MiM Mailbag: Resident mom barely keeping head above water

When I heard about the latest topic week on work-life balance, I became excited to participate and finally submit a post. I've been a long-time reader and often refer new mamas in medicine to the site. I’ve spoken at a Resident Physician Parenting Workshop for the last two years and was a member of a recent Task Force that authored a document called Medicine and Motherhood: Can We Talk? I'm a mother to a joyful (but sleep depriving) 2-year-old, spouse to a wonderful MD/PhD student, and very happy to be finishing a family medicine residency here in Canada shortly. I thought I could write something witty, something useful, or share some secret for success… but all I can do is shout out for HELP!!!

I'm looking for help because, well, this teetering balancing act of physician, mother, spouse, friend, and committee member is about to fall apart!

I've cut back on committees and extracurriculars and even did a career switch (internal medicine to family medicine) in attempt to regain some equilibrium. I have in-laws that are happy to help, use money from my line of credit to have cleaners every other week, and have a fabulous daycare. And yet, I'm still barely keeping my head above water.

Hubby and I barely see each other -- this month I'm working nights in Emerg and he's on 1:4 call for the general surgery service. I think we spent less than 8 hours awake in each other’s company this week.
I never seem to have time to study or read around cases. Hubby feels like he's barely prepared for days in the OR and for exams. I feel like I could be a better doctor if only there was more time or energy.
And this beautiful child, well, he doesn't like to sleep much. And although my brain screams "No Way!", my heart is ready for another baby (or two).

How do you other MiM make it work? Everyone else seems to do it "better" than us -- they study more, are more well prepared in the OR, their dinners are home-made, and their kids are sleeping longer.
Said only very slightly tongue-in-cheek...

-Resident

Balancing Act

I come from the generation of women who were raised from a very young age to believe that they can be and do it all. College, career, friends, marriage, kids, and a perfect family life, unhindered by a stellar career, and of course, a kicking body. As most of us in medicine, I have a strong tendency toward demanding perfection, of myself, of my relationships, and especially of my work. Anything worth doing was worth doing perfectly, down to the last detail, or I just wouldn't do it. Ha. Ha. Ha. And then I got smacked, hard, with reality. As others have so astutely stated, the enemy of good is perfect. Many of my posts on MIM have been pertinent to work/life balance, or, more specifically, lack thereof.

At first, I did a really good job balancing self care, school, and friendships. In med school I made a concentrated effort to work out several times a week, studied most of the rest of my time, and while my older friendships got put more or less on hold, I had good friends in medical school with whom to blow off steam after examinations. Then came love, followed shortly by marriage, best decision I have ever made unto this day, and I don't regret it a bit, but the gym was the first to be phased out in favor of nurturing the relationship. And, to quote the Barenaked Ladies "When we are happy we both get fat and still, it's never enough..."

In residency, he was working, and I was working, and we cherished the time we had together. We hired a cleaning lady who also did laundry, and were able to spend most of our free time together nurturing our relationship and our relationship with our family and friends. Life became infinitely more complicated with one child, and we were nearly pushed to our breaking point when, in the throes of an incredibly demanding work schedule, we had our second child. We lived 14 hours away from much of our friends and family. Mr. Whoo was working 10 hour days, I was working 12 hour days (if I was lucky), and our children were in day care 10 hours a day, despite having a twice a month cleaning lady, any spare time was spent digging out from underneath mountains of laundry, and our life together was coming apart at the seams.

There was no more robbing Peter to pay Paul, and we finally had to make some very difficult decisions. The first of which was Mr. Whoo quitting his job to hold down the home front (i.e. find it under Mount Laundry and the River of Dust) and be available for our children and family. The second of which was my decision to break my contract (which cost us a bit financially) and find a more reasonable call schedule in a location closer to our family and friends. In addition to seeing more friends in person, facebook helped so much in sharing my life with my family and far away friends. I'll be the first to admit, my life is far from perfect, but compared to a year and a half ago, my life is a spa vacation. My children are still fairly young at 3 and 6, and they still have very few extra curricular activities. I know more juggling will be in order once they start, but so far we've handled Daisy Scouts and dance class fairly well. The last thing I have yet to get totally back on track is taking care of my own health. I've lost almost 30 pounds since moving here, and plan to find a way to continue to get back into good health. My *final* frontier, but a kicking body? Likely not.

So, in short, we *can* have it all, with a little help from our husbands, family, friends, and by standing up for ourselves and finding a position that allows us to fulfill our calling as a physician and still tuck the kids into bed most nights of the week. Every woman on this board has achieved so much, each of us in our own way. We've done it all, and so can you.

No balance on the crazy train

I must admit, work- life balance is something I lack.

