My mom is a blogger???

My daughter Mel is learning to read. At school, she is learning "popcorn words" which are basically two and three letter words that are commonly used. When I'm reading something, she'll point to the words she knows and say, "I know that one! It's one of my popcorn words!"

(Why is everything kids say so darn cute?)

Anyway, I know reading is just around the corner, which makes me realize that soon she'll be able to read things like... this blog. And that makes me a little anxious.

I feel like she may not "get" the things that I write online. Maybe this will be yet another piece of evidence that her mom is hopelessly uncool. Or worse, maybe she'll be offended by some of my posts that involve the challenges of being a mother in medicine.

I could, of course, continue to keep it a secret. My parents don't know I blog here, nor do my friends. But it's a little harder to keep it a secret from someone I live with, especially since she'll probably be using my computer sometimes.

For those of you who are bloggers and have kids old enough to read, do they know you blog? What do they think about it? For those of you with younger kids, do you plan to tell them?

Listen to Susan

As I sat at the funeral of a friend this past week - a brilliant former NASA astrophysicist and mother to two sweet boys, 5 and 7 - I felt the collective reverence emanate like an aura over the pews for a woman who was truly extraordinary. Susan and I met through blogging years ago and though we were writing in a medium that engaged distant audiences, we happened to live within miles. For as long as I knew her, she carried a diagnosis of inflammatory breast cancer (diagnosed in 2007). With courage, grace and honesty, she blogged about her journey through chemo, mastectomy, remission, recurrence, hospice, and too much pain. Yet what defined her was not this; it was a true joy of living, of living each breath, of tremendous advocacy, that made her luminous beyond the normal range of our ordinary mortal existence. She was the type of person that if you met her, you loved her. Simple as that.

In the homily, I learned something new about Susan: she had undergone an accelerated Rite of Christian Initiation of Adults (the process by which adults convert to Catholicism) to develop a deeper relationship with God and to draw strength from this relationship through her illness. Seeing her and her family at church each week, I had assumed her faith and religion were constants in her life equation - not something so new and dynamic. I thought about my own RCIA experience 9 years ago and how much that has meant to who I am today.

Since her death, so many who loved Susan have written about her and about how they will honor her. Encouraging their children to love science, to practice present-parenting, to support breast cancer research, to schedule their mammograms. For me, she will inspire me to have more faith, less doubt. Yes: More faith. Less doubt.

Because, I doubt. I worry. In the almost-year that my husband has been stationed in Afghanistan, the anxiety has ebbed and flowed, with occasional spurts of outright fear. I play mind games with myself, practice superstition, believing that the course of events could hinge on a mental misstep. In everyday life I worry too. Small things that shouldn't matter. Small things that wouldn't matter if I had Susan's perspective and her faith. Why not practice more faith, more optimism, more belief in the goodness of others? Because life is too short to worry so much for things beyond our control.

A friend on Facebook shared this recently: Worrying is like praying for what you don't want. I never thought of it that way, but how true. Why devote such time and energy to such negativity when there is living, loving to be had? Why not allow one's faith to carry some of the burdens?

Susan was good at many things but perhaps what she was the very best at was loving others. This was evident at her funeral - her love reflected in all those who came was evident. Radiant. Uplifting. Her best friend, a professional musician, sang the Gospel hymn "His Eye is on the Sparrow" in a voice so pure and clear - quite possibly the most beautiful thing any of us have ever heard. We were rapt. Silent. Reverent.

If we all could believe and love a fraction of what Susan could, imagine how many more breaths would be filled with joy instead of fret. Hope instead of worry. Striving towards this is how I will remember Susan. She is the cheerleader I'll hear on the inside. The hug from within.

In a wonderful interview last year, Susan was asked, "you're a role model for finding beauty and joy in life no matter what happens - what are your top 'little things that count?'"

