Trying not to be "one of those" mothers.

CindyLou, believe it or not, is now 7 (going on 13) and Bean just turned 4 (!). In the days of old, when Mr. Whoo and I were uninitiated to hard-core parenthood and naive to the social rigors that exist in the suburbs, we concocted a wonderful fantasy that each of our children would select 2 different activities completely of their own accord, without pressure from either of us, and while we would always encourage them to finish out a season, we would never be "those parents" who pushed them to be "better, stronger, and faster." Ha. Ha. Ha.

Enter these last few months, where CindyLou chose cheerleading and tumbling (With or without a nudge from her mother? A former cheerleader, who always regretted a lack of formal tumbling training? Ok, probably a little nudge.) Bean chose soccer (pretty much of his own accord, well, that, and the fact that it is pretty much the only organized sport available for boys at age 3). We started out with the best intentions, and really, watching 3 year olds playing soccer is a bit like watching cats being herded on the field. Except, then Bean really started to *get* it, and then he got *really good* (for a three year old). Each game he would score at least a couple of goals, setting his own goal for each game for *at least* five goals per game. Then he achieved that goal, and all of the sudden, Mr. Whoo (assistant coach) felt like he had to take his own son out so other kids had a chance to score. The other parents would ask where or how often we practiced with him (exactly twice, right before the first game and then again right before play-offs), like they were somehow implying that we were driving him to his successes (we were not). It made me uneasy to have that feeling of competitiveness creep anywhere near my sweet 3 year old baby, who was just there to have fun.

Things were no better with CindyLou, sitting behind the glass with the other "gym moms." I did my best to fade into my chair while the other mothers, obviously veterans, systemically analyzed and subsequently ripped apart each girl in the gym, including their own daughters. Despite my best intentions, however, it completely stoked my competitive fire, and made me want to take CindyLou home and drill motions and practice flexibility for hours on end. How dare they judge my babies like that, and, indirectly, how dare they judge *me*? It is a strange new world, the world of competitive extra-curricular activities, where the parents are just as cruel and mean as the kids can be.

Growing up, for me, it wasn't this way. Parents did not hang around at our practices and activities and compare notes. I did tap at 5, piano at 8, softball and cheer in 4th and 5th grade, band (clarinet) in middle school, and cheerleading through middle and high school. Parents were only there for recitals/games. Maybe that made it easier to not be so fiercely competitive. I think this can apply to the academic setting as well, although, to this point, we have had no "real" report cards with As or Bs, just Ms for "meeting criteria." So tell me MiMs, how do you stifle your competitive streak and just keep your cool around other "tiger-like" mothers and fathers? How do we teach our children to be *their* best, without making them feel like they have to be *the* best?

Spoiled?

I was the daughter of a single mom who was also a student, so as a child, I always felt like we were living in poverty. Toys were something I got on my birthday and Christmas, and that was it. So when I was four years old and I saw this set of three identical blond-haired dolls of different sizes at the drug store downstairs, I knew I had no chance of getting it, even though I really, really (really) wanted it.

Then, miracle of miracles, I got the chicken pox and my mother bought me the dolls! It was totally worth being covered in pox to get that toy. I will never forget it.

My daughter is now four years old. She doesn't need to be pox-stricken to get toys. We buy her toys all the freaking time because she wants them and we can easily afford it. And as the only grandchild on both sides, her grandparents shower her with toys.

A couple of weeks ago, I bought a present (a pet shop dollhouse) for the birthday girl at a party we were going to and my daughter saw the present and threw a fit because she wanted it for herself. She even said she'd skip the party if she could keep the present. And in the back of my mind, I thought to myself that it wouldn't be so bad if we bought a second pet shop dollhouse and it would make her SO happy. Then I was disgusted with myself. What have I become that I would even consider such a thing?

That's the problem with being financially comfortable. You can easily afford to buy your child whatever toy they want, and in fact, it's easier to do so than to listen to them scream. It takes real self-restraint to say no. But every time I buy her something, I feel like I'm spoiling her and turning her into a person who doesn't appreciate what she has. There's no way she's going to look back fondly on most of the toys in her room 25 years from now.

Our resolution was to make a sticker chart on the wall, to allow her to earn the present by cleaning her room, brushing her teeth, etc. Since then, she's entirely forgotten about the pet shop dollhouse and now wants something called a pillow pet. (It's a pillow! It's a pet! It's a pillow pet!) But either way, she's going to earn it and maybe that will make it worth more to her.

MiM Mailbag: Third year med school schedule as a mom

Hi Ladies!  I'm an M2, and soon I'll have to put in my schedule request for third year rotations. I know all the theories about the best schedule as it affects your career. But what about your children? 

My son will be two when I start my M3 year, and he's never spent the night away from me (at my school, surgery is the only rotation with overnights). I was thinking about starting with the lightest rotations and working up to surgery last, so my schedule won't vary wildly every few weeks.  But does anyone have any suggestions as far as how it will affect him?  (or just tips on how to maximize our time together?  Or how to ease the transition from him having a mostly stay at home mom to having me be gone a lot more?)

