Just Another Manic Monday

No one has written about a typical day in their field in a while. I thought today would be a good example to remind, most importantly the surgeons who think we are sitting back drinking coffee while they are waiting for their frozens to be read, but also everyone that pathologists do not just sit around admiring each other's ear hair grow.

I was in the carpool line at 7:30 this morning when my pager went off. I was happy sitting in the carpool line, since last Thursday and Friday I had to drop the kids off at 7:00 so I could make it to the Conway hospital to cover the OR. I watched the kids bound out of the car and then called transcription. "You are on standby for CT3 for a needle."

Standby can mean either five minutes or thirty minutes, depending on whether or not a tech remembered to call and give us a heads up, and also how long it takes the radiologist to guide the needle to the mass of interest in whatever organ is under investigation. I told her I would be there as soon as possible, and hastily trucked it down the interstate. Luckily I made it to the transcription area in about 10 minutes, right when they called to say they were ready for me. Unfortunately I simultaneously remembered that I had a record seven pending cases from Conway sitting on my dining room table. One was a medical liver that needed to be sent out for consult. Three were diagnostic cancer cases. Oh shit, I whined to a colleague. Headed to CT.

As I walked into CT3 I noticed that the tech, a sub, was placing the slide into alcohol for a modified Pap stain. I sighed and glanced at the radiologist. "You forgot I am a diff-quik girl." We all have our stain preferences, and they hadn't screwed mine up in a couple of years. He looked at me and said, "You want me to get you some more? I can get more. You haven't been around here in a while." It had been about six weeks since I covered EV cytology. I glanced at the CT monitor and saw that the needle was in a large mass in the lung. I told him I would give it a shot and see. Peered into the microscope and luckily it was a no brainer. I wandered back over to the radiologist. "Despite the fact that I feel like I am Alice in Wonderland, I think I can call this one. Positive for malignancy." I got the schedule from the tech and saw that there were many needles today - liver, lung, mediastinal mass, a couple of inpatients that needed to be worked in, but nothing for an hour.

I got coffee, got coverage, and booked it home to get Conway cases and bring them back to work. I was busy with cases and needles until noon. I got a call around 10:00 from one of the transcriptionists asking if I would do an outpatient referral FNA from an ENT in fast-track ED at 1:00. "Sure, I'm not going anywhere, thanks for asking." At noon I was hungry, but got paged for standby. I normally don't like to eat when I might get called out, but hell, I thought, I've got this lunch thing down to a ten minute fine art. Heat Morning Star spicy black bean burger in microwave 45 seconds. Prepare nuts and carbs of my choice. Add liberal honey and small amount of spicy mustard to heated burger. Eat quickly and chase with bottled water. Finish off with Take 5 for dessert. I managed to squeeze it in before I had to go to CT again.

At 1:00 the cytotech preparing the outpatient came into my office. "The patient is here but they can't get us a room for another hour in fast-track ED." I asked him how in the world did this happen, didn't the transcriptionists call ahead to reserve the room? We are supposed to call ahead if it is scheduled for after 11:00, ED gets busy in the afternoon. I was a little mad, we had been over all this months ago - it was supposed to be working smoothly by now. I went out and apologized to the luckily good natured gentleman with a facial mass. He had another appointment at 2:30, but said he would stick around until then in case a room opened up. It didn't. He said he would come back at 4:00.

I called the head transcriptionist into my office. "Can you please gently remind all the people that schedule needles that we have to call ahead to reserve a room after 11:00?" She told me the problem was that some of the people in ED told them they didn't have to call ahead, and it had become confusing. I told her, "Tell them to ignore those people, from now on. This is compromising the patient's time, and that is not fair." She agreed, and I decided that was enough for right now.

The week filled up all afternoon - fat pad aspirate on Thursday, special request from a breast radiologist for us to do and immediate on-site evaluation of a breast mass at the breast center at the end of the week, etc., etc., all requiring phone time and logistics. Cases got finished, needles got evaluated, and I even found time to fill out picture order forms for kids school pics and print out their menus for the next couple of weeks. The kind gentleman came back at 4:00. We chatted in between me sticking a needle in the side of his face. "That thing is pretty scary," he said. "Oh, you mean our gun?" He laughed. "You call that thing a gun?" I said, "Yes, isn't that funny - it is really only there to create negative pressure. I thought about using the French technique here, meaning I wouldn't use this gun to hold the needle and syringe, but the texture of the lesion requires this contraption, sorry."

