The Sleepover

I am being all sentimental, here. This is not a MiM post, but it is a post from my own blog that I sent to KC by e-mail last November, at the suggestion of my blogging friend Ramona. KC invited me to join MiM the next day. Being a part of this community of Mothers In Medicine - both mothers and readers - has meant so much to me, over the last few months. It is the perfect example of "give a little, and receive thousandfold."


Last Thursday afternoon Mike called me at work.

"Sicily's been invited to a sleepover."

I was mortified. "What? Who?"

"Her friend Emmarie. The one that came to the Halloween party." I had thrown a little Halloween party for Sicily - well, not me really. Sicily made the invitations and cajoled me into throwing the party for three of her friends. She picked the fabulous lantern art activity. She made the goody bags. I just chaperoned - cannot take a single bit of credit. One of the girls was a new friend from her school. I met the dad for the first time when he picked her up, and I hadn't yet met the mother.

I frantically asked Mike, "When is the sleepover? Does Sicily know about it?" I was thinking maybe we could just make an excuse to the parents and never tell her about the party.

He replied, "Yes, and she's really excited. It's Emmarie's seventh birthday party. There are four other girls going. It's tomorrow night."

My head went into a tailspin. I wasn't ready for Sicily to spend the night at someone's house, other than a family member. Sure, she had been begging for a long time, but I actively avoided the subject. And I thought her first one would be a friend that we had known for a long time, and we knew the parents, like Helen or Phoebe. Or Annika. People I was comfortable with, and trusted that they weren't murderers or child molesters. But at the same time, she is over six and a half. I had to let this happen at some point. But six and a half is still so young, I thought. I didn't remember doing this sleepover thing until I was at least eight or nine.

While I was taking her to her stroke technique class Thursday night, she was complaining about her day. I love telling people that I need to leave early so I can get Sicily to her stroke class. They look so puzzled, and I wonder what they are thinking. Is it a class where one learns how to gracefully survive a brain infarct? Or a lesson in the proper etiquette of soothing one's cat? Sometimes I jump in and just tell them she is learning swim strokes, and sometimes I make them suffer and ask.

I was tired of listening to Sicily complain. So I started whining. "Listen to my day. I had one of the biggest caseloads I've ever had. And I'm tired from traveling. I was working crazy hard and busy this afternoon, and your Dad called and told me you were invited to a sleepover. I was so upset and worried, and wanted to try to hide it from you. I don't know the parents, and I am not sure I want you to sleep in a house with people I don't know. I'm scared, Sicily."

She was clearly shocked. She doesn't hear me complain, often. "Mommy, why are you acting like a child? I'll be fine, I really want to go. I've been wanting to do this for a long time." I said, "OK, but I'm taking you over there. And I'm warning you. I'm going inside to meet the mom. If something seems off to me, or I don't like the look of the place, I'm leaving, and you're coming with me."

"Mom, what would have to happen for you to not let me stay?"

"Well, if there are children hanging from the kitchen ceiling bleeding, or screaming in the back room - not excited, party screams, but 'I'm being tortured' screams, then you definitely cannot spend the night."

I looked in the rear view mirror to gauge her reaction. She was smiling and rolling her eyes. "Mom, you're crazy."

Friday night I raced home to get her - I had to drive her 45 minutes away to a gated community in a suburb. Mike and I had looked at a house there many years ago, so at least I knew the area. It was nice - large lots, giant houses. Not that this fact calmed me down - evil people transcend socioeconomic status. We had a long drive, so we discussed manners. I quickly glossed over the basics - "If you don't like something they are offering to eat, say no thank you. Use the word please if you need help." We did some role playing, and she gleefully mimicked her most horrible screams at foods she did not like as an example of what not to do. She was having fun. "What else, mom?"

"Well, the goal of spending the night out is to behave well so you will be asked back again, if you like it and are having fun."

"So what would I have to do that they wouldn't ask me back?"

"Well, I wouldn't blow your nose on their cat. They might not like a snotty cat."

"Mom! How do you know they even have a cat!"

"I don't, that's just an example. I also wouldn't poop on any one's head."

She cackled. "What if I pooped on their head, and then had diarrhea on it?"

"Then you definitely wouldn't be asked back. In fact, I might be required to take you to the doctor."

"Oh, mom. Would they give me a shot?"

"No, but he or she might make you talk to him or her. About why you pooped on some one's head. It's really not done, in polite society."

I checked the mirror. It was dark and rainy, and her eyes were glowing. She caught me watching her, and looked away and shrugged. She gave me my favorite response, to the information I dole out to her. She looked away, scrunched up her face, and said nonchalantly, "Hmm."

When we arrived there were lots of girls jumping around animatedly, and the mom was busy with make-your-own-pizza fixings and cupcakes, so I didn't keep her long. I just introduced myself and wrote down phone numbers. I could hardly get Sicily to say goodbye to me - she was having so much fun.

