A patient recently eyed me right before a bedside procedure (I was supervising my residents) and asked with one eyebrow raised, “How long have you been a doctor?”
I thought about it for a couple of seconds, doing the math. “13 years.”
His face registered a small shock. Then, he relaxed a little. “Do you have children?”
“I have three.” His eyes widened, and he smiled.
Thirteen years is a long time; many things have happened to me that undoubtedly have shaped who I’ve become since I graduated medical school. I’ve certainly changed in many ways. Which ways were due to medicine and which were due to plain old maturation? My marriage? Having children? Other life experiences?
Upon reflection, I think medicine is responsible for this: more compassion.
There is a belief that medical training may result in the opposite. That because we see so much death and suffering, we have to harden a little to get through it all and come out emotionally unscathed. I certainly don’t think that’s universal and likely some of those observations arise from the development of burnout, the dampening of resilience.
As a hospitalist, I witness suffering from illness regularly. I am, not too rarely, the bearer of bad news – the cancer we found, the poor prognosis, the decline in function that is unlikely to be gained. I see people at angry, vulnerable, hurting points in their lives. I’ve seen illness stem from poor choices. But just as often, I’ve seen illness strike with absolutely no provocation, turning someone’s life into a nightmare overnight.
Being a doctor has not made me numb to the suffering of others, despite sometimes feeling surrounded by it. On the contrary, it has made me more acutely away of what makes us human and connected. I think this has altered my approach to the universe. Probably, choosing to work in the veterans health system has something to do with that. I’m driven more by service now than when I was younger. I did community service in college, more because I felt I had to rather than because I wanted to. I do it now because it fills a need to serve and sustain.
The man who cleans my office is my favorite person at work. He is a wonderful soul, kind, generous and thoughtful. One day, after reading a column I wrote about emergency research done without consent, he said to me, “KC, I have observed that you have a deep, abiding compassion for those without a voice.”
I didn't know what to say.
Is that me? That wasn’t me before medical school, but if it is me now then I am grateful that becoming a doctor has made me so.
Friday, December 13, 2013
Thursday, December 12, 2013
Guest post: How Medicine’s Changed Me – the Good and the Bad
After 11 years of training and going on five years of practice, there is no question that medicine has changed me in numerous ways. Some definitely for the good. Some for the not-so-good. On good days, I’m more optimistic and have a deeper faith in humanity as a result of my practice. As a pediatrician, I see patients who are often funny, are so incredibly resilient and have lives full of possibility ahead of them. I have seen and participated in miracles. I have witnessed deep compassion and graciousness, in both my coworkers and the families we serve. I have seen others make sacrifices to do their best for our patients and their families. My practice is frequently deeply rewarding.
But my practice can also be incredibly difficult. As a pediatric emergency medicine physician, I bear frequent witness to the senselessness of tragedy. I have struggled to save a life and failed. More than once. I deliver news of devastating new diagnoses - the brain tumor, leukemia, intracranial bleeds. I have been yelled at, cursed at. It is a rare shift that I don’t see a child for suspected or known abuse. I care for families who are at the end of their rope, trapped in generational cycles of poverty and violence. I see children whose physical symptoms are the result of anxiety, fear and toxic stress. At times, I feel my patients are trapped, that their lives are not filled with possibility. Currently, it is the changes brought about by this aspect of my practice that I struggle with.
I know that I’m not the same person now that I was when I slipped into my first white coat. I’m not even the same person I was when I finished my fellowship not quite five years ago. There are days when I struggle to be compassionate and gracious to my patients, their families, my coworkers and myself. Days when I feel unable to tolerate complexity. Days when I don’t tolerate the chaos of my home as well, when I feel unable to be fully present with my husband and children. There are cases that haunt me, that I feel will always haunt me. This problem goes by many names - compassion fatigue, vicarious trauma, secondary traumatic stress. Some say it is burnout; some say it contributes to burnout. Define it how you will, it is real and it is common.
There is a growing movement in the medical community to combat this dark side of our vocation. The hospital at which I work recently started a program for staff well-being that includes mindfulness seminars and meditation sessions. Even though I am in the beginning stages of a practice of mindfulness, it’s already helping me deal with this dark side of medicine. This new awareness, this mindfulness, is another way that medicine is changing me. Out of necessity, yes, to enable me to deal with some not-so-good ways that I have been changed by carrying out this calling to bear witness and to enable healing. But ultimately, learning ways in which to combat these not-so-good changes that often accompany a life in medicine will result in another good change - the ability to be more present at work and home, to live more fully and to care more compassionately. And to retain my sense of gratefulness for this vocation that I am, when it comes down to it, oh-so-thankful to be pursuing.
Kim
But my practice can also be incredibly difficult. As a pediatric emergency medicine physician, I bear frequent witness to the senselessness of tragedy. I have struggled to save a life and failed. More than once. I deliver news of devastating new diagnoses - the brain tumor, leukemia, intracranial bleeds. I have been yelled at, cursed at. It is a rare shift that I don’t see a child for suspected or known abuse. I care for families who are at the end of their rope, trapped in generational cycles of poverty and violence. I see children whose physical symptoms are the result of anxiety, fear and toxic stress. At times, I feel my patients are trapped, that their lives are not filled with possibility. Currently, it is the changes brought about by this aspect of my practice that I struggle with.
I know that I’m not the same person now that I was when I slipped into my first white coat. I’m not even the same person I was when I finished my fellowship not quite five years ago. There are days when I struggle to be compassionate and gracious to my patients, their families, my coworkers and myself. Days when I feel unable to tolerate complexity. Days when I don’t tolerate the chaos of my home as well, when I feel unable to be fully present with my husband and children. There are cases that haunt me, that I feel will always haunt me. This problem goes by many names - compassion fatigue, vicarious trauma, secondary traumatic stress. Some say it is burnout; some say it contributes to burnout. Define it how you will, it is real and it is common.
There is a growing movement in the medical community to combat this dark side of our vocation. The hospital at which I work recently started a program for staff well-being that includes mindfulness seminars and meditation sessions. Even though I am in the beginning stages of a practice of mindfulness, it’s already helping me deal with this dark side of medicine. This new awareness, this mindfulness, is another way that medicine is changing me. Out of necessity, yes, to enable me to deal with some not-so-good ways that I have been changed by carrying out this calling to bear witness and to enable healing. But ultimately, learning ways in which to combat these not-so-good changes that often accompany a life in medicine will result in another good change - the ability to be more present at work and home, to live more fully and to care more compassionately. And to retain my sense of gratefulness for this vocation that I am, when it comes down to it, oh-so-thankful to be pursuing.
Kim
5 Ways Medicine Changed Me
I like lists so let's go for it:
1. I'm more outgoing
Except in certain fields (rads, path), you just can't be as good a doctor if you're not at least somewhat outgoing. I think introverted doctors come off as cold or aloof.
2. Sleeping with a pager wrecked my sleep
I used to be able to sleep through my husband snoring. Now I can't.
3. I'm a much bigger hypochondriac
I really wish I didn't know the worst possible case scenario for every illness.
4. I'm more humble
Because I know that there's no way I can know it all.
5. I've gone from being incredibly squeamish to feeling like there's nothing so bloody or disgusting that I have to look away
Well, except maybe in the movies.