To be honest balance was a problem for me before marriage and children- well before earning my MD and before I took on the responsibility of caring for extremely sick patients.

I can remember in high school rushing home from basketball practice to work on the lay-out for the school newspaper. With copy and photos spread across the dining room table I would stay up all night long until it was perfect. In college I would sometimes sleep in the laboratory in order to run experiments, even on the weekends. Because of the fear that my work would not be good enough this super human dedication provided comfort that at least I would not fall short in effort. My extreme personality served me well in residency and fellowship, and I excelled.

This is my nature, and honestly this behavior had some consequences. Over the years I learned to accommodate or “tone down” these tendencies. In personal relationships, I realized my expecting perfection was alienating (and annoying). I learned that diversification was necessary to achieve balance, so I included exercise and relaxation in my schedule. Over the past few years I recognize that these changes are working for me. I find that I am happier and more effective through letting go, and exercise continues to be a good outlet for stress.

Fast forward to now, and although a recovering perfectionist I constantly battle feeling overwhelmed and exhausted. Right now I am not working, at home with my 6 week old son. I am determined to use my return to work as a fresh start. I have been soul searching trying to figure out what changes I need to make. This is difficult. One obvious problem- I am not working at all and still feel exhausted and overwhelmed. Not unusual for a new mom, and expected based on the irregular sleeping schedule. But as I review my spiral notebook full of lists I have created…… feeling frustrated that I am unable to make much progress on the multitude of tasks…. I wonder if this is hopeless. It is a similar feeling that I experience when working, with so much to do and unable to achieve the momentum to get to the bottom of the list.

Seriously I need help. From others I know that the first step to work life balance is learning to say no….. but why is this difficult for me? My problem is not saying no (I can be really tough when necessary), my problem is being able to discern what tasks are valuable and which are not.

Examples:
Tasks that are not fun or productive but nonetheless necessary: Just because it feels like drudgery does not mean that it can be skipped.

Tasks that cannot be left undone (someone else must be found to cover): I would rather not do it, but is it worth the trouble to finding someone else? Maybe I should just get it finished already.

Tasks that are opportunities with potential strong upside: These are the easiest to say no to (many of my male colleagues would jump at the chance) but why must I pass on opportunities that I have earned?

With reflection and soul searching I realize my old tendencies are possibly still at play here. That an underlying personal expectation for perfection and fear that my work would will not be good enough still plagues me. I am afraid it is true, and despite significant personal and professional achievement I still rely on external measures of success. I now believe that this is at the heart of the matter. I hope this is the beginning of my next personal transformation…… but still at a loss for how to overcome this hurdle.

I figure that I am not alone- for the ability to withstand numerous years of training and tolerate long hours must commonly be motivated by similar ‘dysfunction’. What is the secret to better discernment? Any advice from those who already figured out how to disembark the crazy train, or from others riding along with me?

Managing Expectations

When I opened the email from KC saying that we were doing a topic week on “work- home balance” I laughed out loud. That particular day, I had failed miserably at achieving any kind of balance in my life. Poor scheduling had put me, once again, working through lunch, not giving me time to eat. I was not on call, so when I went in to tell my labor patient I would not be able to be at her delivery, she broke out into tears, begging me to stay. Home only briefly, I then had to run out to a friends Christmas party that I had promised to attend. A crying child had to be peeled off my leg, “Mommy don’t leave!” as I sneaked out the door. Arriving at said party late without a side dish, I realized I had forgot that it was pot luck. I mingled briefly, feeling guilty the whole time, then headed back home, to tuck in kids and finish editing a journal article that I had gotten at least 10 e-mails on that day (MUST FINISH ASAP!). Crashing into bed much later that night, I apologized to stay-at-home dad/husband for the week of extended hours. His answer was quite profound, “You really need to learn to manage your expectations .”

Luckily that day was the exception and not the rule. I think most days I do a fair job of finding balance. His advice was good though, communication and managing my own expectations for how much I can do is key. I am not superwoman, neither do I want to be.

So, in addition to his suggestion; here are some examples of how I try on most days to implement balance.

