Forget 50-50

Yesterday I saw a new patient in my clinic, an elderly woman with metastatic breast cancer for several years. In oncology, the only part of the history that interests me more than the HPI is the social history. It is often where I start when I meet the patient, and not only because it's an ice breaker and comforting territory (most patients come to oncologists scared out of their wits). It is there that I learn how educated my patients are and whether they work in science, accounting, or engine repair, which helps me to decide what "level" of explanation of very complicated stuff will best serve them and whether I might be able to draw analogies with things that are familiar to them. It is there that I get some early prediction of compliance and ability to cope with the disease and its treatment: does she have family to bring her to appointments?, does she have someone to go across town to the 24 hour drugstore for her at midnight when she needs more nausea medicine? The social history is my gem.

The patient I saw yesterday had been married for almost 70 years. Wow! You don't see that often. Many people don't even live for 70 years all total. I congratulated them on it and remarked about how wonderful it was, but the conversation quickly turned to their concerns: their kids and grandkids and greatgrandkids (can I still be around them if I am on chemo?) and vacationing in Florida every winter (is is still safe for her to do it?)

At the end of our visit, my last of the day, her husband said, "May I ask you a personal question?" "Sure," I answered. "Are you married?" "Yes, for 8 years, 3 kids 6, 4, and 2." They beamed. Then he said, "So, don't you want to know the secret to staying married for 7 decades?" I thought about that for a moment. Of course I wanted to know. I am in a profession with a high divorce rate. I am married to someone who is active duty military, a group that also has a high divorce rate. I am the child of divorced parents. I hadn't really given it much thought before, but if I had, I might have felt doomed. So suddenly, the social history felt more like a gem than usual. "ABSOLUTELY! PLEASE!" I replied. He said, "Forget 50-50." I must have looked confused because he went on. "Your generation has come closer to equality for women and men than any in the history of our country. And that's a wonderful thing. Only trouble is that now everyone thinks everything, every minute, should be perfectly equal, perfectly divided, 50-50. And the reality is that, in a marriage, it just about never is." His wife had been listening quietly, but then piped up. "It's the truth. When our kids were very young, I was at home with them, and he traveled most weeks Monday through Thursday or Monday through Friday. There were years there where I felt like I was doing 90% of the work of our home and family." He interjected, "You didn't feel like you were doing 90% of the work, honey. You WERE doing 90% of the work." She nodded in agreement. She went on, "Even after he changed jobs and was home more, I still was the one who ran the carpools and worked the bake sales and double-checked the homework. It was 70-30, maybe 60-40 at times, but never 50-50, though we didn't really think or talk in those terms back then." He admitted, "There were times when we thought it wasn't worth going on. Mostly she thought it wasn't worth going on. But we stuck it out." She said, "It's true. There were times when I thought the tables would never turn. But...the last 8 years, Henry has done everything. He cleans our house. He gasses up our cars. He weeds the garden. He shops for the groceries. He makes every single meal. He even buys the cards for all the kids' and grandkids' birthdays and anniversaries and so forth, brings them to me with a pen to sign, and gets them into the mailbox on time. I still remember the day I was told I had metastatic breast cancer almost 9 years ago. I never thought I'd be sitting here having a conversation about it in 2010." Her eyes filled with tears. "We're taking one day at a time," her husband said, clasping her hand in his. "She's long ago beat the odds everyone gave her. And if she keeps it up, we MIGHT actually end up 50-50 after all. And that's the secret."

So, there you have it, folks. Quit counting beans. Forget 50-50, and perhaps you'll find yourself still married 70 years from now. And you might even realize on your 70th anniversary that you are, finally, in fact 50-50.

Why not research?

When you go on an interview for med school or residency, the interviewer will always ask you if you have any questions. (I recently drew a cartoon to that effect.) My advice is to have questions. At the very first med school where I interviewed, I was asked that question and I honestly just didn't have any questions.... I had already spoken to half a dozen med students, gotten a tour of the hospital, and had an interview with another person. So I honestly answered, "No, no questions."

The interviewer looked at me in complete and utter horror. I was later rejected from that school.