1. I'm more outgoing
Except in certain fields (rads, path), you just can't be as good a doctor if you're not at least somewhat outgoing. I think introverted doctors come off as cold or aloof.
2. Sleeping with a pager wrecked my sleep
I used to be able to sleep through my husband snoring. Now I can't.
3. I'm a much bigger hypochondriac
I really wish I didn't know the worst possible case scenario for every illness.
4. I'm more humble
Because I know that there's no way I can know it all.
5. I've gone from being incredibly squeamish to feeling like there's nothing so bloody or disgusting that I have to look away
Well, except maybe in the movies.
Wednesday, December 11, 2013
A Different Perspective
The title for this topic week is change; specifically how becoming a doctor alters one's life. There is no question of change, only how. For me, the most profound change is the perspective I have gained from training and experience, which has been both comforting and distressing. The ultimate goal is to find a balance in the enjoyment of what you do despite the inside look at inherent system and personal flaws that are revealed on that long journey.
As a pathologist in a large group practice, I work intimately with my co-workers sharing tough cases. As a fresh trainee I had a lot more defenses built up about showing a "stupid" consult. Over time, as I have become more comfortable and developed relationships with my partners, it has become easier. Some cases are diagnostically challenging, and just as a clinician doesn't always nail the patient's disease with the first test they order, a first glance at the tissue doesn't always provide clarity into the disease process. Even though we are all trained to render similar services, we each have our strengths and weaknesses based on training level and personality types, and I am thankful that I do not practice solo because we are so much better as a team. And I don't mean just us pathologists - I am also thankful that I can open the EMR and get input from radiology, pulmonology, oncology, and all the clinicians or just pick up the phone. Communication often makes a difficult case crystal clear.
Numerous recent articles are highlighting the drawbacks of our medical system, and having inside perspective makes a lot of it ring true. "You're Getting Too Much Healthcare" by Jamie Santa Cruz was published in The Atlantic this week and Elizabeth Rosenthal is doing an illuminating series in the New York Times I have been following called "Paying Till It Hurts." Sure, every system has its positives and negatives, but it's easy to become disillusioned when you get first hand experience navigating the real world and jumping through all the hoops that seem distant from your idealistic image of yourself as a pure patient advocate. One of the most challenging things I work on is finding value and purpose in the many things I do that help the patient, and not getting too frustrated over the more mundane and nonsensical aspects of medicine that I witness - many of which appear business driven. Having a rich life outside of work with children, family, relationship, friends, exercise, etc. - all of that helps round out the negatives. An alternative would be to bail on the system - something I have witnessed a handful or so of my classmates do over the last ten plus years since I have graduated. They have found happy and fulfilling lives outside of medicine. I don't think there is a wrong choice; everyone has their own path to follow. Mine is certainly in constant evolution.
Up to this point in my journey, I have shed a lot of the insecurities of youth but gained insecurities of experience; the latter being much more tolerable and rationally tackled through knowledge and resources. I have been elated by success and ravaged by missteps. I have been buoyed by support from this community of women and also retreated from it to nurture myself and my kids. Change is inevitable when you choose this road. Although some of it feels reactionary, which can yield cynicism and doubt, the most important changes are those gained from knowledge and experience - lifelong processes - the kind of glacial change that affects your core being. This kind of change brings a sense of control, purpose, maturity, and peace into your daily challenges and decision making, both inside and outside of the hospital.
As a pathologist in a large group practice, I work intimately with my co-workers sharing tough cases. As a fresh trainee I had a lot more defenses built up about showing a "stupid" consult. Over time, as I have become more comfortable and developed relationships with my partners, it has become easier. Some cases are diagnostically challenging, and just as a clinician doesn't always nail the patient's disease with the first test they order, a first glance at the tissue doesn't always provide clarity into the disease process. Even though we are all trained to render similar services, we each have our strengths and weaknesses based on training level and personality types, and I am thankful that I do not practice solo because we are so much better as a team. And I don't mean just us pathologists - I am also thankful that I can open the EMR and get input from radiology, pulmonology, oncology, and all the clinicians or just pick up the phone. Communication often makes a difficult case crystal clear.
Numerous recent articles are highlighting the drawbacks of our medical system, and having inside perspective makes a lot of it ring true. "You're Getting Too Much Healthcare" by Jamie Santa Cruz was published in The Atlantic this week and Elizabeth Rosenthal is doing an illuminating series in the New York Times I have been following called "Paying Till It Hurts." Sure, every system has its positives and negatives, but it's easy to become disillusioned when you get first hand experience navigating the real world and jumping through all the hoops that seem distant from your idealistic image of yourself as a pure patient advocate. One of the most challenging things I work on is finding value and purpose in the many things I do that help the patient, and not getting too frustrated over the more mundane and nonsensical aspects of medicine that I witness - many of which appear business driven. Having a rich life outside of work with children, family, relationship, friends, exercise, etc. - all of that helps round out the negatives. An alternative would be to bail on the system - something I have witnessed a handful or so of my classmates do over the last ten plus years since I have graduated. They have found happy and fulfilling lives outside of medicine. I don't think there is a wrong choice; everyone has their own path to follow. Mine is certainly in constant evolution.
Up to this point in my journey, I have shed a lot of the insecurities of youth but gained insecurities of experience; the latter being much more tolerable and rationally tackled through knowledge and resources. I have been elated by success and ravaged by missteps. I have been buoyed by support from this community of women and also retreated from it to nurture myself and my kids. Change is inevitable when you choose this road. Although some of it feels reactionary, which can yield cynicism and doubt, the most important changes are those gained from knowledge and experience - lifelong processes - the kind of glacial change that affects your core being. This kind of change brings a sense of control, purpose, maturity, and peace into your daily challenges and decision making, both inside and outside of the hospital.
as an extrovert without good answers
Though I am loath to admit it, I am, by nature, an introvert. And despite the recent torrent of articles espousing the benefits of being an introvert (also see here, here, and here with funny retort here), it's the part of my personality I like the least. I wish I was better at small talk, better at making friends, more relaxed in a crowd, not so ready to leave a party, and not so frequently told to "smile".
Medicine made me into an extrovert. Or maybe an introvert who can affect the persona of an extrovert with an enthusiasm that actually is genuine. I do smile, a lot actually, and frequently when I don't feel like it. In my white coat I am animated and chatty and quick to introduce myself. Perhaps not surprisingly, I like myself as the extrovert - it's like pretending to be the cool kid I never was. And, again painful to admit, I think patients also prefer Extrovert Me.
On a less frivolous note, I was very much looking forward to this Topic Week, and so am now surprised by how difficult I've found writing on the subject matter. It's hard to collect all the ways medicine, with its messy contacts and daily pressures, changes its practitioners, then analyze and distill that change into a theme confinable to a blog post. I think, after many hours staring at my computer screen, that I can't be complete in the assessment. I will have to focus my thoughts more than I'd planned.
Please excuse the generalization, but I think oncology, perhaps more than primary care and medicine subspecialties, treats patients whose disease cannot be clearly linked to poor lifestyle choices. Yes there are associations between obesity and breast cancer, smoking and (amongst others) cancers of the head and neck, lung, and bladder, and the various HPV-associated malignancies, but the majority of patients had no reason to think they were at risk for cancer. In plain terms, they never saw it coming. These patients, and particularly the young ones, will spend a significant portion of our initial visit asking and re-asking the question "how did this happen?", for which an abbreviated synopsis of cancer genomics is often emotionally unsatisfactory and scientifically insufficient.