1. Schedule exercise. I am sure that one of the things that keeps me sane is that I exercise 3-5 times a week. I work out my frustrations on the treadmill and lap pool instead of my coworkers. I don't however routinely train for races, because this takes too much time. I would like to do a triathlon in the next couple years, but I want to plan ahead for a time when I won't have other projects looming.
2. As soon as you can possibly afford it, hire a housekeeper. This is not a luxury. I put this off way too long.
3. Communication. My husband and I have our phones synced with our home calendar, so any event goes immediately on the schedule. We’ve also started a weekly “team meeting” where we talk through our schedule and expectations for the week. You can also come up with code words for naughty things to put on calendar :)
   
4. Schedule. As my practice has gotten busier I have had to become more strict with my scheduling, for my own sanity. Previously, I would do surgeries or schedule patients during my lunch hour “if it was more convenient for the patient” or “if there were extenuating circumstances”, however these situations became more frequent over the years as my practice got busier. A few months ago, I ended up with surgery scheduled at lunch every day for 2 weeks straight. I re-evaluated my schedule. I realized that eating lunch and sitting down for 15-20 minutes a day was a necessity for my sanity.
5. Prioritizing socialization. I think this is where I feel like I fail the most. I manage to over-commit myself socially and at the same time, still have trouble keeping up with my friends.
6. Spend at least one day a week with the kids with no other distractions. In our house, this day is usually Saturday. Our kids are not overly scheduled. They will occasionally want to participate in activities, but not usually year round. I try to spend one day a week home with the kids, just hanging out and having fun.
   

Now as far as residency is concerned, balance is not always possible. Maybe for some of the residencies that don't require as much call, it may be more possible, but for OB/Surgery/Ortho residencies, its all about survival. You work, and when you 're home, you spend every moment with your kids that you can. That's all I remember, it was a giant blur. It was worth it, though, to be able to do what I loved, but those were years of sacrifice. When it was time to practice I chose a family friendly location and made it work.

My main source of balance comes from the fact that I have such an amazing stay-at-home dad/husband. (I wrote a full post on this in the past, for those commenters who were requesting more information on the topic). This year, in addition to the new baby, he has started a part-time business from home, which has presented its own challenges for us to find balance. Overall, he still does the majority of shopping and childcare. Our relationship is stronger than ever, and I respect/love/adore him more and more every year. I do feel the weight at times of being the sole provider, and I think this leads to overextending myself with my work schedule.

The key becomes realizing that the nature of medicine means that you won't have balance every single day, and that's OK, but you must have some sense of balance overall.

Walking the Line

I’m not just a mother in medicine, I’m a divorced mother in medicine. KC pointed me to Michelle Au’s blog, the underwear drawer, which I follow. She’s married to a physician (I was) , and was kvetching recently over her spouse going to a meeting for a week, leaving her alone with the kids. She lamented over the missed support, and wondered how single moms do it.

Would you believe it is easier for me, as a single mom? That doesn't speak very well for my marriage, but if it worked, I wouldn’t be where I am today.

I have grown so much over the past year, since my separation in February and divorce in September. I have come into the financial light, which hasn’t been easy, but ultimately oh so empowering. For the first time in my adult life, I am not house poor, and not dependent on another to tell me how and if I can spend money. More importantly, I have slowly progressed from a state of mental fragility to one of mental health. I’m not entirely there yet, but my perspective of myself and my surroundings is less tenuous. The highs are not as high, but the lows are not so low. I feel even and grounded. This has to be good for me and my kids.

I hired a sitter to pick up my kids this fall and carpool them around to various activities – something I can see that I needed to do for a long time. Over the past couple of years I was picking 6:00 activities that I could try to do myself with the kids and it was stretching our evenings out way too long. The last thing I need to be doing at the end of a busy day is carpooling them around to swim practice until 7:00 at night. Evenings and meal times were horribly stressful, and bedtime was rushed and, well, not fun. My kids are still only five and seven. There will be time for all this later. This fall the latest activity ends at 6 – and that is our rough day –Wednesday. I’ve managed to squeeze in more cooking and reading at bedtime.

I have less ancillary hired help than I have had since the birth of my daughter, and my house is more clean and organized than it has ever been. It feels warm and homey, instead of cold, stark and empty. I get to create what I want, when I want to. Drag out bedtime reading extra chapters until 8:30? No problem. Let my son crawl in bed with me at 4 a.m. after a nightmare? No big deal. Reading in my bed late into the evening? A luxury I have missed for 13 long years. When I am home with the kids, I get to focus on them entirely. When they go to bed – I focus on myself and my needs. This feels incredibly self-indulgent and wonderful, after years of a marriage that wasn’t working.

My seven-year-old Cecelia sometimes asks me, “Mommy, why can’t you stay home like so-and so? “ She sees the difference. But I love my work, and now that I am divorced, staying home is not an option for me. Even if I was still married, I don’t think I would do well without it. When I first got married back in May of 1997, I had three months without work/school before I started med school in the fall. I degenerated into a couch potato Lifetime addict. Remember? A Baby Story. A Wedding Story. I knew them all. It was sad and ridiculous. My now ex made me promise that I would always work or be in school, he was so fed up with my inertia. Having kids is different – much busier – but when I was off with them for nine days over Thanksgiving, despite the fact that I managed to squeeze in 24 miles of running and 10 or so of biking, as well as numerous wonderful kid memories, my mind still turned to mush and I was itching to get back to work. I do better on a schedule. I have difficulty self-imposing one. And I love what I do – I wouldn’t be the same person without the daily intellectual challenges that pathology provides.