So I came up with a few go-to questions. One of them I always asked was, "What are the research opportunities like at this school/residency program?" I had absolutely no interest in research. But interviewers like it when you seem interested in research, because it brings prestige to the hospital.

Years later, I found myself in a research fellowship, finally putting my money where my mouth was. I applied for an award that would have paid my salary for several years and launched me into a career in research. I convinced myself that research was what I wanted to do, that it would be great for my resume and that it would allow me flexibility in my life more than a clinical career. It also seemed like research was a good career for a mother. It actually surprises me that so few women do it.

Unfortunately, my application for the award was promptly rejected. "Too many applicants, blah blah blah." I'm not used to academic rejection and it felt awful. As I read the email in disbelief, I decided that I couldn't live my life this way. I would not apply for future research awards. I would be a clinician, not a researcher.

Because I like to make lists, these are the reasons I ultimately decided research was not for me:

1) I don't like the feeling of being rejected, which I'm told is something you have to get used to in research (and love).

2) Although few jobs are permanent, living from grant to grant is nerve-wracking, I've heard.

3) Due to the economy, I've seen a lot of research departments getting served with major cutbacks. This might be a bad time to start being a researcher.

4) I do think a job in research lends flexibility, but it also results in a workday that never ends. When you're a researcher, you're basically always working or feeling like you ought to be. For the first time in my life, I'd like to be able to get home from work every day and just be able to relax.

5) I miss treating patients for the sake of making them better, rather than eying them as research subjects.

6) I personally don't get excited about research. I don't think research protocols are cool. I mostly think they're agonizing and have lots of frustrating red tape. I could spent hours whining about my 100-page IRB application, but I think I've already gone on for too long.

I do want to continue to publish interesting case reports, but I think my research experiment is officially over.

Another Speech I Never Gave

Back from another commencement, where I heard a great speech on neglected tropical diseases and the possible impact that doctors who treat them could have on child health, world poverty , and thereby war and other ills. As inspiring as that was, I wish I could have shared a very different experience with the graduates.

A couple of weeks ago, I evaluated a refugee applying for asylum. He was an accomplished professional who had been persecuted and harassed for decades in his home country, because of his activities against corruption and mistreatment of others. Before he finally fled, leaving his wife and children in very perilous circumstances, he was detained and tortured. Upon coming to this country, he was detained again, in stressful and humiliating conditions.

He recounted his entire history with little affect, breaking down only once, as he talked about losing his family and his country because of his beliefs. As part of my evaluation, almost by rote, I asked about his medical history. Since coming to the US, he had had to make a visit to an emergency room. Although the hospital knew he was destitute, they were still dunning him for the bill. This bothered him terribly—-not as much as being tortured, of course, but it was by no means a trivial stress.

He mentioned that the hospital had found him to be hypertensive but did nothing about it. Though not part of my usual protocol, I put on a cuff and found that his blood pressure was indeed way up. At the end of the interview, I spent a few minutes scouring the internet and calling around, and was able to get him a follow up appointment in a free clinic. After I completed my affidavit for his attorney, I received a message: “He was very pleased about the appointment for his blood pressure.”

This comment really struck home. My simple act of medical care, freely given, was something a first year student could have done. Yet it seemed to redress in some small measure the injustice and the tragedy inflicted on this man by his countrymen, and by the moneychangers in our own temple. I wanted the students, now doctors, to reflect on the profound impact that they will have on others, even if they don’t cure thousands of children of parasites, or never perform lifesaving surgery, or make a million dollars. Moments of grace occur in every field of medicine, in the most unexpected ways. Recognizing them and, occasionally, sharing them with others, is a feeling like no other.

That’s what I would like to have said to the class of 2010.

Mommy guilt

I've noticed that one common theme on this blog: Guilt.

As working mothers, we often feel guilty. We feel guilty for not spending enough time with our kids, and at the same time, we feel guilty for not working hard enough at our jobs. After I was recently saying how I felt bad that my husband had a longer commute to work than I did, a male attending said to me, "You are always feeling guilty. I never feel that way. Ever."

I recently read a post on The Differential, a medical student blog, where a 4th year med student writes about her children being angry that she's moving them halfway across the country for her radiology residency. She feels guilty for uprooting her family and wonders if she should have picked a less competitive specialty that was more geographically flexible. For the most part, the comments to her post were supportive, but of course, there were a few people who called her "selfish" and said that she is not putting her children's needs first.