Her answer:  Children’s laughter. Soap bubbles on a summer afternoon.  Reading books together in an easy chair.  Family meals.  Cuddling.  Taking time for a night out with friends — even when there is other work to be done. Stargazing or watching the clouds pass by. Asking a child a question, and listening — really listening — to her answer.

We said goodbye to Susan this week but her inspiration lives on inside us all.

Guest post: If I can’t freeze time, can I slow it down?

It’s FirstBabyBoy’s third month birthday today! Ack! Already he seems to be growing up too fast. It feels like yesterday when we weren’t sure whether he was smiling for real or smiling because of gas, and in truth, he has been smiling for real for ~ 7 weeks… we think.

I want to slow it all down. Stop it all even. Freeze. Like Evie from Out of This World.

I've been trying to juggle learning to be a new mother, taking care of lovely FirstBabyBoy, showing up to academic days, working on my research project, and trying to study. I know what I have to do to balance it all – efficiency, focus … but I don’t seem to be able to focus currently on things as intensely like I usually did pre-motherhood. I am determined to debunk mommy brain myths and not give us MiMs a bad reputation. But the plan is not working as well as I’d hoped… yet.

I am constantly struck by how I have had misconceptions in various stages of life and have to continually re-evaluate. I read my own journal entries from months previous and worry of even posting on this blog because I am concerned I will come back one day and say: can I retract what I said? There’s no second chance to make a first impression, but please, I am a different person now and am not really that ill-informed.

For instance:

Pre-Birth Thoughts: Being a first-time parent is going to change my life, but in some ways, it must be easier than residency, and I should have more time. After all, I’ve had all those call shifts to prepare me for sleep deprivation.

Post-Birth Thoughts: Hmmm…how is this going to work? It’s like falling in love all over again, and just like the first time (i.e. falling in love with professional husband not in medicine), I now have new goals on top of all the other life goals that I wanted… and wasn’t even sure I had time for those pre-baby goals before.

But wait, I try to reason, it’s only for some time i.e. 5 years if not more for fellowships or masters or research or other such pursuits. And one can always be more efficient with time. And work harder. And do more.

In reality, here I am doing things slower than ever… and dare I confess, enjoying the slowness. I was given In Praise of Slowness by my mother-in-law, and I am often tempted to practice it…. Or who am I kidding? Maybe I am practicing it more often than I should.

Maternity leave makes me feel like I have the luxury of time some days (a mirage if I am to accomplish all above goals). But there is such joy in puttering at times.

FirstBabyBoy is in week 14, and still, every smile feels like a gift. To smile at him and see that moment when he registers my smile and his lips start to curl, the corners of his eyes crinkle upward, and his face lights up, transformed, beaming with sheer joy: it feels worth every moment taken.

Right at this moment – FirstBabyBoy and Hubby are both lying asleep, rhythmic breathing, content after a home-made family dinner, baby having fallen asleep early… allowing hubby and I time to read interesting non-fiction literature, discuss those pieces, as well as check-in. I even got to chat with a friend as well – an amazing MiM resident who is transitioning back to work and has not seen her 13 month old for bedtime for a few weeks due to the nature of her current rotation. I don't feel like trading places. It is the first time since entering medicine that I have been able to celebrate the full 15 days of Chinese New Year with family.

Maternity leave is a gift.

But maternity leave also has its cons - there are challenges to being away from residency especially with procedural specialties like anaesthesia where being good and fast is very important… there’s always talk of the residents coming back who aren’t that slick. I don’t want to be that resident. Barash, Miller, other textbooks wink at me from the book shelf. And maternity leave may have paused residency for a while but the play button will resume. I would want it to. But it is a little bit of a changed game now. More than ever, it feels like a triathlon where I won’t be the best runner, cyclist, or swimmer, but need to be good enough at all three to be the best triathlete I can be.

