The Day I was Nearly Arrested on Assault Charges {subtitle: How I'm Finding Time to Train for a Marathon}

Earlier this week I found myself stuck at a “doctor-y” event. As I made small talk with a colleague, I mentioned that I was training for a marathon. Despite that fact that I am currently blogging about running and training consumes most of my thoughts, I promise I don’t talk about it incessantly to random people, but in this instance it did come up in conversation.

After I mentioned my training, her face contorted into what can only be described as a scoff. She then replied, quite condescendingly, “Must be nice to have THAT kind of time.”

My face turned beet red and my blood began to boil. Then without thinking I pulled my hand back and smacked her right across the face, leaving a bright red hand print on her left cheek. She was was stunned at first, but then her instincts took over and she kneed me in the gut. Before I knew it, we were in an all out fist fight in the middle of a cocktail party. My husband broke up the fight, but not before someone called the cops. I am currently writing this from jail. 

Ok. So, nothing in italics ACTUALLY happened (except in mind. repeatedly. for about a week). In reality I smiled and walk away, like a good girl, who didn’t want to have to explain a criminal record.

Obviously in a state of pure boredom, I decided since there was nothing else going on in my life, I would run a marathon. I’m busy and so are my running mates. The expenditure of my time is not something  I take lightly. We all have a lot on our plates, but like all things that are important to us, we are finding the time for this marathon.

How do I find the time for this?

5. Follow a Plan

We are following Hal Hidgon’s Novice 2 training program. The best way to avoid injury and reach my goal is to stick to the plan as close as possible. Each week I check off my boxes as I pound out each mile.

4. Run When I Can

The only time that works for me is mornings. Some mornings have been painfully early and cold, but nevertheless I’m out there. 

3. Accountability

When my alarm goes off at 5:30 and I check the temperature and it’s 13 degrees, knowing that my friends are out in the Arctic air waiting for me is what gets me out of my cozy bed. There are 6 of us training in my neighborhood. Though we can’t do every run together, we are each other’s cheerleaders.

2. Giving Myself some Grace

I have missed a few workouts. If I’ve been at the hospital all night delivering babies and I have to choose between running and sleep, then I choose sleep. I don’t make up my runs in the evening, because that’s my family time. Yes, my Type A personality would like to follow the plan to perfectly, but life happens and that’s OK.

1. Have an Awesome Husband

Obviously, somebody has to get the kiddos ready in the morning while I’m out torturing myself, and that somebody is my super husband. You need your spouse to be supportive (or a least tolerant) of your crazy hobby when you start logging this many hours.

Despite being a runner for the last 17 years, I have never ran a full marathon. In my early 20′s, I did races all the time, but never more than a 15 K (The Tulsa Run, which is still my favorite race). Over the years the responsibilities of life kept my running to 3-4 miles a couple of times a week, barely enough to stay fit. 

As my kids have gotten older, life has gotten a little smoother. I've decided this is my year to check "26.2" of my bucket list. Wish me luck, I'm a month away from my goal and I can't wait to cross that finish line. 

Haters gonna hate. But I'm gonna run.

originally posted at drheatherrupe.com

Jack Of All Trades, Master Of None

(Patient accounts have been altered so as to protect their privacy and identity)

When I walked into my internal medicine practice office yesterday morning at 6:30 a.m., I was surprised to see only three patients on my schedule. Then I remembered there was a major winter storm forecast, and no one was sure how bad we were going to get hit. By the time the early administrative staff was arriving at 7:30 a.m., patients had realized the storm was basically just alot of wind, and they started calling. And booking. The 8 a.m. slot filled, then the 8:20, soon all the rest... I had an almost-full schedule in no time. And it was almost all "urgent care".

I love urgent care. It's so nice to take a break from the "comprehensive annual exam". Or at least, the way I approach those... I tend to obsess over missing something, and so I take the annual exam as an opportunity to comb through the patient's chart, and attempt to make appropriate note of every past, present, and possible future health issue. Plus, this is my big chance to catch up with folks on their Real Lives. So, What do you do when you're not sitting on my exam table in a johnny? Of course, folks come in with their own agendas, the lists of questions jotted down on the backs of envelopes or in the iPhone. Some docs shut all that down, citing "This is your preventive health time only!" which is ridiculous. So, the issues are addressed. Then there's the vaccines review, and lab ordering... These may or may not be straightforward, and more often than not involve additional discussion. My physical exams always run overtime.

So, a day of mostly urgent visits, those single-issue problem visits that can be serious, but at least, straightforward, are a welcome change.

