Easy Bake Oven

I'm not much of a cook.

I could fill you with stories - like how I accidentally read the wrong page while trying to bake the Christmas Rum Cake when I was home for break from college, and ended up mashing the ingredients for two different cakes (the other one was strawberry, I think), necessitating an extra trip to the grocery store on Christmas Eve. Or the time I attempted Chocolate Mousse for a supper club and wasted three cartons of eggs. My final mousse had the consistency of chalky pudding. Or the time I was cooking dinner at an evening shift at the home for people with schizophrenia in college, and ended up almost setting the kitchen on fire trying to follow one of my client's recipes for home fried potatoes. Or the time I decided to bake chocolate covered peanut butter balls with my daughter for all of the teachers at her school for Christmas, and I got the wrong kind of chocolate that wouldn't solidify unless it was refrigerated (not to mention that I forgot peanut butter wasn't allowed at the school, so me and my cold peanut butter balls were ushered frantically out of the building the next morning by a teacher's aide - you would have thought I was trying to smuggle cocaine into preschool). Luckily the temperature was in the twenties, so I enjoyed all the peanut butter balls myself as they sat happily in the front seat of my car over the next week.

When I went to pick out a birthday present for my daughter Sicily's 7th birthday last March, I thought the Easy Bake Oven was just the thing. I remembered having one when I was little, enjoying baking tiny brownies, and decided it would be perfect for me and her to do. I would create fond memories with her, baking tiny desserts that required little to no cooking ability.

It's now August, and the Easy Bake oven has sat unused in a cupboard for months. My daughter pulled it out this morning.

"Hey mom! I think I'll finish this sock puppet on another day." She pulled out her sewing kit from Ramona this morning and made a wonderful sock puppet with a lime green sock, a button eye, and hair made from the cut off fingers of an old mulberry-colored mitten. They end result was fabulous. My only assistance was threading the needle in between YouTubing barracuda attacks with my son Jack. "Can we do the Easy Bake oven?"

At first I hemmed and hawed about how we didn't really have time and it would take too much effort.

"Please mom? I don't remember who got me this, but I'm really excited to use it. You can even pick out what we make first."

I felt guilty at the months that had gone by. "I got it for you." I looked at the clock - only 9:30 a.m. Her dad wasn't coming to pick her up for lunch until 11:30. "OK. Let's figure this thing out."

Luckily, my dad set it up with the proper bulb back in March so it would be ready to use. I plugged it in, thinking the 15 minute warm up time would be too much to prepare the mixes. I was wrong. While Sicily was back in her room making her bed, I asked Jack what he wanted to make. "Chocolate chip cookies."

When Sicily returned, Jack convinced her that I decided on the chocolate chip cookies. "Come on, mom, don't you want to bake a cake?" I told her if the cookies worked out OK maybe we could do both.

I found the recipe and we poured the tiny packet of powdered mix into a bowl. I prepared butter and paper towels to grease the tiny pans and made a little plate of flour for shaping the cookies. I read 3/4 on the amount of water to add to the mix, and realized after pouring less than half of 3/4 cup of water into the mix that it was way too much. I consulted the recipe and quickly realized my mistake. 3/4 of a teaspoon, not 3/4 cup. Oops. We started from scratch with a new mix.

After Jack and Sicily each made three cookie dough balls to place in their pans, I grabbed the plastic pan holder and attempted numerous times unsuccessfully to shove the pans backwards into the oven through the cooling rack. Finally Sicily said, "Mom, maybe it goes in this way?" I told her that wasn't likely, it was probably a design flaw, and searched out the instruction booklet. She was right.

8-9 minutes later (isn't that the same time it takes for regular cookies?) we had tiny conglomerated flat cookies that looked like they weren't fit for our snake. Sicily looked crestfallen, but I assured her that looks aren't everything, and they probably tasted OK. She and Jack happily devoured their cookies, and we moved onto the cake.

Once again, the amount of water to add was negligible, but the consistency didn't seem right, so we added a little drop by drop (I felt like I was back in Chemistry class doing a pH lab titration). The frosting was similarly difficult. Sicily became angry when Jack ate all of his frosting, so instead of a two layer cake we just made a tiny cake sandwich with a chocolate frosting center and I found some tube icing and sprinkles in the cupboard to decorate the top. The entire process took about an hour longer than if we made a regular cake, and the end result was paltry. Despite liberal greasing by Jack, the cake came out of the pan piecemeal like a uterus in a laparoscopic hysterectomy. Jack took two bites and wandered off to his room to play. Sicily cut the half dollar-sized piece of her cake into three pieces - nibbled one, gave me one, and gave the other to her dad when he arrived.