Thanks! 
Sarah

This Won’t Hurt a Bit (and other white lies) - My Education in Medicine and Motherhood – A Book Review

I first heard of Michelle Au on Mothers in Medicine – saw that KC, our fearless leader, admired her blog. As an admirer of KC and all things MiM, I started to follow her blog over a year ago. I was not disappointed. Her mind is incredible, I envy her picture-taking abilities, and she is an endless font of entertainment and wisdom. She’s a hop, skip, and a jump away from my home in Little Rock, AR, and I enjoyed watching her struggles through the ice storm last winter as I flew into her current home Atlanta to visit my brother and sister at the end of their long icy convalescence. She drove to work bravely and safely, I drove to work bravely and safely. I feel a kinship with her.

I’ve been following the acceptance for publication of her first book, and stole away from work one day to buy it at Barnes & Noble toward the beginning of the summer. So when KC posed the question in Big Tent – that is our group discussion area for all the bloggers – “Who would like to read and review Michelle Au’s new book for MiM?” I literally jumped at the chance. “I do! You don’t have to send me a free copy – I’ve already bought it!” And so here we are.

The book is a series of vignettes that takes us through her med school experience, residency with major decision changes, and new path to motherhood. She is brilliantly funny, has enormous emotional wisdom beyond her years, and displays honesty and humility that brings the reader to the center of her journey, rather than preaching from a false ivory tower of medicine.

Art, music, and books are as important to humankind as serving others. They forge a common link by bringing out experience and emotion that we all share. Nowhere is this more real for me than sadness. There is a story in the book – I hate spoilers so I will be generic – about a pediatric patient she encountered in her training. Her description of witnessing a bedside interaction between the patient and two other children brought me to tears – they don’t come easily to me. When I collected my feelings to return to the book, I saw that she too collapsed in sadness at the nursing station, and I felt a strong connection, even though I don’t know her. That is what makes a great book.

I obviously enjoyed the book because since her path is so similar to mine, it brought back many memories from my training. One thing that was remarkable to me was watching her navigate the physician/physician parenting dynamic. She and her husband seem to support each other so well. Physician/physician couples have a higher than average rate of divorce – those who know me here know of my own experience in this arena. I asked her today in an online interview (swoon! I talked to her!) to give advice, which I think applies well to any home situation where both parents are working.

“Well, first of all I'd like to ask your readers to e-mail me any tips that they might have, because even twelve years into our relationship, we're still trying to work these things out. But I'd say that most important thing in a two-physician family is the idea of triage. On the whole, a family with two working physician parents is going to be strapped for time, and quite simply there is not enough time in the day to do all the things you would like to do. So just do the things you need to do and screw the rest. You need to spend enough time with your patients and do a good job at work. You need to feed and clothe and bathe your kids. You need to spend time with your family before bedtime, just goofing around and loving them. Everything else can wait. Triage.”

Love the medical parallel. Triage. Take care of your needs. I went to visit my best friend from med school, who recently had her second child. Her house was an absolute mess, but her family was happy. Taking care of your basic needs is most important when times are tough.

So I hope it’s obvious, I loved the book. Highly recommend. I might even go out on a limb to say that it should be required reading for all women interested in medicine and/or starting a family. I could go on and on, but then I would be telling the story. Of the book. And frankly, I think you should just go out and get a copy and read it. I have no financial interest in saying that. Incidentally, I also discovered in my interview that Michelle loves Chinese soup noodles. And she cannot write while listening to music (me neither!). She is super cool.

Not just us anymore

I had planned to write about my first post baby overnight call which occurred a couple of weeks ago. Long story short, I survived, hubby survived and my little peanut survived. I felt good to be back in the hospital and thankfully it really was like riding a bike, everything came back to me (FYI - I actually can’t ride a bike, but that’s another story). I may still write about it later, because I did gain some nice insights, however, now as I get ready for my next overnight call and a potential procurement call, I decided to write about this new feeling of accountability.

I have one more year left in the lab and I just started taking overnight ICU call twice a month in order to keep my feet wet. Last week I was asked if I would like to to cover some organ procurement calls as well. Initially, I wanted to jump at the opportunity (I’m interested in transplant surgery). However, when thinking about the burden middle of the night procurement puts on my hubby (especially with one car), I decided to table it unless they were really in a bind. Then, I kept thinking about it. And suddenly I was paralyzed about the thought of getting on a random, unregulated jet in the middle of the night with a baby at home. I’ve flown on a number of procurements in the past and I love riding in the jet. I love the free meal we get on the ride over, the much needed nap on the way home, and the urgency of getting organs back to help save someone who has been desperately waiting for them. However, now all I could think of was the danger of these jet journeys. What if I crashed? How could I be so frivolous with my life and safety? Even while on call, I find myself being a LOT more diligent about wearing my PPE and more being careful when putting in lines. A fellow resident is currently suffering on antiretrovirals after being stuck with an open bore needle of an HIV patient - one of my biggest fears. Now, these fears which were sort of trivial, in the background, part of the job fears have moved promptly to the forefront of my mind. I now feel as if I’m not just taking risks for me and my grown adult husband. Now the risks affect my innocent child.

