Mothers who lie

Okay, someone I hold in high esteem (basically one of the most intelligent women I know) is a philosopher by profession and recently wrote a chapter in a book. But not a chapter in a book that is too hard for us non-philosophers to read, but one we can all get into. I wouldn't say it is dumbed down, but just that it is very readable. It essentially delves into the philosophy of motherhood. Please believe me that this is not a "buy this book" post (no link to Amazon here); I'm telling you the truth. And therein lies the issue. That's what it's about. The chapter is entitled "Lies and the Lying Mothers Who Tell Them." With proper mention of Kant and Bok and Augustine and Mill.

What lies have you told to your children, as a mother and/or as mother in medicine? Perhaps some creative mothering? Maybe:

• If you jump on the couch that way you will crack your head open.
• That's a beautiful drawing.
• Your little brother did it by accident, I'm sure.
• You will grow nice and tall if you go to sleep right now.
• It's very late.
• The tooth fairy _______ (fill in the blank).
• Don't touch that! It will make you sick and you will have to miss your party tomorrow.
• You will literally turn into macaroni and cheese if you have that for dinner again tonight.
• There are no monsters upstairs in your bedroom closet (okay, that one is true), but if you don't get dressed right now they might start wearing your clothes.
• We are leaving this store right now.
• This won't hurt.
  
• I'm almost done (with this email, post, tweet)
• I'll be home soon.

Is it okay to lie to your kids? Is it for their benefit? Wishful thinking? For the greater good? What lies have you told to your children, as a mother and/or as mother in medicine?

Happy Mother's Day

My Mother worked.

She spent her formative years in the convent to escape a rough home environment, and became a nun.

She left the convent in her early 20's and worked three jobs, including running an EKG machines, running errands for a lady in exchange for a room near her college, and working in a cafeteria at the local University where I eventually went to medical school. These jobs, in addition to a scholarship, helped put her through nursing school.

She met my Dad while dishing up grubby fare in the cafeteria line. He was in medical school. She likes to joke that she divorced God to marry my Dad, but really the timing wasn't right. When she came down to Arkansas from the convent in New York to visit her Dad (she quickly discovered in her 20's that he hadn't changed much in being able to offer her support), she couldn't get bus fare back to New York, and never got an answer when she wrote them for help. So she wrote to a local college instead, detailing her desire to be a nurse, and they hooked her up with the aforementioned jobs.

After going through nursing school, she took various jobs including helping organize and run free clinics, becoming the director of nursing at the Health Department, getting her masters in Public Health, doing school nursing, and eventually volunteering her skills in orphanages in Russia and Thailand. Did I mention I am the oldest of four children? My sister has her P.A. in anesthesia, my brother has a Ph.D. in food science, and my youngest brother is finishing law school at the top of his class. Needless to say, none of us were neglected.

Today she is a proud grandmother of four and devotes her time volunteering and traveling around the country visiting her four kids and grandchildren. She also keeps my Dad in line - he is still working as a neonatologist and when she leaves town all the flowers in the house die, the food pantry becomes appallingly stark, and he becomes a recluse (no offense, Dad!). We call her Babcia, the Polish word for grandmother.

I hope I am half the Mom to my kids as she is to all of us, and can touch half as many lives as she has throughout hers - I would then be more than whole.

Happy Mother's Day to all!

Twitter to Tenure: My (parenthetical) story

I'll soon be heading to the 2011 Society of General Internal Medicine's annual meeting. As prelude to a workshop called "Twitter to Tenure," I, and several fellow academicians are blogging about how social media has helped our academic careers. See bottom of post for the other posts in this series. And if you'll be at SGIM, please come and say hi!


If I had known that starting a personal blog in 2006 would eventually result in such great things for my career, I would have started one a long time before that. The truth is, I was simply trying to capture the moments of new motherhood that I didn't want to forget. (Also, before 2006, I was like, what's a blog?)  In the process, I unknowingly set wheels in motion that would eventually help shape my future personal and career pursuits. (Bonus!) This is what you call a win-win. Win-wins in life are the best.