While we were waiting for the second layer of cake to bake in the oven, Sicily was enjoying the last bites of her cookie flatbread and absentmindedly cleaning the flour from the table with a baby wipe (Love them! Still use them! Make-up remover to counter top cleaner!). "Mom, isn't this just wonderful? Isn't it the most fun you've ever had? Can we do it again soon?"

A better cook might me more successful than myself with the Easy Bake Oven. But as Sicily smiled up at me this morning with cake batter and cookie dough spattering her mouth and cheeks and flour dusting her nose, I had no regrets on the money I'd spent for her birthday present.

The last diaper and other things I do and don't miss...

My baby is turning 4 (years) tomorrow. Soon there will be no massive car seat, just a booster. Got me thinking about the other things that end or go away, and those that I miss but don't miss.

The last clean emergency use diaper, in the trunk, glove compartment, bag.
The last dirty diaper (emergency use?) in, well, you know where it goes.
No more potty seats (yay) but still helping to wipe their bottoms...

But on to another theme. With losses and transitions I find a happy and a sad. Good bye to pumping (yay), breastfeeding (awwww).

Last power outtage where we have to worry about losing all the stored frozen breastmilk in the freezer (yay), but still threw out lots and lots of chicken nuggets.

Love reading all good books to the kids all the time (and bad books some of the time) , and wondering if daughter is needlessly worried that we won't read to her now that she can read (not true, honey!!)

Didn't realize that with kids (or even just one) comes that last time I'd get to sleep late! But that will hopefully return someday.

Gave away the swing, bouncy seat, and play-yard! More space. Filled with more stuff.

Goodbye high chair. Still some laps!

Goodbye stroller. Still some carrying!

Last day of daycare. First day of Kindergarten.

Last maternity leave. Last return to work from maternity leave.
Last labor.
Last baby.
But very full lives together ahead and of course oh so many firsts to celebrate!

Some lasts are more momentous than others. You just never know. Hoping not to have any last hugs, last kisses, last sharing, last snuggles, last giggles...

What do you and don't you miss?

MiM Mailbag: Experiencing medicine while pre-med

I'd love to hear more about what people did for clinical experience during their premed years. Hospital volunteering? Shadowing?

I'm a non-traditional undergrad student, I'm married, I have two kids and the youngest has special medical needs. I've been volunteering in a pediatric EC for over a year, but I see very little medicine as there is a policy that volunteers can't be present during treatment. My daughter sees about 8 different physicians from various specialties, so I have some exposure from those interactions and the years of testing and treatment we've been though, but I doubt there is a spot for that on my med school applications! I'd love to find a way to experience/observe a little more actual medicine during my undergrad years. Any suggestions?

Adventures in dentistry

Recently, we took Melly to her first dental appointment. I was told that three years old was the age they're supposed to go, so I made her an appointment. She was pretty excited because they hyped up dentist visits at her daycare.

I took her to a large local pediatric dental practice. They had a child-sized dental chair and let Melly pick out what flavor toothpaste she wanted to have her cleaning with (bubblegum was one of the options, of course). They taught her about the machine that sucks water out of her mouth and the little whirly machine that cleans the teeth. When they gave her a little pair of sunglasses so the light wouldn't hurt her eyes, I almost died of cuteness.

One thing I wasn't impressed with was that there was nowhere for parents to sit in the room. There were no chairs around, so I was just kind of hovering over her uncomfortably. I know you surgeons stand in place for hours, but I can't. I finally asked if I could borrow the dental chair that was empty next to me, and the hygienist told me quite snootily that I could, but I'd have to get up immediately if someone needed it. She acted like wanting to sit during this hour long visit was a totally ridiculous request.

The dentist finally came in. He was very young and handsome and I liked him right away. He counted Melly's teeth as I ogled him. I thought to myself, "This is the best dentist's visit EVER!"

Dr. Cutiepie straightened up and faced me. "She's got some decay on her two upper molars."

"What?" I said.

"We can just fill them in for her," he said. "We'll give her a little nitrous gas and she won't feel it at all."

"What?"

All of a sudden, I wanted to throttle Dr. Cutiepie. I despised him. How could my three year old child have cavities? Was that even possible? Dr. Cutiepie was... what? Twenty five years old? He didn't know what he was doing. They didn't even have chairs in this goddamn place. Obviously he was making this up to get money. I don't know what kind of monster would do something like that, but I haven't trusted dentists since two of them tried to high pressure me into getting my wisdom teeth out. (My family dentist assured me I didn't have to.)

The dentist visit ended with the hygienist snapping a Polaroid of Melly and Dr. Cutiepie, which I promptly burned the second I got home.

My parents both had friends who were dentists, so I spent the night trying to figure out what to do. They said if she had cavities, it was better to get them filled. I felt awful. Why did my preschooler have cavities? I thought about her diet and started to blame myself. Maybe I let Melly have too many treats. But we don't give her any candy or fruit juice. Maybe we hadn't enforced toothbrushing well enough (or at all). My husband and I decided to initiate a fascist toothbrushing regimen.

