when are we done with training?

At no other time in my medical training was I as confident that, with hard work and dedication, I could master the field of internal medicine as when I was a newly minted third year medical student.

Fresh from having taken the USMLE step 1, I interpreted my ability to recite the mechanism of penicillin resistance or the role of histamine in the immune response, and describe in great detail the unabridged and factual accounting of the patient’s forty year occupational history as evidence that, while I still had a ways to go, the practice of medicine could become as comfortable and familiar as reciting passages from a play or riding a bike. One day, I would just know it.

This is, of course, an exaggeration, but not one without merit as there is no other time in one’s medical training when one is so completely unaware of how little they know about medicine. Each additional year I've spent in training has only deepened my appreciation for that which is both unknown and unknowable, and despite this appreciation I still am occasionally horrified by lapses in my knowledge base. I resigned myself to the fact that my training will continue for as long as I practice, well after I am board certified in oncology and hematology. 

Many readers of this blog are likely familiar with Dr. Karen Sibert, whose name I first learned after she wrote an article titled "Don’t Quit This Day Job" that appeared in the New York Times. There were many strong responses to her criticism of female physicians who choose to not work full time, one of which appeared in this blog. She recently posted on her blog a piece titled "Give yourself a break - Don't have a baby during residency", which has also created quite a stir. This posting as been the subject of many blogger’s recent pieces and I don’t want to repeat some very well articulated responses – one of which appears here. Even the comment thread of Dr. Au's post contains interesting reflections on the competing obligations of medical training and early motherhood.

I have a different question, not related to work hours, coverage schedules, ticking clocks, or the financial or marital implications of having a baby during residency. My question is this - when are we really done with our training? It's a question I myself, still in my own training, am not in a position to answer. But I have serious doubts that the need to check current treatment recommendations, latest journal publications, available clinical trials, or consult physicians more senior than myself, isn't going to end when fellowship does. If anything it could get more difficult to maintain sufficient knowledge base once I am removed from the structure of a training program.

It is probably a good time to point out that I am not in a particularly procedure-heavy field of medicine. In the middle of the night and as a senior IM resident, most questions regarding the management of critically ill patients could be handled over the phone. As a heme/onc fellow I spend a lot of time reading and, obviously, consulting with my colleagues, usually during daylight hours. I am not sure if the same is true of more procedurally oriented programs such as surgery or anesthesiology, where perhaps there is a greater need for someone more senior to actually stand by you and aid in management. A person who might not be available once you have completed training. But I did once overhear a surgical attending loudly berate his chief and junior residents for not being able to answer a pimp question on neointimal hyperplasia, which struck me then, as it does now, as not a subject far more medicine-y than surgical. The attending went on to say (or really, more like yell) that his own residency training had become obsolete ten years after completion and that if they were not in the habit of prioritizing self directed learning now, they would soon find themselves without the knowledge base or skill set to safely operate in the community.

So, if you accept that the need to question what you do and do not know will never end, and that as a member of this field you are professionally obligated to avail upon yourself all necessary resources (including colleagues) required to provide your patients with the best care available, I wonder how relevant an end point "residency" is when trying to assess the ideal time to start a family (and again, I am not taking about call schedules).

I had my first baby as a second year medical resident. Yes, it was hard. But I learned to adjust the way I studied just as I learned to adjust every other aspect of my life. Social life, goodbye. Athleticism, goodbye. A working knowledge of current events, see ya. Mommyhood, marriage, and medicine were made my priorities then, as they would have if I'd waited until after residency, but at least by learning to restructure earlier in my career, I was doing so with the safety net of a training program rather than as a new attending.

For example, prior to becoming a mom, I had studied mostly in the evenings and weekends, usually beside my husband in whatever little apartment we shared at the time. That was simply not going to work with a baby at home. So, with IM boards looming, I requested the month of July (I was still a resident in July as I was paying back the time I had taken for maternity leave) to work on an outpatient rotation. I got up early to be at Starbucks at 5am and studied there every weekday morning until boards. No evenings, no weekends. And I was fine. More than fine. When it comes time to study for my oncology and hematology boards, will have a 4.5 year old and a 1.5 year old. Mornings in Starbucks might not be an option, but neither is not studying. I will have to adjust again.