I don’t really know how to deal with this new feeling of accountability. Specific to the risks of being a transplant surgeon (flying and Hep C) I plan to follow one of my husband's suggestions of finding Pauline Chen and asking her! (Yes, he, the non-medical one, knew about Pauline Chen!) I enjoy my work and I fully understood that there were some occupational hazards when I signed up. However, in the meantime, I wonder how others feel about the things we expose ourselves to at work and how that affects our children.

Guest post: Get your boots on

Last week, I was pleasantly surprised to see Sheryl Sandberg, Facebook’s COO, featured in The New Yorker. Considering her TEDWomen talk in December, and her recent commencement speech at Barnard College, she has been front and center in the effort to support women’s success at the very tops of their fields.

For those who can’t access the links, Sandberg’s main points from her TED talk are these:

1. Sit at the table; own your own accomplishments. Studies have shown that for men, success and likability are positively correlated, whereas for women, success and likability are negatively correlated. Women need to attribute their own success to themselves, even though there is a risk of not being liked. In her Barnard speech, she says, “[But] I know that the truth comes out in the end, and I know how to keep my head down and just keep working.”

2. Make your partner a real partner. Women still do twice the housework and three times the childcare as men, even though they also are working outside the home. In homes where responsibility is equally shared, the divorce rate is halved. “It’s a bit counterintuitive, but the most important career decision you’re going to make is whether or not you have a life partner, and who that partner is. If you pick someone who’s willing to share the burdens and the joys of your personal life, you’re going to go further.” (Side note: a recent article in Time magazine notes that women and men work about the same hours in the day, although women work more unpaid hours, i.e. in housekeeping and childcare. This is usually accomplished by the woman scaling back her paid hours.)

3. Don’t leave before you leave. It is so common for women, from the moment they even start thinking about having children, to start leaning back from their careers, sometimes without realizing it. “Keep your foot on the gas pedal until the very day you need to leave…and then make your decision,” says Sandberg.

I watch these videos of Ms. Sandberg, and wish she could have teleported herself through the last decade and shaken some sense back into the old college me. You see, I made the wrong career decision ten years ago, and the only reason was because I didn’t believe in myself. I became a nurse when I really wanted to become a physician. Even ten years ago, there was no question in my mind that I would have made a good physician, and no question in my mind that I would love, adore and provide for my future family. But I still feared becoming a mother in medicine.

So why didn’t I go for it? For years, my pat answer was that I wasn’t sure medicine was for me until I was well into my nursing career. Now that I can finally admit this to myself, I think the real reason went deeper than that. I chose nursing because I was afraid that if I chose medicine, my boyfriend might get cold feet, and I might emotionally damage my future children. I was afraid that medical school rejection could be the ultimate social suicide. I worried that my friends and family might judge me for “choosing career at the expense of my family” and turn their backs when I most needed their village around me. As Sandberg might say, I was simply afraid of not being liked—in the most extreme way.

But ten years later, I do have something else to say, and that is that I did go to medical school, I did marry my college sweetheart, and I do have two happy, well-adjusted children. I am surrounded by friends and family, and I have done well in school. The sky, in fact, has not fallen.

While I am so proud of the above accomplishments, I still find at times I still revert to my old ways. I apologize for everything—for taking 20 minutes to pump breastmilk on clerkships, for passing off daycare duty to my husband, for not knowing when I will get home. But here’s the kicker: I don’t actually feel bad about any of the above, and I don’t think anyone in my family even expects me to feel bad. They know it comes with the job. What I feel bad about is that I should feel bad and I don’t. It’s as if I’ve been conditioned to believe that worry is synonymous with love, and that constantly shortchanging myself is penance for wanting children.

This, to me, is the fundamental problem of women today. It seems like we have no faith in our social or professional supports to help us get done what we need to get done. We’d rather hide behind the façade of martyrdom than find a way to get what we need—and then we tell the next generation “I gave up my career because you can’t be a good doctor and a good mother” or “I had to work 100 hours per week, and that is the only way you can deserve this job.” And so we saddle the next generation of mothers in medicine with the baggage of choosing either success or likability. Again.

What if we women did something radical instead? What if we thought long and hard about what we really want and actually asked for it proudly? Maybe that means finally having “the talk” with your significant other. Maybe it means keeping the kids in daycare one more hour to get something important done. Maybe it means daring to ask for part time—or partner. Maybe it means saving your apologies for when you have actually done something wrong (and, ahem, it is not wrong to have a career and a family).

When I think of the two most radical things I have done in my life—applying early decision to medical school with a marginal MCAT score and asking the cute guy in my dorm to come swing dancing with me, I realize that they are two accomplishments of which I am most proud, because those risks have given me a thousand-fold return. What if, when it came to big decisions, we honored our id as much as we do our superegos? What if we not only made radical decisions but celebrated other women who dared to do the same?

I was a child in the 1980s, and the message to little girls was “you can be anything you want to be.” I still believe that. But I think our daughters need a stronger message: “You can be anything you want to be, on your own terms, and you deserve to be happy.” And when we live out this message, it won’t be in an aggressive, cold-hearted way, but rather our way—with kindness, creativity and collaboration.