I knew a few people in my class who uprooted their families to train in competitive specialties. They were all men. (Although to be fair, 90% of the parents in the class were men.) If a man had made a post like that, would people have called him selfish? I don't think so. If only because a man never would have made a post like that. If the father's career calls for a cross-country move, that's just The Way It Is.

Men don't write blog posts about how they feel bad they missed putting their baby to sleep two nights last week, they don't obsess over the fact that their infant got one bottle of formula instead of breast milk (ever notice that there aren't any male "boob nazis"?), and they don't attend lectures about how to achieve a work-family balance. There isn't going to be a blog called Fathers in Medicine any time soon where men talk about the challenges of balancing fatherhood and a career as a physician. Not to say male physicians don't love their kids, because I know they do. But they don't have the kind of guilt that we do.

Actually, I'm a little jealous. Maybe we should all try to be more like men and not feel so damn guilty all the time.

Cheap labor

On my daily internet travels, I recently came across an article about women's vs. men's salaries.

In 25 of the highest paying professions, women earned less than men in every single one where they had data. And of these dismal numbers, physicians were the worst: women earned 64% of what a man in the same exact job would make! (Although that mean salary seems awfully low. Just sayin'.)

I've heard rumors that this is true, but it still surprises me if these numbers are real. What is the justification for paying a woman less then 2/3 of what you'd pay a man in the same job?

Guest Post:: My Husband was Invited to Girls Night Out

About a year ago, I was sitting in my living room with my husband after wrangling the kids into bed when he made the announcement.  “I just got invited to girls night out” he said, with a little hesitance in his voice – like he wasn’t really sure if he should tell me.  “Huh?” I said, sort of half listening as I zoned out to Access Hollywood, my secret indulgence that enables me to block out the craziness of the day.  “I just got an email inviting me to girls night out in two weeks,” he repeated.  I tore my eyes away from Billy Bush and stared at him.  “So, what are you going to do?”  I asked.  “I’m not going,” he said, “you should go.”  And we stared at each other some more.

This pretty much sums up the awkward relationship we’ve held with our peers ever since my husband and I decided he should stay home full time with our kids while I battled my way through my pediatric residency program.  His teacher’s salary was not enough to compensate for two full time daycare slots and patchwork additional child care that we would have needed to piece together to keep our children clothed, fed and guarded while I worked ridiculously bizarre hours at the hospital.  So, we decided that he would stay home.  It was a great decision - one that has allowed me incredible piece of mind.  Our children (now 5 and 2) have experienced a relatively “stable” life despite my unpredictable schedule.  But it has not been without consequences.

For one, my husband is REALLY good at being a SAHD.  I mean REALLY good.  Painfully good.  In-your-face-you’re-inadequate good.  I am so thankful for all he does, but there is a small part of me that sometimes wishes he could be a little less good.  About two weeks into his SAHD stint, he had arranged for a multitude of activities for our daughter – music class, playgroups, swim class.  And he has kept the momentum going - over the past three years, he has managed to integrate himself and our children into a wonderful community of friends in our town.

Contrary to my anxieties, the other stay-at-home parents (99.99% moms) have welcomed my family into playgroups, playground meet-ups and a wide array of other activities.  Hence the invite.  I’m sure the email was intended to be inclusive of my husband in an opportunity to get out and socialize away from the kids.  Instead, it paralyzed us in a moment of uncertainty.  Did the women involved in “girls night out” want an opportunity to bash the working parents and commiserate about stay-at-home parenthood?  Did they want an opportunity to gather with other women in the community, regardless of how their days were spent?  Should neither of us go?  Both of us?  Do they think my 6 foot 4, rarely clean-shaven husband is a girl?

In the end, my husband and I gave up on trying to figure out the intention of the group.  He knew that while he was able to finesse his way through a life of being a SAHD in a predominantly SAHM world, he could not stomach being involved in a “girls night out”.  I realized that I wanted the opportunity to be with other moms – working or not - and to develop friendships despite inevitably feeling the occasional sense of being the odd one out.   So, I went.  And I have to say I am grateful to my husband for forging me a space in a great community of friends who are willing to deal with our unusual set-up.  This works for us.  Secretly, I’m hoping that his next invite is for a manicure and facial at the local spa…


Pedimom is a pediatrician in a private practice in New England.