Things will get more and more demanding on all fronts. As much as I want to think things are challenging as a junior resident, it will only become more so in further transitions as one moves towards senior resident in future years and attending. Not to mention as baby grows up and mommy responsibilities expand. And if I want this marriage to thrive through it all, as well as contribute meaningfully as a daughter and sister, it is going to require time and effort and efficiency, speed, not slowness. And compromises. Juggling between the various experiences. How will it all happen?

Everywhere I go, I see examples of women who have done it,who seem to have it all – the dazzling career, family, kids, beautiful home with the home-made meals and crafts. And the façade of ease. But how is it actually done?

As usual, pre-reading to prepare, I turn to scouring the world out there for information.

Imagine my relief at finding Mothers In Medicine, and the kind of community and voice a blog creates. A group of people willing to write, share, laugh, support, nurture…Being an extrovert, growing up in a tiny fishing village in a third-world nation, I very much appreciate community. This is different than a fishing village community, but it is an amazing and inspiring community – a global village.

I read recently that the difference between extroverts and introverts are that extroverts tend to de-stress by discussion with others whereas introverts de-stress by spending time on their own. Being extroverted Myers-Briggs, I do find that it’s in the multiple discussions that insights appear. So please, do share what you think of this fast, slow conundrum. Although, as my introverted husband points out, I also cherish these silent moments to write and reflect. But, add resident + wife + kid + daughter + sister + friend = very little time for such conversation with multiple people in life or for writing and reflecting. And now add “mother” to that list. How will this all fit?

It makes me think with renewed respect for those MiMs who have gone before, who in many ways had it much harder. Thanks everyone.

Now has anyone else had a secret urge to freeze time at times?

-ASA

overheard, son in bathroom, reading my journals

"Mom, you've had that Pediatrics in here a long time," says 5 year old son in the bathroom, seeing my copy of this journal on the step stool aka magazine rack.

"But you know what? I get a new one of those every month in the mail," replies MiM from the kitchen.

"Yeah but this one's been here waaaaaaaaaaay too long," he persists.

Time to get reading? Get the dust off my journals? Move it to my bedside table? Get an iPad/e-reader?

I'm Bringin' Sexy Back

The OR desk just called to inform me that I was supposed to be starting my first case at 7:30. I glance at my clock. Its 7:25 and I’m sitting at my kitchen table eating a bowl of grapenuts. I look again at my calendar, its empty. My notoriously anal surgery scheduler must have forgotten to put the case on my schedule. I hate the feeling of starting the day 3 steps behind. As I hurriedly get dressed, I realize that I have not done laundry. The only clean bra left, is a black lacy push up number that I bought on a whim for my last anniversary. I have only worn it once. Normally it lives at the bottom of the drawer next to the unmatched socks. Oh well, I think as I pull on my shapeless dark green scrubs over head, no one will know. I grab a banana and head out the door.

I drive quickly to the hospital. My scheduler rarely makes mistakes. Tell myself it’s not the end of the world. I make myself calm down before I call her. She apologizes.

As I rush into the hospital my phone rings. It’s the radiologist calling with a CT result on a different patient. He is concerned for malignancy . The corridor is loud and crowded, I can’t hear him clearly as I race down the hall. Holding the phone with my left hand, I place the index finger of my right hand in the opposite ear in order to help drown out the background noise. As I briskly march down the corridor in intense conversation with the radiologist, I notice several people looking at me quite funny. A couple folks even point and laugh. How rude, I think, rather irritated in general. As I approach the elevator, I realize the source of laughter. I was holding the banana in my right hand… which was held to my right ear. So to everyone in the corridor I had appeared to be having a serious conversation while using a banana as a phone. Nice.

Next stop is the OR. I took a couple of deep breaths, apologize for my tardiness, reviewed the charts and performed the surgery. I then head to office where I am greeted by a very sweet “I’m sorry” coffee, from my scheduler. All is well with the world, other than getting a couple teasing texts from people about my banana phone.