God I worried so much last year (was it only one year ago?) about the drama I would create – my ex and I work at the same hospital. But drama can be controlled, to a large extent, by how you react to it. No reaction often kills it. And it is quite amazing to learn that when you are the subject of gossip, you are somewhat immune to it – as if in a bubble. Like the eye of a hurricane – no one really questions you directly so if you choose, you can be a non-participant. I chose. It worked. It’s finally over, and it was relatively painless, compared to the struggles in my marriage. The year of counseling time we put in at the end has helped tremendously – not in friendship, but certainly in team parenting. He has gone his separate way – I don’t communicate with him at all except in regards to the kids. Our level of civility now, only three months after divorce, is pleasant. I hope it continues.

For the first time in many years, I feel somewhat normal. I am grounded in reality, not mired in fantasy. I am a part of the equation – no longer lost. My work-life balance is exactly where it needs to be. Now that I am a partner, I can choose to relinquish work and money for time with the kids, to create more balance. I finally feel like I am in control. I love being a mother in medicine. That is enough, right now. I’m certainly not an advocate of divorce. But I am an advocate of happiness. I feel like I’m finally getting there.

"Perfect" is the Enemy of "Good"

Over the years, I have come to the painful realization that I am not perfect.

OK, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don't read this, patients, because you wish even more than I do that I were perfect (especially when I'm operating on you). But it's true.

Long ago, I remember feeling that perfect was achievable. In my innocence, I pictured myself with a high-flying academic career in a big city neurosurgical teaching program. I would have a handsome husband with a powerful career of his own, 3 perfect children, and a home straight out of Southern Living. (I even subscribed to the magazine.) Of course, I would need no help taking care of the house, because I would do it all myself. I would have no surgical complications, and every patient would love me. I would be Harvey Cushing and Martha Stewart, all rolled into one!

I think it began to sink in that this was a little unrealistic just before the start of residency. My husband and I had just returned from our honeymoon. I had left myself 4 days to move halfway across the country and set up housekeeping before our first day as interns. With one night left, I found myself staring in horror at boxes still sitting implacably all over our new house. Yikes!

Through our years in residency, we added a baby and a hefty dose of realism to our lives. Thoughts of Southern Living fled from my mind. Indeed, thoughts of homemade baby food, beautifully decorated nurseries, and hosting book and supper clubs also vanished. I felt lucky to keep the bills paid on time, the vaccinations on schedule, and the house clean enough to walk through (with my husband doing a lot of the work himself). Despite all this, we both somehow made it through residency with our marriage intact.

Now it is more than 15 years since that idealistic, newly married intern walked through the door of a new life.

Looking back, I'm proud of much that I've accomplished. I have a thriving practice and a family that seems pretty well-adjusted, despite all the gruesome patient stories told over the dinner table. I'm a lucky woman.

I'm not so proud of how I've balanced work and family over the years.

Anyone who goes into a demanding surgical subspecialty knows what it will be like. There will be sacrifices and long call nights. There will be stress and (yes, Fizzy) tears. There will be time away from family. Anyone who loves a surgical subspecialist knows this, too. My husband knew this when we started dating in medical school. But he also knew how much my career meant to me. He knew I wouldn't be happy without it. He married me anyway.

The decision to marry this wonderful man has been the saving grace of my life. He has done so much with so few complaints. In an culture that is still macho in many ways, he has done a lot of laundry and a lot of childcare. He takes our son to school and picks him up. He helps with homework and goes to pediatrician visits. He has been the hands-on parent where I have not. Without him, our family would have disintegrated.

Not that I haven't done anything, in my own defense. When I'm not at work, I'm all about home and family. I have made it to every band concert and the majority of my son's sporting events. I actually made it to every single football game this season, even though they were on Thursdays. For several years, when my son wasn't eating well, I made dinner from scratch almost every night. Some nights dinner was late, some dinners were frozen from earlier weekend cooking sessions, but they were done. I supported my husband when he wanted to make a radical career change, without questions or criticism. I have tried. I have tried HARD.

But I admit, I have spent long hours at work. Because I'm busy at work, I don't fully appreciate the long gaps they feel at home. And I admit, I have taken my husband for granted a lot, which is wrong. I have leaned on our marriage hard, drawing strength from it to keep doing this incredibly difficult job. I worry sometimes that I may have weakened it too much.