Writing leading to...
In my early days of blogging, I posted feverishly, to my 3 readers, one of which was my husband. We're talking practically everyday (I sigh when I think about how much more time I had when there was only 1 child to contend with). In the process (of talking to those 3 people), I developed my writing voice. It became like nothing to write a post- I could whip one out in 5-10 minutes, honing my story-telling, organization and my writing got better. (Please do not use this previous sentence as an example.) Malcolm Gladwell talks about this 10,000 hours phenomenon to achieving excellence in anything--I haven't come close to that but blogging so frequently was a start.

Writing opportunities...
An amazing thing happened in the midst of blogging feverishly (now over 3 readers): people found my blog and offered to pay me to write about parenting --humor writing. Paid! To write! This was a huge boon since it felt like I was an actual writer who could (occasionally) make people laugh. Meanwhile, the blogging (on multiple blogs now) continued, more hours under the belt. I networked with other bloggers, went to blogging conferences (after at first scoffing at them--who would go to a blogging conference??? Lame. I've realized, since, how much I love eating my words, or at least, embracing being lame.). I am not sure when my affinity for using parentheses developed.

And medical education applications...
I now appreciated what blogs could offer (discussion, community, feedback, support, to name a few) and while studying adult learning theory and the theoretical underpinnings for reflection in medicine, started a reflective writing blog for internal medicine clerkship students. Students' writings blew me away as they wrote frankly (amazingly frankly) about professionalism, doctor-patient relationships, empathy, and the struggles and anxieties of being a medical student. This led to workshop presentations at conferences, a paper in an academic journal, and networking with some pretty awesome collaborators.

And research....
Having had a blog where I occasionally mentioned issues that I saw in the hospital, as well as developing a (vaguely, on good days) humorous writing voice, I could appreciate the line that physician-bloggers had to manage between privacy, humor, disclosure, and professionalism. I became interested in the intersection of professionalism and physicians on social media and had an idea for a study on medical students and unprofessional online content. I also got involved with other forms of social media - Facebook and Twitter - and more ideas for studies came. This research has led to plenary talks, media interviews, grand rounds invitations, national conference workshops, and has defined a career path. Not to mention it's just fun to do these studies. Note: I would have never imagined I would be doing research when I was a resident! Thoughts of doing research in the past had always been accompanied by images of pain and suffering, like having a fork stuck in an eye.

And staying up-to-date with news from my field...
I've become a Twitter convert, thanks to Twentors (sorry) like Vinny Arora, an amazing academic rock star and Star Tweeter (ST). It has become my go-to source for breaking news and keeping up with my areas of academic interest --medical education and social media in medicine. I do not follow anyone like Paris Hilton ("I'm sooo tired! Need a nap!"), and instead follow those who have similar interests (as me, not Paris--pretty sure our interests don't overlap) or provide interesting perspectives and links. See Vinny's post for more resources about how to use Twitter professionally.

And Mothers in Medicine...
And of course, blogging led to the birth of Mothers in Medicine. Enough said.

So, social media has been good to me. It might also be good to you too.


Also see the following STs:

Alex Smith's (@AlexSmithMD) intro post on Geri Pal.
Vinny Arora's (@FutureDocs) post on FutureDocs.
Bob Centor's (@medrants) post on DB's Medical Rants.
Eric Widera's (@ewidera) post on Geri Pal.

Patient Negotiation

Over the course of any given day I sometimes find myself either pleading or negotiating with patients to take steps to improve their health. Am I the only one who has found this to be the case? It is becoming increasingly frustrating. Sometimes I just want to say, “Listen, you came to me for help. I am telling you to do ____ it is up to you to do so. Please feel free to come back when you are ready to listen to the advice you paid for."

Sometimes I think parenting has prepared me more for medicine than medical school. Raising teenagers has taught me the skill of listening and then collaborating to reach an agreement without inciting a rebellion. These can be tricky, shark infested waters, one must tread lightly. The last thing I want is a patient stopping his medications or a teenager sneaking around. Unfortunately, I did not raise my patients from infancy. Their previous doctor relationships could have been positive or negative. Their perception of the doctor-patient relationship could be completely skewed from what I would want to instill.

Or maybe this phenomenon is a result of an American culture that encourages instant gratification and looking for the easy solution. Yes, you must give of your liter of soda a day to get your blood sugars under control, and yes, you must exercise to lose weight and feel better and no I don’t have a pill that will fix all of your personal problems. What is a doctor to do? Give up or continue to chip away at a brick wall with a wet noodle? When these patients start to bother you, is this the beginning of burn out?

