her child, but we’re out of the supply;
· a mother who doesn't want H1N1 vaccine for her child (once we have a good stock in)
· a former resident’s baby for a well check
· quick: what’s that rash
· not so quick: a teen who is about to be kicked out of school, needs residential treatment for his addiction, in my office with his mom, both wanting help
· pre-op physical and can you see the sibling too for her cold
· phone calls and school forms intermixed with above
· and a few others

Rush home. Finish my electronic medical records securely, but from home, after the kids go to sleep. Will this be a good commute day or a bad one? Often depends on the weather.

There’s the periodic 5pm meeting that I phone in to so I can commute home in time to make dinner.

And twice monthly when I am on call, which means I answer my pages by phone in the presence of the kids from 5pm-8pm, so they know as well as I how to respond to a parent of a child with a gastro or the appropriate Tylenol dose for fever.

Evening:
Some arrangement of the village picks up the kids, quick dinner prep, not real cooking but is healthy enough, kindergarten homework, all eat together (wow!), competition for who gets to hold a conversation with whom, try to make tomorrow’s lunches while doing dishes after dinner, reading books, playing music, 30 minutes of video time, get in the bathtub, brush teeth, books books books, pee again, one more book, one child to bed, more books with older child, pee again, finally both are sleeping.

Rest of evening:
Catch up with spouse, more online time, maybe a little bit of TV, crossword, finish something for work, finish electronic medical record notes, read residency program applicant’s interview for the next day, maybe take shower, more spouse fun time, sleep…

The ebb and flow of an academic neurologist

I am an academic neurologist with twin four year old girls. Academic life has teaching, research, and administrative responsibilities that you basically try to squeeze in between seeing patients, so I didn't write about one particular day, just what the daily ebb and flow is like.

6:30am: wake up, get ready for work, make kids’ lunch
7 to 7:30: commute, listen to NPR, try to plan day
7:30 to 9:30: answer emails, try to do some uninterrupted writing, prepare something to teach the residents that day
9:30 to 12 inpatient rounding, teaching
12 to 1pm: grab lunch, or attend noon conference
1 to 6pm: afternoon clinic, if not a clinic day, meet with clinical trial coordinator, interview applicants, go to committee meeting (quality assurance for the department), do paperwork for clinical trial—data safety reports, case report forms, adverse events, etc., prepare grand rounds or other talks, submit abstracts, apply for grants, call patients that need follow-up, write prescriptions, go back to the hospital to see new consults or follow-up on EEG or MRI results that have been done during the day, meet with resident advisee
6 to 6:45pm: commute, try to clear mind of work, sing in the car
6:45 to 7:30pm: see kids for the first time in the day, play with them while husband makes dinner (or vice versa), eat dinner
7:30 to 8:30pm: play with kids—board games, 10min of piano practicing each, games on nickjr.com, or watch Dora
8:30: husband does bath with kids, while I start the clean up from dinner
8:45 to 9:30: help kids get dressed, floss, brush teeth, read several stories, sing several songs, then lights out
9:30 to 11pm: I do one or more of the following in order of frequency:

Chores: clear dishes, sweep under table, plan future meals and shopping list, consolidate trash, separate recycling, laundry, clean toilet, general pick-up of clutter
Relax: fold laundry while watching TV, read in bed
Spend time with husband
Work out for 30 minutes on the Wii Fit
Go to bed early
Do work: edit paper, prepare talk
Socialize on phone with mom, sister, friends
Try to avoid eating anything
Try to avoid facebook

Note: When I am on service, which is six months of the year, I am also on 24 hour pager call, usually getting 2 to 3 after-hours pages per night. I rarely have to go in.

Typically go to bed at 11pm


Husband and kids’ schedule
7:30am—wake up, play with each other in bedroom
7:50am—Dad wakes up, tells kids to get dressed while he shaves and gets dressed
8:10am—Dad goes into kids’ room to find them in various states of undress and helps them finish getting dressed
8:20am—Go downstairs, get cup of milk to drink from the refrigerator (already prepared by mom), get socks and shoes on, get jacket, lunch bags, make toast and bring toast to car
8:35am—leave for preschool, eat in the car
8:45am to 5:30pm: spend day at preschool while Dad works from home as a software engineer
5:30pm—Dad picks up kids from school, they put away jackets, shoes, get a small snack and play until mom comes home


