A Scientifically Stellar Lunch Date

"Education is the kindling of a flame, not the filling of a vessel." - Socrates

I was trying to set up a science birthday party for my son back in May. He was turning nine and wanted a mad scientist theme. I wanted a mad scientist to take the pressure off of me. I hit a wall with the local science museum, and decided to try the school to see if any high school students were interested. As the upper school administrative assistant was giving me the names of the science teachers, one rung a bell.

"Did she have an old last name that was -----?"

"Well, I don't know. Since she has been working here that has always been her name. I could ask."

"That's ok, I'll just ask her myself. Can I have her e-mail?"

After I sent a query I remembered a few months back when I was sitting at a low bleacher in the gym. My daughter was picked as the lower school representative to read a passage at a convocation and I got covered to watch and support her. She was confident and well spoken; it was a thrill to witness. As I glanced back at the audience I saw someone who looked like my high school physics teacher, plus 24 years (both of us!). Surely not, I thought. Now I knew I was wrong.

I left my phone number and she called me that evening. We were both rushed and excited to catch up (me more than her - she is eternally calm). She said, "I told my husband this is a first. To have students matriculating toward high school that are the children of a former student. I am overwhelmed." We planned an early morning before school meeting within the week. I met her in her classroom and we reminisced. We were her first class. I remember relating to her because she was young and enthusiastic and intelligent and female. She reminded me she had just come from California after training back then, but grew up in Arkansas. She charted her career trajectory - teaching to business then back to teaching - and I reciprocated. She promised to try to help me find a student for the party. She reminded me of the plaque we designed for her to commemorate her first class. I told her I thought I had a picture of our class giving her that plaque (it was a small class - numbered in the teens) and I would try to unearth it when I moved later on this year.

The students didn't work out, but that was for the best because my son was the scientist at his party and he was awesome. But the door I opened to my teacher was worth the effort. I e-mailed her after the party was over and invited her to lunch and to tour my work. I told her that if she had any interested students I would love to host them for something similar - I am always trying to recruit future pathologists. I was over the moon when she accepted and we set a date for mid-summer.

It was a Monday not too long ago. I was covering cytology, so radiology needles. I checked the schedule in the morning and asked for a window so I could eat lunch with my science teacher. The tech told me that 11:30 would work best, so I texted my teacher to set it up. The radiologist covering that day was accommodating.

"You are taking your high school science teacher to lunch? That is so amazing and inspiring. You are making me want to do something similar. But I didn't have any good mentors that I remember."

"You mean that you can't find anyone in your history to give credit for your current awesomeness?"

He smiled. "Well, maybe I can think of someone. I'll work on it."

After my third needle of the day I raced to the lobby to meet her. We hugged and had a good heart to heart over soup and salad - she insisted on picking up the tab. I showed her pictures of my son's birthday party. She said, "You are a true scientist. You hit some obstacles but didn't let it stop you from formulating a new plan. And it looks like it was a great success." I glowed in her praise, just as I did when I was 16 and I figured out a physics problem or successfully completed a lab experiment.

I showed her the Gross Room and Blood Bank and Microbiology and Histology and introduced her to most of my partners. I think she had as much fun experiencing a different world as I did when I alighted her classroom a few weeks back. We were interrupted by a student who was taking a make up test and needed help. I was awed by her calm reassurances and professional demeanor. I cannot wait for Cecelia and Jack to soak up her carefully and expertly doled out knowledge like the sponge I was back then. I hope she inspires them as much as she inspired me.

They are well on their way to becoming scientists. A little expert guidance always helps to kindle the flame.

Guest post: The whole truth

"Tell all the truth but tell it slant" (Emily Dickenson)

Much is written about how women, and mothers in particular, hurt each other by only showing their competent and successful side. I agree. This isolates us. I’ve had people ask me: “How do you do it? How do you manage being a doctor and a mother at the same time?” Most of the time I say “I don’t know," and that is true in part. I am just doing the best I can and it never feels good enough.

But here is the whole truth. I have a LOT of help. An insane amount of help that I feel embarrassed that I need and for which I feel undeserving. Particularly here in Utah where many women have a lot of children and do a darn good job taking care of them all while looking fabulous in the process, I admit that I feel guilty that I don’t measure up. I feel silly that I have a hard enough time taking care of two.

