I'm not a psychiatry resident, but I have two female friends/acquaintences in psychiatry residency at two different programs who are both going through some issues with their maternity leave and I was wondering if anyone has any thoughts to help them out:
Apparently, one year of psychiatry residency involves an outpatient continuity clinic. Due to the rules of residency, you cannot miss more than six weeks of this year at risk of repeating the entire year.
So despite the FMLA guaranteeing 12 weeks of leave, a woman having a baby that year can only take a maximum of 6 weeks off, or else repeat the entire year. Even if you have a C-section.
I just got off the phone with my friend, who is in tears over this. She was ready to make up any time she missed, but not repeat an entire year. She's gone over the situation with her chief resident and he claims there's no way around it.
Has anyone had any experience with this and has any advice? (Beyond "suck it up"?)
Thursday, June 23, 2011
MiM Mailbag: Pumping during fellowship
Hi, I’m so glad to find this group! I’m starting GI fellowship in 10 days and trying to figure out a pumping plan. My husband (a surgeon) and I have a 12 week old son and we’ve just moved across country for fellowship. I have the Medela freestyle, which I love. However, I stored up enough expressed milk to only last us maybe a couple weeks. My program is supportive of my need for pumping, but given the amount of conferences and rounding on a daily basis, my only time to pump is essentially in two 2-hour blocks when I need to see consults and perform endoscopy (unless I’m in clinic). I’m trying to decide whether I should try and pump during the day or just switch to pumping bid (morning and night). I feel like formula supplementation is inevitable. I’ve already noticed my supply go down with changing to pumping 4x/day in anticipation of fellowship starting. Any advice?
Wednesday, June 22, 2011
Guest post: Major breastfeeding (advocacy) fail!
Heading to Target to do some shopping, I waddled my way (at 7 months pregnant) onto the Metro and found an aisle seat. Sitting behind me, I noticed a couple of very fashionably dressed high school students. Sitting several seats in front of me, a corner of boisterous 1-4 year olds of various ethnicities darted between their mothers/nannies legs to peer questioningly at each other and then dart back to the safety of their own corners. I watched, enthralled by the happenings of these cute little humans exploring the train; a particularly cute Latino little girl wanted to sit on the floor and her mother quickly let her know that she couldn’t. She started getting upset and I quickly averted my eyes and opened my new novel. I feel that when parents have to admonish their children, it’s their business what they do and they don’t need an audience.
Several pages into the book chapter, I hear one of the teenagers behind me say, “That is soo nasty! I can’t believe she’s doing that.” I turned, saw two women in their 60s shaking their heads in disbelief. I raise my eyebrows unknowingly and turn back to the toddlers. The Latino little girl’s mother had started nursing her sans cover to distract and comfort her. My Metro stop came before I had a chance to say anything to the teenagers or to the women.
I smiled at the nursing mother and waddled away. But inside I felt like a major failure!!! Uggghhh. I should have said something witty! I should have said “breastfeeding is more natural than formula” or “what’s nasty about feeding a fussy child?” or “seriously ladies, I’m less offended by her nursing her child than folks feeding theirs salty chips and sugary soda everyday”. But no! I had to waddle off of the train. I was ashamed. Did my unknowing smile make the women think I was agreeing with them?!? I sure hope not!!! I am one breastfeeding-mama-to-be. Forget the old women who may have been set in their ways, but what if those teenagers had never considered the benefits of breast feeding? Again, I felt like a failure.
Becoming a vocal Breastfeeding Advocate (self proclaimed title) in the last few years has been somewhat of a journey. I did not know many mothers who breastfed their babies when I was growing up. My own mother only briefly breastfed my brother and myself secondary to discomfort and lack of resources and support. More recently, when one of my good friends whipped out her breast to feed her son during dinner day several years ago I was a bit taken aback. For me, it took time to realize that breastfeeding was perfectly normal and that I had to get over my hang ups of “modesty” and “privacy”.
The issue has become all the more important now that my husband and I are welcoming our own little baby into the world. Personally, having a supportive husband who doesn’t see the need for formula, several busy friends, sorority sisters, and a mentor who successfully breastfed from 8 months to the 1-year plus mark also helps. Although I plan to use a cover to be a bit more discrete, I applaud the mama on the Metro who appropriately responded to her little girl in the most nourishing way she could! Next time I hear someone say something disparaging I’ll be ready, no more breastfeeding advocacy failures for me!
Mommabee is an upperclass Medical Student at a mid-Atlantic medical school who is interested in community-based Pediatrics and has a background in public health. She and her husband are pregnant with their first Baby Bee.
Friday, June 17, 2011
Guest post: Happy Father's Day
Confession time. Despite a paucity of evidence, I once lured my unsuspecting husband and daughter into the bathroom and told them to strip. I handed my husband a tube of 5% permethrin cream and proceeded to apply the same cream to our daughter and myself. My husband, well-acquainted with my neurotic behavior, laughed, shook his head in mild disbelief, then willingly obliged. “Jeez”, he muttered under his breath “I give you a car, and you give me scabies” (a reference to our recently purchased vehicle). My decision to call in three scripts for permethrin was based on two intensely pruritic hands and one overactive imagination. My lips were also swollen, but despite repeating over and over in my head, “You have an allergy, not scabies”, the heebie jeebies were welling into a tornado of anxiety that was wrecking havoc on my paralyzed little brain.
My husband puts up with a lot of crap being married to a doctor. And although I would like to think of my neurosis as merely an occupational hazard, I suspect it was likely a preexisting condition, exacerbated by the daily exposure to other people’s illnesses. I am forced to recognize that this career, and the ways in which it has dictated my behavior, can be a hardship on my non-physician husband.