I am just beginning to understand how frequently life lacks good answers to some very good questions. Terrible things happen to people undeserving of an early death or a near lifetime without their spouse. We do not all get what's coming to us.
I used the fumble the question "Do you like what you do?" because, although the answer is yes, there are times when it's truly horrible. I can't cure a substantial number of people who walk through the door and my job can involve making people understand something they don't want to understand. But there is meaning to what I do, there is meaning to palliation and prolongation of life, even when the situation itself seems meaningless. Medicine has taught me to find meaning where it isn't apparent and, in doing so, helped me to enjoy this short life that happens to us all.
Tuesday, December 10, 2013
How medicine changed me during the snow and ice
I am in medicine, where I must get out of bed and leave home on a “snow day” after arranging care for
my own kids, to de-ice my car, commute through snow, sleet, and freezing
rain, so that I can be available in person for my patients. Before medicine, I would have probably lounged around, woken up late, and
perhaps taken a walk just to enjoy the snow.
As a medical professional, I have responsibilities rain or shine. Just like a post officer, "neither snow, nor rain, nor heat, nor gloom of night stays these couriers [read: medical professionals] from the swift [read: caring and comprehensive] completion of their appointed rounds." The mother portion of me as a mother in medicine feels particularly bad leaving my family on a snow day. The medicine portion of me as a mother in medicine feels good, to be in a service profession, indeed.
(And maybe we'll get out early, in time for some twilight sledding.)
As a medical professional, I have responsibilities rain or shine. Just like a post officer, "neither snow, nor rain, nor heat, nor gloom of night stays these couriers [read: medical professionals] from the swift [read: caring and comprehensive] completion of their appointed rounds." The mother portion of me as a mother in medicine feels particularly bad leaving my family on a snow day. The medicine portion of me as a mother in medicine feels good, to be in a service profession, indeed.
(And maybe we'll get out early, in time for some twilight sledding.)
Medicine Made Me the Person I Am
As someone who went directly from college to medical school, I have spent most of my life in medicine. Medical training morphed all the areas of my life. I have no idea what I would be like if I wasn't a doctor, but I know medicine has made me a stronger, more appreciative person.
Medicine made me stronger. Its 3 a.m. and the baby's heart beat drops into the 60's. It's my patient's third baby. I check her cervix and she's a good 8 cm. The nurses and I give her oxygen and change her position but nothing helps. As the bradycardia approaches 5 minutes the tension in the room begins to rise. I am the doctor. Likely the only one at the hospital, at this hour. It's a tough decision, but this is my call. My pulse starts to rise, but I take a deep breath to calm myself down. I'm bone tired, but that really doesn't matter because I've done this so many times; I know I am strong enough to push through the fatigue, the stress and pressure. I have to be. This team needs be to be a calm, confident leader. As the bradycardia passes 10 minutes, I communicate the seriousness of the situation to the patient but not try not to scare her. We must proceed with an emergency C-section. A chaotic symphony of orders, instruments and bed pushing ensues. A healthy baby is born moments later.
Moments like these have given me some wrinkles and grey hair over the years, but have also given me nerves of steel.
After surviving residency, two kids and private OB practice not too much scares me. I know that I can tackle most any challenge whether emergency surgery, bodily fluids or board meetings. I am afraid at times, but neither fatigue nor feces make me flinch.
Medicine taught me to appreciate the little things. Life contains so much sadness; too much cancer, drugs abuse and loss. Beauty and miracles abound, but around the next corner you find stupidly ridiculous tragedies. Life in medicine becomes a daily decision not to become jaded. I'm stronger and little rougher around the edges but I refuse to be jaded.
One small way I do this is to purposefully enjoy the happy moments of my day. When I deliver a baby, assuming mom and baby are happy and healthy, I take a moment to soak in the moment. I simply observe the mother's face light up as I place her baby in her arms for the first time. I watch the expressions of astonished love and the happy tears rolling down dad's face. I remind myself that THIS IS WHY I do it. All the late nights,emergency c-section and all the sadness ARE worth it. I get to make a difference in this family's life. I get to play a small but integral part in helping make their family.
This goes to my home as well. I appreciate my own children's health. The little moments of hugs, giggles and homemade cookies are stored away in my memory for safe keeping. Many bedtime stories are missed but the ones I'm there for are cherished.
Medicine made me a scientist. Medicine teaches you to reason. I look to randomized controlled studies to help make decisions for my patients. I follow the standard of care for my specialty. I know my strengths and limitations. I find these principles spilling over into other areas of my life as well. I have consumer reports and google ratings to help decide on appliances or any other purchase. I rarely make a decision without research to back it up. If only there was a published standard of care for parenting toddlers.
As a premed college student, I was nearly bursting with enthusiasm over my chosen profession. I could rarely wait for the point in an introduction when I would get to declare my plans to "be a doctor." But medicine is more than a profession, it's really become a large part of who I am. Medicine has made me a stronger, smarter, better person and I'm thankful for the privilege of being a physician.
Medicine made me stronger. Its 3 a.m. and the baby's heart beat drops into the 60's. It's my patient's third baby. I check her cervix and she's a good 8 cm. The nurses and I give her oxygen and change her position but nothing helps. As the bradycardia approaches 5 minutes the tension in the room begins to rise. I am the doctor. Likely the only one at the hospital, at this hour. It's a tough decision, but this is my call. My pulse starts to rise, but I take a deep breath to calm myself down. I'm bone tired, but that really doesn't matter because I've done this so many times; I know I am strong enough to push through the fatigue, the stress and pressure. I have to be. This team needs be to be a calm, confident leader. As the bradycardia passes 10 minutes, I communicate the seriousness of the situation to the patient but not try not to scare her. We must proceed with an emergency C-section. A chaotic symphony of orders, instruments and bed pushing ensues. A healthy baby is born moments later.
Moments like these have given me some wrinkles and grey hair over the years, but have also given me nerves of steel.
After surviving residency, two kids and private OB practice not too much scares me. I know that I can tackle most any challenge whether emergency surgery, bodily fluids or board meetings. I am afraid at times, but neither fatigue nor feces make me flinch.
Medicine taught me to appreciate the little things. Life contains so much sadness; too much cancer, drugs abuse and loss. Beauty and miracles abound, but around the next corner you find stupidly ridiculous tragedies. Life in medicine becomes a daily decision not to become jaded. I'm stronger and little rougher around the edges but I refuse to be jaded.
One small way I do this is to purposefully enjoy the happy moments of my day. When I deliver a baby, assuming mom and baby are happy and healthy, I take a moment to soak in the moment. I simply observe the mother's face light up as I place her baby in her arms for the first time. I watch the expressions of astonished love and the happy tears rolling down dad's face. I remind myself that THIS IS WHY I do it. All the late nights,emergency c-section and all the sadness ARE worth it. I get to make a difference in this family's life. I get to play a small but integral part in helping make their family.
This goes to my home as well. I appreciate my own children's health. The little moments of hugs, giggles and homemade cookies are stored away in my memory for safe keeping. Many bedtime stories are missed but the ones I'm there for are cherished.