But still, how could a three year old have cavities? I'm in my early thirties and I've NEVER had a cavity. Not even one! And believe me when I say my parents were not big enforcers of toothbrushing.

I decided to get a second opinion. There was another pediatric dental practice a few blocks away that had come highly recommended. I actually meant to book an appointment with them in the first place, but I got confused on Google Maps because the other practice was only a few blocks away. Why the hell were there two large pediatric dental practices three blocks apart? Who designs this stuff??

The new dentist was older and much less cute, and I was happy. And guess what? It turned out that Melly didn't have two cavities after all.

She had three.

The dentist explained to me that her back four molars came in without any enamel on them. He said she might have been ill when they were growing in or maybe it was genetic. He assured me it absolutely wasn't from anything I did wrong. I later discovered from my father in law that my husband required sealant on some of his teeth when he was a kid. So her cavities needed to be filled and the back four teeth sealed.

I decided to go with the second practice because the dentist was older and could make the Donald Duck voice. Also, he said that we didn't need nitrous, which I thought was bullshit and our insurance wouldn't even cover. We got the cavities filled and Melly was a rock star. Afterwards, she said, "It hurt a little, but not a lot."

Putting it in perspective

I had a rough week, to say the least. My tumor board presentation went fairly well, but I was called out by my attending for a mistake on my epidemiology slide. It was a minor point about the prevalence of a less common type of thyroid cancer than the type I was talking about, but it still wasn't fun being corrected at the podium.

Earlier this week, I found out that a Friday night social event at a good friend's house is not open to me anymore if I have my kids with me. I understand the concept of wanting a childfree space, especially since many of the regular attendants are childless, but it still really stung, especially after the week I've had.

The status conference over the custody of my younger son went better in some ways than I expected, and worse in some ways than I expected. I got to sit with my soon-to-be-exhusband in a waiting room for an eternity, and he spent the entire time doing the Dr. Jeckyll / Mr. Hyde routine that made my life miserable when I was with him. "I hope you're enjoying your rotations...Being a medical student means you're a bad mother...I hope you find happiness...Have fun at residency when you'll never get to see your children...I just want us both to be able to spend time with Z...You never loved me, and just used me as someone to watch your kids when you went to school...(Sorry, can't come up with another positive quote)...My next wife will make lunches for me to take to work; you didn't and that means you didn't love me..." and it went on, up and down (mostly down) the roller coaster while we waited for our paperwork. I left and sobbed in my car, and considered dropping out.

I drove hundreds of miles this week in my car (and my piriformis and sciatic nerve are not forgiving me for that, yet). My rotation site is about 30 miles from my house on the highway, which is fine with me, and I put my older son in a camp at which I was a former counselor. It is near his dad's work and my mom's house, which is even farther from my house, and on ground roads (ugh). I also had to pick up Z from my ex's house, which is even farther away. Yesterday, after picking up Z at the ex's, then driving the opposite direction to S's camp, I turned around again and drove 70 miles from my house to go to the viewing for my classmate who died recently.

My sons came with me to the viewing. She is being buried in her white coat, and we were asked to wear ours. The kids were very understanding about going. We only stayed for a short while, and sat in the back of the room. I briefly paid my respects at the coffin and to her family up front. Z crawled into my lap when I came back to our seats, and I held him and kissed his head. As I sat there and listened to my classmate's mother wail with pain, and thought of her baby in the NICU, I thought how lucky I really am. Danielle wanted nothing more than to be a mother, to hold and nurse her baby, and to be a doctor. She never even got to meet her baby, and now her family is reeling from the sudden, heartbreakingly unfair loss.

In a few years, this shitty week will be a distant memory. I can still hold my sons and kiss their soft hair. I am still (so far) going to achieve my dream of becoming a physician. I still have a strong social support system with loving friends, even though, sometimes, it can be more piecemeal than I would like. I am trying to keep it all in perspective.

(Cross posted at Mom's Tinfoil Hat)

Confess. What's in your purse?

I have a disease. LPS. Large purse syndrome. It's an affinity for massive purses that can double as laptop bags and everyday work bags. But it's also my primary purse. (Please note that this purse is very stylish but still enormous.) When I am forced to take a clutch out for a night on the town, I feel so constricted! There's barely enough room for my phone, a tube of lipstick and a credit card.

The natural consequence of toting such a massive purse is that things go in and they never come out. It's also the cause of me not being able to find my keys floating around in all the debris --I once lost a pair of sunglasses in there for an entire week. It's also becoming heavier and heavier (but imperceptibly so on a day-to-day basis) from the constant accumulation. I'm waiting for my pinched nerve to develop.

The natural benefit is that, if stranded in the wilderness, I could probably survive the longest among other-small-pursed women from the sheer raw materials a la MacGyver.

