Guest post: My brain doesn't function anymore

I’ve just experienced one of the most embarrassing (not worst patient outcomes, just down to the core of my doctor-ego embarrassing) moments so far in my academic career.  I need some positive reinforcement, honesty, and maybe reassurance that maybe it wasn’t as bad as it felt.  Here’s the backstory… I wrote MiM about a year ago when I was trying to decide between a fellowship application to Endocrine or applying for the Chief Medical Resident position. I got some really helpful opinions and turns out I got the Chief job and will be putting off fellowship for a few years, probably with some hospitalist work in between. I also, in the meantime, got pregnant again and had our second child. It was all part of the grand plan to get as much paid maternity leave as possible before the bubble of residency is over and to spend more time with my new baby as I could, because chief year was supposed to be more flexible than being an attending... Plus, I’m already super tired and overworked, might as well just do it all now… right? It doesn’t get any easier? (this is my rationale… flawed as it may be)

 

So now baby boy #2 is 3.5 months old, older boy is 3 years old. I’ve been on maternity leave for 8 weeks, and then research for 8 weeks.  It’s been blissful bonding time with baby boy #2.   Now I’m coming up on the end of unstructured time in residency… and today I presented my research at the resident research symposium.  I only had to get some slides together to fill a 20 minute time slot with my results.  Pretty simple. Not presenting at ACP or other Fill-in-the-blank Big Subspecialty Conference.  The slides were good and I had some positive results. Problem is… my brain is not what it was a few months ago. I haven’t had to interface with a lot of people at work in MONTHS. Major clinical rotations were done for me over 6 months ago.  Let’s face it: I have Baby Brain and this phenomenon is real.  With my first son, I started intern year when he was 4 months. So okay, I had an excuse for not knowing anything then, because no intern really knows how to do their job in the beginning. What’s my excuse now?  No one really remembers that I just had a baby 3 months ago. Or that this is my first real public presentation outside of my data crunching at home.  

 

So here’s what happened tonight and why I can't stop crying. Okay, that part is likely hormonal.  But I am honest-to-goodness downright embarrassed…

 

My slides went well. People were impressed with the findings. Then came questions. I am not a fan of public speaking on a normal day, but now I felt like I was having an out of body experience.  I could not think. Initially, I was able to say “yes, good point, that would be an excellent idea for future study… blah blah blah”  Then the Chair of Medicine asks a question. In hindsight, he was prompting me to recall part of the lipid metabolism mechanism which may explain part of why my research finding was the way it was (without getting too detailed).  I couldn’t come up with anything.  My program director then tried to prompt me again to answer with a knowing sparkle in her eye.  She practically winked (may be an exaggeration).  Again – MIND BLANK – nothing… I asked him to repeat the question.  I couldn’t even come up with filler. It was like the dream where you are naked at school. “uh… uh…”  That’s all I could say. I couldn’t believe it. I thought I was going to vasovagal right in front of everyone.  Saddest thing is, I knew the answer; I just couldn’t recall the words.  Maybe I had a TIA. Nah… it’s baby brain.

 

The worst of it:  My next major work project is… presenting GRAND ROUNDS for the medicine department.  In 3 weeks.  It’s a tradition for all the incoming chief residents in my program to present grand rounds and I have been preparing, stressing, and thinking about this for 6 months.  But now I’m downright terrified. I’m so scared my brain is going to fail me again and leave an auditorium to fall silent to simple questions that I should know the answer to. Here I am people – the new face of our Big Academic Internal Medicine Program.

 

I need my brain back.  There are so many patients I need to care for, medical students to teach, a residency to effectively run, and the ABIM to pass in a few short months… I need it back. I need to know that I can still do this job.

 

Niquekee

No more pumping!

I have been given the go ahead by our pediatrician to start giving whole milk in June, so I have two more weeks of pumping, then I am done for good! I'll keep breastfeeding for as long as she wants it or around 18 months, whichever comes first, so I won't be saying goodbye to that just yet. But I refuse to touch that pump ever again.

Things I'll miss about pumping:

1) Automatic excuse to disappear in the middle of the day at work

2) Get to eat whatever I want, yet still had calculated BMI of 18 at last doctor's appointment

Um, I think that's it.

Things I absolutely won't miss about pumping:

1) Always having to do it every day, no matter how crazy busy I am at work

2) Trying to figure out how to pump at conferences (especially fun when power goes out on entire block)

3) Having to carry the pump everywhere

4) Realizing I'm at work and forgot pump at home

5) Storing and transferring pumped milk to bottles

6) Drinking constantly yet still always being dehydrated

7) Waking up 30 minutes early every day to pump

I met my goal of pumping for a whole year. I didn't meet my goal of not supplementing with formula, thanks to unexpected mold growth on my breast pump tubing, but I'm not crying over it. I only used two cans total the whole year. And as I've said before, I don't think there's actually anything wrong with formula.