So here, in a nutshell, is a list of all of the help that I have: a housekeeper a morning per week. And in addition, gulp, a lady who comes two times a week to help with laundry. I shop online and save most errands this way. As if that weren’t enough, I am fortunate enough to have my parents here in Utah. In addition to watching Adelyn during the day, if we are late for school pickup, or if I have a late meeting, my mom is there for backup. Oh, and since we are in full confession mode, also a therapist to help me deal with all the damage done to my psyche by medical training. Have I suffered any real trauma in my life that would actually merit a therapist? Nope. Yep, I am a spoiled white WASP (I’m not actually sure what that is but I think that that is the category people would put me in.) So what am I doing with all this help? Am I volunteering for humanitarian causes? Am I the PTA president? Nope and nope. Here is what I am doing with that time: spending it with my kids mainly. All this help allows me to spend a lot of quality time with my girls. I hope it is doing them some good but I am never quite sure. I desperately want to volunteer to help disadvantaged kids but right now, I have all I can do to take care of my own children. And so I am an armchair do gooder, making donations and all that other useless stuff. I cook several times a week. I sometimes have people over for dinner if the house is presentable enough (though I should do so no matter the condition of the house…foolish pride). I read I bit. I run. When I am feeling brave I take the girls to church on Sunday. I garden and putz around our property. I sit on the front porch and drink iced tea. I occasionally get together with friends or talk on the phone with them or write a letter. Oh, yeah, and I'm a doctor. A decent one most days, and some days a downright good one. If I didn’t have all this help, none of this would be possible.

What are my kids doing while I write this? Watching a dumb cartoon with negative educational value. It’s 90 degrees and in the heat of the day and we already read, and done 2 crafts and some homework pages and eaten and cleaned up and attempted naps and I have no more tricks up my sleeve. And darn it my husband has just arrived home early and caught me ignoring the children while they watch TV.

There you have it. Judge away. Or maybe, just maybe, cut me some slack. Cut other women some slack too. And if you do more than me with less and get by without any help at all, I am truly happy for you. But it's okay that I'm not that way.

I realize that sometimes women take offense when you say things like “I don’t know how you do it.” But when I say that, I am being genuine. The woman with 5 kids--you are my version of a rock star. If I have a lot of questions for you and ask you how you do it, it is because I admire you, like some people might do when they meet a world class athlete or a famous author. To me, you are doing the impossible. The woman staying home with 1, that’s a huge job too. The woman with no children-- wow you must be able to accomplish so much, and gosh it must be so nice to be able to read the paper in bed or join friends for cocktails at night or have a glass of wine on the plane without a small person dumping it out and making the whole aircraft smell like a vineyard and good for you for knowing yourself well enough to make that choice (and if it is not a choice but one that has been forced upon you by infertility, I am sorry and this is why I try not to ask women if they have children lest I hit a sore spot). The woman who has made it to the top of her field? Thanks for paving the way. The woman doing important work to end social injustice? You are ALL my heroes. And I’m grateful to have so many of you in my life.

-a geriatrician and mother of 2

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?

I Spanked My Kid.

Genmedmom here.

I spanked my oldest last Wednesday. Twice. He's only four, he's autistic, and I hadn't seen him all day. I am such a jerk.

My day had started at five a.m. I had several extremely complicated and sick patients and several extremely complicated phone calls and a load of logistical paperwork and an inpatient to see and it was downpouring when I left work and I had to walk a mile to my car and the afternoon rush-hour traffic was standstill in the tunnel and I was forced to breathe car exhaust and I felt sick all the way to Nana's house blah blah blah.

I had been truly looking forward to seeing my little man and my little bug. But all the way to my mother's house (she picks the kids up from school/ daycare), all I was thinking was that I had to get the kids rounded up and in my car and back home for baths and bedtime, and I wasn't sure what time Hubby was coming home. I was stressed that I might be solo for the whole night-night routine (Panic!!!!)

When I got there, Babyboy had a poop and a terrible diaper rash, and he didn't want to be changed, so he twisted and turned, and he started grabbing things and throwing them at me, including poop-covered baby wipes, and I yelled STOP IT and swatted him on his butt. Then five minutes later he shoved a throw pillow at my infant niece, and I yelled THAT'S IT and I spanked him.