I finish up late and head to my dermatology appointment. I have had several atypical moles in the past, so I get skin checks every 6 months. As I arrive at the office, the nurse takes me back hands me a small paper gown and says ”everything off but your bra and underwear” then quickly steps out.

At this moment I begin to panic. I suddenly remember that I am wearing my sexy bra.

What is my dermatology colleague going to think when they have me slip off the gown and I stand there being analyzed looking like I stepped out of a Victoria secret catalog, except add 15 pounds, spider veins and pasty January legs.

I weigh the options: reschedule appointment, get completely naked, make bra joke or just pretend that I don’t look like a wannabe pin up girl.

I go with ignoring the elephant in the room.

Attractive dermatologist, who is my same age and is seen at regular social functions, steps in the room. I make no small talk just look straight ahead as I drop the sheet at let them exam me.

I stand up tall and proud. I’m all cleavage and cellulite in the always flattering florescent lighting of the cold exam room.

“All’s good. I’ll see you around,” Dr. Derm says awkwardly.

I take another deep breath and laugh.

On the drive home I think back over the silly day I’ve just had and realize that in general I take myself way too seriously. As physicians we get held to higher standard, but at the end of the day doctors are just like everyone else. We have bad days. We forget to do laundry. We have cellulite.

I could have rehashed the day in anger. Instead I told my stories to my husband over a nice glass of wine that night, and we had a really good laugh.

MiM Mailbag: Interviewing pregnant

MiM,

I am a fan of the blog and have been scouring looking for advice from anyone who has interviewed obviously pregnant for residency positions. I am down to Psych vs. Peds probably Peds, but was wondering if anyone had any advice on this one.  I would not want a non-family friendly program but at the same time don't want to end up scrambling because no one in their right mind considers a pregnant interviewee? 

 

Thanks! 

Reliable Moms

Believe it or not, I have a fair amount of medical publications to my name. I enjoy writing and I find it incredibly satisfying to see my name in print (even online print).

During my fellowship, I had a bunch of articles printed in peer-reviewed journals and even got to write a short book chapter (wrote it, not first author on it, still cool). But since then, things have been a little quiet on the medical publication front.

Recently, however, I was approached by a well-respected colleague at work about contributing to a book chapter. He was straight with me that I'd probably be doing the bulk of the writing and if so, I'd get the credit.

Him: "Do you have any interest in this?"

Me: "YES!!!"

Yet at the same time, he was scaring me a little. He kept asking me questions like, was I sure I'd be able to dedicate "a large chunk of time" or about what my childcare situation was like. He kept asking me if I really thought I'd be able to do it.

And as much as I really, really wanted to work on this project, I started to get nervous. I didn't want to, like, give up seeing my children for the sake of this chapter. And what if something came up with them? Some illness or god knows what?

I always thought of myself as super responsible. When a project is due Friday, I like to have it done by Wednesday. But when you're a mom with a full time job, is it really possible to be completely reliable?

yet another posting on career vs. family

A few months ago I was having a not-so-great day on the Transplant service. The not-so-great aspect of this day had been brought about by the need to discharge a single patient after his allogeneic stem cell transplant. Having to discharge a patient after allo stem cell transplant is both the most mind-numbing and complicated role of the fellow on the BMT service as it can involve the need to coordinate home health, home blood draws, line care, monitoring of drug levels, home antibiotics, home TPN, outpatient medication, PT/OT equipment, transportation, clinic follow up, and a lot of patient teaching.  In fact, no discharge would be complete without an irate call from the discharge planner about some order I entered incorrectly.

While although important, this isn't very satisfying work and I was already a tad annoyed by some of the inevitable “complications” that had arose. I was trying to hide this annoyance and get through attending rounds quickly when my attending turned to me and mentioned that there was a grant proposal meeting regarding a clinical trial our institution was trying to get off the ground. It was this afternoon and I should definitely go.

My annoyance deepened.  Oh sure Dr. Attending. With about ten thousand little BS issues I have to resolve in the next two hours, I definitely want to go to your grant proposal meeting. Wonderful.