My older daughter self-weaned at one year, but I have a feeling it's going to be harder to do the final weaning this time. This one is mega clingy... her first word was "mama," and if I'm home, she refuses to be held by anyone else. But I'm not going to worry about that until the winter.

Career day embarrassment

I am one week and three days from graduation. WOOOHOOOOOOOOO!

I am incredibly busy, which means I am also paralyzed in the face of all the crap I have to do, and procrastinating on the internet. Hello!

Yesterday I was a presenter for career day at my 7 yr old son’s school. I wore my white coat, wore scrubs, and brought my stethoscope and other tools. I presented in six classrooms (exhausting!), but started off in my own son’s first grade class. I had an apron with sort of anatomically correct removable velcro body parts, which I used to play a matching game with the kids. If a kid guessed which organ I was describing (this organ is a muscle that pumps blood to the body!) then that kid got to put that organ on the volunteer kid who was the “body” wearing the apron. It was especially fun when we got to the kidneys and the large intestine. Poop! Pee! “EWWWWWWWW!”

There were only seven body parts, though, so I brought in my ragtag collection of toy doctor tools. Several people bought toy doctor sets for my kids when I got into medical school, so I had four plastic stethoscopes, a plastic syringe, toy otoscopes, etc. I passed those out to the kids who didn’t get to put on an organ, so they could guess what they were used for, and was one kid short. So, I gave that kid my coffee mug. I made a joke about how that was the most important doctor’s tool, since it helps keep doctors awake, and remarked on how much coffee I drink.

My son rose his hand, and offered, “She drinks beer, too!” I said “And, goooodnight everybody!” and quickly defended myself. “I didn’t drink any this morning! I didn’t have any last night!” and spent the rest of the half hour trying to convince my son’s teacher that I don’t have a drinking problem.

*facepalm*

Cross posted at Mom's Tinfoil Hat

MiM Mailbag: Living with the in-laws?

I will be starting my pediatric internship year soon, after 6 months out of clinical practice (I took some time off between my 3rd and 4th years to spend time with my newborn and graduated a few months after my classmates). I have a fiance, a dog, and a 21 month old daughter. We are so very undecided about our future living situation. My soon to be in-laws have a house approximately 30 minutes, with traffic, away from the hospital. Since we can't afford to buy a house at the moment, we are considering the following options, one of which I am uncomfortable sharing with others who know me, for fear of judgment. One option is that we all live with the in-laws. I think I would go crazy with this option as the in-laws are a loud, lively couple very much ingrained in their ways. The other option is to rent somewhere between the in-laws and the hospital so that my mother-in-law (unemployed) can help out, either by driving to us or us dropping off our daughter with her. The last option, and the one we are strongly considering, is that I rent a small place near the hospital and my fiance, daughter and dog reside with his parents.

I'd greatly, greatly appreciate your opinions and own experiences with the issue. We need more spaces like mothers in medicine!

Sincerely,

B

Parenting in medicine mentoring panel

I just attended the annual Society of General Internal Medicine conference - a conference that always inspires me. You can tell the values of an organization from its meeting. SGIM is understated (no commercial sponsors or huge pharma-dripping exhibit hall) and the work presented is largely focused on health disparities, improving the health of our society, and education. The opening plenary session was titled "Does the Moral Arc of the Universe Really Bend Towards Justice?" (The answer was a heartening yes.)

One of the sessions I attended was a Parenting in Medicine Mentoring Panel, a wonderful idea with an unfortunate acronym. Nancy Rigotti, who directs the Office of Women's Careers at Harvard and a past President of SGIM, led the panel. Mothers in medicine of various stages of their academic career shared their stories, much like we do here. There was also time for questions in the packed room of mostly women and a handful of men (including one division head who spoke about his support for work-life balance in his department by budgeting maternity leaves and family leaves, into his yearly FTE equation, and contracting with emergency child care services- awesome.)

Some key points that were made by panelists and the audience:

• Being a physician makes you a better mother. That quality of being calm under pressure comes in mighty handy when you’re faced with a teenager who announces, “I didn’t go to school today.”
• Make your partner a partner. Many women echoed this. Some split the weekdays in terms of who was responsible for making dinner for the evening
• Get help to do things you don’t want to do to spend that time with your kids. If you can afford housecleaning help, it is worth it.
• If you find yourself working in an unsupportive environment, find a peer group who all have kids to help cover each other when needed.
• Take risks - in your career path, in life
• There is no one way to do it. We each find ways to make it work with our families and choices.
• Don't delay having your family. Unintentional childlessness or having fewer children than desired happens to mothers in medicine.
• On-site childcare can be a godsend.
• Make family dinners a priority.
• Share our stories, form communities of support. (See: MiM byline)

Finally, this thought was shared: Kids are a gift, not an achievement. In all of these ridiculous Mommy Wars and trying to decide who is doing it better, why not just focus on the gift?