Don’t get me wrong though. I have many patients that are more than willing to do the work that is needed. They may grumble and tell me I am ruining their fun but they make some changes for the better. I usually thank these patients for doing the right thing and tell them I am going to brag to the other doctors what “good patients” I have. Oh my, I feel like I am bragging to the other mothers in the play group.

MiM book giveaway: In Stitches, by Anthony Youn

5/3/11 1:30 pm update: The two winners were randomly selected and emailed. Will keep working on SpaFinder...

****

It's been two years since our first book giveaway (Remember "Match Day" by Brian Eule? Fizzy and I reviewed it here and here.) That was fun, and we're ready to do it again with the newly released memoir by Detroit-based plastic surgeon Anthony Youn. Why? Because Mothers in Medicine deserve free things.* And to read. And to win free things to read. (Also, mani-pedis, but haven't worked out that deal for you all yet. SpaFinder, call me.)

A little about the book from Amazon.com:

Tony Youn grew up up one of two Asian-American kids in a small town of near wall-to-wall whiteness. Too tall and too thin, he wore thick Coke-bottle glasses, braces, Hannibal Lecter headgear, and had a protruding jaw that one day began to grow, expanding Pinocchio-like, protruding to an unthinkable, monstrous size. After high school graduation, while other seniors partied at the shore or explored Europe, Youn lay strapped in an oral surgeon’s chair as he broke his jaw, then reset it and wired it shut for six weeks.

Ironically, it was this brutal makeover that led him to his life's calling -- and the four years of angst, flubs, triumphs, non-stop studying and intermittant heavy drinking that eventually earned him an M.D. Thanks to a small circle of close friends and an obsessive drive to overachieve, Youn transformed from a shy, skinny, awkward nerd with no confidence and no clue into a renowned and successful plastic surgeon.

In Stitches is a heartfelt, candid, and laugh-out-loud memoir of one man's bumpy road to becoming a doctor and learning to be confortable in his own skin.


To score your copy, just send us an email (mothersinmedicine@gmail.com) with the title "In Stitches" between now and tomorrow (5/3), noon EST. We'll randomly draw 2 names to receive a copy of the book. There are no risks to entering besides the normal risks associated with everyday life.**

For more info, you can read an excerpt on KevinMD.com, visit the In Stitches Facebook page, or see Amazon.com.



* You don't need to be an actual Mother in Medicine to enter! Any reader is welcome.
**That line was for anyone who has had to submit something to the IRB.

Pregnancy During Residency: A Retrospective

A lot of people seem to ask questions about whether it's "possible" to have a baby during residency. Obviously it's possible! What you're really asking is: how much does it suck?

When I was pregnant with my daughter, I had a laundry list of complaints about being pregnant during residency. These are a few that still stick with me:

1) My chief resident initially told me that I could only take 3 weeks maternity leave.

2) It was generally the resident's job to hold patients' heads during flexion-extension spine films, which would come up maybe every other week or once a month. Most of my attendings understood that I couldn't be in the way of X-ray beams and would generally do it themselves. I had one attending (a mother herself) who seemed baffled by why I didn't want to do it. "But you'll be wearing lead," she pointed out. She refused to do it for me and made me find another resident willing to do it. (And the first resident I asked was a total jerk about the whole thing, immediately asking what I'd do for him in return.)

3) I had to start a new rotation during my last month of pregnancy (our rotations lasted several months). That meant the call cycle reset, so they tried to squeeze several months of call into that month for me. And the rotation itself, while not one with long hours, was physically strenuous, involving walking all over a hospital that was several different buildings spread out over maybe half a mile. I begged for any clinic rotation that would involve less walking and more sitting. No dice.

4) I had this conversation with my program director. Except we actually had the conversation via email, so the whole ridiculous exchange is saved in my inbox for posterity.

5) The tremendous guilt trip laid on me. Notably, an email was sent out by the chief saying that nobody was allowed to take vacation while I was on maternity leave. (This did not happen.) I envisioned that everyone hated me and made myself miserable over it. I don't think everyone actually hated me, although I think a few people did, and they were probably not the same people I thought hated me.