He mentioned the trial would involve the use of autogenetic stem cell transplant in patients with HIV-related recurrent lymphoma with the goal of curing the recurrent lymphoma and eradicating the HIV.

Now he had my attention.

Although I complain about the fellow’s role on the BMT service, I actually find transplant fascinating and have considered extending my fellowship for additional BMT training.  And while it might sound strange, I also find HIV fascinating and for a brief period considered ID just so that I could study and treat HIV (the fact that all the ID peeps I know get to do some wild traveling might have contributed to my interest).

A corner of medicine that involved both? Here, at our institution? I was definitely interested.

The meeting was between the clinical transplant staff and the basic science team. It started with the members of the lab explaining each step in the development of the vector carrying the gene for HIV resistance and how it would be introduced into the patient’s stem cells. I don’t want to embarrass myself by pretending I could follow all of the molecular biology, but followed enough to become very excited by this project that bore more resemblance to science fiction than any clinical experience I had ever had.  My attending then took over and explained what they proposed would happen to the patients who received the genetically modified stem cells.

I’ve worked on a lot of dead-end and/or boring research projects. In fact, I’ve never been part of a project that really piqued my curiosity, although some have been better than others. I had certainly never felt as excited by any project as I was sitting in that dark conference room.

I wanted in. I wouldn’t care what menial task it was, although I did start to envision what it would be like to write the first manuscript of a paper on curative HIV therapy.

My unborn son thumped me and reality set in. It is not a bad reality, but it is this – I almost certainly not staying at my current institution when I am done with training, and this project is still years away from inception. This is not because I don’t want to stay– and sitting in that room I really wanted to – but because we need to move closer to family when I am done here. I am actually very fortunate in that, my husband, who has followed me three times during my training, wants to move to the town in which I grew up and I have promised both him and my family that we will relocate as soon as I complete my fellowship.

I have also already decided against additional BMT fellowship training, which would almost certainly be required of any MD who wanted to be a part of this project. I have multiple reasons for this decision, including the need for a job with regular hours (please!), the need to start paying back my loans, the obvious financial needs of our expanding family, and again, the need to relocate. I like transplant, but I don’t feel as though it is something I absolutely have to do in order to feel intellectually and professionally satisfied. 

But I can’t pretend part of me doesn’t want to go after this. After all, I started med school when I was almost 22, I am now 31, so what is just a few more years of bad hours and worse pay for the chance (and it is really just a chance…) to be a part of something huge?  Maybe this isn’t the time – after I have almost a decade invested in my training- to start passing up opportunities.  

But that wistful, sometimes nagging, line of thinking hasn’t dominated my decision-making and, at least right now, I am very comfortable with the current plan as it is in place. 

This has become a much much longer post than I had intended and I worry I might have lost some of you along the way. This is unfortunate because part of my reason for posting it is to get feedback from those of you who have faced similar decisions. To be clear, I really don’t think I will regret the decision to move and forgo the very remote possibility of being part of this project, but it is the idea of slamming doors now, so early in my career, that is unsettling.

Thoughts?

Guest Post: I won't be the first, and I won't be the last

"Are you crazy?" This question, or others of the same variety, that range from "are you SURE?" to "Is your husband okay with it?" describe most of the reactions I get when I tell people that I plan to start medical school this summer. While the reactions were a bit less intense when I declared my medical aspirations as a single woman during undergraduate school, the shock factor increased exponentially once I got married and pregnant, with a baby due this April before the summer I hope to begin.

One part of me wants to scream, "No! I'm not sure, I'm freaking out, and your skepticism and complete lack of confidence is not helping!" The sane, collected persona that answers, however, jokingly replies "I'm not the first and I won't be the last! I'm sure we'll be okay."