Almost exactly a year ago, I wrote an anguished post here about a day in my life. Seeing it in writing and hearing all the feedback made me see that I had to have better control. Since then, I have worked very hard on finding a better balance.

I have now hired a cook to come to our house and make dinner every weeknight. She does the grocery shopping and some of the cleanup. That may seem pretentious, to have a private cook, but it's worth it to me. We also have housekeepers come twice a month, but this is not new. I have hired another physician who helps me with the patient load in the office (although not in surgery). I have committed to taking a big family vacation every summer and every winter (at least a week and a half). I spearheaded hiring a new practice administrator, who has done such a good job that I no longer stress about every detail of running the office. Things are better, although the patients are no less sick, and the job is still demanding.

I now have a Facebook page that allows me to communicate with friends and family more efficiently. My husband and I had our first "date night" last month - dinner and the new Harry Potter movie. It was wonderful and relaxing. We plan to do this every month now.

I actually asked my husband and son what they thought about my work-life balance to get their perspective for this post. Those two peas in a pod both looked at me blankly and said, "What balance?" We all laughed, and I sighed.

As I have finally admitted, I am not perfect. I am, however, doing my best. They know how much I love them, and they know I am trying. We have a saying in surgery: "'Perfect' is the enemy of 'good'." I don't want to be Martha Stewart Cushing anymore. I just want us all to be content.

Next Topic Week on MiM: Work-Life Balance

For the last Mothers in Medicine Topic Week of the year (the week of Dec 13), the topic will be Work-Life Balance. For the new readers out there, topic weeks are weeks devoted to one topic only, and guest posters as well as regular MiM writers are welcome to contribute posts on the topic. (These started out as Topic Days, but with sometimes as many as 12-15 posts, it got to be a bit much to cram into 24 hours.)

For our Work-Life Balance topic, anything related to the topic is fair game. How we each define/measure/struggle/negotiate it, times in our careers where it was the most/least struggle, strategies we use to achieve it, its importance to us, perhaps what we've done in the workplace to facilitate this for everyone else, etc.

Readers, please submit your posts, if so inspired, to mothersinmedicine@gmail.com. These can include questions to pose to everyone else, as well.

(See sidebar links for previous Topic Days/Weeks)

Hope to see you next week!

Fourth and final

The immediate, unmistakable second pink line on the test laid on the bathroom counter - oh, the power of that pink line. The possibility that it stands for, the hope for a healthy pregnancy and a perfect newborn and another loved child. One slim line that releases a cascade of happy plans.

And yet, personal and professional experience with pregnancy loss have primed me to assume nothing. I'm expecting strikes me as presumptuous. And so I am not expecting. But I am pregnant.

On discovering I had conceived, I was overwhelmed by the sense that this was obviously grand work, this close involvement with birth, and briefly, all else looked anemic. I am thrilled, at least as much as I can remember with my other children. It doesn't feel commonplace; my previous experiences - good and bad - make it that much more meaningful. It's been almost five years since Ariana was born. This me, the 36-year-old mother of three, physician to refugees, living in Deep Cove, has never been pregnant.

I first felt the baby move at sixteen weeks: a soft swipe, a sliding sensation. Then the movements changed to knocks, small thuds, bumps and turns. I often lie on the couch, pants unbuttoned, both hands on my belly, waiting for baby to buck and shift; its solid presence can take my breath away.

I'm 27 weeks, 3 days. I have a globe of a belly, a baby cardigan on the needles, three very pleased children and a non-stop pace at the office that keeps baby rocked to sleep most of the day.

I'm in no hurry to progress. Right now, everything is as it should be.

what's your own "wikileaks" moment?

Have you had anything leak out about you that you hadn't intended? Something your colleagues found out that you had wanted to keep personal. Or something your significant other, kids, family found out about you? Or are you a wikileaker yourself??

One of mine, albeit minor, occurs whenever anyone finds out I was a cheerleader in junior high school. Whoops, there, it's out. Though I am surprised and kind of proud that my feminist mother and egalitarian father "allowed" me to be a cheerleader... cringing as they both must have been until I found tennis. I think about all this anew with my own daughter.

Oh, and future wikileaks on my horizon, when my kids find out I drink a LOT of diet pepsi.

MOC, SAMs, and CME, Oh My!

Maintenance of Certification is a veritable alphabet soup.

I vowed not to blog for a couple of weeks, because I have lots of SAMs to catch up on at night by December 31st. Self-assessment modules, that is. You see, in the age of MOC, it is not enough just to go to conferences and perform the CME (Continuing Medical Education) that has been required by pathologists throughout the ages. I was part of the lucky class to be the first group required to participate in MOC. Maybe in other fields MOC has already been in place, but in pathology it just started four years ago. So now, as a part of CME, we have to find and purchase activities that mandate a pre and post test. Not only that, but we also have to get peer reviews and prove that we are part of a QA/QC (quality assurance and control) activity at our hospital. I haven't figured out exactly how to do that yet, but as the head of microbiology I do attend the QA/QC meetings once a month so I am hoping that will do.