Now I have the perspective of time and I realize that my program, at the time, was just ill prepared to deal with a pregnant resident. The residents were mostly men (I was temporarily transported back to the 60s for residency) and there hadn't been any maternity leaves in 2-3 years. Nobody was entirely sure what to do. I do know there were people who stood up for me and tried to make my life easier. And in retrospect, I should be grateful to those people rather than pissed off at everyone else.

Also, I feel like I could have been a little (lot) less whiny. I think I went overboard with the "poor me" routine. Yes, I was a pregnant resident, which sucked. But it could have been worse. I could have been a pregnant surgery resident.

I think back then I lacked a certain maturity (another argument against 6 year MD/BS programs... 24 is WAY too young to be a doctor). In retrospect, I'm a little embarrassed by the way I reacted to certain "unfair" situations early in my residency. I still think the X-ray beam thing was really really wrong, but beyond that, I feel like I should have just sucked it up, realized that it was my choice to have a baby during residency, and been better at accepting my situation. It wasn't great, but it wasn't all that bad either.

Speaking out about kids, football, and traumatic brain injury

I attended a Grand Rounds on Chronic Traumatic Encephalopathy (CTE) and the NFL earlier this year given by neuropathologist Dr. Daniel Perl. It was eye-opening for me. Despite all the recent media attention given to cases of NFL players being diagnosed with the disorder post-mortem (usually following untimely deaths due to suicide or bizarre "accidents"), it hadn't really penetrated my consciousness. But to see the actual images of abnormal tau protein staining in these relatively young brains - heaps and tangles similar to Alzheimer's but in slightly different locations - well, it was chilling. Even more chilling was hearing about these findings in younger players, those without years and years of professional-level play. Including those without many (or any reported) concussions. I started thinking about all of the children in the US who play tackle football and wondering: When are these changes happening? Why aren't we talking about this re: children? How many mothers might not realize that their children could be sustaining irreversible injuries that only manifest many years later? This. is. huge.

I debated whether or not to write about the issue. On the one hand, I felt passionately that discussing these issues was a matter of public health. Yet, I also weighed this against the likely backlash from football supporters and the kinds of personal attacks that commonly happen on the comment pages of online media forums.

In the end, I decided that this was too-important of an issue not to write about, stick and stones notwithstanding. My op-ed is in today's USA Today. Would love to hear your thoughts (including dissenting!), mothers in medicine, about this issue. Do you (would you) allow your children to play football? Do you think developing CTE is a reason for concern in kids? What do you think should be done to protect kids who play? Pediatricians, do you discuss this with your patients/parents?

MiM Mailbag: Will pursuing medicine dream sacrifice family time?

Dear Mothers in Medicine,

I came across this blog via “A Cartoon Guide to Becoming a Doctor” and have been a frequent reader of yours for a while now. You each give great perspective on what it is like to balance work and family. I am fairly young (22) and planning to apply to medical school within the next year. However, I am concerned about how much time I will actually get to spend with my family (many years down the road since I don’t plan to have children right now) AFTER residency. I figured its going to be hectic and crazy during medical school and residency so lack of family time was a given. I want to go into primary care (pediatrics) but I heard from several medical students and residents that you’re always on call because new mothers call a lot.

My main concern isn’t whether I should go into pediatrics or not….it’s if I should re-think about going to medical school and pursue a PA program instead? All my life, my mom has been busy working to provide for my three sisters and I and was never able to attend any of my extracurricular events. I do want to be a doctor but I don’t know if sacrificing family time outweighs my dreams of pursing medicine. I have the impression (please correct me if I am wrong) that many Physician Assistants have “normal work hours,” which allows them more time with family and friends. I’m worried that if I do go the PA route, I wont be satisfied and will look back and think maybe I should have applied to medical school.

I was wondering if you could please provide some advice…I know that I am not a mother yet, but I will be some day. Thank you so much!