In an effort to quell the bubbling fears of anxiety that increase with each kick of my growing baby and doubt from my peers (interestingly, mainly from my parents' friends and less from individuals of my own generation) I look to websites like MiM and other blogs that discuss women with similar experiences. I take comfort from their humor, honestly, and tales of unimaginable successful balancing acts.

I look forward to joining the community of people that "are not the first and won't be the last." I am excited to pursue a career that I have a passion for and a deep interest in.  I hope that with all the changes in healthcare, I can still make my current ideal of a family physician or pediatrician a financial reality. I also hope that I find a voice to one day inspire those that are looking down the same path, the way that many other anonymous Mom MD's inspired and bolstered me.

-M2B


I am an aspiring medical student, starting medical school in August 2012. I grew up in Los Angeles, but am waiting to hear where I'll be studying medicine next year. I am married to a wonderfully supportive man who has no idea what a wife in medicine will bring, but is up for the challenge. I am expecting our first child in April, and am excited to start on this crazy adventure.

Overheard in a MiM car

[On the way to 4-year-old son's doctor appointment]

MiM: We're going to the doctor's! Do you want to be a doctor when you grow up?

Son: I can't.

MiM: Why do you say that?

Son: (Pause)...are there daddy doctors?

MiM: Yup. There are daddy doctors.

Son: OK, (with glee) I want to be a doctor!

Doctor, Heal Thyself!

Who here hasn’t needed to lose a few pounds? Well, I am a bit beyond needing to lose a “few”…

Babygirl is officially a month old, and I am officially a month postpartum. For two pregnancies now, my usually healthy diet slid into more of a “everything in moderation, and I mean EVERYTHING” diet. I don’t binge, and I don’t even like junk food or fast food… BUT I love me some dense whole wheat toast with tons of butter for breakfast, and high-quality dark chocolate for snacking, and a cup of premium ice cream after dinner, and… you get the picture. Two years of this kind of snacking, and I was bound to gain some weight.

Especially since I used to be very active. Like, distance-running, cross-country-skiing active. BUT for two years, that whole part of me has been on hold. During my pregnancies, I maybe did some prenatal yoga, and took some walks here and there, but basically, I became a slug. I did hire a trainer after Babyboy, and I did lose 15 pounds then… But as soon as I was pregnant with Babygirl, I slid right back into snacky-snacks and slugginess.

So, this week, I finally stepped on the scale to see what the damage was. Ouch!

I am a full 40 pounds above my normal healthy weight, with a BMI of 30. That means, I am obese.

And so, horrified, I decided to take action.

I have NEVER in my life been so fat. Sure, I gained a lot of weight during med school, and then residency, due to lack of sleep/ time/ stress/ poor diet. But never THIS much. Both of those times, I shed major pounds by eating low-carb and exercising.

Now, I am a huge fan of diet and lifestyle changes towards better health. I counsel all my patients over and over again on the merits of a diet high in fruits and veggies and lean protein, combined with regular vigorous exercise. I ask my obese patients to come back every 3 months for weigh-ins and blood pressure checks, and I spend a lot of time with them, describing what is a healthy diet and what is real exercise.

In our practice, we have a diabetes nurse who helps counsel patients, and I send her my pre-diabetic patients, as well. If I were my patient, I would probably send me to her. Diabetes runs in my family, and I did have a sort of high-normal glucose tolerance test in this second pregnancy.

And so, because I recognize that without some major changes, I may be headed towards a bad health outcome; and because I need to follow my own advice; and because I really don’t want to have to buy a whole new wardrobe (!) I got started right away.

As soon as hubby got home that day, I asked him to watch the kids so I could go running. Luckily, he is also really into fitness and eating healthy, and he was totally supportive. Shocked, but supportive.

I found and pulled on a (very tight) jog bra OVER my nursing bra, laced up some stiff sneakers, and headed out the door. There was about 4 inches of slush on the ground, and it was drizzling. YES! I love this. I imagined that drivers saw me as the intrepid warrior, determined to run in spite of the elements. Really, they probably saw a mooselike creature in ill-matching baggy pants and her husband’s rain jacket toodling up the hill like a manatee on land. BUT, I pulled down my baseball cap and ran harder.