In addition to not having me committed over the permethrin incident, in this first year of my fellowship my husband has shouldered a disproportionate amount of child-related care and chores. When I left for work last Saturday morning, my daughter was naked in the bathtub, in the throes of a wicked GI virus. My husband was at her side, cleaning and comforting her. I wasn’t worried that she critically ill as she had just been eating and running around earlier in the morning, but I still felt horribly guilty for leaving my family at this moment.
And while I am almost certain my husband didn’t mind, much less resented, my departure, I do wonder if he fully appreciated the extent of his parental participation when he married a female physician. Did he know that he would be in charge of daily school lunches, drop-offs, and pick-ups? That he would know the pediatrician better than his physician-wife? I can’t imagine that he did as I didn’t predict (nor wanted) it myself.
Although I recognized how very fortunate I am in my marriage, I sincerely hope that amongst this group of mommy-MDs, I am not unique in the depth of support my husband provides me in my career and our child in my all-too-frequent absence.
So ladies, in celebration of the men whose lives might have been a whole lot simpler had they just married someone, uh, less interesting.... I’d like to say: thank you.
Happy Father’s Day
s
s is a hematology/oncology fellow in California. She lives with her husband and 2 year old daughter. She blogs at www.theredhumor.com
My husband puts up with a lot of crap being married to a doctor. And although I would like to think of my neurosis as merely an occupational hazard, I suspect it was likely a preexisting condition, exacerbated by the daily exposure to other people’s illnesses. I am forced to recognize that this career, and the ways in which it has dictated my behavior, can be a hardship on my non-physician husband.
In addition to not having me committed over the permethrin incident, in this first year of my fellowship my husband has shouldered a disproportionate amount of child-related care and chores. When I left for work last Saturday morning, my daughter was naked in the bathtub, in the throes of a wicked GI virus. My husband was at her side, cleaning and comforting her. I wasn’t worried that she critically ill as she had just been eating and running around earlier in the morning, but I still felt horribly guilty for leaving my family at this moment.
And while I am almost certain my husband didn’t mind, much less resented, my departure, I do wonder if he fully appreciated the extent of his parental participation when he married a female physician. Did he know that he would be in charge of daily school lunches, drop-offs, and pick-ups? That he would know the pediatrician better than his physician-wife? I can’t imagine that he did as I didn’t predict (nor wanted) it myself.
Although I recognized how very fortunate I am in my marriage, I sincerely hope that amongst this group of mommy-MDs, I am not unique in the depth of support my husband provides me in my career and our child in my all-too-frequent absence.
So ladies, in celebration of the men whose lives might have been a whole lot simpler had they just married someone, uh, less interesting.... I’d like to say: thank you.
Happy Father’s Day
s
s is a hematology/oncology fellow in California. She lives with her husband and 2 year old daughter. She blogs at www.theredhumor.com
Wednesday, June 15, 2011
Don't Give Up on Women in Medicine
The Mary Elizabeth Garrett Room lies off a busy corridor on the main floor of Johns Hopkins Hospital. As a medical student and later an internal medicine resident at Johns Hopkins, I often treated the small women’s lounge and adjoining locker room as a sanctuary amid my hectic days and nights of studying and call. Its namesake, a philanthropist who was one of the wealthiest women in the US in the late 1800s, used her financial power to provide opportunities for women to gain independence and autonomy. She and her friends offered to raise a badly needed $100,000 for the endowment of the Johns Hopkins School of Medicine if the trustees agreed to admit women on the same basis as men. The rest, for future women in medicine, was history.
In her New York Times opinion-editorial “Don’t Quit This Day Job” (June 12, 2011), anesthesiologist Dr. Karen Sibert argues that women physicians, who increasingly work part-time or leave clinical medicine altogether to find better balance between work and family life, have a moral obligation to practice medicine full-time. She rightly points out that there are limited medical school and residency slots in the face of a growing physician shortage, particularly in the primary care fields that attract women in high numbers. However, Dr. Sibert’s envisioned ideal would be a great loss to patients and the profession, and a major step backwards for women in medicine.
Historically, the practice of medicine had required a selfless devotion to the profession at the cost of personal and family life. Turn of the 19th century legendary physician Sir William Osler is credited for saying, “Medicine is a jealous mistress; she will be satisfied with nothing less.” These roots are evident in the harsh training environment that prevailed for so many years, requiring super-human work hours, rare days off, and expectations to work through personal illness. Slowly, medicine professional culture has made progress, realizing that the care of its members—in all senses of that word—helps physicians (men and women) lead more balanced, healthier, happier lives and helps patients by improving the quality and safety of their healthcare experience through physician work-hours restrictions.
For women physicians, who continue to perform the lion’s share of household duties and child-rearing despite a more progressive society towards the division of household labor, this has meant the increasing availability of part-time positions, job-sharing, and other creative solutions to allow them to continue practicing medicine while fulfilling commitments at home. Achieving work-life balance means greater satisfaction for one’s career and keeps women (and men) physicians in medicine. Indeed, it is this flexibility that is possible in certain specialties such as primary care, dermatology and radiology that makes medicine an attractive career for many women, despite the years of difficult training and medical school debt.
We are, after all, talking about a profession that is built around caregiving, with the parallels between caring for patients and families undeniable. Women physicians spend more time with their patients, up to 10% more, and have been shown to have a distinct style of doctoring from their male counterparts: more encouraging, supportive and patient-centered. The contributions of part-time women physicians are no less in quality to the lives of their patients; shouldn’t such devotion to caregiving at work and home be traits encouraged in physicians?