Mothers in Medicine; Daughters in Life

All the years I was growing up, my mother was active in the Parents Auxiliary of the school I attended with my three siblings. When she finally had to give up the house where we grew up, she moved into a nearby development. No less than three of my classmates’ parents live in the same place, and the number of people who had children in my school is much higher. Yesterday, I attended a memorial service for one of my mother’s friends. A classmate was there comforting her own mother. A former teacher from the school is also there; he gives classes that my mother attends. Suddenly the Parents Auxiliary has become the Daughters’ Auxiliary.

I wish I thought that the time I have invested both in my childrens’ institutional life and in my own will provide similar sources of connection when I am older, but I can’t see it. Being a doctor is isolating—many of my most longstanding and intimate connections are with patients. My colleagues and I work quite independently. I hardly know my colleagues’ families or the parents of my children’s friends—certainly not the way my mother did. My husband is also a busy professional—he is a little more connected, having coached my children on various teams—but at this point in our lives, we rarely see the other parents whose children shared activities with ours.

Maybe it will be different when I am much older, or maybe I will find in myself a gift for making friends outside of work, once I am no longer working. I suppose I should stop worrying. If I live long enough that I need to find new ways to connect to people, outside of doctoring and mothering, that will be a blessing in itself.

It's only Mother's Day because of you!

That's what I told my kids tonight in the tub in between shampoo and conditioner. Yes, I only get to celebrate because you came into the world 6 years and you 3+ years ago. But remember, I told them in all seriousness, mother's day doesn't start til at least 8am tomorrow (Sunday) morning, so let momma sleep. (Hmmm, should I have pushed for 10am? 11am?).

While those might have been the "good old days" of sleeping late, I was just In Medicine then, 6 years ago, In Medicine and proud, but not nearly as fulfilled as these very full and filling days, as a Mother In Medicine.

Happy Day! The one day which, really, is just like all the rest!!!

The Quilting Scrap

This morning, my four year old son John woke up on the wrong side of the bed. He came to my bed two minutes before I had to get in the shower, and I snuggled with him. Told him that I needed to get ready, and did he want to stay in my bed or watch some TV?

"I want to snuggle in your bed, mom."

A minute after I got in the shower, I heard a soft whine. It slowly increased in pitch, and I swear I heard the words, "TV." So we were going to play this game - I've changed my mind, mom, and you need to respond pronto. I yelled at him to come in the bathroom and talk to me, but he continued the whine until my shower was done. I wrapped myself in a towel, and wandered in the bedroom. He wailed, "I wanted to watch TV while you were in the shower!"

I grabbed a blanket and wrapped him in my arms. "John, you still have time to watch a little TV while I am getting ready. No worries." I carried him through the living room into the kitchen, and he calmed down quickly.

"Someday soon, you are going to be as big as Uncle Matt (my six foot plus tall baby brother), and I won't be able to carry you. Can you imagine me carrying Uncle Matt?"

He giggled, and pointed to his head, "I would be all the way up to the ceiling!"

I settled him on the chair, got SpongeBob going, and went back to my room to get ready. Pretty soon, I heard more wailing - something about strawberry milk. This was just an "I need mom" mood - he has been over strawberry milk for months. When I fixed him some over the weekend, he didn't even drink it. I let him wail and finished getting dressed. Walked into the kitchen where he was now happily distracted by the TV. I warned him, turned it off, and told him it was time to get dressed. Full scale fit ensued. "But mom, I wanted to drink strawberry milk while I was watching TV!"

Most mornings are easy with John - he is almost five and the tantrums are now few and far between. He is normally sweet, happy, and helpful. I could tell today was different, so I prepared for a doozy. It was like watching an impending train wreck - all I could do was jump on for the ride and hope we wouldn't end up in the hospital.

He started to kick and scream and refused to get dressed. I tried soothing him with calm words, but we were beyond that. Frustratedly telling him I would just take him to school in his underwear did not help the matter any.