AC

Call Day: Internal Medicine Intern

5am: wake up
5:30: head in (baby is still sleeping)
5:45 arrive and see my first patient
round - round - round - we can admit 5 patients and often the private attendings give us procedures to do
12 lunch lecture
then we start taking all the code blues, and keep admitting patients until 7am the next day
usually our last admit is around 1am, and it still takes me forever...
maybe get a wink of sleep
up at 5:30... start rounding on my patients... start in the ICU and then head for the floors
follow up on labs, CTs, find consults, etc.
around 1 or 2 or 3 start thinking of heading home
make check out list
call husband to have him pick me up... maybe 2 hours of sleep in a 32 hour shift... I've got too much to live for to be in an accident on my way home
sleep 3 hours
pick up child from daycare, he's within walking distance
lay on couch while husband takes care of kid, makes dinner... too tired to move much
play with baby
feed baby
put him to bed
spend 30 minutes with husband watching TV on the couch
go to bed around 8pm or 9pm
spend basically no quality time with husband or child
return to hospital at 5:45 the next day

(so... 2/5 days I spend virtually no time with my young family.. the other 3 days I am exhausted.. and attendings are constantly complaining on how lazy interns are these days)

Oh, and I should include my schedule when not on call... it is so much better, but I guess my schedule is a vent. Often a 65- hour work week which is awesome for an internal medicine program.

How I Spent My Maternity Leave

I am winding down from an extended maternity leave. I decided after having my third kid in April of this year that it was time to take some time off from being doctor, and focus on just being Mom. I am now in my 7th month and I have had a wonderful time. It's amazing how fast time has flown. I found a list yesterday that I made before I had my baby, of all the things I wanted to do in my time off. Fortunately, I have done most things on the list - the last thing on the list is to make a scrap-book for the kids, which I'm not sure will get done.

I spent most of my time being Mom - doing activities with the kids, thinking about their diets, their sleeping habits, organizing their toys and arranging play dates (most of which I could barely find time for in my juggling act prior to leave).

Over and above being Mom, I seemed to have gone through various phases during my leave:

The first couple months I spent in a post-partum state. Sleepy, emotionally labile, sensitive about my weight and just trying to establish new coping mechanisms with three kids. Fortunately, that phase seemed to go by quickly.

The next two months, while my baby was temporarily sleeping through the night, I spent most of my time on me - I worked out every morning, read a book, started a global health blog, established a presence on twitter, got involved in some volunteer work...yes, a busy couple of months.

The next phase was in the fall, flu season started and the baby stopped sleeping through the night. I spent at least one month again sleepy and this time driving to doctor's appointments or vaccine appointments all of which seemed to be inefficiently staggered.

Last month, I focused on doing research on schools (since my eldest will start kindergarten next academic year). I'm trying to determine my answer to public vs, private school and get to know the options in my area. I had been meaning to do this for the last year and I finally made this a priority.

Finally, in the home stretch, I am now interviewing for a full-time nanny. I've met at least a dozen ladies from all walks of life and have yet to find the right match. This process has taken much more time that I anticipated and after spending the last 7 months with my little one, I'm much more attached than I expected.

After deliberately neglecting my medical journals for the last few months, it's now time to dust them off and get reaquainted with the medical world. I'm nervous about all that I must have forgotten and all the patient follow-up that always follows me home. Yet, I'm excited to start being a doctor again - having spent so much time on myself, it will be nice to focus on my patients.

Time Flies

It's the end of 2009 and this is just my fourth post of the year. Thanks to KC for allowing some flexibility this year. New baby, then a layoff and subsequent job search...I got too busy to post here regularly. But now I'm back.

Last year at this time, we were in the midst of adopting our daughter. One year later, it seems she's always been here. Time flies. I note some of my mothers-in-medicine colleagues have new babies in their homes. I would encourage them to take plenty photos to document how time flies.

Here, for example, is a demonstration of what a change just one year can make...

Just to update you in all areas of the Fat Doctor Life, I thought I should just list some general subjects.

• My weight: Highest ever. One foot in the grave. Not yet hopeless, but not sure what I need, want or can do right now. Praying for guidance.
• My career: Happiest job ever. Teaching, clinic work, may get back to some hospital work soon.
• My family: Son growing into a funny, smart kid. Daughter just had her first birthday and is starting to toddle. Husband is busy with work, the church and taking care of me. He remains my favorite person ever.

So the holidays are back now and the FD family has a full schedule of work parties, church programs and family get togethers. I'm busy but not complaining. This is the kind of busy that makes the world go round, the kind of busy that makes time...well...fly.

It's good to be back.