Invoking the predicted physician work shortage as a reason why women physicians should not work part-time or leave clinical medicine places undue guilt and blame on them. The main factors driving up physician demand is the growth and aging of the US population and health care reform. While women physicians do work fewer patient care hours compared to men, what kind of profession would we have if women who might decide to work part-time later were denied admission? More reasonable (and humane) answers to the physician shortage lies in lifting the residency training caps to train needed physicians and creating new models to increase efficient use of the existing workforce.
Besides, women (and also men), who choose to spend a portion of their medical careers working part-time or who take an extended leave, may return to full-time work at a later time, for example, after their children reach a certain age. Thus, there is a need for effective physician-reentry programs that help prepare any previously trained physician to return to the workforce, providing education and re-training as well as portals to reenter medicine.
Let’s not forget about the men. Besides early to mid-career women, men approaching retirement age are the other fastest growing segment choosing to join the part-time physician workforce. Survey data show that today’s medical students and residents, both men and women, say achieving a balance between their work and professional lives will be the most important factor when establishing a fulfilling career in medicine. Medicine mistresses are going out of style all-around, much to the dismay of the medical henchmen: Burnout, Stress and Dissatisfaction.
To be sure, medicine is a public good. Federal dollars support physician training, and certainly, it is imperative that medical school admissions committees select applicants, male and female, who show a strong commitment to medicine. Yet after training, men as well as women may decide not to practice clinical medicine. Is it more problematic when the reason is because a woman wants to raise a family versus a man who takes a job with a consulting firm? I hope not. These are difficult personal decisions, emphasis on personal. Like everyone else, doctors need to make decisions for the health of themselves and their families. Life happens.
I am a mother, and I am physician. These two roles are complementary in more ways than they are not. The increase in flexibility for women physicians in recent times has been a boon to those of us who have found a calling in medicine but do not want to sacrifice having a full family life. Isn’t that what Mary Elizabeth Garrett had in mind as well? Independence and autonomy for women to practice what they love, to be empowered by having choices.
Katherine Chretien is founder/editor of www.mothersinmedicine.com.
In her New York Times opinion-editorial “Don’t Quit This Day Job” (June 12, 2011), anesthesiologist Dr. Karen Sibert argues that women physicians, who increasingly work part-time or leave clinical medicine altogether to find better balance between work and family life, have a moral obligation to practice medicine full-time. She rightly points out that there are limited medical school and residency slots in the face of a growing physician shortage, particularly in the primary care fields that attract women in high numbers. However, Dr. Sibert’s envisioned ideal would be a great loss to patients and the profession, and a major step backwards for women in medicine.
Historically, the practice of medicine had required a selfless devotion to the profession at the cost of personal and family life. Turn of the 19th century legendary physician Sir William Osler is credited for saying, “Medicine is a jealous mistress; she will be satisfied with nothing less.” These roots are evident in the harsh training environment that prevailed for so many years, requiring super-human work hours, rare days off, and expectations to work through personal illness. Slowly, medicine professional culture has made progress, realizing that the care of its members—in all senses of that word—helps physicians (men and women) lead more balanced, healthier, happier lives and helps patients by improving the quality and safety of their healthcare experience through physician work-hours restrictions.
For women physicians, who continue to perform the lion’s share of household duties and child-rearing despite a more progressive society towards the division of household labor, this has meant the increasing availability of part-time positions, job-sharing, and other creative solutions to allow them to continue practicing medicine while fulfilling commitments at home. Achieving work-life balance means greater satisfaction for one’s career and keeps women (and men) physicians in medicine. Indeed, it is this flexibility that is possible in certain specialties such as primary care, dermatology and radiology that makes medicine an attractive career for many women, despite the years of difficult training and medical school debt.
We are, after all, talking about a profession that is built around caregiving, with the parallels between caring for patients and families undeniable. Women physicians spend more time with their patients, up to 10% more, and have been shown to have a distinct style of doctoring from their male counterparts: more encouraging, supportive and patient-centered. The contributions of part-time women physicians are no less in quality to the lives of their patients; shouldn’t such devotion to caregiving at work and home be traits encouraged in physicians?
Invoking the predicted physician work shortage as a reason why women physicians should not work part-time or leave clinical medicine places undue guilt and blame on them. The main factors driving up physician demand is the growth and aging of the US population and health care reform. While women physicians do work fewer patient care hours compared to men, what kind of profession would we have if women who might decide to work part-time later were denied admission? More reasonable (and humane) answers to the physician shortage lies in lifting the residency training caps to train needed physicians and creating new models to increase efficient use of the existing workforce.
Besides, women (and also men), who choose to spend a portion of their medical careers working part-time or who take an extended leave, may return to full-time work at a later time, for example, after their children reach a certain age. Thus, there is a need for effective physician-reentry programs that help prepare any previously trained physician to return to the workforce, providing education and re-training as well as portals to reenter medicine.
Let’s not forget about the men. Besides early to mid-career women, men approaching retirement age are the other fastest growing segment choosing to join the part-time physician workforce. Survey data show that today’s medical students and residents, both men and women, say achieving a balance between their work and professional lives will be the most important factor when establishing a fulfilling career in medicine. Medicine mistresses are going out of style all-around, much to the dismay of the medical henchmen: Burnout, Stress and Dissatisfaction.
To be sure, medicine is a public good. Federal dollars support physician training, and certainly, it is imperative that medical school admissions committees select applicants, male and female, who show a strong commitment to medicine. Yet after training, men as well as women may decide not to practice clinical medicine. Is it more problematic when the reason is because a woman wants to raise a family versus a man who takes a job with a consulting firm? I hope not. These are difficult personal decisions, emphasis on personal. Like everyone else, doctors need to make decisions for the health of themselves and their families. Life happens.