I made it out the door in time to problem solve some phone issues at Verizon before heading home to relieve my after school help and start dinner for the kids. Cecelia had been to the orthodontist, her mouth was sore, so I suggested pasta for dinner and prepared elbow noodles, cheese tortellini, Parmesan, hard Romano, basil pesto, and spaghetti sauce - we had a sort of a pasta bar going on and everyone was happy. After 15 minutes of itouch time and 15 minutes of me demonstrating yoga poses (I started back last week after a 9 year hiatus) to the kids for copying, much to my son's amusement and my daughter's amazement, we started bedtime.

I hope tomorrow is a little bit lighter. Based on the last two weeks, I'm doubting it. Something about school starting and everyone, doctors and patients included, returning from vacation has made our lives much busier lately. Hard to complain about work, I guess. But there is something ominous about the pager going off in the carpool line. It sets a frenetic pace for the rest of the day.

Depression and the Working Mom

I can't possibly be the only working mom who sometimes contemplates life as a stay at home mom (SAHM).

I've had periods where I got to briefly experience life as a SAHM, such as during maternity leave or the month between residency and fellowship. I love it in theory. It's nice to be there for your kids all the time, make nice hot dinners on the stove, and keep the house tidy.

And as we all know, juggling full time work and kids can be a huge challenge. I get jealous of women who don't have to resort to bribery to get out the door before their first patient each morning, and get to spend the whole day enjoying their kids. I feel sad sometimes, thinking about how I'm missing out or that my life is too stressful. My kids are only going to be so cute and little once and I'm missing it.

However, my father (obviously reading my mind), recently forwarded me an article about how SAHMs have a higher rate of depression than working moms. (He's always forwarding me helpful and relevant mental health related articles. After I got married, he forwarded me an article about how women who got married and divorced had a lower rate of depression than women who never married. Thanks for the confidence, Dad.)

And actually, reading this article made me feel better. It was a reminder that even when I don't love every aspect of my job, I like feeling productive, interacting with people, and of course, bringing home a paycheck. It makes me appreciate my kids more when I'm with them, and it makes me feel less like taking a bat to the TV whenever I see Spongebob on the screen. And it fills me with pride when my daughter says she wants to be "a doctor like Mommy."

Running, Running…and More Running

Have you noticed that as time marches on we are always running, often literally. We are rushing to work, to an appointment, answering a page, picking up the kids, making dinner, paying bills, planning vacations, reading CME and just trying to keep our heads above the water. No wonder we are stressed and anxious. Did we just replace our ancestors’ worries of finding food with time consuming errands?

Our lives are so filled with little worries that together they take one big toll on our peace of mind. And then you add economic worries, job loss, news of wars and droughts and is becomes overwhelming! When did life become so busy or was it always like this? When I was a kid we did not have money, computers, vacations or the internet. We had TV but when dad came home he took it over and if you were within hollering distance you became the remote control. Oh, how I hated that. Solution…go to your room and turn on the radio, read or go outside to play with your friends.

So, how did I get from there to here? Here I am in the middle of life and truly believe all the information coming at me has caused me to have issues. I want to participate in many things, travel to foreign lands with my kids, see my children participate in sports and music and excel in school, learn Spanish and the guitar (oh if I could only sing!), train for a marathon, write another book, hike and spend more time taking pictures. Seriously, does anyone else have this problem? Is it a personality disorder yet to be discovered?

I really want to simplify life and slow down to smell the roses but my fear is missing out on an amazing experience. Can you imagine going one week without any TV, radio, internet and cell phone? I know I panic when I realize I can’t find my phone or when the internet is down. How about you? Are you addicted to technology and has it affected you or have you seen it affect your patients?

Busybodies

Last year, I was at a Costco, waiting on a very long line. There was a family ahead of me with two small kids. The parents weren't really paying attention to the kids and I happened to notice that the little girl had peed her pants. There was urine all over her pants and a little puddle underneath her.

I must have stared at that girl for several minutes, trying to decide if I should alert her parents. On one hand, I think I'd like to know if my child was standing in a puddle of her own urine. Then again, I didn't want to be a busybody. Finally, when the parents still weren't noticing, I decided to say something:

Me: "Um, sir... your daughter...."

Father: "Oh, it's okay. I've got my eye on her."

Me: "No, she, um... peed...."

Father: [looks at girl] "Ava! Oh no!"

