Time for children

Last weekend I was at my friend's baby shower and making small talk with the mother of a baby boy a few months younger than my own son. His mother was a co-worker of my friend, both physical therapists at the local medical center, and the conversation turned to the topic of child care.

I mentioned that I had just worked with an intern who was 38 week pregnant, had planned to take a 4 week maternity leave (she was a prelim and had to start her second program on time), and had a complicated childcare plan in place that involved a sitter coming over to the house around 5 am - when she and her husband (a surgical resident himself) had to leave for the hospital, the sitter would then drop the baby off at daycare when it opened at 8am, pick the child up when daycare closed, and stay with the child until she came home from the hospital around 7 or 8 in the evening.

"Geez", she said, "Maybe she shouldn't be having children. It doesn't sound like she has time for them."

Whoa. Maybe she shouldn't be having children? I should mention that, although I hardly know this intern at all, I like her and I am worried about this plan for what I think are obvious reasons. Children get sick. Patients crash, usually right as you are about to leave. Daycare closes early on Friday for "Teacher In-service" (like every month it seems). Sitters have "things come up". And what about weekends?

My reaction to her situation wasn't that she shouldn't be having children, but that she needed a nanny to get her though a tough few years. I made what I hoped was a polite excuse and left the conversation. 

I was more fortunate than this intern in both the length of my maternity leave and that I had family that could move in with when my daughter was born, but without those two variables my situation wouldn't have appeared that different. I wondered if the same sort of judgement would be passed on me if my early months and years of motherhood were observed by similarly minded outsiders - even now as my mother lived with us for the last two weeks while I was on the inpatient ward rotation. 

I don't feel bad about how I raised my daughter when I was a resident, I feel grateful to my mother and mother-in-law. But I guess we all have different comfort levels for having other people participate in the care and raising of our children. I've had a lot of help with mine and, for the record, I've been pretty happy with the outcome so far. 

Day 1 of regular exposures

Today I dropped Zo off at his first day of daycare. We finally found a place that we loved with enough diversity so that our little chocolate chip wouldn’t be the only little brown boy in the institution. By word of mouth, we found a quaint cottage-like Spanish immersion preschool run by super cute ladies from Venezuela and Mexico. He loved it during our tour and even attempted to hop out of my arms into the Director’s arms. He was so smitten that I ignored the many dripping noses of the cute 1 year old kiddos who would be in his future class.

This morning I dropped him off around 8:45am. And he was one of the drippy-nosed children. For the last 3 days he has been a sneezing, coughing fussy fuss-face. Top it off with a set of 12 month old immunizations and both parents with sore throats and sneezing and you have entered our purgatory. I have flushed and aspirated his nose so many times that he anticipates what is coming and gets his wail ready. He has woken up so many times in the past few nights that I haven’t been able to lay down for more than 5 minutes without hearing his coughing and whimpering. I can’t wait for this cold to be over so that we can officially begin sleep training him. Add a hectic Ward month with long nights and early mornings and all I can say is that I am so tired. I am so very tired.

As I walked out, painted smile on my face, holding back the tears welling up in my eyes, a cute cherubic girl smiled at me and motioned for me to hold her hand. The Director hurriedly waved to one of the teachers so that she could wipe away the thick yellow-green goo running from her nose, sliding down her face. The teacher laughed nervously, I shrugged knowingly. I have been around enough children to know clear, yellow, and green ooze is somewhat of a rite of passage. Thus began Day 1 of our son exposing others to his germs and his classmates exposing him to theirs. Here’s to a robust immune system! Here’s to my growing Little Man!

MiM Mail: Dealing with a chronic illness

Hello MiM blogosphere-

I'm a surgical resident, wife, and mother.  I love planning, writing lists, checking boxes, and emailing my husband with "action items" -- basically, the 21st-century Honey-Do list. 

Despite all of that, I have found myself in a situation that I never planned for. 