Medicine made me a scientist. Medicine teaches you to reason. I look to randomized controlled studies to help make decisions for my patients. I follow the standard of care for my specialty. I know my strengths and limitations. I find these principles spilling over into other areas of my life as well. I have consumer reports and google ratings to help decide on appliances or any other purchase. I rarely make a decision without research to back it up. If only there was a published standard of care for parenting toddlers.
As a premed college student, I was nearly bursting with enthusiasm over my chosen profession. I could rarely wait for the point in an introduction when I would get to declare my plans to "be a doctor." But medicine is more than a profession, it's really become a large part of who I am. Medicine has made me a stronger, smarter, better person and I'm thankful for the privilege of being a physician.
Guest post: How has medicine changed me
Since the age of 22 I have been entrenched in medicine-went right from college to medical school and residency. The formative years of my 20s have been busy dissecting bodies, studying dense medical textbooks, giving case presentations, rounding, taking call, eating bad cafeteria food, searching Up To Date, and learning how to adapt to different classes/teams/attendings/colleagues every month. I also took A LOT of tests. Looking back now 4 years post-residency, I am simply not sure how I did it!
Medicine has changed me in ways that could be viewed as “good” and “bad.” Medicine has given me more empathy; it has showed me the importance of compassion and hope; it has made me a better listener; it has given me confidence and the strength to be vocal; it has given me a career to be proud of. Medicine has also given me my husband! (We met, married, and couples matched in medical school.) It has shown me the value of wonderful friends and family, which many people do not have. It is a privilege to help people in their times of need and share intimate details of their lives. I trained in emergency medicine and have a valuable breadth of medical knowledge from excellent training. The knowledge helps me daily both on the job and off.
On the flip side, medicine has changed me in some negative ways. I am more judgmental-there is a need for quick (instantaneous) decisions when talking to a patient in the ER. I am cynical-while practicing medicine is considered a privilege, it is also a burden, and we usually see people at their worst. I take frustration out on my family because I know they will always be there (I hope). Medicine has been consuming and I have missed out on a lot of experiences….like family birthdays, funerals, weddings, parties, leisure, travel, holidays, and such. These missed experiences have caused me to be resentful and bitter at times.
I am not sure about you, but I feel like one of the most important things medicine has done is make me a better mom! I have 2 young kids and am grateful everyday for my medical knowledge. I know how to observe, study and treat my kids. I also know where to look for the answers I need for them. This medical knowledge helped immeasurably with my son’s near-death from kidney failure when he was 2 weeks old and all the subsequent care he has needed. Some mommy physicians complain that they “just know too much”....but I would never trade in that knowledge for ignorance.
No field or career can only have positive impacts on a person, and overall, I am proud and grateful to be a physician. Being a ‘mommy’ physician is an even bigger badge of honor in my mind. There have been a lot of challenges/walls/ceilings to break through….and a huge inner struggle to conquer the mommy guilt and “just keep swimming….” (Thanks, Dory.) Time out of training has brought more clarity with this issue and the compromises needed to make work and life, work. I wish all of you luck with making medicine work, as well.
AW
Medicine has changed me in ways that could be viewed as “good” and “bad.” Medicine has given me more empathy; it has showed me the importance of compassion and hope; it has made me a better listener; it has given me confidence and the strength to be vocal; it has given me a career to be proud of. Medicine has also given me my husband! (We met, married, and couples matched in medical school.) It has shown me the value of wonderful friends and family, which many people do not have. It is a privilege to help people in their times of need and share intimate details of their lives. I trained in emergency medicine and have a valuable breadth of medical knowledge from excellent training. The knowledge helps me daily both on the job and off.
On the flip side, medicine has changed me in some negative ways. I am more judgmental-there is a need for quick (instantaneous) decisions when talking to a patient in the ER. I am cynical-while practicing medicine is considered a privilege, it is also a burden, and we usually see people at their worst. I take frustration out on my family because I know they will always be there (I hope). Medicine has been consuming and I have missed out on a lot of experiences….like family birthdays, funerals, weddings, parties, leisure, travel, holidays, and such. These missed experiences have caused me to be resentful and bitter at times.
I am not sure about you, but I feel like one of the most important things medicine has done is make me a better mom! I have 2 young kids and am grateful everyday for my medical knowledge. I know how to observe, study and treat my kids. I also know where to look for the answers I need for them. This medical knowledge helped immeasurably with my son’s near-death from kidney failure when he was 2 weeks old and all the subsequent care he has needed. Some mommy physicians complain that they “just know too much”....but I would never trade in that knowledge for ignorance.
No field or career can only have positive impacts on a person, and overall, I am proud and grateful to be a physician. Being a ‘mommy’ physician is an even bigger badge of honor in my mind. There have been a lot of challenges/walls/ceilings to break through….and a huge inner struggle to conquer the mommy guilt and “just keep swimming….” (Thanks, Dory.) Time out of training has brought more clarity with this issue and the compromises needed to make work and life, work. I wish all of you luck with making medicine work, as well.
AW
Monday, December 9, 2013
How Has Medicine Changed Me?
KC suggested this topic, and I have had to think and think about it. How HAS medicine changed me?
As an uber-idealistic practically socialist gunner med student, I had a vision of myself in the future as a doctor completely devoted to the poor and disenfranchised of the world. I was going to work for Doctors Without Borders or something like that. I was going to deliver skilled medical care with aplomb, to the suffering and forgotten. My vision was pretty vague, but definitely included basic field hospitals, palm trees and grateful patients.
I held onto this vision well into residency, shrugging off questions about how I would finance my dream, seeing as I paid for med school with loans, and would end up about $120,000 in the hole, before interest.I shrugged off those questions, figuring where there was a will, there was a way. I did every international elective I could. I ended up in crazy places (and I have many crazy stories) from Guatemala, Nicaragua, Peru, Ecuador, Sri Lanka...
As the end of residency approached, along with those ever-increasing loan statements, I started looking for a job in my dream field, which was, in my head, basically "International Health". Of course most medical jobs in this area don't pay much; and though many allow loan payback deferment, the interest still mounts... I considered going for an infectious diseases fellowship, but I had signed on for Primary Care loans, and would take a penalty if I broke my commitment to primary care.
I tried some things; I did work in HIV research and thought about pushing that work into something more... international. I struggled. I got kind of depressed, trying to reconcile my vision with the reality of life, and finances.
But then, something else was happening. I was in my mid-thirties, and I was starting to have other visions... Visions of family. Of settling down, raising kids, of community, of stability.
There was a transition, a positive one, and I ended up here, in a very nice suburban home, with my wonderful rock-stable husband and two healthy kids, working in a small practice at a respected academic institution, providing primary care to decidedly American patients. I'm really very happy.
A lovely patient of mine, someone who has faced many medical adversities, told me once that "it's the kindness of caregivers that gives a person courage." I do try to remember that, even when faced with an angry patient... Be kind. It matters, whether it's with first-world or third-world patients.
So, I try to be kind. And it's all good. What's so funny is that I feel like I'm a nicer person now than I was when I was supposedly devoted to saving the world...I seriously think that's how medicine has changed me. It's made me a nicer person, though not in the way I anticipated it would.