Now I feel terrible.

I've yelled and spanked before, and it always makes me feel like the most ineffective, inept, stupid, bad mommy. I intend to avoid this primordial parenting technique. But when I'm exhausted, and I can't seem to get control of my kids, I just get so frustrated and angry, and I can't seem to access any of the more advanced parenting skills I've read about.

And, spanking works. In the very short term. Very, very short term. Babyboy stopped throwing poopie wipes the first time, and he stopped shoving pillows the second time. But he cried and wailed for Nana, who never loses it and is always calm.

So, obviously not a great parenting tactic. And if my colleagues and patients saw me lose it and get physical over poopie wipes and pillows, I would be mortified.

The best book on parenting an autistic child that I have encountered so far has several wonderful lessons and suggestions on this very topic. I've dog-eared the pages and read them several times.

The book is Ten Things Every Child With Autism Wishes You Knew by Ellen Notbohm (Future Horizons, 2012), and chapter 9, "Identify What Triggers My Meltdowns" is applicable to any parent of any child who ever throws a tantrum for any reason.

She writes: "If you react with anger and frustration to your child or student's meltdowns, you're modeling the very behavior you want him or her to change. It's incumbent upon you as an adult, at all times and in every situation, to refrain from responding in kind. Be your own behavior detective. Figure out what triggers your own boiling point and interrupt the episode before you reach that point. When your thermostat zooms skyward, better to temorarily remove yourself from that situation."

In my case, Babyboy may have been overstimulated, and then protesting. There were many family members in the house and in the room; I had just arrived; the television was on; it was stormy outside... and I was pinning him down to the unpleasant and even painful task of a diaper change. When he acted out, I could have held in all my frustration, got the poop reasonably cleaned up, and put Babyboy in time-out in another room, away from everyone. That may have avoided the second outburst and spanking.

Of course, there are many people who feel that spanking is acceptable parenting behavior, and Ellen Notbohm has these questions for those folks:

"Consider:

Does spanking follow careful weighing of alternative responses and a reasoned decision that, yes, striking someone one-quarter our size is logical, provides a good example for them to follow, and will produce the desired long-term result? Can we be sure that it teaches the child what she did wrong?

Does it give her the knowledge and skills to correct the behavior? Or does spanking spring from aggravation, wrath and desperation?

Does it foster respect and understanding, or humiliation and bewilderment? Does it enhance the child's ability to trust us? Is it a behavior we want the child to emulate?"

Of course, this all makes perfect, clear, sane sense. And I've read it, and I get it. But in the moment, I haven't been able to consistently refrain from yelling and spanking. And I'd like to.

I think the real answer is in identifying Babyboy's triggers and trying to avoid them. In my case that day, there was an even better potential solution: I could have taken him to another, quiet room to change his diaper, and, after a bit of cuddly mommy time, I could have given him some control over the process, a job to do, like handing me the wipes or unfolding his clean diaper.

That response would have been ideal. It would have required some thoughtfulness, some space, some time.

As Ellen Notbohm writes, "Many will be the wearying moment when the root cause of your child's meltdown won't be immediately evident. There may never be a time in your life when it's more incumbent upon you to become a detective, that is, to ascertain, become aware of, diagnose, discover, expose, ferret out..."

As a physician, I am so accustomed to multitasking, problem-solving, wasting no time, get the job done... With Babyboy I need to slow down, breathe, and think. Study him, and anticipate the acting out, the outbursts, the tantrums, and steer around, or make them disappear. I do think it's possible...

Has anyone else out there had any similar experiences/ got any suggestions to share?

MiM Mail: Disclose family in residency applications?

Dear Mothers in Medicine,

I was so excited to have found this blog! What an inspiration! I'm a 4th year medical student with a busy little 12 month old. My husband is wonderfully supportive and great at stepping up and taking care of our son when my schedule gets crazy. To be honest, when I first found out I was pregnant I would have never thought that med school + a baby would be so doable (ridiculously hard at times, but totally doable). Sure, there were many times when I was ridiculously sleep deprived and didn't get to see my husband or baby awake for a day or two. And sure, there were several times where I spent my pumping session crying in addition to stuffing a sandwich into my mouth as quickly as possible. But I did it, and I *think* I did it well. I don't mind anonymously tooting my own horn on this one because I'm darn proud. This past year has confirmed that I'm on the right track-I love being a mom, and I love being in medicine!