Recently, I was diagnosed with a chronic illness.  Without getting too specific, it will impact how I do my job, but won't prevent me from doing it.  Think of something along the lines of Crohn's disease, Type 1 DM, or lupus.  I have to take medication, monitor my symptoms, and go to doctors appointments.  I might have to take a 5 minute break during cases that last more than 6 hours.  But, my doctors and I see no reason why I cannot continue to provide excellent care to patients.  I'm lucky that there is even an attending surgeon at my institution who has the same chronic illness that I do.

All that said, finding out this news has been Really Hard.  It's scary, and overwhelming, and my head is spinning.

I worry about where my disease will take me... What complications are in store?  How will I handle it on those days when I feel really bad?  Why isn't there a cure for this thing, yet?  But, what I'm worrying about most are the practical things...legal protections, financial expenses, keeping insurance, dealing with a chronic illness and surgical residency (a chronic condition in and of itself!).

So, I appeal to you all with three big questions.  Maybe you've been through something like this before?  Or seen someone go through it? 

1.  What and how do I tell my co-residents?  My attendings?  My program is hard and the hours are very long (80 hour workweek, what??), but it's actually not all that malignant.  I know my coresidents and attendings will prioritize my health and giving me 10 minutes of self-care time during a 15-hour workday probably won't be a big deal... But, what I really worry about is the loss of opportunities.  Like, if one of my attendings wants a resident to help with a cool research project, but they don't ask me, reasoning that the extra work will be too burdensome with my illness.  Same thing if a good case comes in late in the evening...what if they don't ask me to stay because of my illness?  Will all the credibility I've built up as a hard-working, excellent resident slowly be eroded by missed opportunities? 

2.  How do I handle this with future employers, when I apply to fellowships and ultimately attending jobs?  Am I obligated to disclose this information?  My field is fairly in-demand (at least right now), and I'm a good resident at an excellent program, but is chronic illness a big enough 'black mark' to mar even an otherwise exemplary CV?  I'm terrified that if I'm not the best-of-the-best--if I'm just average--my illness will make it such that employers pass me over for someone who is totally healthy.

3.  How can my husband and I protect ourselves financially from the risks of my chronic illness?  He works full-time in a well-paying field... though his salary is about half of what my eventual attending salary will be... assuming I don't scale back to a slower-paced practice given my situation.  We always assumed my career would be the primary one... we'd move to follow my job prospects, I'd have the Cadillac disability insurance, he might even eventually work part-time or stay home entirely to focus on parenting.  It seems like all of that is changing, and I'm struggling to figure out how we should reprioritize.

Kind of a heavy post, I know... but I certainly appreciate any insights.

-Claire

Sick Day

I wake up at 4AM feeling nauseous.

I'm not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, "Wow." Then they vomit again. And then a third time. And now it's on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, they burst into tears, because vomiting makes kids cry.

And they want a hug. But they're freaking covered in vomit. I mean, you have to hug them, of course, but you have to at least attempt to strip off some of those vomit-soaked clothes first.

I get this horrible sense of foreboding, but I somehow manage to fall back into a restless sleep and wake up later with my alarm. I still feel really nauseous and my stomach kind of hurts. But I get up and force myself to take a shower.

The living room still sort of smells like vomit. I swear, we cleaned it. I went to the drug store and asked the clerk what would get out baby vomit from the carpet and I got a bottle of Woolite. But I don't know, maybe there's a patch of vomit somewhere that we missed. Probably there is. There was just so much of it.

If anything could have made me feel less like eating breakfast, it's walking into a living room that smells like vomit. Thank God both kids are already awake. I feel like if I have to argue with anyone or do anything unexpected today, I will break down.

The daycare serves breakfast till 8AM, and I think I'm going to make it. We arrive and as I bring my littlest into the toddler room, I see a bunch of one-year-olds sitting around the table with little bowls of food. But I don't see the food cart. "Can she still get breakfast?" I ask.

"Sorry, you're too late," they tell me. It's 8:01AM.

"Is it possible for her to get any food at all?" I beg. "She didn't want to eat before we left." And keep in mind, if you tell me "no," I may vomit on you.

They seat her at the table and say they're going to try to scrounge up some food. If they're deceiving me, I don't even care anymore.