After a family dinner, Mike retired early in preparation for a big hunting weekend and I stayed up. I was watching Escape From Alcatraz, and it was so much fun to see a movie set in the place I had visited Monday night. I think Clint Eastwood was thrown into the same solitary cell that I had spent time in, on D Block. At about 11:15 p.m., my cell phone rang. It was Emmarie's mother. "Sorry to wake you - Sicily just wanted to talk to you." She passed the phone before I could reply.

"Mommy, I miss you! I love you! Can I talk to Daddy and John?"

"No Sicily, they are long in bed sleeping. You should try to go to sleep, it's really late. Do you need me to come get you?"

"No, I just wanted to tell you I missed you."

"I'll be there first thing in the morning, I promise."

"No, mom! Not first thing! I'm always the first to leave. Come a little late so I can play, OK?"

I smiled. "OK sweetie. Try to sleep. I love you. Goodnight."

Whew. We survived. I hung out with the mom the next morning, for a half hour or so, and she seemed nice. She was pleased with Sicily, telling me amusing stories from her observations, and I reciprocated by sharing some stories about her daughter when she was at the Halloween party. She assured me that she was the second to last, not the last kid to go to sleep. Oh the trials of motherhood. I don't know what I'm gonna do when Sicily goes off to college.

I love all the posts I have read since I joined this blog. Every. Single. One. Have to say my favorite fun addition to my own blogs that I follow are Fizzy's cartoons. That girl's got some seriously hilarious cartoon talent (and I notice her artistic skills are developing quite nicely)!

Happy Birthday, MiM!

I guess I shouldn't be surprised that it has already been another year! Did you know that MiM was born under the sign of "Gemini," with described traditional traits such as being "adaptable, versatile, communicative, witty, intellectual, eloquent, youthful, and lively?" Personally, I could not agree with this description more! Also, based on my long list of face.boo.k friend birthdays this week, this is a great time to be born. Looking over the last year, I see that I've not been the most prolific of bloggers, but I do like the blogs that I have written for the site. I would have to say that my "Tips for Surviving Call During Pregnancy" post was the favorite of my contributions for the year. I also have to mention The Mommy Doctor's post "Why do you have to go to work, Mommy?" because it really touched a chord with me, and I love the discussion generated by the post itself.

I love writing for this blog because I feel as though I am in a great company of not only great writers, but wonderful physicians, mothers, and friends. It is an amazing experience to sit and put my thoughts and experiences as a physician mother to words and to sometimes help another woman who may be struggling with the same thoughts and/or dilemmas. So, thank you, KC for inviting me to write for the blog (two years ago!) and thanks to all of you, dear readers, for making this site such a vibrant and supportive community.

Thank you and happy birthday for your site

I found your site recently, and not only has it already been a godsend for the present, but it shows me a bright future where I can be the OB I want to be WITH a family. So many people downplay any mom doing anything but peds or family medicine or general IM that will have any kind of life for their family, and through the stories and posts I've read on your website - I'm encouraged and inspired to keep pursuing what I know I am meant to be.

I absolutely also love how you can view all the blogs you have linked - I absolutely love laughing with my MS2 friend -  who I am trying to leave alone as she studies for the boards-  over Fizzy's cartoons. I also love the OB blogs and posts listed. I love hearing more about career field I am interested in, and I especially like hearing the positives and negatives of managing it with a family. I am expecting my first child right now - due to give birth in Pulm next year (YAY - not), but I'm thrilled to have two weeks over Christmas off with my very newborn after getting through that horrid Pulm test on no sleep with a days old baby. No one in my world understands what this is like, but I feel like I can read the stories on this website and know that you guys have been here and made it out to the other side of things. Thank you for helping me know that those of us who have kids can still be what we want in medicine. And not fail out! !!!

I'd say my favorite posts are the ones by the OB's on the site - I love the things I say every day at home and at work ones. And I really do love Fizzy's cartoon blog. The latest USMLE cartoon is especially cracking me and my friend up right now as I'm trying to keep her positive as she gets closer to her test. 

You may share my response, but please hide my identity. I have a unique last name that is easily googleable. :)  In fact, it is so scary how traceable I am - that I'm lucky I didn't do anything in my before-medicine days very scandalous, as I don't think I'd ever get a resident position. LOL.

--
MS1
MD school somewhere in the south

Mothers in Medicine turns 2

This holiday weekend marks Mothers in Medicine's 2nd birthday. Two years ago, I was riding in the car with my husband after a night out, turned to him, and said, "You know what we need? A group blog by physician mothers. To share our stories." A few short, frantic-with-inspiration days later (filled with many, many emails to strangers-now-friends), Mothers in Medicine was born.

It has been nothing short of wonderful to see it grow, to write alongside these amazing women, and build an online community of support.

To help celebrate our birthday, like last year, I've asked our MiM contributors to write about their favorite post they wrote over the past year, and/or their favorite post written by another contributor or guest poster. We also invite our readers to share your favorite posts from this past year - the posts that most inspired you, or that you most identified with-- the posts that left an indelible mark on your being. Send your thoughts to mothersinmedicine@gmail.com and we'll feature all of these birthday posts over the next week.

But, mostly, thank you for reading, for writing in, for commenting, for being part of this community that gives Mothers in Medicine a  place to share our stories.

Happy Birthday, MiM!

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