I thought of this today as my hand blindly searched the cavernous innards of my purse, looking for my pager (yes, amazingly, I still  have to carry one of those), and wondered if my purse (or contents thereof) was just an idiosyncratic collection of me or a sign of my profession (physician), my role in life (MiM) or perhaps my specialty (internal medicine).

So, I took an inventory and found the following (please don't laugh or judge):

• smartphone
• pager
• epi-pen (for me, but not afraid to use it, if necessary, on anyone who needs it.)
• 5 tubes of lipstick/lipgloss
• pink emery board that reads "Mad Housewife"
• a sticker that reads "I voted" in English and Spanish (could this be from the last presidential elections???)
• remote slide advancer
• office keys
• 3 travel-sized body lotions that appear to have been appropriated from 3 different hotels
• ipod nano
• flash drive
• sample of dental products given to me by my dentist at dentist visit 3 months ago, still in bag
• bead necklace made by 5-yr old daughter that I wore to work one day because I promised her
• trash*
• feminine hygiene products
• tin of Wine Wipes ('wipe that wine off your smile')
• wallet
• gum, free-floating and also in a package
• a rock from the beach vacation
• small sand dollar, see above
• toy gold medal from a gymnastics "ceremony"
• business card holder
• prescription bottle with 1 lone spare zyrtec
• a lone nickel
• 2 individual free-floating "fruit snacks"*
• 1 cookies and cream candy egg*
• business card from guy who hit on me in the security line at the airport (politely took it then stuffed it in the bottom of my purse.)*

*removed or consumed during purse inventory process. Okay. I lied. Those fruit snacks are still rolling around in there. Not sure if I have the energy to locate them again.

Okay. Your turn.

Gossip!

I'm really trying my best not to gossip at my New Job.

My residency was all about gossip and rumors. We residents would literally spend hours gossiping and exchanging rumors. One of the residents said something that really stuck with me, which was, "It's really terrible to gossip. Yet it seems like that's all I ever do."

It bugs me though because I've noticed that rumors have a tendency to not be true. Or at least warp the truth. And lead to unnecessary anger and resentment.

For example:

Soon after I came back from my maternity leave, I was gossiping with another resident. He said to me, "I have to warn you about something I heard."

Apparently, there was another female resident in my program who had a tendency to call in sick a lot, arousing the wrath of several other residents. Anyway, two residents were talking smack about her calling sick all the time in front of a female attending named Dr. Goody. And Dr. Goody nodded sympathetically and said, "Oh, I know who you guys are talking about! You mean the resident who just had a baby, right?"

I was SO ANGRY about this. I had worked with Dr. Goody for three months and never once called in sick. I had been back from maternity leave for two months and not called in sick once. I was furious that Dr. Goody would make this assumption about me. She should have stood up for me if she thought those guys were insulting me! What a catty bitch!

When I saw Dr. Goody at senior graduation a month later, she was really friendly and made big fuss over my new daughter. But I was still angry. I figured it was all an act and she didn't really like me at all.

Fast forward to over a year later:

I was chatting with a resident in my class, who was one of the residents who had been badmouthing that other female resident in front of Dr. Goody. Somehow that incident came up, and I discovered that:

1) It wasn't Dr. Goody who had overheard the conversation at all, and in fact, she had nothing to do with that incident.

2) The attending who DID overhear the conversation (and assumed they were talking about me) had in fact said, "You guys are being really unfair! She just had a baby!"

I absolutely can't believe I spent over a year being angry at Dr. Goody for something that had nothing to do with her. At that moment, I vowed to take every piece of gossip with a grain of salt. (Because obviously it's too fun to stop.)

What is your best cautionary tale about why we shouldn't believe the rumors?

Guest Post: Why It’s All Worthwhile (or What Keeps Me Going)

(I am posting this as a followup to Gizabeth’s excellent, thought-provoking “Disillusionment” post. I wrote this anecdote awhile back but decided to post it now, since it illustrates so perfectly what “keeps me going” and why I’m not disillusioned despite all the difficulties we face. - gcs15)

“Make a Joyful Noise unto the Lord”

In October 2007, the ER called me for yet another emergency. A thin, elderly man lay on the stretcher with his anxious wife at his side. “He’s been more and more confused, Doctor. This is just not like him!” she said. Sure enough, on examination, he had no focal deficits, but he was clearly disoriented. No history of trauma, no blood thinners, just chronic treatment for myelodysplasia (which was stable). His CT scan showed the reason for his confusion: a large subdural hematoma extending over the entire right hemisphere of his brain. Yet another elderly patient with a subdural.