Wishing My Life Away

Do you remember when you were younger and you just couldn't wait for the next birthday? (or holiday? or summer? or Christmas?) My dad used to tell me not to wish my life away. Somehow, I feel like medical training and now, my career, has caused me to wish away a significant portion of my life. Wishing for first and second year to be over to get to clinical rotations. Wishing clinical rotations to be over to start electives. Wishing to get started in residency. Wishing to BE FINISHED with residency (probably one of my biggest wishes, ever). So now, I am here, through all of my training, practicing in what is pretty much an ideal situation as an Ob/Gyn. One weekday call per week. One weekend call a month (with the post-call Monday off). Nice offices, beautiful hospital, great staff, good patients; no doubt, I run from 7 am until 6 pm most days. I think that (most of the time) I am happy, but I still catch myself wishing for the day to be over, wishing for the baby to just come out already, wishing for the next weekend, the next break, to win the lottery, for the next chance to not do what I have spent a significant portion of my adult life busting my tail to learn how to do. What is wrong with me? Burn-out? Have I chosen poorly? Inevitable no matter what profession one has chosen? Is it human nature? Our we destined to continuously wish our lives away? What do you think?

The Valley of the Shadow

I never expected residency to be a cakewalk. I knew it would be hard, especially as a woman. Growing up in the deep South, I understood the concept of the "good ole boys' club." Believe me, it's still alive and well.

In the dark ages, when I started residency, there was no 80-hour work week. We were expected to stay until the work was done, which admittedly prepared me well for the real world. As a new intern, I thought that if I just put my head down, did all the work, and never complained, that everything would be fine. More than one woman had already graduated from my training program, so I figured the ground had been broken. I was optimistic as I rolled up my sleeves and dug in.

In my PGY-2 year, my fellow residents and I calculated that we were working about 120 hours a week on average, and that came to about 33 cents/hour. We tried not to think of that too often!

In my PGY-3 year, I became pregnant (amazingly, nature cooperated with our plans). I spent my third trimester as the junior neurotrauma resident at the second busiest trauma center in the country. It was known to be the hardest rotation in the program. I caught the expected grief from my (male) fellow residents, but I never missed a day of duties or call. I worked up to 38 weeks as planned. I took maternity leave (after a C-section) during my neurology elective, during which one did not take neurosurgery call; my fellow residents were therefore inconvenienced not one whit.

Things went fairly smoothly after my return 6 wks postpartum, to my mind. Fast forward through lots of backbreaking work to PGY-6, my last year. I had just completed a complex spine fellowship and was looking forward to a happy ending in about 6 more months. It was fun teaching the junior residents basic neurosurgical skills. I had a happy, healthy 3-year-old son and a loving husband. I could see the light at the end of the tunnel.

One afternoon, I went to one of the ICU's to deliver the articles each resident had to present at journal club the next morning. I approached a group of about 5 younger residents and greeted them as usual. One of our attendings was doing paperwork nearby. I held out an article to a PGY-5 I'd worked with for years.

He glared at me and said flatly, "I'm not taking this. I have plans this evening, and I don't have time to prepare. You'll have to do it!"

I stared at him, taken aback, as he stood there oozing belligerence. Then the other residents chimed in. In the middle of the busy ICU, they took me apart, my colleagues who I'd worked beside, covered for, praised and supported.

"You are so lazy." "You have a terrible attitude." "You never seem to be there to help with anything." "We're tired of working with someone so lazy." "This is all your fault."

"Lazy." "Lazy." "Lazy." It echoed, etched itself in burning letters in the air. I don't remember much else of what they said; mostly I remember the looks on their faces, the silence of the one resident I thought I had known the best.

I hadn't known them at all. And they didn't know me at all, these men who all had stay-at-home wives who took care of everything for them, had their children, made them dinner. They could carelessly condemn me without ever having been to my home, met my family, asked me anything about my life. They could never know the phone calls I'd taken for them, the things I'd done with patients in the afternoon so the call guy wouldn't be bothered. So much they didn't ever know, and didn't really care to know. So much hard work I'd done that had made no difference.

I remember leaving the ICU, articles in hand, without seeing anything around me. I paused in the parking lot just outside the door; turning, I saw the attending just behind me, and I knew he'd seen the whole thing. I asked, "Dr. X, could I talk to you for just a minute?"

To my complete astonishment and dismay, he stammered, "Have to be at, ah, a meeting, ah..." and actually *ran* to his car, leaving me standing there. So much for expecting any support from on high.

I went straight home and sobbed on the sofa for an hour, unable even to tell my husband what was wrong. Then, as a good neurosurgical resident should do, I prepared all the articles myself. I walked into journal club at 6:00 am and presented them all. I explained to the chairman that it was all my fault they didn't get distributed. And then I went to the OR.