On the other hand, these days highlight what is beautiful, difficult, and terrifying about primary care specialties like internal medicine:

1. You're supposed to know everything about everything.

2. Because we're trained to be always thinking about the Whole Patient- Nothing is ever straightforward.

First patient. The check in sheet states "Cough". Ha, easy. Well, not so much. The cough was undertreated asthma in the setting of a mild cold. But his blood pressure was very elevated. And a quick perusal of the chart showed, this was someone who hadn't been in for a couple of years. Turns out this was someone who had extreme doctor anxiety and alot of issues that needed more fine-tuning. So the visit turned into counseling and negotiations. I set up a followup appointment with the actual primary care and sent my note... Hoping the guy comes back.

Now, running fifteen minutes behind, next patient. "Rash". This is only easy if it's Shingles... and it was. But, the patient is a healthcare provider. And they wanted to know- needed to know- know all the occupational health issues around Shingles. Did they need to notify all the patients they had seen in the past day? How long did they need to be out of work? Did my recommendation around that differ from our hospital's occupational health policy? I wanted to be able to provide a modicum of accurate counseling in all of these areas. I spent some time with her researching the guidelines and then asked her to contact both her supervisor and occupational health for the rest. Then she needed a note. We wrestled over how to phrase it. I hit "print". The printer wouldn't print. Had to run to another computer. Time ticking away.

Then done with that, I had to check my clinical messages (our in-office messaging, where the secretaries and nurses send me anything from patient phone or email queries, VNA concerns, controlled substance medication requests, or abnormal lab or radiology results). I need to quickly scan the list and make sure there is nothing requiring urgent attention. Then deal with those. Someone emailed about their ankle sprain. Nurse: They just want X-rays ordered. Can we do that? Me: Not really, please have them make an appointment. Et cetera.

Then, my email. There's several more emails for me in a now-massive email chain regarding one patient of mine. She has a large team of specialists; her case is complicated; she may need to be admitted, and I would need to arrange that. I read quickly and make sure no one has asked me to do anything yet. I know the specialists probably roll their eyes at my questions. I haven't treated many cases of what she has. I have to read up every time she has labs. But she comes to me, and I'm doing the best I can.

Now hopelessly behind. Next patient: STD screening. Ha, easy! Not. Upon questioning, she tells me one of her partners is a recovering IV drug user. I deliver alot of counseling around this, do a pelvic exam with cultures, send for bloodwork and arrange more followup with bloodwork in two months.

Next: Elderly patient with shortness of breath. She was pretty sick. She told me she had almost passed out in the waiting room. Long and short of it, this person was too sick for my office. But, she resisted my emergency room suggestion. We went into negotiations. I called the emergency room to expedite. We waited for a wheelchair. I typed up my assessment and impression so the emergency docs would have it. Why take the time to chart, when the next patient is waiting? I felt like I needed to present at least a reasonable hypothesis for her condition, as well as defend my decision to send her to the emergency room. I delved more into her chart. Why do her lungs sound like a freight train screeching to a halt? Asthma in someone who's never had asthma? COPD is someone who's never smoked? Pneumonia more likely. Pulmonary edema, maybe.... Type it up. Hit "finalize."

Next: Wrist pain in a guy who does martial arts. I had to do a quick review of the possibilities. Refresh myself on the exam findings in occult scaphoid fracture. Then look up what type of immobilizing brace to prescribe while that is being ruled out. Then the printer didn't work again.

Next: Lovely lady with- finally! A very straightforward issue. Simple. I took care of it and was ready to wrap it up, when, she wanted my opinion on the new blood thinners. She's on Coumadin for atrial fibrillation, for stroke prevention. These new blood thinners are advertised on T.V. The cardiologists are prescribing them right and left. I have never prescribed these. I look it up, with her right there, and review some of the major pros and cons. There's no testing to see if someone is on too low or too high of a dose. That's nice. But, they aren't as readily reversible, so if someone has a car accident or a bleeding ulcer, they may bleed to death more easily than otherwise. Basically, that's what I told her, adding that we can also ask her cardiologist about it. No, she said, I like to know my numbers.

Next, next and next. There was a physical exam in there, and a few more not-so-straightforward urgent care visits. That was it. Nine Patients, and a barrage of clinical messages and emails. I was starving, and I had to pee. I peed, ate something at my desk, and delved into charting, billing, and all the messages/ emails, as well as the arrangements to be made for that very sick patient. I checked in with the emergency room on the lady I had sent in- she was to be admitted. Ha. I knew she was sick.

Mixed in there, I check in with home. I'm thinking about my kids. On my personal email, there are messages back and forth about our autistic son who's had some issues at his special education preschool. School aversion, we don't know why. It's getting better, with a good and patient teacher. But, I worry I'm not doing enough reading and research on autism, that we're not doing enough behavioral work at home. So I got on Amazon and researched, ordered some books.

At the end of the day, I wonder why I'm so fried.

Is it a good, or a bad thing, to be in a job where your mind has to hop, skip and jump and WORK from case to case and even within a case? We see everything and anything, and we're expected to counsel on even more. That, plus the balance with home life, taking care of a family...