Luckily, SAMs were waived for the first three years, because they were not well set up or readily available. I spent about three hours on the computer last week searching for, and paying for SAMs activities. I have to read 10 journal articles from a respected path journal and pay (did I already mention the pay?) to take pre and post tests.

I was sharing my finds with my co-hort who is a year behind me today, and lamenting over the fact that each module took at least half, if not all of the hour of credit that I received at the end of the testing. Aside from conferences, I am used to these CME activities that my group participates in taking a mere fraction of the time rewards doled out. You know - 20-30 minutes for 5 hours. Another one takes about an hour for 10 hour credits. Now I need to spend about an hour a night to get all caught up by the deadline. Don't get me wrong - I think keeping up with one's field is paramount to being a good professional, I just resent being forced to do it someone else's way and document it meticulously. For me, it takes the fun out of it.

I am currently collecting documents for Phase 2 of reporting. I completed Phase 1 a couple of years after passing my general boards. I had a heart-stopping moment this summer when I received a call from the American Board of Pathology. It was August - I had just sold my house, had six weeks to find another, and was facing the same time frame until my divorce trial. The intercom went off in my office.

"Dr. Shyder, you have a call from someone from the American Board of Pathology. Do you want me to put them through?"

"What? The American Board of Pathology?" At first I thought surely it is a hoax to get me to talk to some salesman. But if it was a trick, it was a new one. I asked her to put them through.

"Dr. Shyder, this is so-and-so from the American Board of Pathology. You were supposed to report MOC for your fellowship at the end of January. We have been trying to get in touch with you by e-mail for months."

"Oh my gosh! I've had a rough year. I'm usually really good at keeping up with these things, I promise. What does this mean? Is my fellowship license in jeopardy?"

She seemed amused, but reassuring. "No, we just need to update your professional e-mail address." I had accidentally given them .edu instead of .org. "Then you have to fill out a form requesting combined MOC reporting for your fellowship and your general boards, fax it to us, and nothing will be due until the end of the year."

Whew.

Anyone else have any MOC headaches to share? I'm not looking forward to the board-like exam in six years to continue my AP/CP (anatomic and clinical pathology) board certification. Luckily I do it all at my job - I can't imagine how hard it would be if I had settled into a national lab job reading only GI biopsies or pap smears. But still - combined boards was hard enough when I had just completed my residency and was used to stuffing massive quantities of numerical and graphic facts into my brain like what platelet aggregation patterns flag Von Willebrand's disease vs. aspirin effect and the numerical likelihood of a unit of blood containing different transmissible diseases. Now, if asked to interpret these tests or dole out this information, I can just look that stuff up - I've got it at my fingertips. I sure hope the MOC boards are open book.

Ode to Mulan

I hate the movie Beauty and the Beast.

We recently retrieved the movie from the jaws of the Disney Vault. I think I liked it the first time I saw it, when I was a kid, but this time it just left a bad taste in my mouth. The music is good, I suppose. But Belle is so annoying. What a horrible role model for girls. Here is a woman who is "smart" because she reads books about princesses falling in love, and has absolutely no aspirations of her own to accomplish anything.

Yes, she wants to leave the town she lives in. And true, she doesn't want to marry the arrogant jackass. But the joyous ending for her is just falling in love with some guy who isn't an arrogant jackass (anymore). Who appears to only like her because she's pretty. Plus she does nothing to help him when he's fighting the bad guy... aside from loving him, I guess.

My daughter has a bit of an obsession with the Disney princesses, as evidenced by the drawings on her underwear, so I can't help but notice that all the movies are like that. Ariel and Jasmine are spoiled little brats. Cinderella falls in love with a guy so generic that he doesn't even have a name and is merely defined by being "charming." It's kind of sickening.

That said, I love Mulan.

We just rewatched it as travel entertainment, and each time, I like Mulan better. If you've never seen the movie, it's about a Chinese girl who poses as a male soldier so that her ailing father is spared joining the army. She completely kicks ass as a soldier and there is only passing mention of her romantic interest in her commander.

But you know what I really love about that movie? Not that Mulan kicks ass, but I love how in the beginning, she sucks at everything. She is terrible at every part of training, and her only comfort is that everyone else is equally terrible. I totally relate to Mulan! Granted, she gets really good within the span of a two minute training montage, but I still like her for it. And I love that she continues to doubt herself until she finally gains confidence in the last sequence.