For the next 6 months, those residents made my life miserable. Every day, I dreaded walking into the hospital. I dreamed about the word "lazy." I never, never asked for help, because you don't do that in neurosurgery. I blamed myself, because that's what you do as a surgical resident, even though I knew better. But I faced them all down, every day. It was the hardest thing I had ever done.

To this day, I still don't know why they did this. I'll probably never know, since I avoid the residency reunions held every year at the national meeting.

I was so relieved to get in the moving van at the end. Shortly before we left, the chairman held the annual dinner honoring graduating residents (there were two of us). My fellow residents had prepared the slide show, including a section spoofing the "Priceless!" commercials on the air at the time. It intimated that getting gcs15 to come in to help with a case was "priceless." My husband and my co-senior resident's wife got the same "spouse's gift" - a dried flower arrangement.

My neurosurgical training was excellent, and it has stood me in good stead over the 10 years since finishing. I have enormous respect and gratitude for many of my professors. I can say that I am a good surgeon with confidence. I love my profession, and I still can't imagine doing anything else.

What I have come to realize, however, is the destructive effect residency had on me. I'm sure I'm not the only one. I love neurosurgery, but I hate its culture. The primary tenets are: don't ever complain and always accept responsibility, even if it's not your fault. Most importantly, don't EVER, EVER, ask for help. If you do, it's a sign of weakness. If you do, you are not worthy of Neurosurgery. Call me if you need me... but don't call me, because you will be vilified. This is true in training, and it's just as true in practice. And if you don't fit the neurosurgical stereotype, you don't "belong."

I have never really gotten through the Valley of the Shadow. I have worked harder and longer than I should have worked to prove to everyone, especially myself, that I am not "lazy" after all, even though I know I never was. I swore that no one would ever speak to me again like those residents did, and I found myself unleashing a tirade on an anesthesiologist once because of that. He started off, "The problem with you is..." and I just snapped. It was visceral. The shadows still darken the valley.

Running a neurosurgical practice is hard, complicated work, but I have made it harder than it should be. Because of this, my family has suffered. I have tried very hard to strike a balance, but it has not been enough to avoid inevitable crisis. Wisdom is only gained through hard experience; I hope I have enough now to finally get past the demons. With this, much of the fault is truly mine. I should have forced myself to exorcise them long ago; I underestimated their menace.

To those who would tread the path of surgical subspecialty, I say it can be done. I know what I must do to correct my mistakes and make things better for my family. You will make your own mistakes and face your own Apollyon, but you too can overcome. One day, the culture will change. We must make it so.

"Now morning being come, he looked back, not out of desire to return, but to see, by the light of the day, what hazards he had gone through in the dark. So he saw more perfectly the ditch that was on the one hand, and the mire that was on the other; also how narrow the way was which led betwixt them both; also now he saw the hobgoblins, and satyrs, and dragons of the pit, but all afar off, (for after break of day, they came not nigh;) yet they were discovered to him, according to that which is written, 'He discovereth deep things out of darkness, and bringeth out to light the shadow...' " - Pilgrim's Progress, by John Bunyan

Cleaning House

It was 6 months ago that I said to my husband, “Gee, our bathrooms are pretty grimy. I’m going to make it a priority to clean those.” Babyboy was 3 months old, and it seemed normal and reasonable that the bathrooms would be less than spotless. We were new parents. I had a hard time breastfeeding. I was tired. My husband was working, which meant traveling a lot, and he was pretty tired. But I really thought that we would get around, somehow, magically, to the cleaning of the bathrooms...and to mopping the kitchen floor, wiping down the refrigerator, reorganizing the cellar, laundering the curtains. But I went back to work in the clinic, and we fell into a busy rhythm... and all those tasks that so need to be done so never got done.

We did the basics: the essential laundry (especially when there was poop or spitup involved), an occasional vacuum of areas that guests might see (usually five minutes before they were to arrive), a hasty wipedown of the downstairs half-bath (ditto), and picking up the cat puke (generally within 24 hours of seeing it). You know, the basics.

So, nine months after the birth of our first child, my husband and I realized that if we ever wanted a truly clean (or even minimally hygienic) house again, we needed to pay someone else to do it. What really spurred us was the idea of a CRAWLING BABY. All the magazines say that to prepare your home for your exploring infant, you need to get down to your child’s level to look for potential danger: uncovered outlets, small objects, sharp corners.