Is it a good thing to be a Jack of all trades, Master of none?

-posted by Genmedmom (generallymedicine.com)

Guest post: Tales of a hybrid doctor/stay at home Mum-- Part I

11pm, January, 2009.

I stare at my face in the bathroom mirror with the magical belief that the reflected version of myself might, if I stare at it long enough, offer my real self an answer to the predicament I find myself in.  My bare feet are rooted to the frigid laminate tile, obstinately clinging to that spot and holding my reflective self hostage until she offers up some guidance.

This tumultuous day had started at 2.00 am, that morning, when my 18 month old daughter sat up and, with eyes still heavy in deep sleep, started vomiting. I rushed to her side, watching in dismay as projectile puke, mixed with bits of basil green pesto pasta, erupted all over her bedding and nightclothes, seeping through to her skin and trickling up to matt her brown curls. When her vomiting subsided, I cleaned her up, changed her sheets, took her temperature and gave her the once over: any skin rash? Is she limp or listless? Does she have tummy tenderness or diarrhea? Having ruled out the presence of a more sinister cause for this jarring episode of vomiting the nocturnal drama appeared to be over.  I settled her down back to sleep and then lay down myself and was asleep all of 15 minutes when the puking started all over again. It was a long night filled with five cycles of vomit, clean up, sleep; vomit, clean up, sleep…

At 7am I had forced myself awake and got my son ready for school. I layered him up with sweater, ski jacket, snow pants, scarf and gloves: a mandatory ritual to protect him against the harsh winter morning. I reached for my own coat but was stopped, in my tracks, by the look on his face. He was standing, rooted to the spot, shoulders hunched over when his face became suddenly pale. In a second, undigested milk and cheerios, splayed onto the wooden floor of our hallway and so began another cycle: puke, clean up, wait; puke, clean up and wait…that consumed the whole of the morning.

I had hoped to spend today having quality time with my children, catching up on errands having coffee with my neighbor and, if time permitted, even putting finishing touches on a research paper.  But the day had taken an unscheduled turn and the situation demanded that I submit to the more unpredictable task of caring for my sick children. Patiently, I nursed them and offered them comfort alongside hydrating fluids.  I gave permission for Barney and Blues Clues marathons to take pace whilst I did pile after pile of laundry. As my children sat, huddled together under a blanket, their glassy tired eyes transfixed to the screen projecting their colorful screen heroes, I scrutinized them for signs of more serious illness.  I watched and waited, waited and watched quelling bolts of maternal anxiety with reassurances by the, more objective, physician in me.

Now, in the still of the night, they are both asleep. Our house has been vomit free for the last eight hours and the situation appears to be under control.  Yet, as I stare at my face in the bathroom mirror, I feel surges of anger gathering up from within me. My children being sick had demanded that I be home with them all day, a duty that I fully accepted and was also loathed to delegate to anyone else. Still, hour after hour of not being able to eat, pee, or shower without being interrupted by a child’s need or demand combined with the lack of sleep and extra chores, generated by the sudden vomiting attacks, has all taken its toll.

Most of all, I resent my husband’s absence from today’s circus. Why was he not here to clean up at least one of the 10 vomits?  To comfort our children when my patience was wearing thin? To watch them so I could eat one of the day’s meals seated? Like so many of the husbands that lived on our manicured suburban street, travel had become an integral part of a work life that took place in a global village where competition was omnipresent. One week New York, next week London, a month later a 3 day meet in San Francisco. I had come to dread this time of year for, along with the short days, bare trees and snow storms, his travel schedule became intense and filled with a cycle of conferences, sales meets, deals to close and budgets to spend. Business at the speed of thought, frenetically taking place in four different time zones all whilst he chalked up thousands and thousands of air miles and airline loyalty points.

Years before, shortly after our son’s birth, I had taken on a hybrid identity as both a doctor and a stay at home Mum.  I had returned to work within weeks after birthing both my children, but never to a full schedule. Our profession demanded a doctor be available and on call at all times, so I eagerly offered my services to cover evening, weekend and holiday duties as these were times when my (mostly) male counterparts, who had already put in a long work week, preferred to be home with their families. During the week, my days were filled with diaper changes, making baby food, cooking meals, school drop off and pickups, baking batches of homemade biscotti for the PTA fundraisers and staying on top of the pediatrician appointments, homework, play date and activities schedules. On the days and evenings that I worked my husband took over the child rearing and I headed to the hospital to give expression to that other part of my core identity, that of being a physician.  For the most part, our childcare arrangement worked well and I not only felt centered as I juggled these two joys in my life but had come to feel both these identities, being a mother and physician, were actually complimentary: that becoming a mother had made me a better physician and remaining a practicing physician had made me a better mother.