Adoption Journey Part 2

Since I posted "A Random Day in My Life" a couple weeks ago, my days have changed in the most wonderfully exhausting way. After waiting almost 3 years for a baby, we got 'the call' a couple of weeks ago, and 48 hours later we brought home our beautiful new son from the hospital. Our adoption journey has not been easy, but the final result worth every minute.

Also see:
Adoption Journey Part 1

Next Week: "A Day in The Life" Topic Week

A few weeks ago, RH+ posted A random day in my life which was such a great glimpse into her life from getting up to going to bed as an OB/GYN and mother. More recently, Gizabeth wrote of a historical day in her life, back in pathology residency. Perhaps I'm a voyeur, but I found it fascinating to see another mother in medicine's day, in all its work-life juggling glory. (Also, despite knowing I chose the absolute right specialty for myself as a general internist, I've always daydreamed of spending a day as a _____ (insert Pediatrician, OB, etc)).

What we'd like to do is have an entire week dedicated to posts like these--a Topic Week. In thinking about my fellow MiM contributors, I would honestly love to read any of their typical days from start to finish. Please consider joining us by submitting a guest post with what your typical (or random) day looks like -with as much or as little detail as you feel comfortable sharing. If you do, please include a short bio with your specialty and the general ages of your child(ren). Send submissions to mothersinmedicine@gmail.com. We'll schedule posts throughout the week.

Thanks for reading and sharing.

Walking the Talk

After years of unhealthy living, midnight grilled cheese sandwiches with fries because I "deserved it" for working so hard, no exercise, two pregnancies, and too many nights of not enough sleep, I am finally at a place where I can turn my focus to my very own health. I am gradually increasing exercise, wearing a pedometer, and striving for 10,000 steps a day. I started a 3 month physician-directed weight loss program, and have seen a 7 pound weight loss in 3 weeks. I also found out that I am hypothyroid, so being on medication is likely helping as well. Mr. Whoo and I are signed up for a 5 K in January, so I am tackling my biggest hurdle, learning to run (without crying). It isn't easy. I am working harder than I ever have for minimal results on the scale, but the weight loss is real. If I can lose 8 pounds a month, 6 months from now, I will be nearly 50 pounds lighter. Real life weight loss isn't like "The Biggest Loser," and it is easy to get discouraged when the hard work and struggle doesn't result in game-show like transformation. Being overweight, I've never been unsympathetic to my overweight patients, but working this hard has made me a better counselor to direct their efforts, especially as they try to juggle work and family life. Just as having children has given me a unique perspective to counsel from the seat of experience as well as clinical knowledge. As a doctor, I am trying to heal myself. Have any of you had a health issue that made you a better physician? How has it changed the way that you practice?

Picking up Sushi

I’ve been reading this book called Nurture Shock, by PO Bronson and Ashley Merryman. It’s a gift from my friend who practices at Stanford – a gift she gave me on my recent trip to San Francisco. It is a parenting book, about relating to your child, and each chapter has evidence-based information, presented in a readable format, that blows conventional thinking out of the water. Topics like lying, and race, and the development of intelligence. I tend to gravitate toward fiction, but if you read one parenting book this year, or even this decade, I highly recommend it. It is changing the way I relate to my kids, already.

The other night I was on my way to the Sushi Café to pick up a take-out order with my four-year-old son, John. He had been away for a couple of days for the holiday, while I was on call. I intentionally turned off the radio so we could have conversation in the car.

“Mommy! I just saw a picture of a strong woman.”

“You did? That’s great. What made you think she was strong?”

“Um, I don’t know. She was strong.”

“Did she look smart?”

“Yes.”

“Did she have big muscles?”

“Uh-huh.”

“Was she beautiful?”

“Yes! She looked like the people in Aladdin, she was so beautiful.”

I immediately thought of the book, Nurture Shock. There is this one chapter on race, discussing how our children draw their own conclusions, based on their peers, if we don’t bring it up. Often their conclusions become hard-wired, by the third grade. So it’s not enough just to let them watch “Little Bill.” It’s important that we discuss skin color with them, as early as age three, to get our two cents in. We often think that if we just ignore skin color, they will, too. But that’s not the case. I was fascinated by the research, and resolved to start discussion with my own kids. But I didn’t want to force the issue, I wanted it to come up naturally. Here was the perfect opportunity.

“John, did you know that some people have different skin colors?”

He answered excitedly. “Do you mean like rainbow skin, mom?”

“Well, not exactly rainbow, but that’s a great idea. I mean like brown, and yellow, and pink. Is there anyone at your school that has different color skin?”