I am now preparing to apply to residency positions. As much as I tried to like a field with more potential for control over my schedule (peds, PM&R, pathology?), I realized that I would never be satisfied if there wasn't a significant amount of OR time in my future. I even almost let a few of my attendings talk me into going into general surgery, but in the end I decided that my passion is for OB/Gyn. I'm struggling with this decision because of the many hours/days that I know I'm signing myself up to spend away from my family. My husband tells me that I can always quit and be a SAHM, but that is not my calling and I know it. I'm already feeling guilty about putting my career in front of my family and now I'm faced with the decision of whether to disclose in my applications that my family even exists! I've been told that when selecting residents, if two applicants are otherwise equal, they will pick the one without commitments outside of the hospital. It's illegal, of course, to base decisions on these factors, but it's undeniable that it happens.

I think I've decided to leave any mention of my family out of my personal statement, but there are many other areas in the application process where this information could potentially come out. There are two different areas for explaining any breaks and extensions of the normal 4 year track. I took a LOA after I had my baby. Do I just say I took a medical leave and not explain? Is this a red flag? (Is this going to happen again? What if it was a psychiatric reason and she's unstable? Etc) I have heard of people bringing their kids/spouses to interview dinners. Do I leave them behind? Not talk about them? Hide my wedding ring? How far do I take this? It just feels wrong to hide the two most important and influential people in my life. I used to think that if a residency program doesn't want me because of my family, then I don't want them. However, in an increasingly competitive market, it may be naive and foolish of me to sabotage myself by disclosing personal information that won't even potentially benefit me. It just all feels wrong.

Thanks!

Rediscovering quantity time

It's an old question: quality vs quantity time? When it comes to parenting, the people whose lives allow for quantity tend to argue in favor of quantity, while the people with less quantity argue for the importance of quality. Which is not to say of course, that you can't have quality while also having quantity. In any case, in the Mommy wars, its one of those false dichotomies likely to provoke a melee of defensiveness and self-righteousness.

I started my life as a parent with six months of quantity time. I took 8 weeks off, but then worked part-time, mostly from home. My daughter and I were together almost all 168 hours of the week. We marinated in each other. We stared into each other's eyes for long stretches. Most of the time, neither of us was fully clothed. I was engaged in elaborate procedures to increase my milk supply, so I was either nursing or pumping or nursing-then-pumping every 2-3 hours around the clock, and my daughter was never more than three feet away from me. There was no day or night, just a repeated cycle of hunger, contact, cooing and shushing, punctuated by the pchika-pchika-pchika of my loyal pump. I tried to work when I could. 

Then I started residency and parenting changed completely. Now the demands of my job were absolute, predictable down to the hour for an entire year in advance. I had to be fully available at work and so my partner took over the job of being fully available at home. My daughter started day care and began to adhere to a more consistent bedtime. Instead of working when I could, I had to parent when I could. Many days I had only half an hour or an hour with her before bedtime and I learned to make these minutes gleam with high octane focused attention. Then there were golden weekends, unexpected early days, vacations, and continued nighttime awakenings, which killed me but also kept me going. We cuddled as much as possible. When people lamented to me on behalf of my daughter about my demanding schedule and how little time I was able to spend with her (frequent occurrence), I gently told them how proud I was of the quality of our relationship despite these constraints. I didn't exercise, travel, or buy a new pair of shoes for two straight years but with what time I had, I parented with my whole heart. 