I did not know many women who had opted for this model of parenting. My friends either stayed home full time and planned to take a long hiatus from their professional careers or, on the other extreme, worked fulltime and had employed a nanny or involved another family member to be the primary caregiver for their children. For the most part I felt I had the best of both worlds but today, amidst the fatigue, anger and the stench of vomit that still lingered in my nostrils, I felt trapped.  My own Mum had never had a professional career and Dad had always begun and ended his day at home. On days like this, our hybrid parenting model along with having a travelling spouse seemed unnatural to me and it made me doubt our parenting plan. I wondered if we were tempting fate by taking on a lifestyle we were not primed to pull off.

In the bathroom mirror, my reflection reminds my dejected self that I have plenty of resources: an education; every possible modern convenience; domestic help; kind neighbors; a tight knit circle of friends and a pediatrician who is only a phone call away.  All of these facts were supposed to ease the anxiety and physical burden inherent to child rearing and I knew, all too well, that such resources were denied to many.  Still, on this particular night, none of this “pull yourself together talk” could keep me from an overwhelming urge to sulk and stew.

My stewing is interrupted by my vibrating cell phone, twirling on the marble countertop, as it heralds my husband’s return.

Landed. Home by midnight. Caught a stomach bug :(  Need TLC.

     ***

Dr. S is a married physician and mother of two.

Guest post: Making a career shift to leadership

A few months ago, when I was contemplating a shift in direction in my career, I happened to google 'women leaders in medicine'. Among the websites and blogs that google search generated was 'womenmdresources', and through that, the 'mothersinmedicine' website. Reading through current and old posts was like finding a community of friends I had not known existed. In fact, one of the first blogs I read was from 'anesthesioboist' and the post was about her experience with her child having surgery at Boston children's where she had been a resident. I found myself smiling as I recalled a very similar experience at the very same hospital some years ago with my son needing surgery for a fracture while I was a resident there! It made me feel connected to this entire community out there of women in medicine, especially the unique community of mothers in medicine.

Fast forward a few months, I have made the career shift, which involved going from being a staff anesthesiologist at a small community hospital to being the chief of my department at another small community hospital. It required a lot of thought on my part and discussions with my husband to go after this opportunity especially with one child being almost ready to go off to college in another year and another entering the tween diva stage. Did I want to take on this challenge at this juncture of my career (and challenge I knew it would be) especially with my husband's job needing him to be traveling for most part of the week? It would have been so much easier to stay where I was and go to work and come back home and not have to deal with all the issues involved with taking over the running of a department.

10 years ago, when I was finishing my residency with 2 young kids, if I had had a crystal ball, I would never have seen myself in a leadership position down the road. I thought I would be content with a staff position in a small department, enjoying my work, but leaving it at the hospital when I left in the evening and focusing on my kids and family. And that's what I did. However, few twists and turns in the last few years changed my direction and I feel now, for the better.

I had had some experience with the running of a group without the title of chief in a previous job so I knew the trials and tribulations it would involve.

Ultimately, we decided I could not pass up on this opportunity. That previous experience had whetted my appetite to be in a position to be able to make some changes, to problem solve. I had found it very satisfying when I was able to make some changes to make processes run smoother than they had.

And so here I am, 2 weeks into this new role. It has been a challenging couple of weeks. And I find myself looking forward to more.

-Anesthesia Mom

Guest post: Doubt

Wednesday, March 5, 2014
Queen Elizabeth Theatre

Every seat is taken. The theatre's lights are dimmed over a throng of excited Vancouverites, most dressed in black, some in pearls. After interminable introductions, Hillary Rodham Clinton strides in from stage right, in a navy pantsuit, stilettos and large glasses. She takes the podium and begins her speech on women's issues. She's funny, smart, engaging.

I'm here for the curiosity, not the politics. I was offered a ticket that morning; I didn't even know she was in town. She doesn't disappoint. Her presentation is riveting.

"One of the greatest blocks to the advancement of working women is their own self-doubt and perfectionism," she says.

Yes. That resonates.

She continues, "I've worked with many young people over the years, and almost invariably, when I offer more responsibility to a woman, the response is, 'Let me think about,' or 'Do you really think I could do it?' I have never once offered a promotion to a young man who did not feel more than entitled to it."

I post that to Twitter.

*        *        *        *        *       *       *
Friday, March 7, 2014
Residence, Deep Cove

I'm going through pictures of my brother's wedding from the week before when I come across this:


Whoa. How'd that happen? I've got a girl who babysits, attends youth group and just submitted her course selection for high school. If she goes to McGill for university as she intends, I have just over five more years of seeing this face at the breakfast table every morning.

Her childhood has always stretched ahead of me as far as I could see. The chances to do things with her, to become the mother I want to be - I live as if they will continue indefinitely. So how can it be that I can count on one hand the summer vacations remaining until she graduates high school?