I just got back from a U2 concert, and my ears are still ringing. The turning point in the concert for me was watching four men singing at the tops of their lungs:

“You don’t know
you don’t get it, do you?
You don’t know how beautiful you are!”

So ladies, strap on your boots. We are a new generation of mothers, and we are proud to have it all, and share with each other in our successes.

-scrubmama
mamascrub @ gmail-dot-com

******

So now it’s your turn, anonymous or otherwise: Tell me one way in which you have shortchanged yourself. Now tell me one way you might do something radical. What would you do if you knew you could not fail?

MiM Mailbag: Considering a medical career later in life

Mothers in Medicine:

I just stumbled upon your blog in my quest for information about later careers in medicine.  I have been considering a transition to nursing.  I am 32 years old, have never been married and haven't been a mother at this point.  However, I was wondering if you might have any information or resource suggestions regarding preparing and applying to medical school later in life.  While I am interested in nursing, I did not realize medical school could potentially be an option, that older candidates could be considered, and I would love to find more information about how women are doing this.

Thank you for any guidance you might provide - this blog is great!

B

Boards. Tomorrow. Ack.

Sorry I have been incommunicado, but I am taking my Step II CK tomorrow.



Wish me luck.

Practical advice for nursing mothers

When you announce on the internet that you're nursing your baby and need advice, women are only too happy to give it to you. However, I've noticed that the women most likely to give advice, the ones who frequent the breastfeeding communities, are the so called "boob nazis." They feel so strongly that breast is best, that even an ounce of formula is criminal. For example, a new mother I know was just "dropped" by her online breastfeeding mentor because she confessed that she started giving her newborn one small bottle of formula at night (for the sake of her sanity).

To me, this seems crazy! If you believe so strongly in breastfeeding, isn't it better to encourage women to at least do it part of the time, rather than reprimanding them for taking measures to make it more doable? I've gotten some ridiculously useless advice from women who refused to compromise their breastfeeding ideals. (i.e. When I started giving my daughter solids, I was advised to have her reverse her sleep cycle to spend most of the night awake so she could nurse during this time. Seriously??)

With that in mind, I'd like to offer some practical tips and advice for breastfeeding and pumping, coming from a working mother who believes strongly in breastfeeding but is not a "boob nazi." You can take this advice with a grain of salt, because this is just based on my own personal experiences:

1) Breastfeeding is actually not that easy. I was amazed how challenging it was the first week. Your nipples hurt, the nursing itself hurts, you get dehydrated, and you never seem to have enough milk. Don't give up after just one week. It gets way easier. Promise.

2) One (or even more than one) bottle of formula will probably not result in terminal nipple confusion or a sharp decrease in supply. Due to an ABO mismatch between me and my husband, we produce very jaundiced babies. They got bottles in the hospital. No evil resulted.

3) You are not a horrible person if you allow your partner to give the baby a bottle at night so that you can get a few consecutive hours of sleep and feel human. I resisted this for as long as I could with my older daughter and finally gave in when my health started suffering. It actually ended up being wonderful because it made my husband feel closer to the baby and more comfortable taking care of her.

4) You don't need to have five gallons of frozen milk stored up when you go back to work. If you do: awesome. But if you don't, it's not the end of the universe. Due to a variety of reasons, I had absolutely no stored breast milk when I returned to residency. Despite this lack of foresight and my daughter's monstrous appetite, she didn't get any formula at all for the first three months I was back at work. Obviously it would have been better if I had planned ahead, but I'm just saying that you can make it work.

5) Expect to hate pumping. I have yet to meet a woman who didn't find pumping really depressing.

6) If you're having a hard time pumping during your maternity leave, try pumping first thing in the morning every morning. Your supply will be highest then and the pumping will be most successful. Nurse one breast, pump the other. One 5 ounce bag of milk every morning for 11 weeks will give you about 400 ounces of milk, even if you don't pump any other time.

7) If you work standard hours at your job (Monday through Friday with most weekends off), your supply will probably decrease as the week goes on and be highest on Monday. Take advantage of this by pumping like crazy on Mondays and over the weekend. I used to nurse on Monday morning AND pump out 10 ounces.

8) Keep well hydrated.

9) If you feel you can't breastfeed and your baby gets formula, your baby will still be healthy and absolutely nobody will judge you except for a few nut jobs on the internet. When I was an intern, a graduating resident told me she couldn't make breastfeeding work because of her hem/onc fellowship. That woman was an awesome resident, a wonderful person, and I bet anything she is a great mother. If nursing is going to make you tired, cranky, and unhappy, and you hate it and are only doing it out of guilt... well, I just don't think it's something worth feeling guilty about.

Anyway, that's all I've got for now, but feel free to add your own practical advice. Hopefully, this will help some new moms or mothers-to-be.

Guest post:: Trying to conceive

Twice a day, during my typical 5am - 7pm style day, I sneak away to the bathroom with a little sealed packet.  In that little packet is a small white test strip.  I have a small plastic cup in my hand.  You can buy these little packets online -- 50 of them for about $10.  I  pee in the little cup and dip the stick, waiting to see what lines develop.  One dark line and one lighter line; nope, no LH surge.  Still not ovulating.  Then I wonder, for the hundredth time: is it my irregular schedule?  Is it the q3 call, even though it's home call, still tends to extend my work hours to the 80/week boundary?  Is it the stress of running an Orthopaedic Surgery trauma service?  Is it my complete lack of sleep?  I bury the little stick in the trash, hoping nobody notices it, and I rinse out the cup, dry it off and palm it, heading back to clinic.