I took him to the OR emergently that night. I removed a large window of bone from his skull and opened the tense, bluish dura. A large blood clot lay on top of his angry-looking cortex; once the hemorrhage had been removed, his brain began to gently reexpand. Successful surgery, but how would things go over the next few days? So many irritated, elderly brains begin to seize postop. The mortality rate for subdural hematoma is 50%. This is one reason many budding physicians avoid neurosurgery; we see a lot of terribly sick patients, and a lot of them don’t get back to a functional life.

Back in the ICU, the nurses told me, “We’ve been getting a lot of phone calls about this patient! How did he do?” Evidently, he was a Ph.D., a professor emeritus of fine arts at Bob Jones University, beloved by hundreds of students and alumni around the country. He conducted their orchestra and had been composing all kinds of opera and classical music for more than 50 years. His children was all bright and successful, some of them accomplished vocalists. In short, my patient was a brilliant, artistic man.

His first 2 days postop were encouraging. He began to eat and joke a little. I transferred him to the floor and gave a sigh of relief. That evening, however, the nurses called me. “He’s not looking so good.” When I arrived at the bedside, he was minimally responsive, pale and diaphoretic. A workup, including a CT head, was suggestive of infection. I transferred him back to the ICU and aspirated fluid from his wound; clearly he had developed meningitis. I started him on IV antibiotics and began to really worry.

He was very sick for a long time, but he recovered and actually did very well. I got to know him and his family a little during his illness. They were delightful, cultured people with a great sense of humor. The first time I saw him stand up, I realized he was at least 6’6”! We talked about his passion for music and his love of God, among other things. I told him, “When you are completely recovered, and you are ready to conduct again, let me know. I want to come.” He laughed and promised. Privately, I wasn’t sure that would ever happen, after what his brain had been through.

About 2 months after he left the hospital, he came back to my office. “What do you think about this spot?” he asked, pointing to his head. The wound was infected again. Over the next few weeks, he had 2 more surgeries and IV antibiotics to remove the bone flap, clear the recurrent infection, and implant an artificial custom-made bone flap in the defect. Finally, finally, he was better, this time for good.

The months went by, then a year; no news from him. I thought of him every so often, hoping that his cognitive function was still improving. By this time, he was 78 or 79 years old.

Just before Christmas 2009, my phone rang at home. “Hello, Doctor! Remember me?” Of course I did! “Remember my promise? I am conducting Samson et Dalila in March, and I want to know how many tickets you need.” What a wonderful Christmas present!

So my husband and I took my 12-year-old son with us to my friend’s opera that weekend in March. I can’t remember ever enjoying opera so much. It was stunning. A cast of 200, including 3 nationally acclaimed guest performers, and a wonderful orchestra took a simple Bible story and cast a spell that lasted 3 hours. As the stars of the show escorted my patient onto the stage at the end for a long standing ovation, the supertitle proclaimed, “This will be the final major performance of his career.” I stood with his family in the audience, hoping my eyes wouldn’t overflow.

I could feel in the thunder of applause the impact he had made on so many of his students, and the love and respect they have for him. I could feel the force of his personality and the persistence that brought him back to his baton at almost 80 years old. And I could hear clearly the Almighty whispering to him, “Well done, good and faithful servant.”

Professor, I was blessed to have played a tiny supporting role. Bravo, and bravo!


About my patient: Dr. Dwight Gustafson was the longest-serving Academic Dean in the history of Bob Jones University. Samson et Dalila took 2 years of intensive preparation and rehearsal; it was the biggest such production done at BJU in the last 20 years. Dr. Gus says of his illness and recovery, “Through it all, I kept saying to everyone, ‘God is good at all times.’” I continue to be inspired by his faith and his example. This is printed with his permission.

Disillusionment

When I went into medicine, I had clear goals in mind. Helping people. A stable income to provide for a family. I grew up under the spotlight of my father, who is a neonatologist, and lived in awe of his work. I remember being in restaurants with my dad - people would come up to him reverently and sing his praises (to his obvious embarrassment). Talk about their son or daughter that he had taken care of, and fill him in on how they were doing now. Once, in a small town in college, I was filling out a check at a convenient store. The clerk recognized my last name as the same one as the doctor that saved their premature baby. "Your dad is amazing. It must have been wonderful growing up with a father like that - one who hung the moon."

So although my path was a little wayward, I found myself starting medical school at 23 years old - not too bad after taking three years post college doing B.A. level psychiatric jobs and taking pre-med requisites. I thought I might be a psychiatrist, but quickly changed my mind because I worried about the burnout I might experience taking on the burden of other's emotional and mental issues. Then I decided to be an ophthalmologist, but changed my mind at the last minute - fall of senior year. This is why. I was on a month away rotation in a different state, and worked closely with an ophthalmologist at the general clinic. She was elegant, razor-sharp, and efficient. I watched her manage the clinics with grace and ease - quickly entering and exiting each room, performing eye exams, dictating notes for the chart. She took me out to lunch. Here is what she said.