I drive to work. I'm really nauseous now. I wonder if I could throw up. I don't feel like vomiting is imminent. Like I don't think I'm going to have to pull over and yak all over the road. If I'm not actively vomiting, I'm well enough to work. Period.

In the hospital, I make a beeline for the bathroom. My stomach is cramping and I feel like I'm in labor with a vomit-baby. I lean over the toilet but nothing comes right away. It's generally easier to birth a vomit-baby than an actual baby, but it's just not coming. Someone knocks on the door, which totally disturbs my concentration. I can't vomit with someone standing right outside the door!!

I go upstairs and pick up my patient list. It isn't too long. Maybe I can get through it fast. Hopefully nobody will talk to me.

I go to the bathroom. Vomit success!!! But it's not that much. Maybe my symptoms are all psychosomatic, because I watched both my kids throwing up.

No, I should probably just call in sick. The world won't come to an end. It's not fair to anyone for me to be working in this condition.

I leave the bathroom and just stand there, debating what I should do. My boss walks by and I call his name. "Hey," I say.

"Hey," he says. "What's up?"

"Um," I say. "My girls have been throwing up all weekend and I just threw up. So... I guess I should probably go home."

"Yeah, that's fine," he says. "Feel better."

"Here's my patient list," I say, trying to hand it to him.

"I'm not touching that," he says, recoiling in horror. "I'll get a fresh copy."

Fair enough.

I drive home. Maybe I'm not that sick. Maybe I should have just stayed and worked. But then I could have given this awful bug to everyone I work with. I mean, it benefits the hospital if they don't have half the staff out with a stomach flu. I'm sure they'd rather lose me for a day than have that happen.

At home, I try to vomit in the toilet. I can't. Maybe I should have had a bigger dinner last night. How can I be home if I'm not actively vomiting?? Now everyone is going to think I'm an unreliable mom. My husband comes into the bathroom while I'm sitting on the floor by the toilet. "Maybe I should have worked today," I say.

"I can't tell if you're teasing me or if you're really insane," he says.

Little of both, probably.

Stressed Out

My Life has been a roller coaster for the last couple of months.  I don't mean a nice Disney coaster either, I'm talking about Cedar Point 120 mph craziness.  Two partners have taken maternity leave this year and I have done my best to work extra and be supportive, but I think this year is taking its toll on me.

I feel like I have always kept a a decent work life balance. I exercise, eat well, make time for my family and attempt to take some time for myself in general, but over the last 6 months that balance has been close to impossible.

The additional roller coaster involved being offered  the opportunity of a life time this summer.  I was scheduled to travel internationally for 3 weeks. All expenses paid. Patients were rescheduled, passports obtained and childcare was arranged. I was SOOOO excited. Then the day before departure, the trip was canceled.

{Insert sad trombone}

So, back to work I went.  In hindsight I should have taken some time off, when I already had it blocked, but alas, I'm a glutton for punishment.

Somewhere during these crazy few months I started having these crazy fantasies: what if I had to have emergency surgery?  Wouldn't that  be AWESOME.  I could take a week off to recover. No one could bother me.  Now, before those of you who know me IRL have me admitted to the psych ward, I in no way ever wanted to hurt myself. Or have anything really wrong with me. No crying spells, no anxiety attacks. I just keep dreaming of  having an unruptured ectopic. Serious enough for surgery and a week off, but not life threatening or overly painful.

We go back to fully being staffed next week, and I have scheduled myself some down time to re-energize. I  have been focusing on that and already feel much better.  Hopeful to be back to my peppy self soon.

Anyone else ever get so busy and stressed out that they start imagining how awesome it would be to have appendicitis? 

Guest Post: Pregnancy, Delivery, Postpartum as the Patient

I am a small town girl from the middle of nowhere that recently graduated from OB residency in the big city and I am currently doing an MFM fellowship. I am also now 3 weeks postpartum with my first child. Whoa…what an experience.

I thought I knew everything there was to know about pregnancy, delivery and postpartum issues. Let me just say….life from the table side of the stirrups is a whole new world.