“Um, no.”

“You don’t know anyone with pink skin?”

“Yes! There is this one girl, Ella, not the Ella you know, but a different Ella. She has pink skin.”

“She does?”

“Yes! And then she turns into a fish. And she has rainbow skin. Then she swims. It’s sparkly. It’s so beautiful.”

This wasn’t going in the direction I had intended, but it was interesting. I pressed on.

“John, what color is your skin?”

“Brown.”

“And what color is my skin?”

“Yours is brown too, mom.”

We are Caucasian, but of the darker variety. Myself more than him.

“Brown is a great color. I love brown. Do you know people with skin color other than brown?”

“Yes!”

“Did you know that they are the same as us? With the same love, the same anger, the same feelings, and the same everything?”

“Yes! And they can turn into fishes too!”

I decided that was enough, for one night. The talk turned to gyoza, and sushi, and edamame, and whether or not there would still be a Halloween candy dish at the sushi place. I doubted it, and prepared him so he wouldn’t be disappointed. All in all, I was proud of my venture. Hopefully he got something out of it. At least I started the discussion, one that I plan to continue. Kids need experienced adults to guide them on these issues, not to ignore them and hope they will draw their own conclusions, correctly.

On the way back from picking up the sushi, I saw the billboard he was referring to. Someone was using the image of Rosie the Riveter, to peddle their wares. I love that John looked at this timeless Caucasian icon, and decided she looked like the people in Aladdin. He’s still blind to skin color, I guess. I’ve got lots of time. I hope he always sees a rainbow in every person’s skin.

A Day in the Life

I’m going back in time, for this one. Back to residency, when I had only one child, my first – Sicily. She was six months old, and I often wondered whether I ever really knew the meaning of the word efficiency, before I had her. I also marveled that I used to look at the parents on the soccer field (my husband played soccer at the time), and feel sorry for their constant vigilance in keeping up with their babies and toddlers. Now I felt sorry for the childless ones.

3:45 a.m. Alarm goes off. Baby loves Bach. I don’t really know Bach, but I will forever associate this nameless (to me) song with this activity in this period of my life. I push snooze.

4:00 a.m. Alarm goes off again. I wander to Sicily’s crib down the hall, and bring her back into my bed to nurse her. Complete bliss. I smell her baby head and play with her starfish hands as she gulps down milk. I smell her sweet milky breath and soak in her long eyelashes by the light of the alarm clock as she falls back asleep, drunk and happy.

4:20 a.m. I put Sicily back in her crib, knowing that she will be out until 9:00 a.m., long after I have gone to work. I step into the shower to start my day.

4:45 a.m. I get dressed and dry my hair, careful to keep quiet as the rest of the house is still asleep.

5:00 a.m. I wander downstairs to spend an hour cramming for Step III. I chastise myself for saving Step III until the third year of my residency, but like I said, efficiency now has a new meaning.

6:00 a.m. My husband leaves for work. I heat up a bagel in the toaster oven, plaster it with peanut butter, and wash it down with strawberry milk. Nestle Quick, of course. Amazing how your childhood comforts return to help out during pregnancy and nursing. I pump off 10 ounces of milk in preparation for work.

6:15 a.m. My nanny comes so I can head to work. I march resolutely across the bridge to the Veteran’s Hospital, where I am doing research for a paper. Extracting DNA from paraffin blocks – a methanol extraction technique. I would later present this paper at a meeting in Vancouver. My presentation was on Sicily’s first birthday, so my mom took her to the meeting with me, so I wouldn’t miss it. Our departure was postponed a day, because I wasn't aware that I needed written permission from my husband to take my daughter out of the country (Canada counts??). When we finally arrived at midnight the next night, our room had been given away. We were thankfully placed around 2:00a.m. at a hotel I would later learn, on VH1, was Christina Aguilera’s favorite place to stay in Vancouver.

8:00 a.m. I report to my third year rotation – cytology. My first cytology rotation – a specialty I would later do my fellowship in. At the time, I was not aware of this. I shunned needles, or any extra work, due to exhaustion. But on this day, my attending had different ideas.

10:00 a.m. I practice performing fine needle aspirations (FNA) on an orange, after looking at pap smears for an hour. I am ready to head to the cancer clinic.

11:00 a.m. I watch my attending perform an FNA on an enlarged lymph node on the left neck.

11:15 a.m. I help stain the slides in the on-site clinic. I look into the extra head on the microscope. Squamous cell carcinoma, metastatic. We call the clinician to tell him.