Run Like a Mother

A couple weeks ago, as I was reading the Sunday paper (yes, how 1989 of me),  I saw an ad for a Mother's Day 5 K called "Run Like a Mother."  A Race for 'women only' to celebrate health and motherhood, on Mother's Day. This seemed like an awesome idea, so I called up my running buddies and we made it a date.

The race was happening in a beautiful horse farm that has been converted to a park. What a great way to spend Mother's Day morning, we thought.

Last night as we began to check the weather though, we got a little concerned.  The forecast called for heavy rains.

Whatever.  A little rain wasn't going to slow us down.  I've run many races in the rain, as long as you avoid the big puddles, it's really not a big deal.

As I pulled into the park this morning, I began to have my doubts.  As we gathered at the staring line,  a downpour began.  Next I realized that we weren't running on pavement, we were running through the field.

A boggy field. Wet slippery grass. Mud. Awesome.

My shoes were sloshing, my socks soaked to the core as I rounded the first turn.  At times, I was running in 6 inches of water.

This was not what I had signed up for.

As me, my friends and 200 other crazy moms continued the race, we found our stride. The scenery was beautiful even in the rain. Faithful dads and tots stood with their umbrellas, cheering us on at the halfway mark.

It was definitely a unique experience: how often do I run through a horse field in a downpour?
As I rounded the final stretch with the finish line in sight, I realized that even in my cold, soggy state I was having a blast.

This race to celebrate Mother's Day turned in to a perfect analogy for motherhood itself: it's  messy, much harder than I thought I'd be, but exhilarating and totally worth it in the end.

What was the best part of your Mother's Day?

crossposted at thepregnancycompanion.com

A tired American - an angry rant

Ok, so this is risky, and I’m likely to attract plenty of debate but here I go.

First, why am I writing about this?  Because I took an oath to be a healer.  To me this means tolerance, justice, acceptance in order to achieve a greater good, in order to promote a healthy society.  So, I am just a little irritated today as I look at my country which appears to be at odds with itself.  My anger started while listening to NPR on the drive to work this morning and hearing about all of the discussion resulting from the TIME magazine cover of a model-like mom breastfeeding her three year old standing on a chair.  Criticisms flying everywhere about extended breastfeeding and self-important moms. There is the typical sexualization of breastfeeding with lots of reference to the attractiveness of the mom on the cover, and the usual “if they can ask for it” type comments.  (side note: newborns ask for it too - its called crying!!)  So funny, that anyone who decides to formula feed their infant gets nearly stoned for not going the “breast is best” route.  Then we flip it around and hate on the moms who keep breastfeeding.  I realize I’m using the proverbial “we.”  If this doesn’t apply to “you,” then feel free to ignore.  But for all the rest of us: Lets STOP THIS!  Mothers are always criticizing mothers - breastfeed or not breastfeed, work or stay at home, work a lot or a little, nanny or daycare or grandma, etc, etc.  Even Fizzy’s post last week, illustrated how quickly we jump to judgement.  As clinicians we do know the literature and the evidence, but the first step in being able to do no harm is gaining the TRUST and RESPECT of our patients, and in order to do this there needs to be more tolerance and listening.

Anyway, I’m just all revved up.  I live in the Amendment 1 state.  Justice, tolerance.  I won’t say anymore than that.  Our political system is full of polar opposites, butting heads and refusing to compromise.  We’re arguing over reproductive rights of women... AGAIN!  WHAT IS GOING ON!!!

Can’t we all just get along?

Guest post: Post-partum mental health check

First, I would just like to thank all of you who dedicate time to contribute and maintain this blog. It has been my mental health check throughout my pregnancy, and I can only imagine that it will be an increasingly important lifeline- and reality check- in the years to come.