I guess I did the right thing by telling him, but I immediately felt kind of guilty for making a comment about someone else's kid. Believe me, this is not something I ever do. I was recently at the zoo and stared in agony at this woman who had a one-month old baby with no head control front-facing in a baby carrier, with his head sagging down like it was about to fall off.... but I never would have said anything in a million years. It's none of my damn business.

While I think it's despicable when someone goes up to a complete stranger and tells them not to give their baby a bottle or something like that, I wonder if there are situations where it's appropriate to intervene. For example, would you say something if you saw a woman hitting her child? Or worse?

Ob/Gyns are terrible people who need to die, and other common misconceptions

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.


I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (God forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, the media, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

***cross-posted at Ob/Gyn Kenobi

Gestational Diabetes

(Note: I'm posting this story because someone requested it in the comments of my last post. I apologize if it gets long.)

I failed my gestational diabetes screen by two points.

For those of you not familiar with the screen, it’s a test during pregnancy where you drink this horrible, sugar drink and then come in an hour later to get your blood glucose tested. Considering I was seven months pregnant, not showing, and weighed only 116 pounds, I didn’t think there was any chance of my failing the test. I was so overconfident that I had some crackers right before I had the drink, to make it go down easier. (This was allowed, but probably stupid and likely pushed me over the cutoff.)

The cutoff my practice used was 135 and I had a blood sugar of 137. In some practices, a cutoff of 140 is used. And when I looked this up in research studies, in a woman of my age, race, and BMI, it is appropriate to use a cutoff of 140. Or actually, some say the screen isn’t even necessary in the first place in someone like me.

Now if you fail the screen, the next step is a three hour glucose tolerance test. You come in for a fingerstick and if that’s normal, they give you a huge amount of sugar, do a venous draw for blood glucose, then repeat that every hour for three hours. I did not want to do this test.

You are probably thinking to yourself, “Why is she being such a baby? It’s just four blood draws.” That’s exactly what I’d be thinking if someone told me that story, believe me. I’ve had like a billion blood draws in my life and I’ve always thought of it as no big deal… needles don’t bother me.

Except for some unknown reason, my ob/gyn practice gave the most painful blood draws known to man. Now I can deal with short-term pain, no problem, but on two separate occasions of having my blood drawn at this practice, my arm was basically incapacitated. The pain in my biceps was so bad that I was actually awakened during the night due to pain. I could barely move my arm to drive and I had bruises going all the way up to my deltoids. And the pain persisted for over a week. Both times! Their phlebotomist was obviously not the greatest.

So I wasn’t thrilled by the idea of having four of these blood draws in a row at that practice. (The only other place they’d do them was at a hospital a million miles from my office.) My job involves a lot of writing and I was terrified by the idea of my arm being taken out of commission. I was literally in tears at the thought of being unable to function or sleep due to these blood draws--blood draws that I felt were basically unwarranted given the fact that it was so unlikely that I had GD. If I felt the baby were in danger, I’d have done anything, but it seemed more like this test was being done so they could cover their ass.

Anyway, I did try to keep a somewhat open mind. I felt if they had a convincing argument, I’d do the test. I went to my appointment for the 3 hour test at 8:30AM. I did the fasting fingerstick, which was 90. I asked if it would be possible to briefly speak to any OB at the practice about the test before doing it. Immediately the phlebotomy tech looked really put out, and acted like this was a ridiculous request that would take hours to fulfill.

About five minutes later, they miraculously located an OB that was between patients and she came over to talk to me. Except before I even opened my mouth, the doctor’s arms were crossed and she looked really angry at me for taking up 2 minutes of her precious time.

I explained that I was a doctor, that I researched the test myself and that I knew I was extremely low risk. I explained that research showed that with someone my age, race, and weight, testing wasn't indicated at all, or at the very least, a cut-off of 140 was warranted.

Doctor: [snippily] "OUR cut-off is 135."

I then tried to explain to her about how painful the blood draw had been at that office. They clearly went through the vein both times due to the pattern of bruising. I had been awake all night in pain. And then continued to have pain for a week after both times.

Doctor: [snippily] "That's impossible."

So I guess I was lying?

At this point, all I wanted to do was run home crying. Finally, I said I would do the test in fingersticks on my left hand.

Doctor: [snippily] "Fine, so I'm documenting your refusal to do venous draws!"