Wait! I think, and I suddenly feel scared, sad. I was going to read all of the childhood classics alongside her - A. A. Milne, Roald Dahl, L. M. Montgomery. I collected them from used bookstores, and she's read them, but I never got around to it. I still haven't made her bedroom an idyllic nest; the board is on PInterest but the brown carpet lives on. The plan at the back of my mind was to raise her somewhere with goats and an orchard; we live on a rocky cliff side without even a gerbil.

I was going to become an excellent mom, or even just a really good one, the one she deserves. I could always see just how I'd be one day when I'd conquered all my personal faults. Calm and patient, attentive and selfless. I was going to start going along on field trips and watching her floor hockey tournaments. We would have long conversations lying on her bed in the evenings. I was not going to take her for granted, ever.

I look at the face in the picture above, sweet and spotted, pretty and confident. A flight of conflicting responses pass through me. Pride, panic, affection, sorrow. What to do?

Do I say with satisfaction - Look at that. She knows she is loved, and knows how to love. She's an excellent student, a kind friend. Tucked into the past twelve years are moments I didn't, couldn't have planned. Dissecting a cow heart for her class, sharing anecdotes about her baby sister, playing Clue after dinner for nights on end. I'm irritable and impatient, yes, but I've always been up for adventure. I devote a large part of myself to patients, and she sees the joy that good work can bring.

Or do I say, Hold up a minute! There's still time. Not a lot, and I'm going to have to be very deliberate about this, but there's still time. There are changes to be made, to home and work and heart, and we're turning this ship around, starting tomorrow.

*        *        *        *        *       *       *

Saturday night, March 8, 2014
Residence, Deep Cove

"Are you the father you wanted to be?" I ask Pete. I bring these things up in bed, lights out.

"I've never thought about it," he says. I can't believe it. But I do, deeply envious.

"Scale of 1 to 10."

"Ummm. Seven." No trace of guilt or sorrow.

I can't help myself. "Seven's kind of low. Don't you feel bad about that?"

"When you imagine being a parent, you have no idea what it involves. Once you're doing it and you find out what it's really like, you cut yourself some slack. Lots and lots of slack."



-- cross posted to www.freshmd.com --

Sick Day

The other night, my daughter Cecelia woke me up at 1 a.m.  The day after her 11th birthday. "I'm sick."

She took me into her bathroom. It looked like an emesis crime scene.  Buckets of puke on the toilet lid, leaking into every crook and cranny, spilling over onto the tile. Spattered walls, spattered glass shower barrier. Spots on the ceiling. I wondered briefly if I could leave it for my house cleaner the next day, and laughed at myself.  After settling her into my bed with water and Pepto pills, which she soon tossed elegantly this time into my toilet, I rolled up my sleeves and cleaned. An hour and two paper towel rolls and a carton of bleach wipes later, it was passable.

The next morning I asked her, "Have you ever heard the phrase 'Tossing your cookies?'"

"No Mom, But I can guess what it means."

She had quite a fill on her birthday - cookie cake at lunch and Baskin Robbins Grasshopper Pie after dinner. It had only a vague resemblance of its original splendor as I was mopping it up, pinching my nose against the odor.

I have been reading Generally Medicine's sad and sorry posts about sick children, congratulating myself about my children's overall good health. I must have jinxed myself. Jack threw up all last weekend. He is being treated for Strep, and has just regained his appetite after two weeks.

The upside - Cecelia came to work with me today. Luckily I found a comfy couch for her to rest on day one after the emesis escapade; my parents were in town and willing to help. I did not have the heart to send her to school when my mom went out of town today - she was puke and fever free but still nauseated and only up to clear liquids. So she came to work with me - an embarrassing first. It was a blast.

Luckily I had made it through the busy post-all-nighter (not a fun college one!) day one - overly busy with a lunch presentation to an audience of around 100. I was uncertain if the queasiness in my own stomach before the meeting was butterflies or bug onset. Butterflies, thank goodness, in retrospect.

This day was slower work-wise.  Not easy, but doable. I did not have a toddler, I had an 11 year old, ultimately savvy with her ipad - busily reading and making silent videos with props in my office while I read slides and made diagnoses. I spaced morning and afternoon visits to the gift shop (she had bday money to spend) around needles in radiology and the ED. We had a long blissful lunch. "Mom, I'm so excited to go to the place you eat work at lunch. I've heard you talking about it for years but have never been." Ugh, really? Am I that far removed? Her eating a turkey sandwich, me munching on a salad - both of us talking about the Divergent premiere I am taking her to next weekend. I'm reading the book so I can help her and her friend get dressed up for it. I wondered tonight what I'm going to wear - I'm that excited.