Residency is important. Very important. But, over the course of our careers, it isn't an endpoint when it comes to the quality of care we provide our patients. Being a good doctor is no more a finite achievement than being a good mom. 

Conjunctivitis, I hate thee

Dear conjunctivitis: I don't like you. I kind of hate you. Why do you insist on repeatedly infecting the conjunctiva of my kids? Why do you create big globs of mucus in my kids' eyes? Does it give you some sort of sick, sick pleasure? And how come you're so contagious? If you like my kids' eyes so much, why not just stay there? And making me drag my screaming child to the doctor and force drops in her eyes even though your viral shell is impervious to antibiotics is just plain mean. I think you seriously need to get some help, man.

Oh, did I mention my kid got conjunctivitis recently?

Conjunctivitis is an illustration of everything that's wrong with everything. When the daycare calls you at work, in the middle of a packed morning clinic, saying, "Your baby has conjunctivitis and you must pick her up immediately," you realize that it's impossible to live like this. How do you have a career when you can get called out at any minute for eye mucus? "Sorry, Mr. Smith, I realize you took the morning off from work to come to this appointment and you've been waiting to see me, but I have an EYE MUCUS EMERGENCY at home so I have to leave immediately."

And it's not just eye mucus. Every day, there's a new note on the door of my child's classroom, saying something like, "We regret to inform you that there has been a case of [conjunctivitis, head lice, strep throat, chicken pox, plague] in your child's class. The infected child has been sequestered in a plastic bubble and rolled home, where they will stay until their mother gets fired."

Lately, more and more, the model of one parent staying home or working half days seems to be the only reasonable thing to do. What else are you supposed to do on conjunctivitis days? Or when your kid gets out of school at, like, 2PM for some reason, even though practically every adult works until at least 5PM. Or during those random weeks off. I mean, President's week? Seriously?? What is that?

Can you tell I'm a little aggravated?

Legacy

A few weeks ago my grandmother died. She is the grandmother I grew up with, who babysat me, picked me up from school, fed me, encouraged me and was there for me my entire life. She was an amazing woman. At her funeral I was asked to read a poem, and after hours and hours of searching for something perfect, I decided to write one. Writing this poem has caused me to reflect so much on her life and what she meant to me. When I think of who I am now, what I have been able to accomplish, I know that many pieces of me are pieces of her. My grandmother was a sharecropper. A sharecropper! To think that this small quiet woman once worked under the hot Tennessee sun picking cotton with her beautiful delicate hands. To think of the doors that were closed to her, a brilliant mathematician despite only reaching the eighth grade. She raised six professional children - two doctors (one the first black medical student at his school), an aerospace engineer, a math teacher, an economist, a homemaker. She seriously came from nothing and her legacy is enormous. She helped instill in me the importance of education. This generation is leaving us - the generation of sharecroppers whose grandparents actually remember slavery. So much history! In reflecting on my grandmother, I reflect on my history and the fruit of her sacrifices. I am part of her crop. I have grown up in a world where opportunities are open to me. We do not live in a country of true equality and tolerance, but it is a country where a black woman can be a surgeon, when only 60 years ago blacks and whites in the South lived utterly separate lives. I look at my daughter and I know that I must bottle up and save each bit of this legacy so that I can pass it on to her.

This past October my husband and I took 5 days and took our daughter on a “legacy tour.” She met all 3 of her great grandmothers. Two have since passed away. I am so thankful for the pictures and memories we created. So thankful that we drove over 1000 miles to make it happen. So thankful for family and legacy and my beautiful child.

Baby Names

This might be a slight exaggeration, but all women love to talk about baby names.