As an uber-idealistic practically socialist gunner med student, I had a vision of myself in the future as a doctor completely devoted to the poor and disenfranchised of the world. I was going to work for Doctors Without Borders or something like that. I was going to deliver skilled medical care with aplomb, to the suffering and forgotten. My vision was pretty vague, but definitely included basic field hospitals, palm trees and grateful patients.
I held onto this vision well into residency, shrugging off questions about how I would finance my dream, seeing as I paid for med school with loans, and would end up about $120,000 in the hole, before interest.I shrugged off those questions, figuring where there was a will, there was a way. I did every international elective I could. I ended up in crazy places (and I have many crazy stories) from Guatemala, Nicaragua, Peru, Ecuador, Sri Lanka...
As the end of residency approached, along with those ever-increasing loan statements, I started looking for a job in my dream field, which was, in my head, basically "International Health". Of course most medical jobs in this area don't pay much; and though many allow loan payback deferment, the interest still mounts... I considered going for an infectious diseases fellowship, but I had signed on for Primary Care loans, and would take a penalty if I broke my commitment to primary care.
I tried some things; I did work in HIV research and thought about pushing that work into something more... international. I struggled. I got kind of depressed, trying to reconcile my vision with the reality of life, and finances.
But then, something else was happening. I was in my mid-thirties, and I was starting to have other visions... Visions of family. Of settling down, raising kids, of community, of stability.
There was a transition, a positive one, and I ended up here, in a very nice suburban home, with my wonderful rock-stable husband and two healthy kids, working in a small practice at a respected academic institution, providing primary care to decidedly American patients. I'm really very happy.
A lovely patient of mine, someone who has faced many medical adversities, told me once that "it's the kindness of caregivers that gives a person courage." I do try to remember that, even when faced with an angry patient... Be kind. It matters, whether it's with first-world or third-world patients.
So, I try to be kind. And it's all good. What's so funny is that I feel like I'm a nicer person now than I was when I was supposedly devoted to saving the world...I seriously think that's how medicine has changed me. It's made me a nicer person, though not in the way I anticipated it would.
Thursday, December 5, 2013
Guest post: The Things We Carry
Tim O’Brien’s “The Things They Carried” begins with a list of items carried by a platoon of soldiers during the Vietnam War:
In a writing class, you might learn about O’Brien’s use of repetition, about how he uses the list to reveal something about each man’s character. But I’ve been wondering lately, what do the things that we carry through life reveal about each of us?
My husband and I have too many possessions, this I know; more than we need or can even use. I am also aware that this is a developed-world, middle-to-upper-class problem, and that such complaints are at best insensitive and petty. This is not a war zone and our possessions are not strapped to our backs; instead these are the clothing and household items that pad our comfortable lives. Acknowledging these facts, I still believe that things deserve some examination.
There are the hand-painted margarita glasses that we purchased in Mexico and that have followed us, cloaked in too much bubble wrap, from apartment to apartment. Each time they settle onto a new shelf where they sit undisturbed until the next move. There are the clothes that get passed over each time we dress for work or a special occasion, but that remain in our closet because they might be perfect for an event that just hasn’t happened yet. There is the chair reminiscent of the one that sat in my parents’ vacation home when I was a child, the one that brings back memories of hours spent reading novel after novel. Except neither my husband nor I has sat in the current chair since at least two apartments ago. Instead it holds stacks of books, clothing, and anything else temporarily without a home or that we are too tired at the end of the day to put away.
Why do we keep all of these things? Is it emotional attachment, fear of loss, just plain inertia (of the staying-at-rest variety)? And how might our lives be affected if we were able to detach from our possessions, declutter, simplify?
I recently came across an article written by a woman who, along with her husband, had decided that it was time to do exactly that. They sold or donated many of their possessions, making it a point to buy only what they truly need and will use. In the process, they paid off a large chunk of debt, but the benefit that interested me most is somewhat surprising, something that I crave more than anything: “We're finding more time for the things we gave a lot of lip service to but didn't always make time for: health, fitness, reading and each other.”
Over time I’ve started to realize that, at least in my own life, carrying around a lot of physical stuff can feel just as burdensome as carrying a lot of emotional or psychological baggage. All of that stuff demands management – cleaning, storing, organizing, or at least sifting through as you search for something else – and thus time, energy, attention. If I had less stuff, if I limited my possessions to those that were really important to me, would I use them more? And would I discover more time to devote to the things that I really want to do in life?
It certainly seems possible. My husband and I have decided to give it a try. We are not emptying out our home by any means, but we are parting with a lot of the extras, the things that we had previously kept around on the basis of “what if” or “someday.” Already in our lives it feels a bit easier to move and to breathe.
Except there is one complication. A large part of the impetus for our decluttering is the fact that we are expecting our first baby in February and we desperately want to maximize the time that we are able to spend together as a family, as well as to grow even more fiscally responsible in order to provide for the baby’s future. But with a baby comes stuff. A lot of stuff. And how easily the line between the things we need and the things we need becomes blurred.
When we made the obligatory trip to Babies “R” Us to set up a registry, my husband paused before scanning our first item and warned, “Let’s just stick to the basics. Let’s not go overboard like we did for our wedding.” I paused and recalled the hours we had spent perusing china, crystal, and every isn’t-that-neat-looking kitchen gadget that caught our eye, ultimately adding several of each to our wish list. With this approach in mind, we braved the first overstuffed aisle.
This, I suppose, will be our first test. It is one thing to purge one’s home of a few belongings; it is another to retain the patience and thoughtfulness to avoid reflexively refilling it just because there is space available. And while we have no desire to raise a child or children with rooms overstuffed with rarely-used and under-appreciated toys, neither do we wish to impose on them a stringently spartan lifestyle. The answer for us, it seems, lies somewhere in the balance. And for the first time, we feel ready to set out in search of it.
Becky MacDonell-Yilmaz is a pediatrics resident at Brown University/Hasbro Children’s Hospital in Providence, RI. Her work has been published in the Annals of Internal Medicine, The Writer's Circle, and The New Physician. She blogs about her experiences in training at The Growth Curve: ruminations of a pediatrician in training.
First Lieutenant Jimmy Cross carried letters from a girl named Martha, a junior at Mount Sebastian College in New Jersey…. Henry Dobbins, who was a big man, carried extra rations; he was especially fond of canned peaches in heavy syrup over pound cake. Dave Jensen, who practiced field hygiene, carried a toothbrush, dental floss, and several hotel-sized bars of soap he’d stolen on R&R in Sydney, Australia. Ted Lavender, who was scared, carried tranquilizers until he was shot in the head outside the village of Than Khe in mid-April.
In a writing class, you might learn about O’Brien’s use of repetition, about how he uses the list to reveal something about each man’s character. But I’ve been wondering lately, what do the things that we carry through life reveal about each of us?
My husband and I have too many possessions, this I know; more than we need or can even use. I am also aware that this is a developed-world, middle-to-upper-class problem, and that such complaints are at best insensitive and petty. This is not a war zone and our possessions are not strapped to our backs; instead these are the clothing and household items that pad our comfortable lives. Acknowledging these facts, I still believe that things deserve some examination.