Well, I got down to ground level in our dining/living rooms one day and scanned from under the dining room table to under the sofa. I saw: crumbs, identifiable bits and pieces of dried-up food, scattered kitty litter, massive dust bunnies (bunnies is too tame a term, these were more like dust-beasts), mangled cat toys, and dirt. Lots and lots of dirt.

So at a neighborhood get-together, I took a poll. A lot of my neighbors use a cleaning service. Good, I thought, they won’t think we’re THOSE kind of people. One lady was very happy with her service, and she gave me their contact information. I called. The next day, a woman came by to give me an estimate. She was Brazilian, dressed fashionably, even elegantly. As she walked through the house she occasionally wiped her index finger along a surface (my bookcase of medical reference books, for example). Her finger left a stark streak in the thick layer of dust.

“Hmm,” she said. “Yeah, we can do this. The first clean will need to be a deep clean. Really heavy. The works. But after that, I think one time every two weeks, we can keep it just so. Maintenance.”

She quoted me her price and I took it, no bargaining. I think I was supposed to bargain, but the price seemed so minimal compared to living in guilty filth. I was ashamed of the state of my home.

So they came. The Elegant Brazilian and her crew descended upon our little home and spent three solid hours; they did a good job. After they left, I walked around in awe, and I again felt guilty: It only took these people three hours to scrub this entire home spotless? Couldn’t we have done this and saved ourselves the money?

But these regrets faded fast, as the cleaning job faded fast. It took us (and our pets) about 24 hours to create visible clutter. Two weeks later, the countertops are again sticky and crusty, kitty litter has again migrated to the sitting room, and the bathrooms... well, I’ll spare you the details.

And I am SO excited that they're coming tomorrow!

MiM Mailbag: Have baby AND pass boards?

Dear Mothers in Medicine,

I am currently a resident going into my last year of residency (yay) and was planning on trying to have a baby so that I would deliver at the end of my residency. This would be perfect because in terms of decreasing the amount of time I would have to delay working/fellowship. However, I've been warned by a friend of mine that it might be an awful idea because I would be a new mom while trying to study and take the boards. Anyone with some advice? Do you think it is possible if I plan well and study before that I will be able to pass the boards and have a baby?

Sincerely,

Confused

Opportunity Costs

As a trained economist before I started training to be a doctor, I often think in terms of “rational decision making.” In economics, all of the basic models are based on free markets and rational decision making. One key component of making rational decisions is determining the opportunity costs of one decision versus another. After picking up my daughter from daycare yesterday, I (for some odd reason) started thinking about opportunity costs and the difficulty of actually quantifying it in real life - if only I could assign a real value to what I give up with the decisions I make.

Other people may not have such a hard time with this. My husband and I actually started hanging out because I took 30 minutes to make a vending machine selection. I headed down to the basement with a definitive plan to buy twizzlers, but once I realized that this particular vending machine also had sour straws (a blast from the past), I simply could not decide if buying twizzlers was really worth giving up sour straws. As I agonized over this very important decision, my future husband had time to sort two loads of clothes, put them in the machine and wait to add fabric softener. When he saw I was still standing in front of the vending machine, he asked if I was okay, suggested sour straws, and the rest is history! Obviously, my inability to assign a value to sour straws has little consequence in real life, in fact it worked to my advantage since I got a husband out of it. However, when it comes to big decisions I am often paralyzed in trying to decide if my decisions are worth what I lose.

I can’t decide what specialty to pursue, I can’t assign value to the time I will give up with the additional training or the additional demands of one specialty over another. I can’t decide if I honestly think I can finish my surgical residency or is the cost of the time I will lose with my daughter too great. I can’t decide when and if I should have more kids. I can’t decide if my husband should really go for that higher paying job in a city 2 hours away, and I know there is no need to make all of these decisions all at once, but I can’t stop thinking about what I’m giving up.

Nurses and Female Doctors

Can nurses and female doctors be friends?

That is, nurses and female doctors who work together? Can they be good friends? Outside of the hospital setting?

I think the answer may be no. I wish it were yes. But I'm pretty sure it's no.