I'm disappointed again today.  I do this twice a day -- looking for my LH surge, looking for a sign that I'm ovulating.  On my OR days, it's harder to test in that daytime window.  I usually manage at least one pee-in-a-cup time a day, though.  My cycles aren't regular enough for me to just count calendar days.  My basal body temperature pattern isn't consistent enough just to test around "expected ovulation" time.

When the two lines are the same color, I'll get home at around 7 or 8pm and try to coax some energy into my body in order to get some lovin' from my husband and work on this conception business.  Small windows in time where gettin' busy really matters.  Small windows of time in my life where I want to catch up on sleep.  In the 6 months we've been trying, there have only been one or two cycles where I was pretty sure I had an LH surge and I ovulated.  After those cycles, it was hard not to get hopes up.  Each time, blood in the underwear heralding menstruation left me disappointed.

Each morning, around 5am, I take my basal body temperature before getting out of bed.  All the temperature/charting folks say 3 hours minimum of uninterrupted, good sleep are necessary for a reliable basal body temperature measurement.  HA!  Have they ever met a surgery resident before?  My chart looks like a saw blade ... up down up down up down ... it's no wonder I can't figure out whether or not I've ovulated.  My OB/Gyn doesn't really know what to make of my temperature charts.  He tells me: "Sure, I'd love to say 'get more regular sleep,' or 'try for a more normal schedule,' or 'work on your stress levels,' but I was a resident once, too, and I know how ridiculous that sounds to you.  He's right - if I had a "normal" job, or a "normal" life, those would be reasonable suggestions.  I do what I can with the life I've chosen.

All of this is difficult, even though I've been off hormonal birth control and we've only been officially "trying" for about six months.  What compounds the difficulty, though, is that all this has to be kept under wraps.  Most women who start down the path of trying to conceive are, understandably, quiet about their journey, unless they have a kindred soul (who may also be trying) with whom to share their experiences.  Being a surgical resident just adds another level to the need for secrecy.

In my program right now, there are several male residents whose wives are pregnant.  All of those announcements were met with a lot of "way to go, man!"  "Congratulations!  When's she due?"  "Not much longer until she'll want #2, eh?  Too bad we've got residents' salaries!"  In my program, we average one woman for every 5 or 6 men -- and that's actually a good number, for an Ortho program.  There have been two women before me who had children during residency, and one woman in the class below me.  When they got pregnant, there were significantly fewer "YEAH!  Way to go!  Congrats"-type responses.  Instead, it was a whole helluva lot of "how much time are you taking off?"  "Wait, you're due during a rotation where you're q3 call -- who is going to cover your call?"  "We're going to have to book down that clinic for a month, aren't we?"  And while they were away on maternity leave - most of them took 4-6 weeks - there was definitely a fair amount of grumbling.  I found myself defensive for them: "If this were YOUR WIFE, I'll bet you'd be fighting for every single day of her leave," I'd tell the complainers.  The double standard still gets me.

And so I continue to sneak away to pee in my cup and look for signs that I might be ovulating, despite this ridiculous schedule and stress I put on my body, my mind and my spirit.  I'll deal with the double standard when I get to that point; right now, I'd just like to see two lines of the same color, and my husband and I will keep hoping.

-I'm an orthopaedic surgery resident on the west coast. No children yet.

Safe Landings

A couple of weeks ago, the kids and I went to Florida with some friends. It was an amazing trip. I didn't get to do a vacation with the kids last year - was so busy with divorce and house selling that it didn't happen. I realized, after this trip, how much we all really needed the break from life.

We flew into Destin/Ft. Walton Beach late on a Saturday night. While standing in line for a rental car to drive 2.5 hours to our final destination, the kids were running around the baggage claim area burning off energy. There was a big display of brochures advertising various activities next to the rental car desk. Cecelia (8), oops I mean Ce-silly - she asked me to change her blog name to a pet name her second grade teacher called her - picked up one on parasailing.

"Mom! I've always wanted to do this! Please can we parasail?"

Me, yawning. "Um, OK maybe? Let me look into it tomorrow." I still had the drive in front of me - unknown territory in the dark - and was a little anxious. I was thinking parasailing? Really? How had she even heard of this? I did it once back when I was 15 or so, but hadn't thought about it much since then.

We arrived safely around 2:30 in the morning and had a magical week with friends and lots of kids. Ce-silly was relentless about the parasailing thing throughout the week. On Wednesday I finally picked up the brochure. It advertised that kids 6 and up could participate, which put Jack (6) into play, if he was willing. More enticingly, we could all ride together. I called the place in Destin and they said they would reserve us a spot at 9:45 on Saturday morning, leaving us plenty of time to parasail and catch lunch before our return flight to Little Rock. Everyone else drove, so it would just be us three. Catch was to convince Jack.

"No way, Mom. I'm not doing that."

I explained the process to him, told him I had done it and he would love it.