I am a mother, and I am physician. These two roles are complementary in more ways than they are not. The increase in flexibility for women physicians in recent times has been a boon to those of us who have found a calling in medicine but do not want to sacrifice having a full family life. Isn’t that what Mary Elizabeth Garrett had in mind as well? Independence and autonomy for women to practice what they love, to be empowered by having choices.
Katherine Chretien is founder/editor of www.mothersinmedicine.com.
Monday, June 13, 2011
Rites of Passage
Friday, June 10, 2011
Finding Balance
Life has a funny way of reminding you daily that you are not in charge. You walk into work after a full night's sleep, thanks to my ear plugs because hubby snores. (Don't tell him I told you!) My energy is positive and I am ready to conquer the day. Then I proceed to look through the files of the patients on my schedule and then I realize there are a few chronic pain patients, crabby COPD patient with new CHF that refuses to go to a specialist, and on and on it goes. I feel the wind go out of my sails and I lean back in my chair trying to decide how to move my mood to a more positive state. Then I take a little mental mini vacay to a winning lottery ticket. Yep, it works every time.
Then after an exhausting day at work, going home to make dinner, started and folded more laundry, discussed the day with the family as we played "Apples to Apples" (Fun game if you have older kiddos.) I soon realized that I really am very vulnerable to my circumstances. Dealing with difficult patients...frustration and fatigue sets in...fun game with the family...happiness and energy abounds. Geez, this is sad realization my mood is so easily shifted. Maybe it is hormonal or maybe I just don't like not being in control...ahh...that is it.
I am a control freak. Yes, type A personality to the core. See when I go on my mental vacations I am in control and decide my fate. In real life, not so much. Not sure how turned into this over the years. Certainly not genetic as my mom is a peace maker and sweetheart and my biological dad never stuck around to change or be in control of anything.
I guess when I figure out how to solve this little personality disorder I will probably become a wealthy person. Any thoughts?
Then after an exhausting day at work, going home to make dinner, started and folded more laundry, discussed the day with the family as we played "Apples to Apples" (Fun game if you have older kiddos.) I soon realized that I really am very vulnerable to my circumstances. Dealing with difficult patients...frustration and fatigue sets in...fun game with the family...happiness and energy abounds. Geez, this is sad realization my mood is so easily shifted. Maybe it is hormonal or maybe I just don't like not being in control...ahh...that is it.
I am a control freak. Yes, type A personality to the core. See when I go on my mental vacations I am in control and decide my fate. In real life, not so much. Not sure how turned into this over the years. Certainly not genetic as my mom is a peace maker and sweetheart and my biological dad never stuck around to change or be in control of anything.
I guess when I figure out how to solve this little personality disorder I will probably become a wealthy person. Any thoughts?
Tuesday, June 7, 2011
The Massage
For special occasions, my husband likes to get me creative presents. No chocolates and roses from this guy. He claims it's because I don't like chocolates or roses, but I do actually like chocolates and would be fine with receiving them as a present (not so much roses). Some creative presents he's gotten me have included a membership to the Lobster of the Month Club and a hammock for our tiny one bedroom apartment:
(Unfortunately, the hammock came to life during the night and tried to bring us back to its home planet. We had to destroy it with fire, its only weakness.)
Last year, he bought me a gift certificate for a massage at a spa. Sounds like a great gift, right? Unfortunately, I've never had a massage before and I'm a little bit terrified of them, mostly because I vasovagal kind of easily. When I was having a one on one yoga demo session, the instructor did some kind of massage-like manipulation and I almost fainted, and felt lousy the rest of the day. The same thing happened when an osteopath in my class did some kind of manipulation on my shoulders.
So I traded the massage for a pedicure and a wax, and I was happy. Yes, I preferred having hair yanked out of me by the root rather than get a massage.
I guess I didn't emphasize to my husband my feelings about massage because this year for our anniversary, he again bought me a gift certificate for a highly rated spa in our area. Except this time it was a spa that basically ONLY does massage and variations on massage. And it's a $200 gift certificate, so it's not like I can just toss it. I have to get a massage.
I feel a little stupid about the whole thing, because really, what woman wouldn't want a massage at a nice spa? But I'm seriously worried about fainting during the experience or something along those lines. And isn't part of the fun of a massage looking forward to it? I feel like this is going to become a self-fulfilling prophesy.
So here I am, dreading a massage (and also playing the world's tiniest violin).
(Unfortunately, the hammock came to life during the night and tried to bring us back to its home planet. We had to destroy it with fire, its only weakness.)
Last year, he bought me a gift certificate for a massage at a spa. Sounds like a great gift, right? Unfortunately, I've never had a massage before and I'm a little bit terrified of them, mostly because I vasovagal kind of easily. When I was having a one on one yoga demo session, the instructor did some kind of massage-like manipulation and I almost fainted, and felt lousy the rest of the day. The same thing happened when an osteopath in my class did some kind of manipulation on my shoulders.
So I traded the massage for a pedicure and a wax, and I was happy. Yes, I preferred having hair yanked out of me by the root rather than get a massage.
I guess I didn't emphasize to my husband my feelings about massage because this year for our anniversary, he again bought me a gift certificate for a highly rated spa in our area. Except this time it was a spa that basically ONLY does massage and variations on massage. And it's a $200 gift certificate, so it's not like I can just toss it. I have to get a massage.
I feel a little stupid about the whole thing, because really, what woman wouldn't want a massage at a nice spa? But I'm seriously worried about fainting during the experience or something along those lines. And isn't part of the fun of a massage looking forward to it? I feel like this is going to become a self-fulfilling prophesy.
So here I am, dreading a massage (and also playing the world's tiniest violin).