Where I work, most of the doctors are older. The nurses are younger, closer to my age, a lot are in the same stage of life in terms of having kids, etc. And there are many that I really like and I sense that they like me. We chat in a friendly way and have a sociable relationship. But I feel like there's this WALL between us that will keep us from ever being real friends. My tip-off is that they all call me Dr. Fizzy, despite the fact that I have asked several to call me by my first name. The only ones who call me by my first name are.... the MALE nurses.

Of course, for male doctors, I think it's a different ball game. Because they can flirt. I don't know how many male doctors have become friends with the nurses they worked with, but I bet there are plenty that have started dating.

Or am I wrong?

Kindness

by FreshMD

Last spring, my experience as physician, mother and patient intersected through a calamitous pregnancy loss. A few weeks ago (days after I delivered my daughter), my reflections on those events were published in CMAJ. As on-line access requires sign-in, I requested permission to post the entire article here. As always, details of patient encounters have been modified to preserve confidentiality. My physician gave his consent for publication.


An Eritrean couple first saw me at the refugee clinic four months ago in crisis with an unplanned pregnancy. "It is good now," he says today, gesturing at his wife's belly. "We are happy." It is their last prenatal visit before being transferred to an obstetrician. He says a little speech, thanking me for what I've done, the support and the kindness. "You helped us when we were new in the country, in trouble." I feel professional gratification that they were satisfied with my services, and tell them with sincere emphasis that it was my pleasure! to care for them. As I usher them out the door I've already forgotten their gratitude.

"That was a beautiful speech," says the nurse after they leave. "My patients in Uganda used to do that all the time." I look at her, and I think, Yes, yes it was beautiful. I've heard these speeches before, though, thanking me for kindness, and I feel embarrassed that I'm thanked for dispensing something that cost me nothing: no education, no honing of skill, no effort. I'd rather be thanked for diagnostic prowess or a deftly-performed procedure. But I extend kindness to patients habitually, with an extra measure when I have nothing else to offer.

* * * * *

Seated in my doctor's office, I'm in the chair tucked right next to his desk. This is the first visit that I haven't sat casually on the exam table with my legs dangling over the side, the first time I haven't popped in for something routine like a vaccination or contraception or a prenatal visit, where we talk shop and I ask about his daughter, a medical school classmate. This time, I'm here to follow up a disastrous ending to a second-trimester pregnancy. He knocks on the door, steps in, gives me a long, sober look as he slowly closes the door, sits down. He sits in silence. I can't look at him. Finally I force myself to talk, exhausted, crying, despairing and he listens. He leans over his desk, arms folded on it, looking down. Eventually I look at him, at his solemn white-bearded face, and I note that he is flushed. His eyes are damp. And I realize that he is moved by my distress, and I am completely taken aback.

Over the next few weeks, I think back to our encounter repeatedly. The memory of him sitting there, seemingly with all the time in the world, fully present, saying little but moved by my situation, is an enormous comfort. His kindness is more dear to me than anything he's done for our family over the years, even his delivery of my daughter.

I see him in follow-up two weeks later. The visit is such a solace that I am certain I am being extended divine kindness; my doctor is the unwitting priest. What a profession! What power! I imagine, longingly, that I could only extend the same to my patients.

And I realize with horror that this kindness which has impacted me so profoundly is the very one that I use unthinkingly in my own practice, that I dismiss as a personality trait, a last resort for patients for whom I have no medical therapy to recommend. I feel I have been wielding something powerful without any respect for it.

* * * * *

Back at work, I determine to be conscious of what I give to patients, and to receive what they return to me. An elderly Congolese patient with severe osteoarthritis has found a French-speaking family physician near her home. She makes a short, thankful speech, and this time I don't dismiss the gratitude as grossly disproportionate to what I've done for her. "Every visit, I felt better just to see you," she says. She hugs me; I feel very slight. She presses her cheek against mine and I can feel and smell her hair. "Don't forget me," she says through the interpreter. "Come visit my home."

* * * * *

Weeks later, I see my doctor again. I'm doing much better, and he seems mystified as to why I've come. I wanted to check in, I explain. I can see him trying to figure out what I really want from him, thinking we're doing the doctor-doctor visit dance, where he must guess the investigation, referral or prescription I have in mind. He offers a medication, and I decline. He offers a different one, but I don't want any medications. He asks again why I've come. He has no idea, I realize, no idea how therapeutic his presence is. I don't want to alarm him, so I don't give him the simplest answer: that all I needed, quite literally, was to see the doctor.