The phlebotomist was kind of cold to me after that too, possibly since she was the one who gave me the two painful draws. She started ranting about how she didn't know how to document my results. I felt like I had to apologize with every single hourly fingerstick.

I don’t know exactly what the doctor could have done differently. I would have preferred if she gave me an actual explanation of why it was so important for me to have the test, aside from just reiterating the cutoff. Or if she did agree with me the test was unnecessary, she could have nicely explained to me that she had to document a refusal, but admitted that I was very unlikely to get a positive result.

Anyway, three of the four fingersticks weren't even close to the cut-off. The fourth was below the cut-off, but only slightly. I was terrified the entire night that the mean doctor would call me and try to bully me into repeating the test and threaten to kick me out of the practice.

What did end up happening was that I had to call the next day (originally, they promised they’d call me, but apparently they wrote me off) and they got a different OB to speak to me. It wasn't my usual doctor, but it was one I had seen before and liked. He told me that the test was definitively negative. He didn't know what to make of the one borderline number, but said their glucometer tends to run high, and one abnormal value wasn't enough to diagnose GD anyway. He said to me, “I kind of remember from seeing you and from looking at your weight here… you’re pretty tiny, aren’t you? I really don’t think you could have diabetes. That test was probably overkill. Just, you know, eat healthy.”

(I then proceeded to not gain any weight for the next month because I was so nervous about eating carbs, and meat made me ill.)

Even though I guess it worked out in the end, the whole thing left me with a negative feeling about the practice. I felt uncomfortable coming to my visits and I imagined everyone was angry at me. Moreover, guess which OB in the practice was on call the night I went into labor?

So now that it’s all over and I’ve given birth to an average sized baby, you can go ahead and feel free to judge me and tell me that I sacrificed my baby’s health for the sake of avoiding discomfort.

Being a difficult patient

Especially since I'm a doctor myself, I hate being a difficult patient. I want to be the sort of patient who does everything the doctor tells me to do and never complains and is always healthy.

In some sense I've succeeded. As a mother, I don't call the pediatrician's office after hours more than once or twice a year. Aside from making appointments, I only called my OB's office once: while in labor. But I also feel like I should advocate for myself a little bit as a patient, and I worry that sometimes might cause me to be perceived as annoying.

For example:

At my last visit to the OB/GYN, it was noted that I had my last pap smear six months ago. As such, the doctor told me I'd need to come back in six months for my next annual pap.

Now don't get me wrong, I love getting paps. I love having to pay for them out of pocket due to my deductible, I love waiting an hour to get in to see the doctor, and the exam itself is pure enjoyment. I wish I could get them every week. But in actuality, the guidelines from the ACOG say:

Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years

And actually, the last doctor I saw before I moved a couple of years ago was a primary care physician who confirmed that I only needed to get this delightful test every three years.

So now I have two choices: I can either get an inconvenient and expensive test I don't need, or I can be that patient who shows up with the ACOG guidelines in my hand and explains why I'm refusing the exam.

The 4 Stages of EMR Adaption

Stage 1: Naïve anticipation

Last summer, as we began the process of choosing which EMR (electronic medical records) system that we would buy, I was filled with my usual optimism. Despite the naysayers, I was sure that our efficient office would have no trouble adapting from paper charting to computer charting. Above all else, I was convinced that Moi, ‘Ms. Computer Savvy Blogger' would love EMR. In the months leading up to the transition, I began to look condescendingly at our cumbersome paper charts and our 3x5 card tracking system for abnormal labs, as I anticipated their retirement. They seemed quaint relics, like cassette tapes or Ms. Pac-man machines. I could hardly wait for the charts to be replaced by information at my finger tips and the promised fool proof tracking systems that would improve quality, while making my life easier. Though my partners voiced trepidation about what we were to endure, I had little doubt that we would be paper free in just a few months. It would take work and there might be a few hiccups along the way, but I knew that if we put in the time and effort, the transition would go smoothly.

Stage 2: Adaption Angst

We decided on Greenway, a system that was specifically marketed for OB/GYN. Training was scheduled for early November, with the plan to ‘GO LIVE’ the following week. Leading up to our training, I (as self appointed EMR point person) had several conference calls with our trainer. It was during these calls that the first inklings of doubt began to set in.

Every question I posed to our trainer was answered the same way, “Oh, yeah, that is SUPER easy, I’ll show you next week.” Her voice was high pitched and bubbly, like an excited Barbie doll. While I was naïve enough to think that the transition would go well, I was not an idiot. I knew that not every aspect of EMR would be, as she repeatedly intoned to me, “SUPER EASY!”