"Don't do it. Did you see how many patients I plowed through? It's like that every day - you have to see more and more. Some days I squeeze in 60 or 70. It didn't used to be this way. Did you see me get to talk to a single patient?"

I didn't.

"The techs do all the talking. I don't get to know them at all. I'm like a machine, getting briefed by the techs and looking at their eyes. It's all I get to do. Then I tell the techs what to write in the chart, and have to rush to the next room. Job satisfaction is nil."

My best friend in medical school ended up going into ophthalmology - I'm going to take my kids to visit her this weekend. She works in a small town, and seems to have good patient interactions, but her job is not without its challenges. Overall, she seems happy.

I am reminded of another experience my third year when I was considering orthopedic surgery. I had the grades, and the strength to manipulate the hardware. I was surrounded by encouraging attendings, but they and the residents were all male. I asked if anyone knew any female orthopedic surgeons I could talk to. One of the attendings gave me the name of a woman that rotated once a month from a practice in a smaller town. I called her. She was in her early 50's. Here is what she said:

"I made great sacrifices, for my family, in order to do what I did in my career. If I had to choose all over again, I would choose differently."

The one girl I knew who went into ortho, she was a year above me - bailed for radiology as soon as she started a family.

I encountered a lot of frustration on the pediatric wards when I rotated. The pediatric residents, especially those in the SICU, liked to stay up late talking about how hard they worked and how little money they would get in return, when all was said and done. Massive debts, burnout, and destined for salaries that barely scraped the bottom of the physician barrel. Many residents in the primary care fields appear to share this sentiment.

I was watching a film tonight that my friend Ramona Bates shared with me called "The Vanishing Oath." It messed up in the middle (I think it was my player Ramona), but what I saw was this. An ER doc who sacrificed for many years to study - missing important life events of family and friends along the way - and is now overworked and bogged down in bureaucracy. He feels he has no time to spend with his patients from all the charting and hospital hoops he encounters. A few years out of med school, having barely made a dent in all of his debt, he is ready to get out - or at least take a big sabbatical. I need to give it another shot so I can do a proper review, but the little I saw inspired this post.

I work in the field of pathology. I do have a little patient interaction, but most of my work does not involve patients. I love my job - wouldn't trade it for the world. I have become somewhat disillusioned by how much of a money game it is between hospitals and doctors. I spent a day in a special session of legislature last year, watching a battle, and that was an eye-opener. I am also disillusioned by the lack of teamwork involved. Dr. Gawande said it better than I can in a med school graduation speech at Yale called The Velluvial Matrix that I read earlier this week. It's not that we don't try to work as a team, the system is just set up against us. And it really is our job to figure out how to fix that.

Sometimes when I get really angry and jaded I try to remember that little girl that sat in awe of her dad, through all those chance encounters with the parents of the many babies he helped that would not otherwise have lived. Now I'm doing my own part - although somewhat more behind the scenes. I love calling doctors and telling them the results of their procedures so they can move on to treat the patient. This week, I got to help an enigma of a young girl being treated for a brain tumor with fever and neutropenia. The pulmonologist was so happy when I called to tell her there was pneumocystis all over the GMS (fungal) stain. Something to treat. A cardiothoracic surgeon called me three times, hanging on my assessment of a CT-guided lung biopsy. When I finally called him late in the day to tell him that yes, me and my partner agreed we could name that cancer on three cells so he did not need to proceed to mediastinoscopy - he was overjoyed. One less procedure, and one more step toward treatment. Every day I get to supply a big piece of the puzzle that can help the clinicians move on. That is extremely satisfying.

So my question (after blogging way too much) is - what were your goals when you started medicine? And how have you been disillusioned along the way? What keeps you going?

Guest Post: Pregnant, in surgical training

We recently received this anonymous comment to an older post on childbearing in surgical residency and thought this might open the discussion back up.

Ok. So I am pregnant and in training after practicing for a while. My boss knows, but the rest of the team does not (I am not showing yet).
I am due after I finish my training so my issues are more financial and how to look for a job with a big belly. Also any leave I take it will be just detrimental to me, since I will not be making any money.

I look around the group of surgeons and trainees (100% male) and I feel like I am doing something against that whole environment..

I try to keep in my mind that in order to society to continue, women have to have babies. It is not like we are choosing to take a vacation for months or something.

As for the programs I do believe they should hire locum tenans people to cover for that period of time. For guys may sound unfair, but their mothers and wives were pregnant one day.

I use to be amazed by the residents that only took a month or two off, but now I am contemplating just taking a month off because I cannot afford to take more.

I think a lot of the negative thoughts are in our mind and we just have to shake them off.

As for the right time, I still think its best in training because you have a system of coverage. In practice you will book cases and not know if you will be well enough to finish it.

I had to scrub out twice in 3 months , but I was assisting a surgeon so I just asked the scrub nurse to help out and came right back.