I feel like I missed out with my older daughter. We decided to name her after my husband's mother, whose name starts with M. Once we knew we were having a girl, I made a list of all baby girl names starting with M that were acceptable to me. I gave my husband the list, and we both picked out our top three favorites plus our #1 favorite.

We both had the same exact #1 favorite name. And our middle name discussion went something like this:

Me: "Can her middle name be _______?"

Husband: "I don't care. It's just a middle name."

It was a little harder with the second baby. We decided that we were going to name the baby after one of my grandmothers. One's name started with L, the other with E. Before we knew if we were having a boy or a girl, we immediately agreed on Lauren for a girl. But we had more trouble deciding on a boy name. And I wanted to pick one, despite my husband's insistence on waiting till we knew the gender.

I really liked Elliot for a boy. That was my top choice.

Husband: "Elliot is SO NERDY."

Me: "Oh, come on."

Husband: "That's what you like about it, isn't it?"

Me: "Maybe..."

Then I started pushing for Evan. Evan seems like such a perfectly nice, normal name.

Husband: "I don't like the name Evan."

Me: "Why?"

Husband: "Because I knew a guy named Evan and he was a jerk." (Except he didn't say "jerk.")

The L names presented more of a problem for me. I didn't like Laurence because Larry would always remind me of that guy Larry from Three's Company. I dated a guy named Leo so that would be weird, and anyway, Leonard was too old fashioned.

Although I hate to be a slave to trends, I finally got taken in by the trendiness of Luke and started pushing for that name. After all, there was a really cool boy in Mel's class named Luke. And Becky's love interest in Shopaholic is Luke. Except...

Husband: "I don't like the name Luke. It reminds me too much of Star Wars."

After much more debate, we finally tentatively agreed on Edward. I had reservations because of the whole Twilight thing, but when I checked the baby name charts, the name Edward was still surprisingly unpopular. And we weren't crazy about any of the nicknames for Edward: Ted, Ned, Ed. But I supposed Eddie wasn't too bad. I knew an Eddie who was a nice enough guy.

Then it turned out we were having a girl.

And then Lauren got scrapped for a very stupid reason. But that's a whole 'nother story.

snarky

I try not to be snarky about things in which I have no formal training. Homeopathic, complementary, alternative, and untested (excluding clinical trials, of course) therapies fall into that category. Sometimes this is difficult as I have encountered many patients who have lost the last of their time and money on such treatments.  Or as in the case of Dr. Burzynski, who, over 30 years from his discover of "antineoplastons", still has yet to publish data from a randomized, controlled study in a peer-reviewed journal (And it might be mentioned, also threatened to sue a 17 year old who blogged critically of his purported cancer therapy. Say what you will about pharmaceutical companies, but they don't generally go around suing high schoolers for defamation.)

Given what I have to offer is literally a form a poison, I do understand why patients ask for more "natural" remedies. And their inquiry is not entirely without merit if you consider that some of our most commonly used drugs, like the vinca alkaloids, were derived from plants. However, despite this "natural" origin, no one would categorize vinblastine as anything other than standard, and thus toxic, chemotherapy.  And one that has proven its efficacy in clinical trials. I try to work with patients on this issue - explain that I do not object if the patients wants to incorporate a diet high in vitamin C or the occasional coffee ground enemas into standard chemotherapy, on the condition that the patient tells me what additional therapies they are trying and that the patient understands there is a possibility the alternative (or "complementary") therapy could adversely interact with their chemo in ways I cannot predict.

I am on maternity leave right now, so it is perhaps strange that I have spent the morning googling Dr. Burzynski (although truthfully quite helpful as I really do get asked about the Burzynski Clinic often). I started thinking about this issue when I noticed the tag on the "Mother's Milk" tea I have been drinking two or three times a day -

That says "Traditional Medicinals". My first reaction was "Oh no you don't. It's me, being a practitioner of "westernized" medicine, that is the "traditional" one here. You, my homeopathic tea, are the "alternative". In my world, tea is no more medicinal than the vinca alkaloids are natural. And for the record I don't talk to my tea.