Pregnancy was a whirlwind, with the exception of 5 weeks of nearly continuous nausea and terrible heartburn, I loved being pregnant. I, like many pregnant women, had this perfect plan for how I wanted my delivery experience to be: spontaneous labor, short second stage, no episiotomy, no operative delivery, 7 pound baby.

Well…I was long/closed/posterior and floating at 39+ weeks and I got a primary elective c-section for macrosomia. Baby boy ended up being 8’14 and he is perfect. I have no regrets. C-section recovery wasn’t so bad…the first 36 hours were rough, but otherwise pretty smooth sailing. Baby boy nurses like a champ…although I referred to him as “baby T-rex” for the first 2 weeks. Seriously…the sore nipples are no joke.

So now I am staring down the barrel of the end of my maternity leave. I have always loved my job. Everyday I felt like I did something good. Every baby that I deliver is an amazing experience. If you have to wake up at 2am…why not deliver a baby and change someone’s life forever. I thought my life would never be complete without it. Now I consider leaving my fellowship on a nearly daily basis.  I can’t imagine leaving baby boy for 10-12 hours a day.

I chose to do a fellowship for the potential for a better lifestyle as my children get older and because I truly love “maternal medicine.” But these days I think maybe I should just leave fellowship and moonlight a few shifts a month. At least where I live, I could moonlight 4-5 nights a month and make the same money I make a fellow.

Will I ever love my job the way I used to again? Or will I look at the clock all day and just want to be home? Will I regret it if I quit? Can one really do it all…be a good fellow and a good Mommy? My poor husband doesn’t know what to say to make it better. I have never been a crier…but several times since having the baby he has found me rocking the baby in the nursery with tears streaming down my face. I can’t help but think that by going back to work I will miss all these sweet moments.

DeaconDoc

Cure for what ails ya

Hi, MiM folks. Long time no see.

I have a lot going on. I am a few months into my internship. I am applying for obstetrics residency again. I just submitted four abstracts to two conferences, I just presented at one conference and will be a presenter at another, and there is a lot going on, women's health wise, in politics and in the news.

So what am I so worked up about that I am going to break my blogging fast?

Facebook medical advice.

*Facepalm*

I joined Facebook when I got accepted to medical school. My incoming class started a Facebook group and used it for introductions and announcements. I'd never used MySpace. I started off Facebook with a bang, since our class had almost 250 members in it, many of whom were young whippersnappers used to this social media stuff. Now, of course, I'm a pro, and have been recently accused of being a "Facebook slut" because I have so many "friends." They come from many, many different walks of life. Definitely not all medical people, and not all mainstream.

So, one of my non medical friends (someone I know from an online mothering support group from years back) posted about some symptoms she found troubling. She was suddenly very dizzy - the room was spinning, and her vision and balance were off. Not really nauseous, no other significant symptoms, and I know she doesn't have a significant medical history and she said she wasn't on any medications. She said - anyone have any idea what could be causing this?

"Hmm, sounds like vestibular neuritis," I thought. I posted "Most likely vestibular neuritis - sorry :(" I purposely said "most likely" because hey, who knows, and I didn't want to sound like a know it all. I threw in the frowny face to seem more friendly and less know it all-y, too.

I wasn't so perturbed by the people posting guesses about low blood sugar or low blood pressure, even though those are technically more likely to cause lightheadedness than dizziness. I know that distinction can be difficult even for a trained medical professional. Or a patient describing symptoms, for that matter.

But, then there were some more productive suggestions:

"Go to the ER immediately and ask for a blood test, which will most likely show it is dietary affecting your blood preasure(sic)".
"I felt really bad recently and it turns out it was food poisoning. I poo'd and I felt better!"
"Intestinal parasites can cause this!"

I made a snarky follow up comment about how it was definitely sporns and she should drink some OJ. I didn't mention that I was a doctor and would you people just! listen! and stop making dumb suggestions for non existent blood tests or very unlikely etiologies. Especially since I had twice, nicely, suggested a likely cause that they could have googled. Maybe that would have been better than the sporns comment, I don't know.