I gave up and wandered into my 7 year old Sicily's room and woke her up. "John is having a morning. Please get dressed quickly, and come to breakfast. Maybe if you come in he will change his mood."

She obliged, and walked over to the couch in her school uniform and bare feet, full of her sweetest voice. "John, it's OK! I'll help you." She moved to hug him, but he was still angry, and I worried she was going to get kicked.

"Sicily - thanks for trying to help, but I don't want you to get hurt. Why don't you go get your shoes and socks on and I'll take over."

I walked over to the couch and told John if he didn't stop by the count of three I was going to carry him to his room, so he could finish yelling in there. I knew that would escalate things, and hopefully speed the storm along. Sure enough he completely lost it and began angrily screaming at the top of his lungs. I quickly prepared the kid's breakfast and set it out, and decided to skip my own - would just hit the doctor's lounge when I got to work. He obviously needed my attention more.

I walked into his room - he was balled up on the floor in front of the closet in his underwear, screaming loudly with his eyes closed. I sat down in front of him, level with his eyes. He peeked at me for a second and set his face even angrier and screwed his eyes up tighter. He was lost, and I was at a loss for how to reach him. Calm words didn't help.

Sicily came in the room. "Mom, can I help?"

"Well, you can try Sicily, but I really don't know what you can do. This has been going on for a long time. Don't get frustrated if you can't, he may just need me now."

She said "I know exactly what to do, mom."

She disappeared into her room and came back a minute later with a small scrap of soft blue cloth. The night before, after we read books (they like to hear two Junie B. Jones chapters together now) - Sicily kept popping back into John's room while I was trying to sing and settle him. The third time she was trying to show him the cloth scrap she had just discovered, and I barked at her to wait until the morning. Nighttime routine can really drag out, and sometimes you just have to put a stop to it all.

She approached John slowly and cautiously, waving the scrap of cloth like a surrender flag. "John? Remember that soft blue cloth I wanted you to feel last night? The one from Ramona's quilting basket? I just discovered it last night, and it is so soft and pretty. I looked for another one for you, but there was only this one, but it's OK! We can ask Ramona for some more. For now, do you want to just feel it? Hold it?"

He was still balled up with his eyes shut, but he stopped crying. I was encouraged. I added, "I'll bet we can, John! Ramona puts pictures of her quilts on the computer all the time. She has this wonderful airplane one, it has these beautiful flying airplanes all over it! I'll bet we can find some more soft blue fabric."

I watched his face soften from anger to curiosity. Suddenly he reached out for the scrap of quilt blindly and desperately. Sicily placed it gently in his hands and he caressed it. He smiled, eyes still closed, and retreated back into the corner of his closet.

Sicily smiled at me and crawled in after him. "I wonder if he is trying to hide it, mom."

She was wrong. He came out with two kites I found during spring cleaning. He was smiling broadly through his tears. "Look Sicily! The bird is for me and the bat is for you. When we go to the ocean."

I breathed a sigh of relief. The storm had passed. John handed Sicily the quilt scrap and picked out a school uniform to match the colors she had on. He hastily got dressed and we had time to sit down for a few minutes and eat together before it was time to go to school. I pumped them up talking about the thank you cards they had made for their teachers for teacher appreciation week the night before, and they got excited thinking about gifting their work. They found school pictures of themselves - Sicily's idea, and added them creatively to their bizarre and wonderfully shaped construction paper cut-outs.

I teared up later in the day, remembering how hard it was for him to reach out for help from a place of anger, sadness, and feeling shut down. I could empathize with him, so much. And my heart went out to my daughter, who knows her brother so well - sometimes better than me. As much as those two fight like cats and dogs, they have an amazing bond. Occasionally I look at them and think, "Sicily and John against the world. They will make it, no matter what."

Leave of absence

When I was applying for a new state medical license a while back, there was a page in the application where it asked me what horrible things I had done. Have you ever had criminal charges filed against you? Have you ever been the subject of disciplinary action? Have you ever had your medical license suspended or revoked?

Being the good girl I am, I just checked NO all the way down the line.