Training week did not flow well. While we all did manage to learn the basics of charting notes and navigation of the software, any question outside of basic charting was met with a blank stare from our Barbie doll trainer.

“How do we order labs?”

Blank stare.

“How do we track labs?”

Blank stare.

“How do we fax?”

Shrug.

Things weren’t quite so “super easy” anymore.

She abandoned us after a two weeks. That’s when the fun began.

Stage 3: Self Pity/Anger/Denial

While I did learn the EMR fairly quickly, my biggest disappointment came in the realization that it did not make my life any easier. On the contrary, it added at least an hour to my day. Everything just takes longer.

It took us several months to figure out the extremely cumbersome tracking system for labs. I began to look longingly at the 3x5 note card boxes that I had previously scorned. It takes me 14 clicks to sign off a lab, IF ITS NORMAL! While it used to take two seconds to make a quick signature, now it takes 14 clicks. My nurse also has several extra steps involved with routing documents back and forth. If there is an abnormal lab, I then have to open multiple documents to decipher the plan, task it to the correct staff and turn on all the tracking mechanisms.

Home has always been my sanctuary, unless I was on call. Now I find myself leaving work before my charting is completed, so I can attempt to be home for dinner. After the kids are asleep, I dial in to finish charting. Home is no longer a safe haven. I really hate the fact that I can ‘work from home.’

I began to relish the last few paper chart patients. When I would see a paper chart in the door, I would get that giddy excited feeling, like when a patient brings in hot fresh chocolate chip cookies for you at three o’clock on a Friday afternoon. I realized that it is so much easier for me to remember the patient details by leafing through a paper chart, rather than clicking on 17 different documents in the electronic file. Paper charts were nostalgic for me. I would flip through and see the handwriting of previous employees; coffee stains of the day I was running late and the smiley faces I would draw on the lab results when a patient’s cholesterol finally came down or their Chlamydia finally cleared up. Paper charts are full of physical, tangible memories in a way that an electronic file can never be.

I felt betrayed by Miss ‘Super Easy”. Yes, the actual charting was not difficult, but it was time consuming and the orders tracking system was cumbersome. Most importantly, I didn’t HAVE an extra hour in my day for charting.

And did I mention the FOURTEEN CLICKS?

Stage 4: Acceptance

Slowly, things have become slightly better. I will admit that being able to READ everything is very much a benefit (the computer gets bonus points for penmanship!). Also when on call, it is great to be able to pull up charts at home to review the patients history while talking to them. There is no more hunting down prenatal records when someone goes into labor on a weekend. As patients come back for return visits, it definitely gets easier. EMR still adds time to my already packed work day, but slowly I am figuring out how to make it work for me.

It was the following encounter that convinced me that I had to truly accept EMR and stop my grouching about it:

Last week I was seeing a young girl for a check up before she left for college. She was having issues with her birth control pill and wanted to switch.

This is the type of encounter that makes me hate EMR the most. While in the room with the patient, I have to attempt to look through her old chart which is in a zillion different saved files in her new electronic chart. So as I’m clicking on each file, attempting but failing to find the one that tells me which pill she was on before this one, I make some smarmy comment about how I hate my new computer.

“That’s Ok,” she says in a slightly patronizing voice,” My Grammy is a nurse, and she has a hard time learning computer stuff too!”

At this point my jaw literally dropped. It took every ounce of self control to maintain my composure at that moment.

Ummmmm did she just compare me to her GRAMMY? I am 36 years old!

After a few deep breaths I regained my composure, found the file I needed and sent her on her way with a new script. Sent by e-prescribe, of course.

From that day forward I have vowed to never complain about EMR again. Not even the fourteen clicks. No its not perfect, but it is here to stay.

Every time I get frustrated and want to complain, I just take a deep breath, smile and whisper the word, “Grammy.”

Sexual Harassment in the Workplace

I think this is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly - made me physiologically recoil, but I quickly regained my composure.

He continued the “too familiar for someone you have just met” small talk, some of it bordering on inappropriate, until I found a quick exit when another doctor walked in the lounge and said hello to him. I said, “It was nice to meet you.” I turned around, pushed the green exit button, and walked out the door.