I knew I wasn't fit for further commenting when someone posted how it was "Vertigo. OR an inner ear infection" and I wanted to write in all caps "VERTIGO IS A SYMPTOM, NOT A DIAGNOSIS! SO, NOT "OR"!! AND INNER EAR INFECTION WITH VERTIGO = VESTIBULAR NEURITIS!!"

When did I become such an insufferable know it all?

Sigh.

I should just go take a poo, and I bet I would feel better.

Transitioning

I've been back to residency after my time in the lab for a full three months now.  This transition has been quite a roller coaster.  Here is my reflection of transitioning.

#1 Our lives have totally changed.

Positives:

• I have managed to keep breastfeeding and actually making milk.  I have no idea where my body finds this milk reserve, and I can no longer breastfeed in the mornings because I leave before she wakes up, but this has allowed me to maintain a very precious part of my relationship with my daughter.  With all the change in our lives right now,  I cherish being able to continue our "bu bu" time.
• I truly LOVE surgery.  I love operating and as a more senior resident, it is even more clear to me how much I truly LOVE being a doctor to my patients.  I now get to see my patients in clinic, operate on them, make decisions about their post operative care, and meet with families in a much more meaningful way than I did as a junior resident.  
• Being a mother has CLEARLY made me a better doctor.  I have an additional way I can relate to my patients.  It has enhanced my empathy.  There are so many intangible, hard to describe ways in which I have become a better person, and I can already see this reflected in my work.
• My husband and I have become CLOSER!! Yes, I said closer!  We were struggling post baby.  As my love was exploding for this little perfect human we had created, my husband and I were having a hard time relating to each other in these new roles.  The strain on our relationship was significant.  This is another thing on the list of stuff people never tell you about having a baby (up there with peeing when you sneeze).  One of our issues was me feeling like he didn't respect the work I was doing in the lab. Well, his support of what I do as a resident is unquestionable, he is constantly building me up and teaching our daughter that when I'm away I'm doing something that matters.  We also appreciate each other more because we are both working so hard to make this work.  I appreciate how he takes care of our daughter and our house when I can't be helpful. He appreciates how hard I work to contribute when I am at home.  This has been probably the best outcome of me going back to residency because I seriously worried what would happen to our relationship as I got busier.  

Negatives

• I MISS my baby SO MUCH!!!  I MISS HER, I MISS HER. I MISS HER!
• It is such a struggle to balance.  Trying to study, prepare for work while maximizing my home time with my family involves lots of juggling and making choices to do something less well.  I'm developing strategies.  I sometimes come home after work, have family time, and then set a certain time where I do back to work to finish paperwork and notes and prep and study.  I also have times where I choose to spend time with my beautiful girl knowing that I will suffer tomorrow.  Evidence - this Friday, I BOMBED my case conference presentation - BOMBED IT! But the night before I let my husband stay at his work function because he already gives up a lot for me. And since I hadn't been home before 9pm all week, my daughter literally refused to sleep.  She wanted to play princess with me, watch Dora with me, read books, you name it.  She was literally forcing herself to keep her eyes open.  So after hours of fighting it.  I just let her hang out with me while I tried to prepare for conference.

Transitions

One of the harder things about transitioning back to residency is managing the daily transition from home to work.  With less quality time with my family, I want to try to be the best version of me that I can be when I'm at home.  This can be hard to pull off after a crazy day.  It requires a mind-shift.  It requires me pushing out of my mind the patient who I watched realize his own mortality as he prepared to go to hospice for what will likely be his last few weeks, it requires pushing out of my mind the berating I received at the end of the day from my least favorite attending, it requires forgetting the young moms with cancer, letting go of my mental step my step operating in preparation for tomorrows cases.  It requires me realizing the importance of princesses and shapes and coloring and bath time.  Sometimes I go to Dunkin Donuts, buy two munchkins and sit in the parking lot in silence for 10 minutes just to clear my head.  Sometimes I stop by Krogers on the way home and walk around aimlessly until I feel like a grocery shopping mom (that's when I know the switch has occurred).  Sometimes I listen to breathing exercises on the way home.  And sometimes I fail, and I come home all revved up and worn down and I feel like a bad mom.  