"What if the rope breaks?"

"I'm pretty sure the rope won't break. Haven't really heard of that happening. I think you will be fine, but it is up to you. You can stay on the boat if you want, and I will sit with you."

Ce-silly has amazing lawyer-like powers of convincing and negotiation, and by Saturday, Jack was game. We boarded the speed boat and headed out of the bay to the open ocean. We listened to the instructions of the guides and got to watch a couple of people go before us and return safely, so Jack was excited when it was finally our turn. We harnessed up and sat on the front of the boat.

As the boat sped up, the rope loosened and carried us 800 feet up into the air. It was surprisingly quiet up there - I was in the middle of Jack and Ce-silly. Much quieter than on the boat where the motor competed with the 1980's music. Seagulls and pelicans flew by. We watched a plane carrying a bank advertisement in the distance. Jack turned to me in amazement.

"Mom, this is my dream! My flying dream. You made it come true. Thank you so much. I love you."

My heart melted all over my thorax, despite the fact that I worried I had peaked him out at age 6, and it would be all downhill from here. I noticed that his hands were clenched on the ropes.

"Jack, you can relax your hands, if you want. Sit back into the seat. You will be fine. Did you notice down below, how the sun is shining all sparkly on the water? It looks like diamonds, doesn't it?"

He nodded in assent. Ce-silly said, "Mom, I have to pee. I wonder what it would be like to pee 800 feet in the air?"

I laughed and told her - "Well if you have to, I understand. But hold it if you can - we'll find a bathroom as soon as we get off the boat."

"OK, I think I can hold it. Mom, you know what? This is the best 10 minutes of my life. Only I wish it was a little faster - might be more exciting."

Just then the boat slowed us down and dipped our toes into the water before taking off and carrying us back into the air. Ce-silly got her thrill.

We landed safely on the boat and snuggled up happily to watch the last two rides. Both kids and I were sitting serenely, dazzled by the experience. Maybe we'll go again next year. I had to pay $20 bucks for photo service, but for once, I was on the other side of the camera.

Here's to safe landings for everyone.

Is 12 weeks long enough?

I was recently on the phone with a friend of mine who is 40 weeks pregnant. (My husband has dubbed 2011 "The Year of the Baby" because pretty much every couple we know is having a baby.) She was having very painful contractions that were coming at regular intervals.

"I think you should go to the hospital," I told her.

"No, I can't," she said. "I still have to go to work tomorrow so it won't count as a day off."

I can't throw stones. I spent most of the day I went into labor having contractions at work that were increasingly painful, and ignored the charge nurse yelling at me that she was NOT going to be delivering my baby. I had to get my work done for the day so that it would "count." (In my defense, the contractions were still 15 minutes apart when I finally went home.)

Honestly, I liked it that when people asked me when I was due, I could reply, "Tomorrow." I was proud of myself for working till the day I went into labor for two pregnancies. But that was pretty much all I liked. The last two weeks of pregnancy were an uncomfortable blur of swollen and achy feet, exhaustion, having to pause dictations multiple times to catch my breath, and Braxton-Hicks contractions that liked to come when I was driving. If staying home during that time wouldn't have cost me any money or time with my baby, I wouldn't have hesitated to do so.

FMLA guarantees 12 weeks off. That seems like a long time in some ways, probably the longest I've gone without work or school since I was three years old, but it also means you're going back to work and leaving a two and a half month old baby behind. It means that you don't want to sacrifice any of that time to stay home without a baby in your arms.

And a lot of residents and other professionals take far less than 12 weeks off. I know many women who took only 6 weeks off. I know a few who only took 4 weeks off.

This is not unique to medicine. Most of the women I know in other fields also worked until the bitter end. I don't know any who were happy to be still working at 40 weeks, but it's a necessity when the law only gives us a maximum of 12 weeks, and often that time is unpaid. Canada gives women a whole year to spend with their babies.

I'm not sure I'd enjoy taking a whole year off or if I'd really do it. But it would certainly be nice to live in a country where it was an easy option.

Feelings of loss post-partum

by FreshMD | Martina Scholtens

When Ilia was a few weeks old, Pete asked, and said it so casually from the couch where he was reading after dinner, "Do you miss our old life?" The relief to hear it said. I did. I missed the old routine, driving in to Vancouver in the mornings with four-year-old Ariana in the back seat, CBC on the radio and a day at the clinic ahead of me. Yes, there will be a similar routine in a few months, with an infant in the car and a graduated return to work, but those other days, the particular way they were, are done.

"I guess you'll never have another son-baby, hey, Mom?" asked my six-year-old son cheerfully as he ate his after school snack the next week. I could have cried. I saved all my kids' clothes in anticipation of this possible fourth, and now that she's here I have boxes of corduroy pants, sneakers, little ball caps to set afloat. Somehow my daughters' infancies seem preserved through Ilia wearing their hand-me-downs, but I can't kid myself: my son's baby days are over.