I had not run in almost a year. I made it maybe a few blocks, then walked. Then ran, then walked. I did this for about a mile and half, total-- a laughable distance for me who has run three marathons. BUT, it is a start, and it’s better than nothing!

Hubby also dutifully went to the grocery and bought me my list of South-Beach-Diet-Style foods. (I don’t get any money from them, BTW, the diet just works for me is all). He came home with my veggie juice, Canadian bacon, eggs, cheddar, ricotta, almond butter, and tons and tons of veggies.

That was three days ago. Since then, I have been sticking to the diet, albeit with probably bigger portions and more snacking than is intended (I am breastfeeding, after all).

The late nights up breastfeeding are very tough. I HAVE to eat something when I am up feeding Babygirl at 3 am. Just, now, it’s less likely to be a huge bowl of Cheerios, and more likely to be a cup of plain ricotta sweetened with Truvia.

And that’s OK. The diet, plus exercise- with the goal of getting back to my previous level of active—WILL work.

The diet is meant to stabilize blood sugar swings and reduce craving for carbs. It’s amazing to me how I feel when I drop the carbs and go to this type of diet. At first, for a few days even, there’s a slight woozy feeling, and some intense carbs cravings. After a few days, the wooziness is gone, and there’s almost a buzz of energy as my body starts to burn fat. It feels really good, especially after exercising.

And so starts my effort to get healthy—and slim down.

Now that I’ve blogged about it, I really have to stick to it!

Call Hierarchy of Needs

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.

*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."

*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).

*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.

*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)

**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Ob/Gyn Kenobi

MiM Mailbag: Return to medical school?

Dear Mothers in Medicine,

Over the past month or so I have come across your blog and have become so interested in reading all of the wonderful stories and insight that you post. You might wonder how I came across it...well it's a bit of a complex story. After graduating college in 2009 I decided to pursue medical school. I really felt that I wanted to help people and work with children in my future, eventually enter pediatrics (at the same time though, I think I may have just fallen into this track as I had the "premed mindset" for a very long time). I gained acceptance and started medical school July 2011. Yet about a month into starting began to question my decision. Although I loved living on my own, and had a wonderful relationship with my peers and staff, I could not help thinking about my future and if it would really be anything but work-filled. On top of that I was being pushed to my limits, depleted really, and feeling anxiety and bouts of depression. By this past Christmas I decided to take a leave of absence to decide if medicine truly is the right path for me, as everything seemed to be spiraling in the wrong direction.

After being home for about a week now, my mind is more confused than ever. Is the stress/anxiety/depressive feelings something that will get better as school continues and I adjust? When I start practice will I be able to balance my career with family (mind you, having a family and being invested in them has always been my number one priority)? If I leave now, am I going to look back and regret this...but if I don't leave, what kind of impact is this going to have on my future health and family life? Would being a nurse practitioner satisfy me? Do I want to physically endure residency? And am I willing to sacrifice the next 7+ years of my life and give just so much of myself to a career when there are so many other things I yearn to invest my time in as well?

I know that ultimately the decision rests with me. I have tried speaking with others who have been through the same things as myself as well as those in the profession, but am still having a difficult time deciding whether returning to school would be my best option. It has been a difficult decision to even take a break from school as I have always been the overachiever who just pushes through no matter what-yet this was the first time my body made me take more drastic measure and really reevaluate where I'm heading.

Although you may not have the answers to all my questions I'm hoping that some of you might help shed some light on my fears and whether you ever went through any of this thinking. Looking back do you feel that this career has suited you well (family, health, lifestyle, and all other things considered) or would you have done things differently. Any advice would be much appreciated.

Look forward to hearing back from you all!