I started drinking this tea "just because", and more as novelty than because I worried about my milk supply. That being said, in the last few weeks my milk has been "coming in" more frequently than I remember it doing when I was nursing my daughter. I really don't know how proven a galactagogue fenugreek is, but in my case (the worst kind of evidence - anecdotal...) it certainly seems to be working.

And so I find myself in the odd position of feeling both snarky towards the makers of this "medicinal" tea and yet not able to go an hour without the need to nurse or pump. Of course, the answer could be as simple as it just works, although I would feel better about recommending it should its efficacy be proven in a randomized trail published in a peer-review journal.

Match Madness

Hello, everybody.

Long time no see.

I have been immersed in the turmoil that is the fourth year of medical school. I don't happen to go to one of those medical schools I keep hearing about where the fourth year is easy and awesome. We only get one month of vacation, which includes time spent traveling for interviews. So, with interviews, elective and non-elective rotations, my clinical skills board exam, and being a single mom, I haven't even been opening my laptop most days.

My match rank list is certified, and now I am sitting on my hands and freaking out quietly...well, mostly quietly. For the uninitiated out there, the match is a hellish roulette wheel in which about 37,000 applicants vie for about 25,000 residency positions. This year, I am one of those 37,000 applicants.

I wrote a little bit about my various pressures regarding applying for residency programs here, and that post also has a link to the Match Day topic week here at MiM.

I ended up trying to stay as close to home as possible. I would be happy at any of the programs that ended up on my rank list. I would have liked to have interviewed at more programs. I was limited by my custody agreement, and I further limited myself by only applying to programs in cities where I knew somebody.

I am terrified that I am going to have to scramble. Obstetrics and gynecology has been a really competitive match recently. The National Resident Match Program is nice enough to crunch the data from recent matches, so I have a boatload of tables and graphs to stare at as I freak out. 77.1% of ob/gyn applicants matched last year. 99.6% of program positions filled, which means only 2 positions were left for the more than 200 or so ob/gyn applicants that didn't match. I am guessing most of those applicants didn't have a custody agreement that had pretty strict boundaries.

So, if anyone has any suggestions of how I can distract myself until March 12th, the day I learn if I match, and then March 16th, the day I learn where I match, please let me know.

Speaking engagement

I've agreed to a 45-minute presentation on medicine for my ten-year-old's science class this week.

What to do? I've considered percussing out a liver, telling the story of Alexander Fleming's serendipitous discovery of penicillin, suturing a banana, showing x-ray films of kids who've swallowed various inedible objects, warning against bezoars - let's face it, medicine's ridiculously interesting.

But what would prove most spell-binding to 28 grade-five kids? My daughter's certain I'm going to be awesome, and I can't disappoint her.

Please advise.

Notes from a Post Parent

With our youngest child grown, flown and on her own, my husband and are truly post parents. Others in this phase seem to travel, or acquire pets, or visit grandchildren. Me? I have houseplants and a jar of sourdough starter in the refrigerator. Parenting is, I realize, a state of mind, and the sourdough swells to fill the space. I am always aware, on some level, that it needs to be fed and may generate loathsome smells if I forget it for too long. On the other hand, if I cultivate it properly, something wonderful may come of it, and indeed, at various points, some things already have. The girls all give us much to kvell about--one is making her way as userfriendly liveware for a travel company, one is out to save the world or pass the bar, whichever seems harder, and third is going to be a professor one day. And I reliably make quite passable sourdough wholewheat bread!

Three

Long long ago, I thought I'd have three or maybe even four kids.

Then I had one, and suddenly two kids seemed like more than enough. And I felt pretty strongly about that.

Now I have my two kids and 99% of the time, I feel very satisfied, and even relieved that I'll never have to go through it again. But then there are times when the baby is being real cute (i.e. by existing) and I feel sad that I'll never get to experience this baby cuteness again. So this is me reminding myself of the reasons I don't want three kids:

1) I hate chaos and lots of kids are all about chaos. The logistics of getting three kids out the door overwhelms me. I hate always being on the go.