There are the hand-painted margarita glasses that we purchased in Mexico and that have followed us, cloaked in too much bubble wrap, from apartment to apartment. Each time they settle onto a new shelf where they sit undisturbed until the next move. There are the clothes that get passed over each time we dress for work or a special occasion, but that remain in our closet because they might be perfect for an event that just hasn’t happened yet. There is the chair reminiscent of the one that sat in my parents’ vacation home when I was a child, the one that brings back memories of hours spent reading novel after novel. Except neither my husband nor I has sat in the current chair since at least two apartments ago. Instead it holds stacks of books, clothing, and anything else temporarily without a home or that we are too tired at the end of the day to put away.
Why do we keep all of these things? Is it emotional attachment, fear of loss, just plain inertia (of the staying-at-rest variety)? And how might our lives be affected if we were able to detach from our possessions, declutter, simplify?
I recently came across an article written by a woman who, along with her husband, had decided that it was time to do exactly that. They sold or donated many of their possessions, making it a point to buy only what they truly need and will use. In the process, they paid off a large chunk of debt, but the benefit that interested me most is somewhat surprising, something that I crave more than anything: “We're finding more time for the things we gave a lot of lip service to but didn't always make time for: health, fitness, reading and each other.”
Over time I’ve started to realize that, at least in my own life, carrying around a lot of physical stuff can feel just as burdensome as carrying a lot of emotional or psychological baggage. All of that stuff demands management – cleaning, storing, organizing, or at least sifting through as you search for something else – and thus time, energy, attention. If I had less stuff, if I limited my possessions to those that were really important to me, would I use them more? And would I discover more time to devote to the things that I really want to do in life?
It certainly seems possible. My husband and I have decided to give it a try. We are not emptying out our home by any means, but we are parting with a lot of the extras, the things that we had previously kept around on the basis of “what if” or “someday.” Already in our lives it feels a bit easier to move and to breathe.
Except there is one complication. A large part of the impetus for our decluttering is the fact that we are expecting our first baby in February and we desperately want to maximize the time that we are able to spend together as a family, as well as to grow even more fiscally responsible in order to provide for the baby’s future. But with a baby comes stuff. A lot of stuff. And how easily the line between the things we need and the things we need becomes blurred.
When we made the obligatory trip to Babies “R” Us to set up a registry, my husband paused before scanning our first item and warned, “Let’s just stick to the basics. Let’s not go overboard like we did for our wedding.” I paused and recalled the hours we had spent perusing china, crystal, and every isn’t-that-neat-looking kitchen gadget that caught our eye, ultimately adding several of each to our wish list. With this approach in mind, we braved the first overstuffed aisle.
This, I suppose, will be our first test. It is one thing to purge one’s home of a few belongings; it is another to retain the patience and thoughtfulness to avoid reflexively refilling it just because there is space available. And while we have no desire to raise a child or children with rooms overstuffed with rarely-used and under-appreciated toys, neither do we wish to impose on them a stringently spartan lifestyle. The answer for us, it seems, lies somewhere in the balance. And for the first time, we feel ready to set out in search of it.
Becky MacDonell-Yilmaz is a pediatrics resident at Brown University/Hasbro Children’s Hospital in Providence, RI. Her work has been published in the Annals of Internal Medicine, The Writer's Circle, and The New Physician. She blogs about her experiences in training at The Growth Curve: ruminations of a pediatrician in training.
Monday, December 2, 2013
Guest post: Fidelity
I achingly relate to other doctor mamas each time I read this blog. It is not an easy path that we have chosen. There are a myriad of challenges and rewards on this journey. Some challenges and rewards will be generally the same between us, such as becoming mothers, graduating medical school, and starting practice. Yet even those general similarities will be experienced differently by each mother, each doctor, each wife, each partner, each daughter, each sister, each aunt, and each of us women, under the many hats that we wear.
Lately there has been something on my mind. Not the usual things, like medicine and professional development and children's needs and schedules, though those are all still there. My career as a military physician has taken me away from home a lot this year. The time away from home has presented many challenges (which I would love to discuss with other military doctor mamas), but there was one that I did not anticipate: what do you do when you are attracted to someone else?
We have all had chemistry with someone as soon as we meet them. An instant attraction. Some people are just destined to get along. This chemistry might be with someone of the same or opposite sex, and is probably a prerequisite for those great friendships that sustain us all. I have many friends of both sexes with whom I enjoy a lovely chemistry. Have I found other men attractive since I got married? Of course I have. But I have always considered the question of fidelity (and consequently the topic of unfaithfulness), to be an issue of uncontained sexual desire, and therefore, not applicable to me, since I can "control" myself.
However, now, as a human being and wife and mother, I find myself struggling with thoughts and questions that never occurred to me before. My marriage is actually quite wonderful. I love my husband. Yet, we are separated by so much time and distance lately, that sometimes my life at home takes on that same wispy feel as a dream lost on waking. I miss it and I want it so badly, but it is frustratingly inaccessible. I'm certain that many women in medical training or practice can relate to this feeling. I remember longing for my husband and family even when I was home, because I felt like I was never there. However, I also have always felt that my connection to my home life is more real and tangible than any other connections I have.
Realistically, many of us in medicine will see our colleagues, on an hour-for-hour basis, more than our own families. We can and should expect to form strong bonds with those people at work whom we genuinely connect with. But what happens when one day, you find that the bond is something deeper and stronger than you anticipated – and you don't know what to do?
I know that I am committed to my marriage and I do not ever, ever want it to end. I know that I want to share my life with the wonderful man that I married. I do not foresee that changing. How then, can I struggle to realistically and honestly address the question of fidelity?
Given the sensitive nature of this topic, I hesitate to divulge too much, but I would like to explain this: the person I am attracted to is also married. He is not a patient. He is not in the military. He has a family. He loves his wife and kids. Our attraction is mutual. We genuinely like each other and respect each other, but we are not in love. We have discussed it. We have vowed to not "act" on it. It seems so simple on paper, but I never could have imagined how hard it would be. Even as a write and re-write this post in hopes of "getting it right," I see that nothing I write can convey the frustration, loneliness, doubt, guilt, and confusion that I feel.
I have no doubt that some people will judge me for confessing to these feelings. I recognize that this post might make some people uncomfortable. It makes me very uncomfortable. I write in order to open the door to genuine discussion on a very taboo and (I believe) common topic. I don't know if anyone will post on this other than in a safe, generic way, since many of you have an online presence which may preclude you from writing honestly as yourself. I understand that. I want to be anonymous, too. Yet my own sense of shame bothers me. What exactly do I have to be ashamed of?
I hope that some of you will reply. I sincerely want to ask – what do you do when you are attracted to someone else? How do you cope? Especially when you are away from your home and family? How do you answer those haunting questions that you never, ever thought would be in your head, such as: Is it wrong to be attracted to someone else? If so, why? Is it only wrong if you "act on it" by crossing some sort of physical or sexual line? If so, why? Is it therefore less wrong to "only" have an emotional connection with someone? Why?
Perhaps KC would be willing to post comments for those who are not comfortable doing so.
Lately there has been something on my mind. Not the usual things, like medicine and professional development and children's needs and schedules, though those are all still there. My career as a military physician has taken me away from home a lot this year. The time away from home has presented many challenges (which I would love to discuss with other military doctor mamas), but there was one that I did not anticipate: what do you do when you are attracted to someone else?