This is hard.  Being a working mom is hard and rife with guilt.  But we have to do it.  We have to find ways to do it our way.  I receive encouragement all the time which gives me the little push I need to keep going.  Yesterday, the coffee cart lady who brings coffee to patient families on the floor just randomly tells me I'm setting a beautiful example for my daughter and that I'm a good doctor, just because she overheard me talking about my beautiful girl.  I had never even really spoken to her before this.  It can be hard to find role models, but occasionally I do and they keep me going, and encourage me to be a role model for those that are to come. 

Thats all for now.

Cutter 

When Does The Doctor Get To Call Out Sick?

We've seen posts on this before... But I struggle every time I'm ill. This week, it's not so much my own illness that's been the major problem. It's the kids'. Because they can't sleep. And if they can't sleep, we can't sleep.

It started last week with this upper respiratory bug that's going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the "Three Year Cold". This one was really bad as it hit me on top of my undertreated seasonal allergies and having a 9 month old who doesn't sleep through the night. (I'm just not getting to the Neti pot.)

So no surprise that after a week of this virus, I started to get an earache. Within an hour the earache went from kind of annoying to consistently throbbing. I had a colleague look at my ear to confirm that there was a dull, red, bulging TM there. By the time I got to the pharmacy to pick up my antibiotics, it was screaming, pulsing, popping. I kept putting my hand to the canal expecting to feel pus and blood.

This is on top of a toddler and a 9-month old with copious nasal discharge and coughing. The baby HATES having her nose aspirated, but is used to sucking her binky as she falls asleep. With all the green mucous, she can't suck the binky and breathe at the same time. Thus, misery, for her and us. It's been over a week with this struggle to clear her little nasal passages so she can soothe to sleep...

Our toddler is a bit better off, but still cranky, clingy, picking at meals, whining... And waking up during the night coughing. A cup of juice and some quiet rocking lulls him back to dreams, but meantime, either me or hubby is up, again.

Night before last, it was midnight, and neither child had been able to fall asleep yet for more than a few minutes. Stuffy snotty noses, coughing, diarrhea poopies, fevers, et cetera et cetera, and we had spent hours trying all the tricks... Steamy shower, nasal aspirator, saline wipes, Tylenol, juice, singing, reading, cuddline, cartoons... And I had to be up at 5:15 a.m. for a 7:40 am start time in clinic.

I admit that I kind of lost it. I was personally miserable with my own symptoms, exahusted from several nights in a row of this sort of shenanigans, and I knew I would have only a few hours' poor sleep before I had to truck it to the city and take care of people.

"You have to call in sick," insisted my husband.

"I CAN'T," insisted me.

And I didn't. The kids eventually drifted into snoring/coughing but sustained slumber. My alarm went off at dawn. I hauled my sorry drugged-up ass into the shower, and made it to work alive. I popped Phenylephrine, chugged Dextromethorphan, snorted Afrin, gulped a whole lot of coffee, and tucked a full bag of Ricola into my white coat pocket. I saw my full panel of patients. I got some looks from people, colleagues and patients alike, for my red, swollen, flaky nose, and this wet cough. I kept assuring people, "I'm at the tail end of a cold, I doubt I'm contagious. It's my own misery."

I've commiserated with colleagues. Everyone's been through this before. But we all agree. You SHOULD call in sick for this stuff.... But we all feel like we CAN'T call in sick for this stuff.

So when can the doctor call in sick?

I remember as an intern on a busy overnight call, one of the senior residents started the evening with GI bug symptoms. It was severe, coming out both ends. By 1 a.m., he was laid out in the call room, and the nurses hooked him up to IVs. Still, we interns were coming to him for all the usual overnight precepting: running admits by him, reviewing labs, discussing cases. There was no question of, could he go home sick. We knew that he was febrile and dehydrated and not thinking straight, but it was like, there was no choice. And in the morning, the attendings heralded him as a hero for sucking it up and holding down the fort, despite having active nausea/ vomiting and diarrhea... that was contagious. That left a strong impression on me. Today, I think that was INSANE.