As I was releasing cases and she was packing up her pillows and gift shop loot she started to do this thing she does when fun things are ending. I used to get really frustrated about it. She focuses on the one negative thing in a day of overwhelming fun and positive. She was trying to leave me a secret fun note under my microscope and was getting angry and upset that I saw. I told her that I worry about leaving my microscope light on and obsessively check it as I'm heading out the door - it would not spoil the surprise because I had no idea what the note said. Last weekend my boyfriend and I took her and two friends to the Lego movie and shopping and she kvetched endlessly over not getting to spend enough time in the mattress store because they spent too much time in the shoe store. I think I'm finally getting it. It's just sadness at ending. It's better to empathize than get angry.

I'm going to miss the hell out of her at work tomorrow - I think she's well enough to return to school. I can't wait to see what that note says. And I am kind of looking forward to more sick days with both her and Jack, now that they are old enough that they don't need my constant attention.

Happy 11th birthday and recovery, sweet and wonderful Cecelia.

MiM Mail: Navigating oral boards (and not going insane)

I am a 31 year old Ob/Gyn in the North East and have two small children, ages 1 and 3, as well as a wonderful husband. I am one and a half years out from residency, am becoming a partner in a small private practice, and am preparing for my oral boards. I have a 90 lb labradoodle that eats all my socks and throws them up in the middle of the night in the corner of my room. I have loans, bills, chores, family responsibility, and the list goes on and on. Basically, I could lose it at any given moment.

Typically I am very relaxed about life. I am calm under pressure and actually enjoy that adrenaline rush during an emergency.  I have rushed a mother to c-section in minutes without breaking a sweat and then came home to quickly throw together a home cooked meal.  All while dealing with my three year old in his second time out and holding the 1 year old who just won't let me put her down.   I honestly felt like I could handle just about anything...Until now.  Preparing my case list for the oral boards has been nothing short of miserable.  After a few days of chest pain and frequent trips to the bathroom from anxiety, I am writing this to ask for help.

I am hopeful I can find a few others out there like myself who had this same experience. I thought that the worst part was going to be in Dallas where I will sit on the "hot seat" for three hours and get baraged with questions. And maybe it will be.  Oh God, what if it is worse then this!!!! Breathe, just breathe.   Let me explain the root of my troubles.  I am currently compiling my case list, which means entering in every delivery and surgery I have done in the last year. Thus I am forced to relive and reanalyze each one.  As I am entering in a case, I remember it all clearly and at first think that yes, I did everything just as I should. Warm fuzzy feelings wash over me as I remember how I helped that woman and improved her life or placed a new life into her arms.  Quickly, feelings of doubt and fear wash over me as I panic. Was that the best way to approach her problem? Did I do the most evidence based treatment? Did she have a readmission for  a postop complication that I am not aware of? Do I actually know what I am doing? How did they ever let me graduate!?!

I tried to explain myself to my husband, and of course he is supportive. Reminding me that most young new graduates undoubtedly feel this way too. But do they? That is where I need your help.  I am certain you have all been in my shoes. Struggling to balance motherhood and medicine. Feeling guilty for not reading all the latest journal artricles and at the same time feeling even more guilty for not reading Goodnight Moon that third time because you just needed your kids to be in bed so you could have a moment to yourself.  Wanting to give your husband attention and wanting to sleep.   My identity is both physician and mother/wife. I am where I am and who I am because of my experiences. I love my job and even more I love my family.  I feel truly blessed to  be where I am, and also slightly terrified.  It seems like just yesterday I was graduating from college with big dreams to become a doctor. Big dreams to one day be married with a family. And all of a sudden here it all is in front of me, and all I can do is panic and want to hide under the covers.

So, I am sending this out into the great internet void to get some clarity and advice. How do I continue to "do it all" and not lose my mind in the process? Is there a secret to navigating the oral boards? I need your help.

Whose loss is it anyway?

I recently attended a bachelorette party.  A few of the other ladies were moms, but I was the only physician mom.  One of the other moms struck up a conversation with me about our children.  We exchanged pictures, told stories, laughed.  Then she asked me who watches my baby when I'm at work, and I told her my mother and mother-in-law do.  She proceeded to comment, rather rudely I might add, about how I was missing everything in my daughter's life, and I was missing her growing up.  She even said, "It's hard for the baby without her mommy."   I replied, "I made  my bed, now I have to lie in it," and promptly ended the conversation, as I did not feel like being lectured by a complete stranger about my working status.

When I got home, I was infuriated.  How dare she say that to someone she just met!  Then I got mad at myself for answering the way I did. Yes I did make my bed, but it's not an awfully uncomfortable one, and I like it... most of the time.

Furthermore, I was upset that she said this was hard on my Doll.  You see, I don't think it really is, or at least I really hope it's not.  My Doll is taken care of by her loving, adoring grandmothers who would do anything for her.  They're both kind, sweet, and patient with her.  They feed her, change her, play with her, and bathe her just as I would.