And then I overheard Ariana greeting her little sister. "Good morning, Ilia," she said seriously. "It's your medium-sized sister." Saskia's still the oldest, and Leif's still the only boy, but the crown of youngest child has been passed from Ariana to Ilia, by my choice. Then, after church an elderly woman tugged on my arm, admired the baby and confided, "Mothers have a very special relationship with their youngest daughter." At that moment Ariana came into view, long dark pigtails, thin legs in purple boots making their way across the room to the gardens outside. There she was, the daughter with whom I would have had that extra special relationship - except I'd taken that from us and given it to this newest baby.

Those first two months, I missed my bodies. The one before this last pregnancy. The one before I had ever been pregnant at all. The pregnant one, even, that at least looked purposeful. A week post-partum, sitting at the breakfast table, Leif gestured at my paunch with his spoon and asked, "You know why that looks like that? Because all the equipment is still in there."

Most of all, I've struggled with the (temporary) loss of my identity as physician. At the little good-bye party over cake in the chart room in February, I asked the clinic to please just stagnate until I returned. Of course they will forge ahead and do all sorts of interesting things while I'm away, and I hate to not be a part of it. Some of my patients requested six-month supplies of medications to tide them over until my return. I didn't comply, but I understood. I'm grateful for my locum, but I'm jealous of her, too. I miss the collegiality of the clinic, the focus on others' lives, the escape from my own head, the sense of contributing to the community, the academic stimulation. I'm back to work in the fall, but in the meantime, I feel a little unmoored.

This is my daughter:



How I love this little face. I marvel that someone I couldn't have imagined months ago could feel so inevitable, could have an entire family happily orbiting around her.

Don't mistake this for ingratitude. It's simply an acknowledgment that for this new mother, mixed in with the bliss of those first six to eight weeks, were feelings of loss and grief. Surely I'm not the only one.

Must the doctor ALWAYS be in?

First of all, for any of you who decided to read this post because you thought it might be a follow-on to the discussions about whether it's ok to work part-time in medicine, nope, that's not what this is about. Rather, it's about the tendency to wear our doctor hats even when we're off-duty, when it comes to our own health.

It was a Facebook status update, or rather a string of them, that first got me thinking about this issue: the epidemic of medical hypochondriasis among doctors and other folks in medicine. (For my friends in psychiatry, let me apologize for using hypochondriasis in the lay sense, not with any DSM criteria attached, and for my friends in epi, I know it's not really an epidemic.) A friend of mine, who is a mom of three and a critical care nurse practitioner in the PICU of a large academic center, often posts on FB about her anxiety related to her kids' health. One of them has a fever, and she wonders aloud whether she is the only mom checking for petechiae. Another says she's too tired to bike (in the 98 degree weather) and wants to come in and watch TV in the air conditioned living room instead, and she frets about whether she is severely anemic--it could be acute leukemia! It is easy to witness someone else do this and see the absurdity in it, but when it's YOUR lymph node that you think you might feel in your neck or YOUR lumpy breasts or YOUR bone pain, etc, it becomes a lot easier to let your mind spiral off into the crazysphere.

Most of the mothers in medicine with whom I have discussed this freely admit, "Oh yeah, my thing is cancer" or whatever. Everyone seems to have something she is convinced she is going to get, and it's often what she's surrounded by, not what she actually might be at increased risk for due to lifestyle or family history, that seems to drive the fears. My good friend from medical school who is now a pulmonologist in a tertiary care center became convinced that she had pulmonary fibrosis when she found herself out of breath in kickboxing (after taking off 2 mos from it). Another friend who is a high-risk OB attending just about drove herself insane with fear that she would have fetal death in utero. I have seen her on multiple occasions in all of her (3 healthy) pregnancies sitting in the hospital cafeteria with a sugary drink in one hand and the other hand on her gravid belly, brow furrowed, checking for fetal movement. Another who is a rheumatologist is obsessed with developing lupus, and given that lupus can cause any number of symptoms/signs, she gets a near-weekly dose of affirmation that THIS TIME, she really does have lupus. Kind of ridiculous, right? Except when you're in it rather than on the outside looking in.

I find myself worrying about cancer mostly, which I guess isn't shocking since I'm an oncologist. Every patient I see--well, except for a fortunate few who have been misdiagnosed--has cancer, 100% of them. And I see mostly second opinions, so they are usually pretty sick and often complicated patients. Though they all come with a big, thick chart, I always take my own history, and even in patients with several years of metastatic cancer, I always start with how the cancer first presented. I am struck again and again by how subtle the first signs were--that little twinge of pain in the chest that only lasted for a few minutes or noticing that she was slightly winded, just slightly, after dashing up a couple flights of stairs. Or whatever. I don't see the zillions of people who also had little twinges of pain in their chest or mild dyspnea who turned out to have costochondritis or an albuterol deficiency or absolutely nothing at all. I don't see ANY of those people. In other words, I have no denominator to provide me with perspective. Of course, these histories I'm taking are all retrospective, and maybe the "first signs of cancer" patients report were in fact utterly unrelated to their diagnosis, but have taken on significance in the wake of being diagnosed and repeatedly asked these questions by oncologists. All of this, I know, but I can't seem to remember any of it when it really matters.

So, I wonder: does this worry simply come with the territory when one works in a field where life-threatening diseases are the price of admission? Would I still worry if I were a primary care pediatrician, where the majority of my patients are so healthy they are actually labeled "well child"?