I think it's such a great movie to show to young girls. Every time my daughter watches it, I want to yell, "Isn't she awesome??!"

Does anyone have any other examples of movies we can show our daughters to inspire them not to turn into whiny brats ogling some handsome prince?

I am Tired but Addicted

I started medical school at 28 with 3 little kids who were 5, 3, and 10 months at that time. I had energy to take care of home, husband, kids and study. I made it through residency with a few more gray hairs but was for the most part enjoyable. I had avoided the more strenuous and time consuming residencies because I wanted a family life, which I have truly loved. Then I paid back my time to the US Air Force and life got a little more stressful.

I am not sure if it was the lovely combat boots, the ever changing rules, the fact that I did not have control of my time or travels or the facing a young mother who was about to leave her young infant for a year long deployment. This takes a lot of “brain and heart” energy that I sometimes do not want to expend. I find myself feeling guilty over this but my husband, kids, family and friends need me to be “fully there” also and at times I am just emotionally and mentally spent.

Now as a civilian a typical day may consist of dealing with a depressed cancer patient and their stressed family members, a concerned mother worrying about her obese child, a middle aged woman with vaginal bleeding after menopause, a hypertensive diabetic patient with an oh by the way I have chest pain, or the patient who has lost their job and will soon be homeless and the list goes on and on. Between discussing odd symptoms, rashes, patient comments with colleagues, pouring through online and print resources and cramming the newest medications in my brain…guess what…I am worried about my patients and exhausted at the end of the day.

My weekends take me away to a place without the stresses of patients’ needs but amazingly enough my thoughts always go back to a patient or two. I find myself thinking of a new strategy to combat their hypertension, a positive word I can say to the worried mom, or make a mental note to call a patient on Monday morning to see what the specialist said. So, even though I am tired I cannot pull myself away from the things I love…family, friends and medicine.

I have yet to decide if this line of work is healthy for me but it certainly is addicting and for the most part enjoyable. I certainly pray a lot more these days than I did when I was younger with fewer responsibilities and more energy. I have learned and changed so much from my patients I can’t imagine who I would be otherwise. So as I walk through my day I must remember to take a deep breath, and enjoy these patient doctor moments because I will never be the same.

Thanksgiving Is For the Birds

As a child, I was the pickiest eater on the planet. My seven year old daughter, Sicily, rivals me.

I hated Thanksgiving - large family gatherings with tons of pressure to eat foods that freaked me out. I did not like turkey (still don't, much). I didn't like mashed potatoes. The combination of sweet potatoes and marshmallows was and is nauseating, to me. I couldn't touch green beans with almonds and fried onions. Any form of vegetable casserole scared me. The only cranberry relish I have ever enjoyed, and this just came with adulthood, had a boatload of jalapenos involved. The only pie I have ever craved had the words key lime in front of it - no pecan, sweet potato, or pumpkin for me - they were and still are as frightening as the vegetable casserole. Stuffing smelled good, but the inevitable discovery of a stray caraway seed in the sausage or a sliver of green onion ruined the appeal and I was left with the one food on the entire smorgasbord I was able to stomach - the roll. With lots of butter, of course.

As I grew older I learned to place a variety of foods on my plate and sample each one to the point of politeness, but have never stuffed myself to the fullness that seems to embody the holiday. Watching sports for the rest of the day? Yuck. I'd rather clean out a toilet with my bare hands.

So you can imagine my delight during the summer vacation Russian Roulette scramble when, for the first time in my three years of private practice, I missed out on Christmas week, New Year's week, and even Spring Break. Thanksgiving was still open, and loomed over my head for a couple of rounds until I finally decided, why not? My kids are in private school, so Monday and Tuesday were just daycare - an opportunity ripe for spending one on one days with each of them while the other got to play with their friends. When you are a single mom, one on one time is a lot harder to come by, and the kids ache for it.

So here we are - a few days into my week off of my most detested holiday of the year. And surprise! We've had a blast. The kids loved picking out their afternoon activities - mornings I engaged them in running errands with me. On Monday Jack was a perfect gentleman helping me out with groceries and dry cleaner clothes. He's really stepped up in the last few months and enjoys being the helper in the house - one afternoon when I first moved to the new house a couple of months ago I was cooking dinner and turned around to find him consulting the picture instructions for putting together a vacuum cleaner I just bought. He amazed me by getting all the small parts in the right place and plugging it in for a test drive without any cries for help.

After our errands we went to buy new shoes and finished the afternoon at the movies. Sicily's day on Tuesday was equally productive - we spent the morning getting together bags from the attic boxes for Goodwill and the afternoon shopping for tiny Christmas trinkets for her and Jack's classmates. Managed to squeeze in a little shopping for her - there was a 40% off sale at her favorite store.