I guess is also improtant to keep in mind that all these people around us will go away from our lives at some point, but your baby will be with you for a long time and if something goes wrong, it will be hard to forgive yourself if you think you havent done what was right for your kid.

As my husband says, we are not in control afterall. At some point we have to give it up to the Boss- God

MiM Mailbag: Question from a student

Hi:

I've seen people submit questions to your blog, so I thought I'd ask one myself!

I recently started reading this blog, and I love hearing such a real perspective on medicine.  I'm a grad student, and my plan has always been to apply to med school.  All my pre-reqs, MCAT, etc. are complete.  However, a discussion with a dental student recently got me thinking about dentistry.  My main concern with medicine has been the lifestyle and strain on family.  Not to say that dentists have it easy, but I get the impression that they generally have more manageable schedules.  Of course, I would need to find the same passion for dentistry that I have for medicine.  But I'm curious if any of you considered any other health professions.  Would a career in health care with a friendlier lifestyle still fulfill you?

This blog is such a great resource.  Thank you all for your insightful writing!

Take care,
A

Comic Relief

Our hospital recently bought new scrubs. They reminded me of an incident that occurred shortly after starting my intern year.

My chief resident was late for morning rounds by a few minutes and in quite a foul mood when she arrived. We interns we too afraid to ask what the issue was, but later I heard her venting to a fellow chief.

Evidently her 10 year old son had asked a simple question, "Mom what color are your scrubs going to be now that you are a chief?"

"What do you mean?" she had inquired.

"Well when you were an intern you had scrubs with an orange belt, then second year you got promoted to the brown. Third year you got the red belt. So what color do you get as a 4th year?"

It was at this point that I looked closer at the badge. I saw the much thinner face on her badge that was taken her intern year and realized why she was so upset.

explanation: The drawstring colors are the sizes of the scrubs orange = small; brown = medium; red = large

Fear

I am scared.

Next week I'm going to be starting my first Real Doctor job. After nine blissful years of getting to look over my shoulder, I am going to be on my own, trusted to make my own decisions.

I probably shouldn't be scared. First of all, I did have some attending privileges as a fellow, so this isn't entirely new for me. In fact, much of the time during fellowship, the attending presence kind of annoyed me. I feel ready to make my own decisions.

Second of all, it's not like I'm being released into the OR with a scalpel. My job as a rehab consultant is not the kind where I'm likely to be making any life or death decisions. Harming a patient in any serious way would be challenging, even if I were totally incompetent (which I don't think I am).

Third of all, I won't be in private practice by myself. There will be tons of other senior physicians around that I can ask for advice if need be.

Still, I'm scared. For all the same reasons I was scared on my first day of high school:

What if nobody likes me?

What if I'm not any good at it?

What if I hate it?

What if I'm overwhelmed with work?

What if they steal my lunch money? (Unlikely, but not outside the realm of possibility.)

On my last day of fellowship, they threw a pizza party for me, gave me a card that everyone signed, along with a gift card. I felt so loved. I started to wonder why I'm striking out on my own when I could stay a fellow for another year if I wanted. I know I had really good reasons: (lack of) money, the lack of a future in my fellowship (hiring freeze), a chance for a secure permanent position elsewhere. But I can't help but doubt myself. And be scared.

July Decisions

It’s early July and newly minted interns and residents are gracing the hallowed halls of hospitals across the country. Not only do these intrepid souls have to cram every possible byte of data into their sleep-deprived craniums, maintain their patients and respond to pimping questions from attendings, they need to decide what they will call themselves at the end of their training.

General surgery is easy – when you’re done, you’re a surgeon. No one really has any questions about that. But what if you chose Orthopedic Surgery? When you’re finished, will you refer to yourself as an “Orthopod” (which brings up visions of a scary armor-plated vector to some), or an “Orthopedist” (which, strangely, some individuals seem to confuse with a Podiatrist)? Adjacent to the surgeons are the anesthesiologists – will you (should you) really tell someone you “Pass Gas” for a living?

Then there’s the pronunciation factor. If you choose to go into Obstetrics and Gynecology, will you practice O-B-JIN when you’re done, or are you going to practice O-B-GUY-nee? If you follow in our beloved Fizzy’s footsteps and specialize in Physical Medicine and Rehabilitation, will you be a fiz-EYE-a-trist or a Fizzy-AT-trist? (And when you examine the bony structure of your patients, are you looking at the SKEL-a-tal system or the ska-LEE-tal system? Perhaps it depends on whether you had any British instructors…)

Perhaps most confusing of all, those who choose general internal medicine – will you be an Internist? Will you practice Internal Medicine, I.M. or “Medicine”? Family Practitioners don’t have it much easier – too often, they’re considered Generalists or General Practitioners and the time they spent in training is ignored.