Do you find yourself worrying more than you feel is reasonable about your own health or that of your family/friends? Do you worry about the diseases you see in your own practice, or do you have "a thing" like cancer that you worry about, even if it's outside of your usual practice? And if so, how can we do a better job of being a voice of reason to each other? Because we are doctors. And we are mothers. Which means we have more than enough REAL things to worry about!

My Grams, Her Battle Was My Battle

There are some wonderful people that will pass through your life and when they leave it is very difficult to go on at times. Holidays, special events, and birthdays become painful reminders of their absence. I wrote this article a few years ago when my Grams was still alive and I read it at her funeral two weeks before I deployed overseas to the Middle East with the Air Force. 2007 was a tough year for my family but my Grams was a beautiful person who blessed my life.

"When my grandmother, Grams, came to live with us in 1997 she was depressed and a shell of person that I had known in my childhood. She came to us because she was leaving a violent marriage of 20 years. The Grams of my youth was vibrant and energetic, spending many summers with my younger sister and I shopping or playing miniature golf. But that cold day in April of 1997 I saw a sad hunched over figure in a wheelchair being wheeled off the airplane. I almost did not recognize her.

Grams settled into our home, spending many hours with my young daughter, Emily, looking at the stars and discussing what to wish for. Over the course of the next 7 months her divorce was finalized and we moved from Ohio to Texas closer to my mother. By this point I was beginning to see shimmers of happiness and energy from Grams, but on occasion she would fall back into the depths of depression. She struggled with being dependent on us for everything and pushed away opportunities of socializing with others outside the family.

By 2001 I had begun my third year of medical school and my grandmother watched the youngest of my 3 children, Gabriel. In October she called to tell me that her mammogram had showed an irregularity and she was told by her doctor that it would need further evaluation. My heart sank as I had a gut feeling that it was going to be bad news. I spoke to many physicians asking which surgeon they would take their mother to and Dr. Ronaghan's name came up more than once. We had her referred and Dr. Ronaghan gave us the grave news. She indeed had what looked like breast cancer and biopsy would be the only positive answer. Grams took the news as if you told her that she had a simple cold. My assumption was either she was in denial, had completely lost her mind, or extremely stoic. I, on the other hand, was falling to pieces inside. The thought of losing my grandmother made me nauseous, but I knew she was counting on me to be there for her. Little did I know that I was going to be leaning more on my grandmother during this process than she on me.
A few days later she had a lumpectomy which revealed lobular carcinoma and would need further surgery. Grams remained enthusiastic and positive about her outcome, she almost seemed happier than I had seen her in 4 years. I didn't know what to make of it, but then again things flew by so fast that I didn't have time to process it.

She went on to have a bilateral mastectomy with positive lymph nodes on the right side. So, we weren't out of the woods yet, she would require chemotherapy and radiation. Chemo would begin in December, 2-3 times per week for several weeks. By the tenth day her hair began to fall out in clumps and we began looking for wigs. One night she asked me to shave her head so she would not have to deal with her hair falling out anymore. I had cut hair many times, even Grams', but this request made me anxious and hesitant, almost to the verge of tears. It made me feel as though the cancer was winning, she was losing herself to the enemy. It was taking her beautiful thick white mane that made her my Grams. Well, we went to the kitchen and I plugged in the electric razor. I stared at her for a long time until she prodded me saying, "Laurie, it will be alright, don't worry. Anyway, I am hoping that it will come back curly!" At that moment I began to realize that the cancer was not going to win, because my Grams was strong and positive in heart and mind. I was looking at the Grams of many years ago, vivacious and alive! Yes, alive...she hadn't died yet. Wake up Laurie and join the fight! I went on to shave her head of course after we entertained the idea of a mohawk.

She continued with the chemotherapy and had good and bad days of vomiting and fatigue but her optimistic attitude never wavered. The children had adjusted to having a Grams without hair, the boys, Jonathan and Gabriel, loved to run around in her wigs. In preschool Jonathan was asked to draw a picture of his family. He drew his mom, dad, brother, sister, and Grams. We all had hair except one figure had no hair and was holding something in her hand. When asked who this was and what were they were holding, Jonathan promptly replied, "That is Grams holding her wig." As the story was relayed to her, Grams eyes twinkled as she replied, "Well, it's too hot to wear a wig all the time."
Grams went on to have six weeks of radiation therapy that resulted in severe burns across her chest. She was in pain most of the time and we did what we could to make her comfortable. She never cried or felt sorry for herself. She always asked me how my day went, always worrying that I wasn't eating right, getting enough sleep, or working too many hours. All the meanwhile she was in the middle of a life and death battle with an ever imposing enemy. She prayed and read her Bible daily, always reassuring the rest of us that she would make it.

Indeed, 5 years later my Grams is still here without any signs of recurrence of the cancer. She taught me the power of positive thinking, humility, love of family and faith in God. I can only hope and pray to be a fraction of the woman that is my Grams. And yes, her hair came back curly."

I hope you enjoyed this and share it with others. Remember each day is a blessing and there is only a finite number of these! Create an impact on someone's life, and it can only improve yours.