I feel that the loss is all mine-- I do miss my baby growing up.  I wish I could witness every moment of it.  But for many reasons, I work.  And my hope is that in the future, my baby does not hold it against me that her grandmothers took care of her when she was little; I hope she appreciates having a hard working, self sufficient mommy, who can help to provide her with a more comfortable life then she otherwise would have.  I hope she will always see it as a positive, never a negative.  And finally, my greatest hope is that I am the only one who feels the pain of being away from her.  I can't know for sure how she feels, but I hope she is just as happy being with her grandmas as she would have been with me.

Home sick days

I recently had one of those stomach bugs where I was spending the day racing from bed to the toilet to vomit all day. It was a fun day. I actually had to take one of my rare sick days from work.

But the hardest part of being sick nowadays is that I essentially never get a sick day from home. Not that my husband isn't willing to pitch in, but those days are even more precious than my work sick days. If I ask him to take care of dinner and get both kids into bed, that's not something I'm going to be able ask for again for a while. I certainly can't ask for three or four days of it in a row.

Everyone at work knew I was sick, and going into the weekend, everyone said to me, "Well, at least now you'll be able to relax." Ha! It's way easier to be sick on a weekday.

And this is why whenever we go anywhere, my daughter starts crying that I'm driving her insane with the hand sanitizer.

Daddy time!

My daughter has the most beautiful relationship with her daddy.  They have their own little songs they sing together, bedtime rituals, games only they understand.  She’s his little buddy and I love to watch her chat with him in her little 3 year old way about her day or her thoughts.  I’m currently on a very long night float rotation and my little one is having a hard time keeping her sleep schedule.  Many nights my husband declares that she is going to bed at 8pm on the dot.  I often find her snuggled up with my hubby in bed after they’ve stayed up late watching “one more Dora” or having a jam session in his studio.  There is so much beauty in their father daughter relationship.  It is deep and substantial and real.  I hope their strong bond continues as she gets older and helps her to continue to be strong and self assured.   My husband and I love raising this beautiful girl together.

A few weeks ago I was talking to a fellow resident (and mom of 2) about the typical mommy guilt involved with being a resident and spending time away from your kids.  She’s struggling about choosing a specialty and worried about the damage a more rigorous specialty would cause to her kids.  Somehow we got to the topic of her husband having to comb hair and she mentioned that her daughter actually prefers her daddy’s more gentle approach to her mom’s attempts at taming her hair.  And then we starting talking about all the daddy daughter bonds both of our daughters have and reflected that without their busy mamas, our daughters may not have had the opportunity to form these strong attachments.

My daughter is proud of my work at “the doctor house.”  The time I spend with her is my most treasured and I think our relationship is amazing.  How awesome is it that she also has just as enriching and fulfilling a relationship with her daddy.  And, I’m not suggesting that dads never form close relationships with their daughters in all other work-life situations.  However, just think of how many women you know who report troubled or complicated or loose ties to their fathers.  Maybe our girls would have formed all these same attachments no matter what careers we had.  But, on those days of horrible mommy guilt, it’s nice to think of my baby girl and my hubby dancing, singing and rocking out to their own song.

cross posted at www.myrecoveryroom.com

The Question Box

As a pediatrician who is constantly answering children’s questions --my own (staving off bedtime) and my patients who ask everything-- I love Red Humor’s approach of simply and directly answering the “landmine” questions her children ask, in her recent post.   Her post artfully discusses questions about our treatments for people who are very sick, some of whom get better, and some who don’t.  Sometimes when kids ask where people go after they die, they may be asking literally, what happens to their body, see this from KidsHealth and this from the NIH.  There’s a list of books at the end, and a favorite that I can’t get through without crying is The Tenth Good Thing About Barney by Judith Viorst, or even The Giving Tree by Shel Silverstein (just about growing older).  It’s okay to let them see you tear up (and then feel better again) if you are so inclined.

About 3 years ago, stemming from my sister the philosopher, I had written a post here about "mothers who lie" and creative mothering.  But a friend of mine used another idea that works sometimes called the "Question Box" which you can use when you either don’t know the answer, or you don’t have the emotional energy or the actual time needed to fully answer, or you want to bring in your partner on the answer, or if you are asked something very private in a very public place, and so on.   It goes something like this, “that is such a great question, here is a short answer now, but I think we should write that down and put it in our question box so we can answer it more fully this weekend when me, you, and daddy are all together” or “…so we can look up the answer in this great book I have on the human body” or “I don’t think I have a good answer to that right now, but let’s make sure we look it up together.”    But then you have to get to that question box at some point!

Another fun approach to a different kind of question box question is to just lay it out there, “You are never going to believe the answer to this question” and then go ahead and tell them exactly how that baby really comes out of the woman’s body.  Tell them the people in their 2^nd grade class at school may not know this information yet, and they can wait until their own mommies tell them the answer. And, you can wait a wee bit longer on telling them how the baby gets in there.  Just the facts, ma’am.