We have all had chemistry with someone as soon as we meet them. An instant attraction. Some people are just destined to get along. This chemistry might be with someone of the same or opposite sex, and is probably a prerequisite for those great friendships that sustain us all. I have many friends of both sexes with whom I enjoy a lovely chemistry. Have I found other men attractive since I got married? Of course I have. But I have always considered the question of fidelity (and consequently the topic of unfaithfulness), to be an issue of uncontained sexual desire, and therefore, not applicable to me, since I can "control" myself.
However, now, as a human being and wife and mother, I find myself struggling with thoughts and questions that never occurred to me before. My marriage is actually quite wonderful. I love my husband. Yet, we are separated by so much time and distance lately, that sometimes my life at home takes on that same wispy feel as a dream lost on waking. I miss it and I want it so badly, but it is frustratingly inaccessible. I'm certain that many women in medical training or practice can relate to this feeling. I remember longing for my husband and family even when I was home, because I felt like I was never there. However, I also have always felt that my connection to my home life is more real and tangible than any other connections I have.
Realistically, many of us in medicine will see our colleagues, on an hour-for-hour basis, more than our own families. We can and should expect to form strong bonds with those people at work whom we genuinely connect with. But what happens when one day, you find that the bond is something deeper and stronger than you anticipated – and you don't know what to do?
I know that I am committed to my marriage and I do not ever, ever want it to end. I know that I want to share my life with the wonderful man that I married. I do not foresee that changing. How then, can I struggle to realistically and honestly address the question of fidelity?
Given the sensitive nature of this topic, I hesitate to divulge too much, but I would like to explain this: the person I am attracted to is also married. He is not a patient. He is not in the military. He has a family. He loves his wife and kids. Our attraction is mutual. We genuinely like each other and respect each other, but we are not in love. We have discussed it. We have vowed to not "act" on it. It seems so simple on paper, but I never could have imagined how hard it would be. Even as a write and re-write this post in hopes of "getting it right," I see that nothing I write can convey the frustration, loneliness, doubt, guilt, and confusion that I feel.
I have no doubt that some people will judge me for confessing to these feelings. I recognize that this post might make some people uncomfortable. It makes me very uncomfortable. I write in order to open the door to genuine discussion on a very taboo and (I believe) common topic. I don't know if anyone will post on this other than in a safe, generic way, since many of you have an online presence which may preclude you from writing honestly as yourself. I understand that. I want to be anonymous, too. Yet my own sense of shame bothers me. What exactly do I have to be ashamed of?
I hope that some of you will reply. I sincerely want to ask – what do you do when you are attracted to someone else? How do you cope? Especially when you are away from your home and family? How do you answer those haunting questions that you never, ever thought would be in your head, such as: Is it wrong to be attracted to someone else? If so, why? Is it only wrong if you "act on it" by crossing some sort of physical or sexual line? If so, why? Is it therefore less wrong to "only" have an emotional connection with someone? Why?
Perhaps KC would be willing to post comments for those who are not comfortable doing so.
Monday, November 25, 2013
Guest post: An unconventional couple's match
Match Day 2012 was supposed to be the best day of our lives. Or one of them, at least. But it was so, so not. Monday morning my husband and I left our respective rotations around 11:45am and hopped into our SUV in the hospital parking lot in anticipation of the noon email saying we had matched. We wanted to celebrate that together. My email came: "Congratulations! You have matched to a one year preliminary position." I was devastated. But it got worse. My husband's email came: "We're sorry, you have not matched to any positions."
Can that happen? Did that just happen? I didn't think that was possible. Our numbers were right. We had plenty of interviews. We were matching Emergency Medicine (him) and Surgery (me). A difficult match, but not an impossible one. Right?
He was the better candidate, but we thought Surgery was the harder match. So at match choice #18, after all of our same city match choices, we listed a match-no match option. The thought was that in this certain city we chose, surely he could find something to do for a year. A big city, close to my family, lots of options. We assumed he would at the very least be able to find a preliminary surgery spot at one of the four hospitals in the area. Prelim surgery spots aren't hard to find, right?
We drove straight from the hospital parking lot to a McDonalds and hooked up the laptop and filled out his SOAP application. He applied to all the Surgery Prelim spots in my city (the NRMP will tell a couple, in a match-no match situation, the city of your match). Tuesday, Wednesday, and Thursday came; no interviews, no offers. Match Day came and went, we "celebrated" at home with our baby boy and my parents, and occasional tears.
Then we looked for research positions for the year for him. And... Nothing. We tried, we weren't even picky. But he was over or under qualified for anything we found.
Then one day, out of the blue, he got an email inviting him to interview across the country for a position in Emergency Medicine. He got the position. And yet we struggled with it. Was this a temptation that he should pass on? Was this a blessing? Was it great for his career at the expense of our family? Would we be able to survive without each other? Could I be a surgery intern, with our BABY, without him?
Ultimately, he took the position. We're tough. Yes, he and I are tough. But what I also mean is that we women physicians are tough. We're a different breed, I think. No one can tell us no. No one can put anything in our path too great to achieve our goals. No one can tell us we can't love our job and love our child. No one can tell us we can't do it without certain features of our home life lined up. We can do it.
It's hard every day. That I won't deny. It's hard being away from my best friend and confidante; the person I want to vent to and hug and go on dates with and share in our son's new milestones and that he finally says "Mama." It's hard being a "single" parent. It's hard knowing my son is not with his mom or his dad 24-7. It's hard when your child reaches for their grandmother for comfort when they fall and you are both standing there. And oh yeah- it's hard being a surgical intern, period.
But I'm blessed. We're blessed. Training looks different for everyone (we went to a school where our basic sciences were in the Caribbean; more on that another day). Life looks different for everyone. Just because it's different doesn't make it wrong or weird or not doable. We've learned a lot along the way, and talk about it a lot (when our shifts don't overlap, that is). I'll sum it up for you, in case it would help anyone else along the way . . .
1. Don't be too proud to apply to different locations if you're couple's matching. You'd rather be a doctor in a different geographical location than not-a-doctor in the same location.
2. Surgical preliminary spots aren't as easy to get into as you might think. I think that's the going rate for almost any residency these days.
3. There's lots of spots outside the match that you don't hear about unless you look for them in the right places. Look on your specialty's program director website (a good place to start) to see if there are open positions outside the match.
4. Don't panic if things don't go how you saw them. Where there's a will, there's a way. Don't let anyone tell you something isn't possible.
5. Family comes first, but deciding to be apart doesn't mean they don't still come first. Don't feel bad for choosing it. It doesn't mean you ranked them of less importance. It just means your story looks different.
6. Speaking of stories: Life looks different for everyone. You can use yucky situations for learning and growing, or for being miserable. It's a choice.
7. When you rank programs, go where you love. The rest will fall into place.
Of note- at the time of publication of this blog, my husband has an interview for an open PGY1 EM position that came available in late July right down the street at a phenomenal academic center.
Either way, we know what we've learned through all this.
Either way, we're good.
I am a PGY1 general surgery resident with a husband who is a PGY1 emergency medicine resident and a 2 year old son. I live in the South (Texas). I wrote this originally here.
Can that happen? Did that just happen? I didn't think that was possible. Our numbers were right. We had plenty of interviews. We were matching Emergency Medicine (him) and Surgery (me). A difficult match, but not an impossible one. Right?