More recently, I had to fight with a patient of mine who also happened to be a surgeon. She had developed flu symptoms and wanted Tamiflu, but didn't want me to test and confirm Flu, so she wouldn't have to call out sick, as is mandated by Occ health. "I'm on the schedule, I have to operate," she explained.
Those are extremes. More common, I think, is our family's situation. We're all miserable, but can't justify calling out.

What would you do?

Mommy track

I was just thinking the other day about whether there can or should be a mommy track in medical training.

There are other fields where you can have the option of training part time while building a family. Why not in medicine? And this would eliminate resentment aimed at mothers who might need to leave early or call in sick more often due to obligations at home or pregnancy during residency.

I'd imagine residents would take longer to graduate and get paid half salary. If the residency was primarily inpatient, that might be a little trickier to manage, although in outpatient rotations, I'd imagine the resident could just work half days. In a field like PM&R, I could definitely envision how it might work.

What do you think? Is parttime residency a good idea or a bad idea?

Guest post: Bitten by the green bug

I never thought I would meet someone who is jealous of a med student. Not the kind of "Oh, I wish I got in to X school" type of jealous. The real "wow, you are so busy and love what you do and I want that" kind of jealous. Unfortunately, it isn't a friend or former classmate who was bitten by the green bug; it is my husband. Since we moved to a new city in July once I got into med school, he only had a few months to find a job before the financial and family pressure set in. Now, 2 months later, he is 3 weeks into a job- what he did think was his ideal job, but he HATES it. Hates it to the point he regrets moving, I feel like a cheerleader every day trying to make him happy at home, and this whole situation stressing me beyond the point of what I thought was stress-able. The fact that I LOVE school but also need to study all night doesn't make it too much better. Has anyone else had a spouse/domestic partner who had trouble during training/after? Any ideas?

-SmMommy

I am a mom of a beautiful, smiley 5 month old daughter, wife to a wonderful (if not too happy at the moment) husband, and first year medical school in the school of my dreams somewhere near a coast.

Having kids "young"

I felt very young when I had my first child. There were times when I felt like a knocked up teenager. Mostly because most of my friends and colleagues didn't have kids yet (there were, in fact, no parents at all amongst all the residents in my program) and seemed to be waiting for some undisclosed time in the future.

In actuality? I was 27 years old. Two years older than the average first time mom in this country. Six years older than the average first time mom in 1970.

More and more, it seems like women are waiting until their thirties or even their late thirties to have children. In medicine, I think it's a function of trying to get difficult training out of the way first, which I can certainly understand. There are times when I question my own decision to have kids so young. But ultimately, I think it was a good decision. I've written here before about how I think that career advancement can always be postponed, but having kids is the one thing that's time sensitive for a woman.

Here's why I'm glad I had kids "young":

--Pregnancy was much easier in my twenties than my thirties. The difference was actually surprising, and my glucose numbers were even worse the second time. I had zero complications in my first pregnancy. And since I was so young, I didn't have to go through any invasive testing like amniocentesis.

--Caring for a newborn was easier in my twenties than my thirties. My body was much more amenable to it when I was younger and I had far fewer aches and pains.

--Presumably I'll continue to have more energy to do stuff with my kids throughout my thirties, compared with parents in their forties. I've heard a lot of older dads complain about this.

--My parents are younger and have more energy to help than they would if I had waited till they were in their late 60s to have kids. And similarly, I'll have a greater chance of being a young grandma, who can help with and appreciate my own grandkids (*fingers crossed*).

--I never had to go through the pain of trying to conceive while all my friends were having babies and posting photos of them on Facebook. If I did have trouble TTC at 27, I would have had more time to work on it.

--Arranging coverage was amazingly less burdensome as a resident than it was as an attending.

--At this point, since I feel "done" with childbearing (IUD willing), I can expand my career and take on new obligations without worrying about another pregnancy and baby interrupting things.

--Kids are awesome

Of course, I'm sure there's a similar list of benefits to having kids at age 40.