My ex has the kids for Thanksgiving this year - it's all spelled out in the divorce papers. I worry a little about Sicily weathering the food pressures on her own but at seven she's already got more backbone than I ever had at thirteen. So I think she'll be OK. We've got a fabulous brunch filled with all their favorite foods at my Mom and Dad's on Friday, and full weekend plans with friends.

Thanksgiving. My big holiday this year. The most detested *gasp* turns good. Who knew?

Happy Thanksgiving!

Cry baby

In a previous post, I make a comment about how I sometimes (frequently) feel tearful when I'm on call. At the risk of putting myself out there, I'll admit I've definitely cried on call before. A few of the events that have pushed me over the edge:

--My senior resident telling me at the end of my 30 hour call that even though I was off duty, she expected me to go watch my patient get a colonoscopy. ("It might be painful, but you better go because it's worth it for your education!")

--Spending 14 straight hours rounding on 70 patients on a Saturday and finally getting home, only to immediately get called back to the hospital for chest pain the patient had been having all day and decided not to tell me about.

--After an entire afternoon of coding a patient multiple times and finally agreeing it was hopeless, when the nurse said, "The patient's daughter wants to hold his hand as he goes."

After a while, I got a little better at holding it in till I got to my car, where I'd really let loose.

When I mentioned my frequent tears in a previous post, I think a few people may have called me "emotionally unstable" in the comments or something along those lines. All I have to say to that if that's the case, there are a hell of a lot of emotionally unstable med students and residents out there.

Of the residents and med students I've worked with, I've gotten to see a lot of them cry. In my intern year ICU rotation, I saw practically every female resident working there cry at some point. My senior resident cried when she realized the next morning that she missed a pneumothorax (wouldn't have mattered). She also cried when the coroner yelled at her post-call for incorrectly declaring a patient. I even saw the "badass" senior resident on the team crying one afternoon.

In med school... wow, it happened a lot. After exams, before exams, just randomly in the locker room. I remember during my surgery clerkship, we were having a workshop on tying knots, and one student was having trouble with her knots and burst into tears. I still remember what she said: "I don't even feel that sad. I'm just SO TIRED."

I guess my point is that you shouldn't be made to feel like an emotionally screwed up freak if you cry at some point (or multiple points) in your medical training (or beyond). Unless, of course, you're a man and you cry. Then you're weird.

(I have never once seen a male resident or med student cry before. I wonder why that is. Do they just not feel it or are they better at holding it in?)

Guys Do It All the Time

When I first saw him, I’m pretty sure I let out an audible gasp.

It was love at first sight.

As I approached, I began to get goose bumps.

Could I really be thinking, what I was thinking.

Married, Doctor-moms, in their mid-thirties shouldn’t do such irresponsible things.

But, I couldn’t help it, it just felt so right.

Then his intoxicating scent hit me….a perfect blend of leather and new car smell.

As, I sank into those beautifully stitched seats and took my first test drive, I was officially smitten. He cornered like he was on rails and his torque sent my stomach into a tail spin.

Then I had to break the news to my husband.

Honey, I’m buying a new Camero. A ruby red Camero with leather seats and a kick-ass radio.

Really my husband says? That doesn’t really seem like you?

I know. That‘s why I want it.

Don’t you want a Honda Odessy like all your friends?

No.

We already have an SUV for hauling the kids, so my car essentially drives me back and forth to work which is only 5 miles. I was not even considering buying a new car until mine literally got washed away in a natural disaster*, giving me only days to find a new one. In the past I’ve always carefully researched for months which slightly used car was the proper choice, then proceeded drove it forever. This time, I didn’t have the luxury of months to pour over Consumer Reports, so I just went with my gut.

In the grand scheme of things its not that big of deal what car you drive, so why not have fun with it?. Really, in the words of Mindy McCready, “Guys Do it All the Time.” Most of the Orthopods at my hospital buy a new European sports cars every few years. I spent about a third as much. Hey, I’m just doing my part to help stimulate the economy.

Let me just say that our relationship has flourished. I LOVE my car. It’s a fun escape from my real world. For 15 minutes twice a day , I am no longer a suburban soccer mom, I am the cool kid; the race car driver; the rock star; maybe even the homecoming queen. I am one with the road. I find myself taking the scenic route home , soaking in the sights. Enjoying the purr of the motor as I drive through the country side.

So, I have a new man in my life. Perhaps I am having a little midlife crisis as my mom has suggested.

I don’t really care though, cause my new car is Bitchin’.

*In all seriousness, please take a minute to look through the pictures in this link. Though, mostly ignored by the national media, the Mayday Flood of 2010 was absolutely terrifying to live through.