When I checked in with my female colleague he had mentioned during the interaction a few days later, it turns out she has had some reportable incidences with him. I could handle occasional randy attendings during residency – most harmless, but some encounters are just plain creepy. My female friend did not report this clinician we both had negative encounters with, but she did at least document them in case she needed to support someone else, as well as confidentially notify the Chief of Staff. We wondered aloud that if he treated his colleagues this way, how must he treat his subordinates. She vowed to draw a tighter line if she had another strange encounter. “I wanted to maintain professionalism at the first incident, but I think I will have to be stronger with my words if it happens again.”

I was bouncing all this off of one of my friends from medical school, and she said, “I had two reportable incidences in medical school. But I didn’t report them. I’m sure I told you. Do you remember them?” I remembered one – the attending that tried to hold her hand in the hallway all the time. Once he lifted her shirt and tickled her belly. Luckily that was toward the end of her rotation, so she didn’t see him again. But I did not remember the other, she never told me.

“I didn’t? Maybe not. Probably because at the time, that fourth year medical student reported that doctor that reached up her skirt and grabbed her leg, and she was being raked over the coals. I didn’t want to be ‘that girl.’”

So tell me, I asked. Turns out, in a late night OR, she was being harassed by a surgeon. While she was placing a Foley catheter, he would say, in front of residents, “It looks like you really know how to handle a piece of meat.” Another time, he was pulling a kidney out of a patient, and referred to its erect-appearing state. “I’ll bet this is exactly the state you like your dick to be in.” She told me over the phone, “That was the point I had to step away from the table and leave the OR. It was too much. My body reacted by burning, and my eyes even got a little teary – not with sadness, but with shock and anger. “

She remembered later to me on the phone that she did bounce that encounter off of someone – her then boyfriend. He encouraged her to report it, and they argued about it. She reasoned that she would be off of the rotation in a week and it would be a non-issue. If she reported it, it would be an eternal issue – one that might affect her career trajectory. Later in the year when another female in the class sought her out about her experience on that rotation – she was having similar issues – my friend assented that it was a problem and felt a measure of guilt in being silent, which may have played a part in the continued abuse. Not your fault, I told her, which she already knew, but still. This type of stuff is a Catch-22. I will be interested to read comments about the situation. I can see both sides of the coin, and we both realize there is no easy answer. There is a right answer - to report. But not an easy one.

My current encounter with the clinician was not reportable, but disturbing. I immediately bounced it off of a lab supervisor, and another one the next day. I don’t like these things to be ignored, as they are all too often. Women (and men, fewer for sure, but I do know that it exists) who are sexually harassed often feel guilty somehow, like it was something they did, and are too embarrassed to discuss the incidence. It is especially tough when you are in a subordinate position, under someone who is grading you. So it continues. Our societal reaction to women who speak up often reinforces our silence. It makes me angry.

I wondered aloud to a male colleague – one that we let into the loop for support - about the women, I know they are out there, that encourage this behavior. This colleague is conventionally handsome, I was certain he had experience in this arena. “Does the fact that some women encourage this type of interaction, out of some sort of need or desire, make these men think they can behave this way to anyone?” He assured me that no, it was still inappropriate. “You should gauge a woman’s reaction, her comfort level, to this type of small talk. If it isn’t there – you back off immediately.” I guess some guys don’t get this. No brain to mouth filter. The charge from the inappropriate interaction is enough for them to continue without reserve. Women can overstep bounds as well. My one reportable incident in medical school, one that I did not report, was perpetrated by a woman.

Both my female colleagues (current and med school friend) and I have pretty wide personal space boundaries around men. I do have a sibling relationship with a man at work I trained with – we have known each other as residents and now partners for over ten years. We can share silly sex stories we read – you know, not personal but Anthony Weiner type stuff that I might not talk about with most men – there is just an incredible comfort level. I am friends with his wife. I am finally starting, with my other male partners, to forge sibling relationships after knowing them for over three years. It takes a lot of time for me.

So I am posting this because I hope that some readers out there that may be in a situation they are uncomfortable with can know that they are not alone. It is OK to speak up. Or walk away. We do not have to tolerate this behavior, in the workplace. My friend and I have discussed our current inappropriate interactions with many male and female colleagues, with details, and have found lots of support. To quote Hillary, it takes a village. We can drive this behavior out of it, together.

I have sought and received the permission of both of my friends mentioned in this article to write this post. They have read it and are comfortable with what I have said. The older incident – ten years past now – contains more details, as it is in the past. The current situation is still too fresh to flesh out online.

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?