I just had my first baby... and am starting medical school in August. I am overwhelmed, and absolutely terrified. Unlike what my in-laws, parents, and friends, think, though, I am not worried about missing my perfect wonderful amazing baby... I am terrified that I will (and I know I will- I am already excited) LOVE it, enjoy the learning, the intense environment, and being back in a university setting, pursuing a dream that I hold so dear. But, what happens to baby music classes in the morning? Raising my daughter? Being a wife who loves to cook dinner and get dressed up just for a night in because I love when my husband gives me that smile? (I am, as per the new usual, crying as I write this. Being one week post-delivery has unleashed tears that didn't even flow when my mom was diagnosed with cancer). Will I be able to do it, and do it well? Or will I do each only halfway and shortchange everyone? I still remember my mom- a stay-at-home mom of 7 always being there to bring lunch to school when I forgot it, playing "tummy time" with my little siblings, and teaching me how to read by age 4. Am I giving all this up?

My husband (most unbelievably supportive person) keeps telling me to take one day at a time. August isn't for a while, and we'll figure it out. I know he is right, but it is nice to hear it from others who have gone through the same thing. Am I crazy or is this par for the course?

Giving it away on Mother's (in Medicine) Day

Bringing family
To medical conference
At Disney World. Dude.

In honor of upcoming Mother's Day (May 13), we are hosting a Dansko scrubs giveaway (yes, the makers of your beloved clogs now makes a line of medical scrubs)!

To enter, write a haiku about how you'll be spending Mother's Day in a comment on our Facebook page. The haiku with the most "likes" wins the scrubs. (Vote for your favorite until 8 am EST on May 13). Any reader (mom or not; in medicine or not) is welcome to haiku-away.

Happy early Mother's Day! Thanks for reading.

Guest post: Applying to Residency: Me + Baby, Husband, 3 dogs, 2 cats

In less than one year’s time, I will be embarking on two major life changes: having my first child and beginning residency.

I began medical school single with 2 large dogs and a cat.  People thought this was absurd.  How can you find the time to take care of these animals?  This was simple: my mental health is a priority.  The dogs don’t care if I have a test tomorrow and they certainly don’t care whether I make an A or not.   They have no care for what happens tomorrow or in a year…throw a tennis ball for them, and they have it made!

But my final retort was always: “some students do this successfully with kids; I just have dogs.”  (and you can’t put kids in a crate!)

In the meantime, I met a non-medical man – a writer, a professor and a breath of fresh air from the smog of medical school.  He reminded me of who I was before medical school: I liked to read and write; I liked creativity and conversations.  Long story short, he moved down here and we were engaged and married in a little over a year.

Continuing the quest to balance my personal life and mental health with my medical training, I am going to become a medical student, then resident, with not just 2 dogs and a cat (well, 3 dogs and 2 cats now…I’m an animal lover), but also a husband AND a baby.  Is this absurd?

Once interview season is over I will be back on rotations at the community hospital where I have done my core rotations.  After spending almost a year here, I feel like I have a big hospital family.  Revealing my pregnancy has been met with nothing but enthusiasm.  I feel secure in balancing baby with the last of my rotations here.  But before I can take that deep breath…I have to take boards, go on away rotations, apply for residencies, HAVE A BABY, and after my maternity leave, go on interviews…and hopefully match!

First, I debate over how open I should be with programs about having a baby.  During one of my audition rotations, I will be noticeably pregnant.  I suppose this is a good litmus test for the family friendliness of the program.  However, by the time I am on interviews, I will be at least 6 weeks past delivery and will not necessarily have to disclose that I recently had a baby.  Of course, depending on the length of the interview day, I may need to pump!  Perhaps I need to be confident that I can be a mother and a good resident and thus be open to programs.  But this is the problem: will I be a good mother and resident?  Or are these two things going to be mutually exclusive?

I am also debating where to apply and concurrently having the ultimate debate over what I want to be when I grow up.  Fortunately the debate has been limited to psychiatry versus neurology or perhaps both? And has been limited to such parameters since undergrad, maybe before.  I now wonder what's going to change when this little boy arrives?  How am I supposed to know who I'll be 5 months from now let alone 5 years?

My thoughts race from one obsession to another.   Neurology vs psychiatry, neurology vs psychiatry, neurology vs psychiatry.  Graco vs Chicco.  Graco vs. Chicco.  And boards!  Oh no!  Last night I had one of those ugly recurring medical student dreams of nephritic versus nephrotic disorders...

Sometimes I feel like my head will explode. 

I’ve concluded it is easier to just make decisions.  There is no way to determine the perfect decision, and I imagine that there is, in fact, no “perfect” decision.  I decided to go for neurology.  I am intimidated by the work hours, the larger hospitals and the fact that there are no programs in my hometown where my mother could help with our baby.  But I don’t want to live my life afraid of a challenge.  Besides, I probably haven’t said enough to explain that I have the most supportive husband.  He’s even willing to put my career ahead of his (yet again) to be a stay at home dad.

Life is scary and thoroughly exciting, and these feelings are never mutually exclusive.