Some specialties don’t seem to have issues with confusing acronyms. The only time anyone had any questions about my field of Neurology was when he misheard my response to “What type of doctor are you?” as “An Urologist” rather than “A Neurologist”. Physicians who specialize in Pulmonology, Cardiology and even Proctology rarely receive questions about what they do – most people outside of the medical world know what those names mean. And I’m happy that some specialties maintain their formality: Would you really want to see a Hematologist/Oncologist who refers to herself as a “H-ONC”? (Is “QUACK” the logical next step if that were to occur?)

Medical school and Match Day are memories for those in training by this point, but the hard work is really just beginning. The title “Doctor” is a given – how will it be modified?

A

Guest Post: When medicine gets personal (Part 1)

My journey in medicine has been somewhat semiotic; an ebb and flow journey that has been almost entirely governed by signs. My journey in medicine would seem to be predetermined and there have been many signposts to guide me along the way.

Some call it fate.

Upon hearing my story you might call it bad luck.

Or maybe it’s ‘just the way the cookie crumbles’.

I? I believe I have been blessed.

***

Once upon a fairy tale, I wanted to be a vet. As a little girl all I wanted to be was a vet – I loved animals and the arduous training schedule appealed to my über type A alter-ego. My decision to ‘bat for the other team’ and pursue a career of experimentation on humans came later, much later.

In fact it wasn’t until my final years in high school that I decided I wanted to be a doctor. Cardio-thoracic inspired. It came to me like a cosmic ray, complete with visions of fame of wealth, and probably the standard quo but ubiquitous desire to ‘help people’. I can’t really remember, but I concede that visions of a leather interior Marilyn Monaro did dance in my head!

What? You don’t know what a Monaro is?!

Troglodytes!

Puh-lease!!! I would have looked HOT in a Marilyn Monaro! The wind blowing through my hair...

In reality, today? Today I drive something Toyota-esque, fitted with child restraints, with the occasional projectile vomit from the backseat breezing by my head. NOT exactly what I envisioned!

***

As a naïve and self-absorbed pre-med, I had my life all planned out and I never, not for an instant, thought it would ever go otherwise. My entire life I had always been successful, the top of my class, and I was a stranger to failure. I was arrogant, it’s fair to say, but I had my healthy aspirations to ‘do good’ too.

I grew up in a family which was entirely devoted to community work and the advocacy of social causes. My parents in fact spent more time helping people than they spent taking care of themselves. I wanted to help people too, but medicine was also going to be my way of doing a little better for myself than my parents had. I was a zealous surgeon-wannabe, with just the right amount of arrogance and pride to dream of saving the world.

We all, I believe, want to help people and it’s a big part, hopefully the BIGGEST part, of why we pursue medicine as a career. The desire to help people is quintessentially pre-med, almost every medical school applicant pulls the line ‘I want to help people’, but some mean it more than others. This desire, however, means very little until you have something to back it up with, something to serve as personal motivation. Something.... that can take that desire to change the world and turn it into the desire to be the change that you want to see in the world. Ghandi knows best! After doctors of course ;)

***

I was knocked from my pedestal early on. The ink was barely dry on my medical school applications when the phone rang and I heard the news that my older brother, a long-term mental health patient, had taken his life. In the dark of the night, amid the reclusive bushland of Australia, he had drunken himself into a stupor, taped a hose to the exhaust and, piping carbon monoxide into his car, put an end to his life. It was not his first attempt, but it was his last. And the sound of the telephone ringing can still send a chill up my spine.

I attended my brother’s funeral just 10 days before I was to sit the final exams that were to determine my entrance into medical school. Standing before his open casket I was impressed with the life-like pinkness to his skin, his face looked almost flushed, full of energy and vitality. Today I understand this as a direct consequence of the CO poisoning, but at the time it seemed in stark contrast with the coldness and rigidity of his hands. I know what his hands felt like purely by accident as I was too terrified of the presentation of death before me to touch him. But, as I tried to slip a note into/under his hands as they lay cupped on his chest, my fingers brushed his with a sensation that I will never forget, and I met death. His was a death that could have been prevented, and in that instant as our fingers brushed, his with so much left undone, mine with so much yet to do, I also met myself and I found my reason to be a doctor.

The note? The note was a simple declaration that I would become a doctor, in his honour, and I’d have better faith in, and care for, my patients than that which was afforded to him.

I had found my personal motivation, my reason to ‘help people’, but I was still yet to encounter my Ghandi moment.

This was just signpost 1.

(To be continued)


DSM-IV 299

DSM-IV 299 hails from Australia where she is currently a fulltime mother to Ocean Boy (4), Mini Me (coming up 3) and Freckles (18 months). Now aspiring to a specialist career in developmental paediatrics, having once graced the diseased halls of sexual medicine until one day her life collided with a rainbow... more revealed in Part 2.