Now I'm a third-year and it's not feast or famine anymore. I can eat breakfast with my family, put in a solid work day, then eat dinner with my family. And weekends are back (sometimes). The timing of this detente is coinciding with a leap on the part of my now two-and-a-half year old towards more independence and awareness and conversational ability. To celebrate, I took her on a road trip to see her grandmother in Vermont. We were in the car for fourteen hours in total and I gained a new appreciation for the things that quantity time can give you that quality time cannot. There was a period of twenty minutes in which she screamed "Mommy, I want to poop in the potty!" at top volume and I thought I was going to lose my mind. Then I figured out a tickling game we could play while driving and the car was filled with both of our giggles. We slid from mutual frustration to laughter to boredom to song to negotiation then back to boredom then back to jokes. It's not that these transitions don't happen over shorter stretches but with 72 uninterrupted hours ahead of us, I didn't feel pressured to make every moment fun. I didn't feel pressured to entertain E. We were just inhabiting time together, without bedtime or daycare drop-off or a specific activity to get to. E asked lots of ontological questions like "Mommy, who is your Daddy?" and "Where are all these cars going?" When we stopped for lunch, she laid out her chicken nuggets and french fries in a perfect straight line and said in a matter-of-fact voice, "Nuggets and sauce is my favorite. What's your favorite?" It felt like we were on an epic date, complete with some long silences and surprising moments of synergy and a sense of time without limit.

Like most of the issues in the Mommy wars, there is no one right truth for anyone and on average the truth is somewhere in the middle. The truth also changes. Parenting with limited time taught me mindfulness and focus and priorities. It made me a better parent. Now I'm looking forward to spending longer stretches of less goal-oriented time with E. I'm hoping to build a life in which quality is the focus both at work and at home, with enough long weekends and road trips and lazy vacations in remote places to marinate in timeless time together.

MiM Mail: Keeping the relationship strong and resentment to a minimum

I am a third year medical student who recently had a child and am starting back on the wards soon, after a lengthy maternity leave.  I experienced some of third year already (while doing rotations during my pregnancy), and I'm absolutely terrified about going back!  Nope, it's not about the rigors of the wards or balancing school and medicine (we have older kids so I've done some of that already).  I'm terrified of the resentment my husband is likely to feel while taking care of the kids for such long hours on his own while I'm away and also while I'm studying.

He fully admits that he felt some of that in my first and second year and knows he'll feel it again when I go back since the hours will be longer.  To those in med school, residency, and practicing--what did you do to keep your relationship strong when your spouse often feels like a single parent?  I plan to do as much household stuff as possible, find some extra childcare for a few hours on the weekends when I have tougher rotations, try not to complain, and try to book family time for at least a little almost every weekend.  Any other ideas?  What works for you in this regard?  Thanks so much for any advice you have!

Guest post: Pregnant during residency (and not feeling the love)

Prior to becoming pregnant I thought there were no women's rights issues in today's day and age. It was only after I became pregnant that the struggles became all too real. One of the first questions I received from my program director upon announcing my "good news" was...will you take all 6 weeks? Soon afterward a colleague proudly told me he once worked with a resident who was back to work 2 days after delivery. He was hoping my pregnancy would be uncomplicated so I could do the same. Approximately 25 weeks into my pregnancy my physician said I could no longer work solo 24 hr in house calls or 80 hr weeks and that although I could continue my rotation duties, hours should be limited to 12 hr shifts, 5 days a week, maximum of 60 hours. This restriction came after early contractions, shortness of breath and tachycardia had set in.

Although my colleagues weren't pleased with this decision, they agreed to accommodate me of course with the assumption I will be heavy back loaded on calls when I return from maternity leave because each and every hour of call I miss needs to be made up. Made sense to me since caring for a 3 month old should be easy peasy right?

In the meanwhile I continued to work, study, do research, present at national meetings. Pregnancy brain hasn't always helped while being pimped or taking my yearly shelf exam but I have dealt with it as best as I can.  After receiving  two offers for prestigious interviews at two of the top programs in the US for my subspecialty my program director kindly contacted me to recommend that I not go to these interviews and postpone them in the interest of my health and since my schedule was already so "limited". I thanked him for his concern but went to the interviews anyway while 29 weeks pregnant and was accepted by both, able to have my choice!

Now with only 4 weeks of pregnancy left, my physician has recommended no more calls. I of course have worked with my colleagues once again getting them to cover my remaining calls with the promise that I will owe them all back.

I feel a bit like an outcast of the program right now all because I am trying to balance work with a future family. I hesitate strongly to say I am discriminated against but in some senses, I can't help but feel this secretly as well. I keep telling myself that this too will pass in hopes of things returning to "normal" after the pregnancy.

Has anyone else had similar experiences in pregnancy and if so, how did you deal with them?