I dread/ hate "Family-Centered Rounds"

* I apologize in advance for the number of times I use the word “hate” in this post, but it’s gone beyond dreading into the realm of hating. Let me explain:

I have a background in Health Promotion and I always try to find ways to incorporate patient understanding and literacy in to my interactions. I realized early in medical school that I dread and now hate rounding. Absolutely hate it. As I have often seen it, it is Team-Centered with the patient/ family on the periphery. It is not health promoting. The literacy level is directed to professionals. All big no nos.

After a week on the Wards, I realized yet again that I hate “Family Centered Rounding” for pediatric patients due to the following reasons:
- way too much information is being spewed at parents who have probably just woken up
- way too much detailed information is being reported; if medical students and Interns have trouble keeping up how do we expect families to?
- there are way too many people in the room who have only minimal involvement with the care of a particular patient
- it is unprofessional and unappealing when folks with minimal involvement are only half-present (ex. the other Interns working feverishly to complete notes and orders on other patients)

And my biggest concern is are we hurting patient care when we list detailed and often scary differential diagnoses and mention lab tests that we probably will not perform?

I could go on and on but I won’t. I think Family-Centered Rounds has the potential to be a wonderful educational tool for families, a way to increase engagement in the medical decision making process. At least as I have seen it (at a large urban tertiary care center and at a medium size community hospital), it falls short. Rather than complaining without taking action, I am very interested in helping make these rounds better at my hospital, for our patients. I am motivated, selfishly, to at least work toward making the process less dread and hate-inducing for myself so that I don’t completely omit becoming a Hospitalist from my list of possible future careers.

Questions:
1. How do Family-Centered or Patient-Centered Rounds work (or fail to) at your institution?
2. If you could change this process and make it better given time constraints, what would you do?

I think I see a Quality Improvement project simmering . . . .

Oops Babies

It seems like there are a lot of "oops babies" out there.

I know a bunch of other people who said they only wanted one or two kids or no kids, but then "oops." It seems like everyone I know either had an oops baby or knows someone who did.

I question the concept of oops babies. I wasn't trying to get pregnant either time I did, but I know I wasn't trying very hard not to. (Mistimed natural family planning.) One of my friends in residency got pregnant "by accident" twice, although one time it sounded like she wasn't using any protection. A friend of mine who got pregnant in high school wasn't the result of a broken condom but no condom at all. I do know a woman who got pregnant on birth control pills, and I have to wonder if she was taking them correctly. I wonder how many genuine oops babies there are, or if they're really "should've known better" babies.

Right now, I feel like 99% sure that I don't want any more children and I certainly feel like the stress of another child would be unbearable right now, so I got a Mirena IUD. It's supposed to be greater than 99% effective and as effective as sterilization procedures. But the more stories I hear, the more I worry about an oops baby.

I let a patient do my hair.

Oh yes, I did.

This is not a level of intimacy with which I am that comfortable, but when it became apparent within minutes of starting our appointment that she was not going to Let This Go, I acquiesced.

I was running late, and the messy braid running down my back was obviously going to be a barrier to our getting through a few important issues in this otherwise routine follow-up visit. Before you go thinking this is terribly creepy or whatever - she identified herself as a "trained beautician" who wanted to make me look "as beautiful as the pastor's wife".  Fine. Fine. FIX ME.

I doubt very much any of my male colleagues would have allowed this to happen. I speculated as to if female physicians in other fields would have consented to an exam room "make over". Do patients ask to re-do the surgeon's hair? The psychiatrist's? Surely not. Eventually, as she was still twisting my hair this way and that, I rounded my way to the realization that few, if any other female physicians would find themselves in this position.

This might, in other words, be a me-specific problem. And I am wondering if I should be bothered by it, because, aside from feeling a bit bashful at the time, I'm not. I just hope years of medical training and motherhood aren't eroding an occasionally whisper-thin sense of self-preservation.

But hey, even if they are, I still got a new hair-do that earned me some compliments later in the afternoon. Self preservation? Ah, just FIX ME.