He was the better candidate, but we thought Surgery was the harder match. So at match choice #18, after all of our same city match choices, we listed a match-no match option. The thought was that in this certain city we chose, surely he could find something to do for a year. A big city, close to my family, lots of options. We assumed he would at the very least be able to find a preliminary surgery spot at one of the four hospitals in the area. Prelim surgery spots aren't hard to find, right?
We drove straight from the hospital parking lot to a McDonalds and hooked up the laptop and filled out his SOAP application. He applied to all the Surgery Prelim spots in my city (the NRMP will tell a couple, in a match-no match situation, the city of your match). Tuesday, Wednesday, and Thursday came; no interviews, no offers. Match Day came and went, we "celebrated" at home with our baby boy and my parents, and occasional tears.
Then we looked for research positions for the year for him. And... Nothing. We tried, we weren't even picky. But he was over or under qualified for anything we found.
Then one day, out of the blue, he got an email inviting him to interview across the country for a position in Emergency Medicine. He got the position. And yet we struggled with it. Was this a temptation that he should pass on? Was this a blessing? Was it great for his career at the expense of our family? Would we be able to survive without each other? Could I be a surgery intern, with our BABY, without him?
Ultimately, he took the position. We're tough. Yes, he and I are tough. But what I also mean is that we women physicians are tough. We're a different breed, I think. No one can tell us no. No one can put anything in our path too great to achieve our goals. No one can tell us we can't love our job and love our child. No one can tell us we can't do it without certain features of our home life lined up. We can do it.
It's hard every day. That I won't deny. It's hard being away from my best friend and confidante; the person I want to vent to and hug and go on dates with and share in our son's new milestones and that he finally says "Mama." It's hard being a "single" parent. It's hard knowing my son is not with his mom or his dad 24-7. It's hard when your child reaches for their grandmother for comfort when they fall and you are both standing there. And oh yeah- it's hard being a surgical intern, period.
But I'm blessed. We're blessed. Training looks different for everyone (we went to a school where our basic sciences were in the Caribbean; more on that another day). Life looks different for everyone. Just because it's different doesn't make it wrong or weird or not doable. We've learned a lot along the way, and talk about it a lot (when our shifts don't overlap, that is). I'll sum it up for you, in case it would help anyone else along the way . . .
1. Don't be too proud to apply to different locations if you're couple's matching. You'd rather be a doctor in a different geographical location than not-a-doctor in the same location.
2. Surgical preliminary spots aren't as easy to get into as you might think. I think that's the going rate for almost any residency these days.
3. There's lots of spots outside the match that you don't hear about unless you look for them in the right places. Look on your specialty's program director website (a good place to start) to see if there are open positions outside the match.
4. Don't panic if things don't go how you saw them. Where there's a will, there's a way. Don't let anyone tell you something isn't possible.
5. Family comes first, but deciding to be apart doesn't mean they don't still come first. Don't feel bad for choosing it. It doesn't mean you ranked them of less importance. It just means your story looks different.
6. Speaking of stories: Life looks different for everyone. You can use yucky situations for learning and growing, or for being miserable. It's a choice.
7. When you rank programs, go where you love. The rest will fall into place.
Of note- at the time of publication of this blog, my husband has an interview for an open PGY1 EM position that came available in late July right down the street at a phenomenal academic center.
Either way, we know what we've learned through all this.
Either way, we're good.
I am a PGY1 general surgery resident with a husband who is a PGY1 emergency medicine resident and a 2 year old son. I live in the South (Texas). I wrote this originally here.
Friday, November 22, 2013
Next MiM topic week: How has medicine changed you?
Our next MiM topic week will take place the week of December 9. The topic: How has medicine changed you? Not medicine as in drugs, but medicine as in Our Chosen Profession. During the week, we'll feature posts written by our writers and hopefully you, on the process of becoming a doctor and how we feel that has changed us (if at all). We're excited about this one and hope you'll join in on the fun and reflection by submitting a guest post. If you'd like your piece to be included, please send it as a Word document to mothersinmedicine(at)gmail.com by Sunday, December 8.
As always, thank you for reading and for being part of this community.
As always, thank you for reading and for being part of this community.
Tuesday, November 19, 2013
Are We Allowed a Break?
It's genuinely not my intention to call anyone out or shame them, but the truth is, there was a comment on my last post that I can't stop thinking about:
"I'm reminded somehow of a lady I knew that took vacation from work but continued to drop her child off at daycare at the usual time every morning the entire week. He knew she was on vacation - he was only a toddler but he knew his mother was going to be hanging out without him. I think the attitude or message probably made him feel less valued and I have wondered how that turned out."
My thoughts are:
1) That is one smart toddler if he really understood that.
2) Are we really not allowed to take a week off all to ourselves once we have kids?
3) Is taking short periods of time to ourselves something we should worry will scar our kids for life?
4) If we do take that week to ourselves, should we expect that all other mothers are judging us for it?
Food for thought.
"I'm reminded somehow of a lady I knew that took vacation from work but continued to drop her child off at daycare at the usual time every morning the entire week. He knew she was on vacation - he was only a toddler but he knew his mother was going to be hanging out without him. I think the attitude or message probably made him feel less valued and I have wondered how that turned out."
My thoughts are:
1) That is one smart toddler if he really understood that.
2) Are we really not allowed to take a week off all to ourselves once we have kids?
3) Is taking short periods of time to ourselves something we should worry will scar our kids for life?
4) If we do take that week to ourselves, should we expect that all other mothers are judging us for it?
Food for thought.
Saturday, November 16, 2013
Do you have 5 year plan?
When asked this recently, I fumbled. Actually, I tossed back the answer, asking
the asker to mentor me through getting such a plan. It wasn’t even someone who knew me well and it had
been asked in a fairly casual way. Regardless,
I was not able to answer the question. But
if I were to answer it, the answer would be, “No I do not.”
I feel like my personal
plan is on track, I have some goals which essentially these include some family
fun and fitness. But in the professional
arena, I don’t have a 5 year plan like others do. Do
others have a 5 year plan?
I have quite an accurate 5 day plan. My calendar is reasonably organized. I'm a list writer, whether on paper or on a
smartphone (actually, both) and an avid list crosser-offer. Sometimes
I'm tempted to add things just so I can cross them off again once
completed.
Flash back 5 years ago, I don’t think I actually had a career plan
to get to where I am now, though I am where I want to be. I was "finished" with the relatively more well-defined years of college, med school, residency, public health school, educator-leadership program, (can you say "perpetual trainee" or more generously "life long learner"?). Career-wise, I think that
mostly things have come to me through plenty of hard work, but admittedly with some
luck, good timing, and strong collaborations.
Now I’m trying to think about what will come next. Not that I’m at a mid-life crisis per se, but
just that if I try to map out what’s coming up, what should happen, what I’d
like to do or explore professionally, I’m just not sure. I feel like I can (and do) help others along with theirs, but not sure of my own at this point. In academia there are peaks, valleys,
plateaus and mountains to climb. I am
hoping I can find the right trail. The
journey is still interesting, made more interesting by taking part in mentoring
others, even as I continue to pave my own way.
I have a vision of what I might want to do but I'm not sure how to get there or if it's feasible. I continue trekking onward.
Do you tend to let things happen and see what unfolds along the way, or
do you have a plan?
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