Wednesday, June 1, 2011
Guest post: Top 5 Unexpected Discoveries While on Leave of Absence
As a rising 4th-year medical student, I took an extended maternity leave after giving birth to my youngest daughter, Starlight (for many reasons, mostly practical ones, but some sentimental). While the obvious reasons (a proper recovery, extended breastfeeding, family quantity time) were readily apparent, there were a few unexpected discoveries on the way:
1. Making new friends, and keeping the old. During medical school, and especially during the in-hospital clerkships, my life choices were made for me: either school or family, often in that order. There was little room for anything else, especially not friends. (Have you been friends with a medical student? They are never around, and if they are, they are talking about exams or sneaking peeks from flash cards. And planning get-togethers? Forget it--they're at the mercy of the next clerkship schedule.) So a few months into my leave, when someone asked to set up a play date after a La Leche meeting, I was dumbfounded. That there are other people out there who can relate to me outside of my profession and are willing to rehabilitate me back into the world of non-familial human attachment, was--and still is--a wondrous thing. I am forever grateful for those friends who ask to socialize despite my terrible track record at reciprocation.
2. Time to....think. Don't get me wrong, in school I was thinking all the time. But the thinking that came with school was strictly medical (normal pressure hydrocephalus or early dementia with BPH?). Left to my own devices, I started to think about my medical thinking (metadiagnosing?) and how I was taught. I reflected on what I would do for a career, what kind of thinking I liked to do. I read JAMA for fun, and went to a writing workshop for medical students. I feel...more resolute now, more introspective.
3. Hobbies. While I didn't revive my favorite hobbies with nearly the gusto I intended, it was nice to dabble in them here and there, even if it meant that time-intensive knitting was replaced with beadwork, or jogging was replaced with chasing kids in a park.
4. Kids--they grow! Once Starlight was born, I lived in this fog of sleep-deprived, perpetual kid-tending. Starlight never slept more than 40 minutes at a time, and she constantly needed to nurse. Unlike Sunshine, she wanted to be held all the time. Sunshine (my oldest daughter), being barely two, still needed intensive mothering--I was clothing her, diapering her, and cutting her food in little pieces. She couldn't be left alone more than a few seconds. It didn't occur to me then that this state of being might be temporary. Over the last few months, I've watched Starlight nap longer, learn to explore on her own, and try all sorts of finger foods. Sunshine can now put her own clothes on, play quietly by herself, and use the potty. This was definitely one of my favorite discoveries.
5. I'm the same person I always was. When I started my leave, I had grand ideas of remembering everyone's birthday with personalized cards, preparing elaborate dinners, and finishing all sorts of household projects. The truth is I'm not an apple-pie mom. I'm a doctor-mom, and if my heart and my mind are ever not with my family, they are with medicine. My house never got to immaculate status these last months, but it matters more to me that I was able to tutor medical students and perform experiments. My cooking will never make anyone's life a little better (Mr. Scrub can probably attest to this), but hopefully my skill and empathy as a physician will.
Tomorrow is my first day back. I should be wistful (and probably fearful), but right now I'm full of anticipation. New lithium AA in my pager, and a fresh set of bound notecards to pair with my pocket reference book.
The air is hardly crisp, and the leaves are far from turning, but back to school, here I come!
-scrubmama
1. Making new friends, and keeping the old. During medical school, and especially during the in-hospital clerkships, my life choices were made for me: either school or family, often in that order. There was little room for anything else, especially not friends. (Have you been friends with a medical student? They are never around, and if they are, they are talking about exams or sneaking peeks from flash cards. And planning get-togethers? Forget it--they're at the mercy of the next clerkship schedule.) So a few months into my leave, when someone asked to set up a play date after a La Leche meeting, I was dumbfounded. That there are other people out there who can relate to me outside of my profession and are willing to rehabilitate me back into the world of non-familial human attachment, was--and still is--a wondrous thing. I am forever grateful for those friends who ask to socialize despite my terrible track record at reciprocation.
2. Time to....think. Don't get me wrong, in school I was thinking all the time. But the thinking that came with school was strictly medical (normal pressure hydrocephalus or early dementia with BPH?). Left to my own devices, I started to think about my medical thinking (metadiagnosing?) and how I was taught. I reflected on what I would do for a career, what kind of thinking I liked to do. I read JAMA for fun, and went to a writing workshop for medical students. I feel...more resolute now, more introspective.
3. Hobbies. While I didn't revive my favorite hobbies with nearly the gusto I intended, it was nice to dabble in them here and there, even if it meant that time-intensive knitting was replaced with beadwork, or jogging was replaced with chasing kids in a park.
4. Kids--they grow! Once Starlight was born, I lived in this fog of sleep-deprived, perpetual kid-tending. Starlight never slept more than 40 minutes at a time, and she constantly needed to nurse. Unlike Sunshine, she wanted to be held all the time. Sunshine (my oldest daughter), being barely two, still needed intensive mothering--I was clothing her, diapering her, and cutting her food in little pieces. She couldn't be left alone more than a few seconds. It didn't occur to me then that this state of being might be temporary. Over the last few months, I've watched Starlight nap longer, learn to explore on her own, and try all sorts of finger foods. Sunshine can now put her own clothes on, play quietly by herself, and use the potty. This was definitely one of my favorite discoveries.
5. I'm the same person I always was. When I started my leave, I had grand ideas of remembering everyone's birthday with personalized cards, preparing elaborate dinners, and finishing all sorts of household projects. The truth is I'm not an apple-pie mom. I'm a doctor-mom, and if my heart and my mind are ever not with my family, they are with medicine. My house never got to immaculate status these last months, but it matters more to me that I was able to tutor medical students and perform experiments. My cooking will never make anyone's life a little better (Mr. Scrub can probably attest to this), but hopefully my skill and empathy as a physician will.