11:30 a.m. My boobs are rock hard. Formerly small B’s are now at least double D’s. I need to find a place to pump. Apheresis lab usually has an extra room. I grab my breast pump and empty 15 oz. Quickly store in the fridge to take home to freeze and wash my pump parts. Head to conference.

12:00 p.m. Noon conference. Daddy’s Deli. Veggie sandwiches with sprouts, olive tampenade, guacamole, and mustard. Yum! Pumping milk starves me. Get pimped about liver unknowns over lunch. Performance OK, but not the best. Self-flagellate.

1:15 p.m. Back to cytology. Read fluids with attending. Pleural effusions, peritoneal fluids, cerebrospinal fluid, more paps. Spot Trichomonas before attending. Feel savvy and knowledgeable.

2:30 p.m. Back to cancer clinic. We walk in to see a 65 year old woman with a large sub lingual tongue mass. My attending decides it’s perfect for my first FNA. An easy hit. I brace myself against her cancer-ridden, tobacco-stench breath and dive in with the needle. I got cells. Stain them. No surprise. Squamous Cell Carcinoma.

4:00 p.m. Tidying up in cytology. Finish straggling pap smears and exfoliative cytology. Entertain my attending over the scope with stories. Hope like hell my nanny hasn’t fed my daughter in the last hour or so cause I am feeling full as a tick.

5:30 p.m. Home at last. Sicily is hungry, thank goodness. Feed her and play with her until her bedtime at 7:30.

8:00 p.m. Pump for the last time before bed. Study for noon conference the next day. Clean and sterilize pump parts in preparation for tomorrow. Watch American Idol with my husband.

9:30p.m. Crash.

There it is. A day in a former life. Not one that I envy, at this point in my career. But I miss those starfish hands, and rubber-band wrists. Today, on the way to Thanksgiving dinner, my six-year old daughter was singing Defying Gravity, from Wicked, at the top of her lungs, over and over. “Mom, will you please take my jacket off? I’m so hot from singing.” That sweet little nursing baby is gone forever. A fleeting memory. One that was so all-consuming, at the time. God I miss it, so much.

I’ve Got to Crow: Notes from the Empty Nest

One of the great advantages of now having self propelling children is that I can go to conferences that rekindle my interest in more general professional topics. I just attended a meeting sponsored by the Society for Women’s Health Research on the topic of adherence to medication—what in the not so distant past was called compliance. Improving adherence to medical advice offers great promise as a strategy for reducing health care costs. And I was delighted to find that women physicians already excel in this area.

At the meeting I learned about a big review article (Roter, Hall and Aoki, Physician Gender Effects in Medical Communication: A Meta-analytic Review, JAMA 288:6 756-64)that showed that women physicians, at least those in primary care, spend more time with patients (10% longer visits—an average of only 2 minutes more per encounter). The researchers found women were better at enlisting patients as partners in their care, asking about the social context of illness, and focusing on emotion. I remember, still indignantly, being scolded by a resident for spending too much time “chatting” with patients on rounds. This study—a meta-analysis, please note-- firmly laid that shibboleth to rest. The extra time we spend with patients is not merely social conversation. Women use time with patients well, conveying medical information as thoroughly as male physicians. While the effect on medical outcomes was not reported, other people at the meeting provided compelling data that communication promotes adherence, and adherence promotes health and lowers costs.

These data are something we can all be proud of. I confess I would love to go back to my obnoxious resident and say it out loud: “So there !”

Life update

Sometimes I use this blog to whine about certain mother/medicine-related things that annoy me in my life. Then, because it's a group blog and not my own personal forum, I tend to not follow up because I don't want to hog the blog. (Hey, that rhymed!)

However, since it's been a little quiet on here, I thought I might give a little update on the last few entries I posted:

1) I started NaNoWriMo on Nov 1 and finished a "novel" of 69,091 words a few days ago. It is truly awful and I am terribly proud of myself. Now I can let Wonder Pets have a break from raising my child.

2) A couple of weeks ago, I camped out in the board of health and finally got an H1N1 vaccine for myself and my daughter. We got the intranasal one, so hopefully we've been shedding lots of attenuated virus for my still unvaccinated husband. My hospital still is not offering it, nor is our pediatrician (which may prove to be tricky when my daughter needs her booster).

3) I am currently reading Baby Proof by Emily Giffin, which someone recommended to me in the comments. See? I listen to you guys.

Also, I'm really enjoying life in fellowship. It's great. I'm not a resident, not yet an attending (all I need is time).