And I really have no idea what I am getting myself into…

"Emmylee"

Two Years of Eating McDonalds

In my last post, I talked about "my cousin" who fed her daughter McDonald's every day after school for a year. I wasn't entirely honest about that. It wasn't my cousin. It was me. I apologize for the ruse, although I'll explain in a minute.

In any case, I wasn't the one who fed my daughter the McDonald's. I was the one who ate McDonald's. From roughly ages 9 through 11, my mother brought me to McDonald's for dinner every weeknight.

*cue horrified gasps*

According to some of the comments, I now am incredibly obese. I have serious stomach and liver problems. My cholesterol is through the roof. My blood pressure is sky high. I have type II diabetes. And I continue to eat horribly and take my kids to McDonald's with equal frequency.

Except none of that is actually true. My BMI is about 20. My cholesterol level is excellent, as is my blood pressure. I had two completely healthy pregnancies, and both times lost all my baby weight within a month. I certainly don't have type II diabetes. I cook dinner at home most nights, and limit our fast food trips to maybe once a week, with minimal guilt.

How is that possible? According to the comments, I should be in an ICU right now, or at least on insulin.

Let me back up a little....

When I was in fourth grade, I went to a school that was about a mile away from my house. Every day, my mother would come pick me up at school, and we'd walk home together. There was a McDonald's on the way. We'd stop inside and I'd order... well, I don't remember. Something incredibly unhealthy, no doubt. And probably very tasty, since I was a really picky eater. But I do remember I always drank two cartons of lowfat milk, no soda.

We'd usually spend over an hour at McD's. I would tell my mother about my day, then she'd help me with my homework. Sometimes she'd give me a lesson that she made up herself. She bought SAT books, and when I finished doing my homework, she had me work on math problems from the SAT books. (I scored 650 in math when I took the SATs at age 12.) Then when it was getting late, we'd walk home. I didn't watch any TV at night... when we got home, I'd pretty much go straight to bed.

Sometimes these days I'll say to her, "I can't freaking believe you let me eat dinner at McDonald's for years." Her reply is usually along the lines of, "Leave me alone, life was difficult back then. And you know I can't cook." (She really can't.) It's hard to really get angry because I actually have good memories of those days. Maybe I didn't eat the healthiest dinner in the world, but I got some exercise and I learned a lot. Is that neglect? Is that wrong? Would I have been better off if she did things differently?

I guess the purpose of my post was that we need to look at an entire picture before we make a judgement. Or maybe that these little "bad things" we do as parents aren't as harmful as we think they are, as long as we're doing other things right.

Should I say something?

I think that as moms, we have a tendency to judge other mothers' parenting decisions. It's something I try not to do, although it's hard not to.

I was recently talking to my cousin (a remarried, working mom) on the phone. She has a daughter who's almost ten years old, and she told me that since her husband gets home very late from work on weekdays, she's developed a new routine for the last year. Every single day, she takes her daughter to McDonald's for dinner. Monday through Friday, the girl is being nourished by fast food.

I kept my mouth shut because I hate it when people judge me for giving my kids fast food. But I wonder, is this a time when I should have said something? Will years of daily McDonald's cause long term effects and do I owe it to her daughter to say something? Should I just slip her a copy of Supersize Me?

MiM Mailbag: Radiation during pregnancy

Hello,

I came across your blog entitled "Radiating yourself in Pregnancy." I am an interventional cardiologist and normally spend 2-4 days/week in the cath lab. I am 6 weeks pregnant and am a little nervous to be in the lab so often. I know of some other colleagues who spent a lot of time in the cath lab during their pregnancy and everything seemed to go ok. Their babies seem fine. I have a special badge and a maternity apron to wear under my lead and I have cut back to 1-2days/week. Do you think this is enough? I know there is no real answer to this question just looking for some stories to make me feel better:). I see there is a cardiologist among you. Just wondering if there are any physicians out there who have to be in the radiation for their job and did ok with pregnancy. Thanks!

A

Bad Mom

Sometimes you just feel like a bad mom. Not that you're doing anything wrong, per se, but that everyone else is doing a better job of doing everything right.

Usually I'm pretty open and honest about my experiences, but today I just don't want to talk about it.

Instead, maybe you can do something for me, to cheer me up: Give me (at least) one example of something you've done recently or in the past that made you feel like a bad mom.

I'll put one of mine in the comments.

MiM anatomy lesson

Mama: Where's your heart?
Daughter: (points to left chest)
Mama: Yes! And what does your heart do?
Daughter: PUMPS!
Mama: That's right honey! And what does it pump?
Daughter: (thought-collecting pause) BREAST MILK