Tomorrow is my first day back. I should be wistful (and probably fearful), but right now I'm full of anticipation. New lithium AA in my pager, and a fresh set of bound notecards to pair with my pocket reference book.
The air is hardly crisp, and the leaves are far from turning, but back to school, here I come!
-scrubmama
Tuesday, May 24, 2011
Reverse Sexism in OB/GYN
From the moment I was accepted to medical school, I began to get unsolicited advice about which specialty I should choose. The most common recommendation was OB/GYN. “Female OB’s are in such demand!” I was told on a regular basis. However,I had ZERO interest in becoming one of THOSE women. As I began my rotations, I realized that there was more to the specialty than pap smears and stereotypes. In time I embraced it as my calling.
The year I graduated (2005), 75% of OB/GYN residents nationwide were women. I don’t know today’s numbers, but some recent journal editorials have brought attention to the fact that there are fewer and men going into OB. As more and more practices are marketing themselves as “women only,” some male OB’s are beginning to cry, “Foul!” To some extent they are right.
When I made my appointment for my very first pap smear, I called every female doctor in our town, only to find them all on a 6 month waiting list for new patients. I begrudgingly went to see my male FP, and he was fantastic… well as fantastic as the person giving you a pap smear can be (not THAT fantastic). Some of the kindest and most compassionate OB/GYNs I know are male. Many of my mentors in residency were older male physicians, who would really take the time to teach, while the female attendings often hurried home to their families.
At the end of the day, when starting with a new physician, a lot of women just feel more comfortable with a female OB/GYN. I am part of an all female practice, and honestly that is beneficial to getting new patients in the door. A significant majority of our obstetrics patients will ask to confirm that there is no possibility of a male physician delivering them. I answer in the affirmative, but the answer makes me a little uncomfortable. "I prefer to see a woman because you KNOW what I'm going through" they will often tell me. As women, the ‘been there, done that factor’ can cut both ways. Yes, I do get pap smears and understand the discomfort of putting my junk in the literal spot light every year. I also worked 12 hours the days I delivered my baby, and find it hard to muster up compassion for the multiple complaints of my term pregnant patient who work a part time desk job.
Being a MIM is not easy, but honestly in my field it is an advantage. Is it in yours? These men are saying the current situation in OB is rife with discrimination. What do you think?
The year I graduated (2005), 75% of OB/GYN residents nationwide were women. I don’t know today’s numbers, but some recent journal editorials have brought attention to the fact that there are fewer and men going into OB. As more and more practices are marketing themselves as “women only,” some male OB’s are beginning to cry, “Foul!” To some extent they are right.
When I made my appointment for my very first pap smear, I called every female doctor in our town, only to find them all on a 6 month waiting list for new patients. I begrudgingly went to see my male FP, and he was fantastic… well as fantastic as the person giving you a pap smear can be (not THAT fantastic). Some of the kindest and most compassionate OB/GYNs I know are male. Many of my mentors in residency were older male physicians, who would really take the time to teach, while the female attendings often hurried home to their families.
At the end of the day, when starting with a new physician, a lot of women just feel more comfortable with a female OB/GYN. I am part of an all female practice, and honestly that is beneficial to getting new patients in the door. A significant majority of our obstetrics patients will ask to confirm that there is no possibility of a male physician delivering them. I answer in the affirmative, but the answer makes me a little uncomfortable. "I prefer to see a woman because you KNOW what I'm going through" they will often tell me. As women, the ‘been there, done that factor’ can cut both ways. Yes, I do get pap smears and understand the discomfort of putting my junk in the literal spot light every year. I also worked 12 hours the days I delivered my baby, and find it hard to muster up compassion for the multiple complaints of my term pregnant patient who work a part time desk job.
Being a MIM is not easy, but honestly in my field it is an advantage. Is it in yours? These men are saying the current situation in OB is rife with discrimination. What do you think?
Monday, May 23, 2011
Home vs. Hospital Birth
When a woman I know in real life or online tells me they are interested in giving birth at home, I am never entirely sure how to react.
While I am a physician, I'm not an obstetrician or pediatrician or someone who works regularly with childbearing age women. When it comes to the statistics and research about home vs. hospital birth, I know very little. All I can really offer to an expecting mother is anecdotes from my brief experience on L&D. I can share a story about a severe postpartum hemorrhage that might not have made it to the hospital from home, or the newborn with unexpected heart problems whose life was saved only by immediate medical care. Based on that experience, I would never consider giving birth at home or advising anyone else to do it. But anecdotes don't equal evidence-based recommendations.
In contrast, a lot of women having home births have done tons of research on the topic. Something I recently discovered is that some women who are pro-homebirth not only feel that it's safer to give birth at home, but that this is an undisputed fact supported by solid medical evidence.
There are probably women who read and write on this blog who know the evidence back and forth, but I'm not one of those women.... which is why I'm writing this post. I am not entirely sure what to make of women who proclaim that they're giving birth at home because it's safer, then try to convince others to do the same. Yet I feel like as a physician, I have to speak out on behalf of my profession.
The readers of this blog are generally medical professionals of one kind of another, or at least people who likely respect physicians. So I ask this specific community for the sake of my own (and the readers') curiosity and knowledge: what are your thoughts on home vs. hospital births?
While I am a physician, I'm not an obstetrician or pediatrician or someone who works regularly with childbearing age women. When it comes to the statistics and research about home vs. hospital birth, I know very little. All I can really offer to an expecting mother is anecdotes from my brief experience on L&D. I can share a story about a severe postpartum hemorrhage that might not have made it to the hospital from home, or the newborn with unexpected heart problems whose life was saved only by immediate medical care. Based on that experience, I would never consider giving birth at home or advising anyone else to do it. But anecdotes don't equal evidence-based recommendations.