A few weeks later, I got notified that I was in big big trouble because I should have checked YES to one of those questions: Have you ever taken a leave of absence? Oops. I did, in fact, take a maternity leave. I then had a bunch of new paperwork to fill out explaining my leave of absence, as well as a letter from my former residency program director, also explaining my leave of absence. And of course, none of the faxes would go through.

I've actually been waiting forever to take a leave of absence. A real one, not the exhausting blur that was my maternity leave. First I planned to take a year off between second and third year of med school. Then between med school and internship. Then for sure, I was going to take a year off after residency to spend time with my daughter. Well, that didn't quite work out, although I did take a month off. Two months would have been ideal, but my fellowship director was pushing me to start.

I've realized that it's actually not so easy to take time off once you become a doctor. You gain skills during training and work, and then when you take time off, you lose those skills. Especially when it comes to procedures. Even after maternity leave, I felt a bit rusty.

Also, don't tell anyone, but I kind of like to work. Makes me feel productive.

The medical boards recognize that taking time off is a big deal. You have to account for every second of your life from when you started your MD training. When I was recently getting credentialed at a new hospital, I was physically unable to submit my online application because I wasn't able to "account for" the six weeks between my med school graduation and starting internship. I guess vacation wasn't a legitimate excuse.

At this point, I don't see any extended vacations in my immediate future. I guess I'm OK with that. I mean, look how much I blog when I'm working full time... can you imagine if I were home all day? Still, it's a little depressing to think that the next time I'll have a long vacation might be when I retire.

MiM Mailbag: Having kids during 4th year before ortho residency?

I am a 1st yr medical student who is interested in Orthopedic surgery. My husband and I were talking about when the best time to have a baby during medical school/residency is. I am military so my residency will be in an Army facility. Based on your experiences, would having a child during 4th year be feasible?

Thanks for your opinions

T

Coming Home...

I have mixed emotions about CME courses that take me away from home. Although I enjoy time in a new location and having a break from my typical daily grind, sometimes the toll of being away from family is high, and coming home can be an adventure:

"Mom, while you were gone I forgot to register for my AP exam. What should I do?"

Late fee (after countless calls to coordinator): $50.00

"Mom, before you left, I forgot to tell you I needed a costume for that thing at school"

Improvised costume (NOT Eeyore!): $25.00

Me, sniffing around the kitchen: "What is that smell?"

"Erg, I think I forgot to unpack the milk container from my lunch box last week."

(Husband, shrugging apologetically: "I thought the kids needed showers...")

New milk container and lunch box: $15.00

Finding two dozen chocolate cupcakes in the dining room "Just because we thought you'd like them": PRICELESS

(Cleaning chocolate frosting off of everything for the next 10 days: another post!)

How do you cope with the things that come up while you're gone?

A

Things That I Say Every Day (Home Edition)**

Although the dialogue is less technical, the day to day grind finds me saying many of the same things to my wonderful family. Here are a few of my most well-worn phrases....what are yours?

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Things That I Say Almost Every Day (Work Edition)**

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross-posted at Ob/Gyn Kenobi**

Your alternative career

RH+'s last post got me thinking about choice of specialty.

I am pretty happy with my choice of PM&R as a specialty. Right now, I'd say I'm about 90% happy with that choice. But.... about 10% of me kind of wishes I had become a neurologist.

I took neurology as a rotation before PM&R and I really loved it. It was one of the few rotations where I didn't mind putting in ridiculously long hours. I won't get into all the things I liked about it, but suffice to say, a lot of people tell me I should have become a neurologist. I think it's because I'm a HUGE NERD. Why I didn't become a neurologist is a long story, but like I said, I'm 90% happy with my decision as of now. But if I weren't a physiatrist, I would definitely want to be a neurologist.

So your challenge is to complete the following sentence:

If I wasn't a ____________, I would probably be a ___________.

Feel free to complete the sentence even if neither of the blanks can be filled with a medical specialty. (Example: "If I wasn't a lawyer, I would probably be a zookeeper.") And feel free to explain your answer. What you are NOT allowed to do is say something like, "I love being a urologist so much that I can't imagine doing anything else, and if the field didn't exist I'd just have to throw myself off a bridge!" I mean, yes, you could say it, but I'll secretly think you're full of it.