It's a Stressful Life

During our drive home, my daughter Mel requires a snack. So every day, I have to bring a bag of chips, some crackers, or whatever leftover baked goods were lying around the nursing station for her to nosh on during the ten minute drive home. Sometimes I'll get something extra yummy and I'll be excited to see how happy she is. She even brags about the snack to her friends. "My mommy always has a snack for me in the car."

Yesterday I purchased a little cup of custard for her from the hospital cafeteria. I have always been a fan of custard and I thought she was going to love it. I expected lots of thanks and hugs and a happy drive home.

When Mel got into the car, I presented her with the custard cup. She looked excited and asked me to open it. She took one bite. "I don't like it," she said. "It tastes bad."

I tasted the custard and she was right. It tasted like cardboard.

"Can I have something else?" she asked.

Usually I keep an emergency snack pack of Skittles in my pocket, but I had recently changed coats, so I had nothing else to offer her. "Sorry, honey," I said. "We'll have a snack at home."

"But I'm SO HUNGRY!!!!" she wailed. "I'm going to get a rumbleache!"

"Well, what would you like me to do??" I retorted.

She didn't have an answer, but continued to sob as I strapped Baby into her carseat. I recently purchased a new coat for Baby and overestimated her size, so she's basically floating in this comically large pink coat. And because we're frightened into making the carseat straps ridiculously tight, Baby was screaming by the time I had her secured.

I started the car with both kids crying in the back seat. My blood pressure felt like it was a million over a billion. I considered maybe stopping for fast food on the way back, but really, the only stop I wanted to make was at my OB/GYN to get sterilized.

I don't like stress. Stress stresses me out. While I adore my kids more than anything, it would be so nice to be able to take one shower without someone busting in on me and asking when I'll be done. It would be nice to spend a whole day in bed getting to do whatever I want to do. Something like that feels selfish, even decadent, to me now.

For a brief time, I was trying to do some meditation to help me relax, but in general, I just couldn't find 10 quiet, uninterrupted minutes in my whole day to do it.

The crazy thing is, I don't think I have that much more stress than the average mom. Yes, I work, but lots of moms work. Yes, I have two small kids, but I know lots of working moms who have three or four small kids.

Maybe we're all giant balls of stress. There's this woman I always see at the daycare who comes to pick up her three year old and her twin toddlers, and she always looks so miserable. Is it just a given that when you're a working mom of small kids, you're going to be constantly stressed out? Will I just not be able to relax for another 4-5 years?

final thoughts on last post

As my last post concerned what is arguably the most disturbing aspect of parenthood, perhaps it is appropriate to post, in bookended fashion, on the most joyful.

We brought home our newborn son five days ago. He is healthy and perfect. I am filthy and happy.

I will have to blame poor judgment brought on by the insomnia of manning a 24 hour milk bar for a brief sojourn into the well worn subject matter of writers far more talented by myself.  The death of a child is meaninglessly tragic and unfair and I can't imagine to where or whom one turns for solace. Perhaps the only answer to the question "why" is not truly an answer but a visceral response - to love and love and keep desperately loving the children that we do have. 

I think (and sincerely hope) this is the last time I post on this subject matter. While never forgetting, it is best to move forward and focus on the humor and joy of early parenthood. 

For instance - I am not sure if I should admit this (and again will blame the insomnia) but I was a little shocked by the appearance of my newborn son. His face was purple and squished. Flame colored stork bites stained his upper eye lids and the lower lids were swollen shut by two thick coats of vernix. His nose appeared to have been flattened in order to better accommodate a large crop of infant acne (milia) that sat upon the wide tip. His cheeks sank below the level of his lower jaw, giving the appearance of an edentulous old man. 

The last few days have revealed him to be a reserved little man who doesn't do much in the way of complaining. His emotional range seems to oscillate between boob? and BOOB! I know this range well as I have spent near every waking minute of the last five days staring at him in an almost spellbound fascination. 

I was immediately, and continue to be, deliriously in love.