In contrast, a lot of women having home births have done tons of research on the topic. Something I recently discovered is that some women who are pro-homebirth not only feel that it's safer to give birth at home, but that this is an undisputed fact supported by solid medical evidence.
There are probably women who read and write on this blog who know the evidence back and forth, but I'm not one of those women.... which is why I'm writing this post. I am not entirely sure what to make of women who proclaim that they're giving birth at home because it's safer, then try to convince others to do the same. Yet I feel like as a physician, I have to speak out on behalf of my profession.
The readers of this blog are generally medical professionals of one kind of another, or at least people who likely respect physicians. So I ask this specific community for the sake of my own (and the readers') curiosity and knowledge: what are your thoughts on home vs. hospital births?
Triggers
The first time it happened I was an intern. I was starting the first day of a week of vacation after a 6 month straight spell of no vacation and few full weekends. I had just finished one of our more demanding services and had been up until 1am finishing up notes. I woke up late Monday morning - after the sun was up - and got in the shower. It was a bright, beautiful sunny day! Then, about 5 minutes into this glorious long shower I started BAWLING!!!! Just the day before I heard about a patient that I’d taken care of off and on all year - she had died in hospice earlier that week. She was a patient who I got to know well. I got to know her family. I was devastated but never really felt it because I was just way to busy. Well, five minutes into my vacation shower I started to feel it. I started to think of all the patients who had died - oncology patients who fought hard to the end, sick kids in the PICU, bad trauma patients, EVERYTHING!!! I cried for like an hour! Then I got myself together, and went out for breakfast.
Well, this morning, I was driving to work. I had just dropped my super cute daughter off at daycare and I was having a good morning. Then, on npr there was a story about poet Dean Young who had just received a heart transplant. In the interview he talks about what it means to receive a heart from someone - in his case a 22 year old college student - and suddenly I start crying. A patient I took care of died over a year ago suddenly and very dramatically after being totally stable from his heart transplant. It was a heart I helped procure. He was one of the kindest patients I had ever had. He was young and so happy about the new life he was about to begin. I had a hard time with his death last year but I thought it was behind me. However, here I was, in my car, crying for this patient. I knew I needed to write about this, the thought of writing it out is part of what got me to stop crying so that I could get out of my car and go to work. How do we deal with the crushing losses we are a part of? How do we stay human and also stay sane?
Thursday, May 19, 2011
When Your Patient Can't Get Pregnant- And You Are
Now that I am again expecting, I am wondering how to approach potentially difficult clinical situations in my Internal Medicine practice. It’s too early right now for my pregnancy to be obvious, but I know that it will soon be very obvious to my patients who are struggling with infertility issues or pregnancy losses. Not only that, but I am struggling with my own emotions when I counsel patients through miscarriages or pregnancy complications.
Last pregnancy, when I walked into the exam room at 6 months to see my patient with a cough, it was painfully, massively obvious that I was pregnant. This patient is a lovely woman, about 42 years old. She and her husband had been trying to conceive for several years. She had tried Clomid, in utero insemination (IUI), and several cycles of in vitro fertilization (IVF). They had used up their infertility treatment insurance benefits and a large chunk of savings on the project. We had spoken of her issues before, and I had provided referrals for her to a new fertility center, to try again. But that day, she was only in for her cough.
When I was at 6 months, almost anyone who saw me commented on my pregnancy. Patients would almost invariably enthusiastically ask: A query as to how it was going, how I was feeling, did I know if it was a boy or a girl, etc. I welcomed this banter and enjoyed the opportunity to chat with patients, as most times the banter led to some memories from the patient on their own pregnancies, or expressions of hopes for future pregnancies, or descriptions of beloved nieces and nephews or grandchildren. In short, a pleasant time was generally had by all.
But this patient was clearly pained by my state, and the visit was strained to the max. As soon as I walked into the room, she seemed shocked, silenced, and took some time to get composed. It did not occur to me right away what the issue might be, so I asked her some questions about her illness. The visit progressed, I took care of her cough, but she never once commented or said anything about my state. She kept looking at me as if I had somehow betrayed her. She fairly fled the room at the end of the visit, clutching her prescriptions. I felt terrible.
Afterwards, I asked colleagues how I could have handled this better. It had seemed as if there was an elephant in the room- and at my size, there literally WAS an elephant in the room. They suggested that I acknowledge the elephant, say something like, “It’s possible that my state is upsetting to you right now, and it’s no problem at all for me to find another provider to care for you, if you like” type of thing. I think that with this pregnancy, I’ll be more sensitive to these situations, and likely offer something like that. I’m curious as to what other providers do, especially the OBs, who much encounter these situations far more often than I do.
Now, I am 9 weeks along. I’m exhausted, emotional, and a tad nauseated, but other than being various shades of green during exams, I don’t think anyone would know that I was pregnant. However, it comes up for me, on my end, with the emotions I have in caring for my patients who are having pregnancy issues. Two weeks ago, I counseled one patient through an early miscarriage. She had had a hard time getting pregnant, and the loss was such an overwhelming disappointment to her and her husband. I couldn’t help imagining what it would be like for me, for us, to go through the same thing; as a result, it was difficult for me to contain my own tears in front of them.
I have another wonderful young patient who is struggling with a complicated early pregnancy, right now. She has numerous health issues, and hers is a very much desired pregnancy that has been a long time in the trying. Our LMPs were close to the same date. She does not know that. My pregnancy has progressed pretty normally thus far; hers has been fraught with vaginal bleeding and erratic HCG levels; an early ultrasound showed a small gestational sac with no heartbeat, and she was counseled to hope for the best, but prepare for the worst. This week she has had more vaginal bleeding, and a followup ultrasound showed a fetus, alive, with a heartbeat, albeit a slow heartbeat. She was again counseled to hope for the best, but prepare for a possible miscarriage. I cannot imagine the limbo she must be in. I worry that I will run into her at the OB’s, as we both are going to the same OB office for care. I wonder what I will say, or what I should say, what I need to say.