2) I'm looking forward to a time when my kids are more independent so I can put more focus both on career endeavors and hobbies like cooking. I'm really excited about that. Plus I won't have to change diapers.

3) While I love many things about breastfeeding, it definitely feels a bit like being on a ball and chain for a year. And the whole logistics of bottling and sorting milk for daycare is exhausting.

4) I absolutely hate being pregnant.

5) I like my sleep. A lot. I'm lucky enough this time to have a baby who slept through the night at one month old, but there's no guarantee that will happen again.

6) Some of my friends are now pregnant with #3 and I don't feel even a tiny bit jealous (well, maybe a teeny tiny bit), mostly just horrified. Sometimes I have dreams that I'm pregnant with #3 and it's very clearly a nightmare.

7) Husband doesn't want three kids either.

8) Kids are expensive and I want to retire early.

9) Space is not plentiful where I live so three kids means always being cramped. Most people around here only have two. A large number of the people I know with three kids have one set of twins.

10) Another kid means less time for the ones I already have. I'm looking forward to a day when we can all go to the movies together and see, like, Snow White in 3D without worrying about a baby crying.

On the other hand, my reasons for wanting a third are along the lines of:

Baby socks are so cute!! Sock!

Ultimately, since I'm still in my early thirties, I guess I don't have to decide now. When good old Mirena expires, I'll still be young enough to readdress the issue. But I have a strong feeling that I'm going to choose Mirena #2 over Baby #3. Ooh, and then someday maybe I'll be a grandma. That seems like a pretty sweet gig.

The 5 Trimesters Clinic

When I started in medicine, I thought it might make me a better mother, were I lucky enough to marry and have children. And it has, sort of. But I never expected that being a mother would make me a better doctor.

Six months ago, I organized the 5 Trimesters Clinic, offering psychiatric evaluations to women with problems related to fertility, pregnancy, and childbirth. My co-founder has three young children, the chief resident is pregnant, and the resident who does the work is about to get married. Together our decades of mothering experience have given us a perspective on the whole range of issues that the medical literature on women’s health covers in little Balkanized buckets. (Are you imagining leather buckets with gypsy embroidered covers? I am). Seeing pregnancy and childbirth within the context of an adult life, not as a medical/mechanical problem, seems quite novel to my obgyn colleagues. Seeing psychiatric difficulty as a normal element of pregnancy has been equally intriguing to my psychiatry peers.

Having been there, done that, bought the tee shirt and had to wash baby fluids out of it, I have an interest in many problems that are simply off the medical radar. I am, for example, interested in “Motherbrain,” the transient cognitive impairment some women experience after childbirth. The medical literature pooh-poohs this, but I believe it is real, because I had it. More importantly, it needs to be acknowledged so that we don’t expect new mothers to pass high stakes exams or the equivalent before their babies sleep more than 2 hours at a time. (The scientific studies of this problem excluded mothers who were depressed, the population most at risk for sleeplessness and poor concentration—duh.)

Our clinic pays attention to many matters—the role of fathers and grandmothers, women’s anxieties about bonding during pregnancy, new mothers’ loneliness—that come directly from the experience of those who run it. To integrate mothering with doctoring brings me enormous satisfaction. The greatest joy is passing this wisdom on to the resident embarking on the same journey. My kids are grown, but I am and will be until retirement, a mother in medicine.

Doctor picture

After so much drawing, I needed a break. So I asked my daughter to draw a picture of a doctor and this is what she came up with:

Daughter: "I drew her with blond hair because most doctors have blond hair."

Me: "I don't have blond hair."

Daughter: "Yeah, but most doctors do."

Me: "Like who?"

Daughter: "They just do."

Also, halfway through, she said she was going to draw a nurse instead, and I had to persuade her to make it a doctor. Then as I was scanning it in, she told me to make it pink.

(Cross posted to my personal blog)

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?