It’s about creative mothering and telling the truth.  And being in a special place because of what we do at work every day.  And being there for our own children’s growing minds and emotional development.  With lots of questions and some well-timed answers.

My Big ‘ole Fierce Mama Heart

Somewhere between first seeing the 2 purple lines on my pregnancy test and wrestling with my 2.5 year old toddler as he runs giggling at full speed and throws himself into my arms, I have gained a big ‘ole fierce mama heart. It’s strong. It’s wise (wait, did I say that, ME, wise?!?). It’s powerful. It feels more strongly than anything I ever could have imagined.

It has changed me. Immensely. I know that I am so much more of a better clinician because of it. It keeps me up when I’m on call. It makes me teach the Interns and Medical Students more about how to care for our patients with all that we have. It makes me spend extra time reading and enhancing my knowledge base. It helps me give practical advice to my clinic patients and even though some families still can’t believe I’m old enough to be a doctor, they seem more comforted when I talk to them about my own family.

I’m different because of this shining little boisterous boy who chose me to be his Mama. The one who drools on me as I laugh. The one who says “Mama go to work” and walks me to the door in the morning. I leave each day with him blowing me a kiss after I ask “dame un besito”. He has given me this big ‘ole fierce mama heart that I am soo thankful for.

Guest post: Can't I just relax?

I am a 30 year old mother of 3 children ages 13, 10 and 8 in addition to being a wife and a second year OB/GYN resident.

It’s the weekend and I’m off, which is a miracle in and of itself.  However, what should be time to relax is never exactly that.  Sometimes because of children’s sports activities, or my husband’s work obligations or maybe because we have scheduled time to go “out” with our friends.  Yet more often than not, despite the extended period of time off , I am incapable of relaxing.  My in-laws jokingly ask my husband on a regular basis what is on my agenda for my time off.  My husband literally can not comprehend why I can’t just sit.  

Here’s the thing from my perspective:

I had my first child at 17, married at 18 and had my second and third children at 20 and 21 respectively.  Throughout all of this I took off only 1 semester of school.  I went straight through college and into med school and now OB residency.  Through all of this I have learned to manage time, multitask and be efficient.  Time is of the essence!  For the past 13 years I have had an agenda.  Clean the house, do laundry, academic reading, pay bills, etc.  So, when given a moment that is not already scheduled for me, I feel the irresistible urge to use that time to it’s fullest potential. I have made it a point recently to get a massage once a month.  However, I will admit that it takes me a full 30 minutes for my mind to clear of the tasks that need done.  But hey, that’s a full 30 minutes that I really am relaxed!  Now, as my children and I are getting older, and I am getting further into my career I can’t help but wonder how to break the cycle in my head and to really enjoy my time off.

landmines

My soon-to-be five year old will do or say anything to delay bedtime. Recently she's wanted me to tell her about my day – what type of patients I saw, where their cancers were, and who was bald. If the patient was female and not bald, she wants to know if the hair was short or long. If the patient was male, she wants to know if he had a mustache or a beard. Hair, who has it and where it is, seems very important in her understanding of what I do.

Because the nature of the inquiry is flattering, I usually linger a while at her bedside and try to recall the patients I saw in clinic. I am careful to choose the details that are not inherently upsetting, but the longer the talk, the more likely I am to stumble into territory littered with the landmines of subject matter unbefitting the ears of preschoolers, especially in the few minutes before bedtime.

When it comes to the question of how to and under what circumstances do we “shelter” our children, I think I fall somewhere in the middle. Although sex and violence might be part of life, I think it’s appropriate to limit my children’s exposure to those themes while they are young. I'm not sure I feel the same about medical illness and problems faced by people undergoing treatment for cancer. I was ten the first time I went to Guatemala and freaked out when children tapped on our car doors begging for money. Even though I remember that experience as a very negative one, in retrospect it was probably a good introduction to the topic of inequality. I share the story to make the point that exposure to uncomfortable subject matter can be an important part of growing up.

But 5 isn't 10 and death isn't poverty, and I am still unsure of what I should and should not share with my preschooler.

She’s quite interested in the subject of death, even more so than the subject of hair, and I wonder if it's precisely this interest that makes me uncomfortable. She knows that “old” people die, but asks questions that would indicate she suspects there’s something more to the subject. I’m not sure if she knows that anyone can die at any time, and, more to the matter, if she poses the emotional intelligence to deal with the obvious implications of that realization. 

I’ve heard before that the best course of action when children ask potentially age inappropriate questions is to answer only the question posed, in as direct and simple a manner as possible. But she asks a lot of questions, and each answer seems to spurn on a new set of inquiries.  I hate the feeling of lying to my daughter, but I do it occasionally to get myself out of discussion I’d rather not have.

How much “real life” do you bring home?

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.