How do other physicians cope with these difficult situations? I do not believe that a complete dissociation into professional identity is possible here. These issues hit the deepest emotional, irrational parts of us. For so many women, being pregnant or trying to get pregnant can represent a whole future; hope and loss, life and death, and is life-CHANGING, regardless of the outcomes.
What do people do?
Tuesday, May 17, 2011
Is There a Doctor in the House?
Last week, I had a kid-free weekend coming up. Trying to decide how to spend my time, I googled volunteer opportunities in Little Rock, AR. I came across a website called volunteermatch.com, or something like that, and signed in to look for opportunities.
There were lots of chances to mentor kids, or host exchange students, but I have two kids of my own that I am currently trying to mentor, so I am reluctant at this point to take any others on. It seemed serendipitous that a big event was happening on Saturday, called Take Steps for Crohn's and colitis. They were looking for 50 volunteers to help set up. My brother has Crohn's disease - he is in Boston. I decided to go for it. I e-mailed the coordinator, explaining that I was a physician and touting my personal interest in helping out. She e-mailed me back.
"We had a nurse running the First Aid tent, but she had to back out due to family obligations. Could you man the tent between three and seven o'clock?"
I cursed the fact that I told her I was a physician. I am a pathologist, for crying out loud. I could do someone's autopsy, if they died? I was counting on setting up tents, or maybe hanging up balloons, but running the First Aid tent? Yikes.
I decided well, maybe I'm a pathologist, but I'm also a mom. I don't keep up with my ACLS certification, but I am pretty good at bandaging boo-boos. I told her yes, and hurriedly and desperately recruited my friend Ramona Bates, a surgeon, to help.
Ramona and I arrived promptly at 3:00, and despite our attempts to help in whatever capacity, we were relegated to the First Aid tent. There was a plethora of Central High School students doing chalk art and any manual labor that was necessary. I was worried (Ramona was not), but my worries were to no avail. In four hours, we passed out two band-aids - to the same person - one who was trying to protect a blister during the walk. MEMS was present - it seemed a little silly considering the short walk required after the provision of massive amounts of Bar-B-Q, freebies, and pizza, but I was still comforted that if anyone needed a "real doctor," I had back-up in Ramona and MEMS.
As a pathologist, I worry about my little exposure to the "real world" of medicine. Here I am, a bona fide M.D., and what do I have to show for it? Sure, I make a decent living, and am proud of what I do, but why do I have heart palpitations when I am on an airplane and I worry about hearing an overhead announcement, "We have an emergency and we need a doctor - are there any on board?" Will I be able to perform? I was recently discussing this with an OB - she voiced the same concerns. She was on a plane recently where they asked for a doctor, and after realizing she was one of two on board - her and an ENT - they both reluctantly volunteered to help, wondering if they could do anything for a geriatric stroke victim.
I was talking with one of my partners Monday about my weekend volunteer experience. She empathized. She said, "I think we should have a yearly workshop. Call it, "Is There a Doctor in the House?" And we should be updated on how to respond, as M.D.'s, in emergency situations. We were trained to help, and we should keep up the training, so we can perform in these situations.
One Friday night a couple of years ago, I was triaging bone marrows and lymph nodes that were rolling in mercilessly while I was on weekend call. I had just finished a platelet apheresis on a patient with Essential Thrombocytosis. She had been done for a couple of hours, and for all I knew, she was on her way home. I got a call from the dialysis nurse. "She is on the floor, seizing." Shit. I told her to call the heme/onc. He was climbing a local mountain for exercise. I told her to call the on call hospitalist. He told her to call me. As I was rushing upstairs to get labs and try to stabilize her, with my limited microscope medicine, I got a call from an internal medicine doctor. "Her electrolytes are out of whack. We are fixing it. It is all under control."
We are so subspecialized, in medicine, that the very thing we start off trying to be good at (dealing with these emergency situations) we end up being abysmally afraid of. Maybe it is just pathology. I am a general pathologist. I presented three disseminated fungal infections at a hospital-wide Chest Conference today. I did three fine needle aspirations in fast-track ED. I handled two inpatient needles in radiology - making spur of the moment decisions with limited tissue to benefit the patient in the CT scan, under the needle. I feel like I am so much, but also not enough. Does anyone else feel this way, as a doctor?
Monday, May 16, 2011
What do we owe?
I recently had a discussion with fellow residents, their spouses and friends at a dinner party. We ended up discussing the difficulty of balancing family and a surgical career which brought us to a discussion about two recently graduated female residents who both have young children. They both started out residency very similarly. I had the pleasure of working with both of them and they were awesome leaders and had great technical skills. Both were ironically interested in the same very demanding subspecialty and had done everything necessary to secure top fellowships. Then they both had kids during residency. One went on to pursue her very demanding fellowship and is currently doing well and loving her job. The other finished residency and is now a stay at home mom and also very happy. When we brought up these very divergent career paths it started a discussion about what doctors owe society. One person commented that there is a significant societal costs of training a doctor. In addition, there is a surgeon shortage and therefore a responsibility of those trained as surgeons or any type of doctor, to actually practice medicine. I was surprised by the strong feelings about this issue and felt that personal and family decisions are based on more than these large scale societal issues. Yes - the resident that is not currently practicing as a physician represents some loss to the society. But, I didn’t feel she owed anything to society. She worked hard through medical school and 7 years of residency. She took care of many patients during that time and devoted much of her life to it. In my opinion we all have a right to choose.
What do you think?
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