-An ophthalmology resident 

Play dates: Mothers in Medicine Style

Most of the Mothers in Medicine contributors, including myself, write anonymously. I write about my husband O and my son Zo knowing that folks who know me can figure out pretty quickly who I am. I write as if my boss is reading my posts, though I have never actually told her, but just in case, I write as if she may read them, nothing too embarrassing. I write to share and get feedback from folks near and far who understand my struggles and my triumphs in ways that my non-physician family never truly will. I have been writing for MiM since I was a Medical Student and over the years I have started telling folks beyond my family to check out my posts including some trusted work colleagues.

Over the years, I have felt like I have come to personally know many of our regular contributors and even a few of our regular commenters. I hope that someday there will be a big Mothers in Medicine Conference or maybe just a gathering at a bigger annual professional conference. When I read Cutter’s posts I said, hmmmm, I think we work in the same hospital! Flash forward to several months later (and many thanks to KC) and Cutter and I had our first MiM meet up at a local museum. Her daughter is super duper cute and Zo was smitten at first glance. He quickly followed her to the slide and then he began chasing her around the exhibits.

Play dates are always good times to reflect on the joys and vent about the struggles of motherhood, but when the other parent is a MiM, it is especially cathartic. Cutter is amazing. Chief Resident, Super Mom/Wife, super hair braider (from Youtube videos nonetheless). We spent hours talking and it was so nice to have someone who understands the doctoring and the mothering because it makes for a really unique life.

I have had a few other play dates with women Doctors including several with a beloved Attending who has young children. These times are equally amazing. She has the wisdom of being several years out of residency and fellowship. The first time I asked her and her kids out for a play date, she gladly accepted. We met up at another local museum and the next time at a park. Each time there was a lot of her being a cheerleader, saying “You’ll get through this.”

Play dates with stay-at-home mothers usually involve looks of pity and many exclamations of “I can’t believe you work that much.” Play dates with 9 to 5 working non-physician mothers usually involve less pity, but still many “I can’t believe you work that much” looks. There was none of that at our MiM playdate and I liked it!



Here’s to many future play dates, MiM style!

Happy Doctor's New Year!

It's here! The first day of the golden year of residency. The last year of residency.  I can barely contain myself! As we all said our goodbyes to the graduating residents yesterday, I felt a pang of resentment... That they are leaving us, leaving me.  Then I remembered that this indicates the end of my torture and the start of a new life.  I hope.  I hope, I hope.

Waking up this morning, I remembered the morning of my wedding day.  I had just woken up bright and early when I saw my hair stylist drive up and park her car.  I ran downstairs to open the door but my mom beat me to it.  When she walked in, I started jumping up and down out of excitement.

I'm not jumping up and down today... But I kind of feel like it!

Happy new school/residency/work year to all of you who live by the July 1-June 30 year!

Doctor's Lounge

I have been working at my hospital for almost seven years. That's a long time.

I walked into the lounge at about 9 something a.m. this morning to get hot water for a cup of black tea.

There were three women sitting at a table by the front door. I introduced myself to one of them two weeks ago - she is a newish PM&R doc. Works mainly at the rehab tower. The other two I didn't know. They looked young and hip - I imagined they were residents. I looked over at another table and saw a woman sitting with a man. Two women were standing at the food station getting some of what was left of breakfast. That's seven women, counting me, and one man in the lounge. Unprecedented.

I felt like climbing onto a table and dancing and singing at the top of my lungs. I didn't. That would have looked crazy. Instead I walked over to the table with the one doctor I knew in the room and said, "I have been here seven years, and I have never been in the presence of this much estrogen in the doctor's lounge."

It is usually an all Caucasian male crowd, with a few exceptions to the former descriptor. Rarely women. I could sit down and chat, but why? To listen to random sports talk I had nothing to contribute to? I usually just get my coffee and maybe a hard boiled egg if I forget my bean burger for lunch while eavesdropping. I leave quickly.

I wandered over to the coffee area to make tea, still resisting the urge to sing and dance something crazy and free and female-oriented. Alicia Keyes was running through my brain. "This Girl is on Fire"

After I made my tea, I walked back over to the table by the door. The PM&R doc said, "I was just telling them who you were." I introduced myself to the other docs by my first name. "I'm Gizabeth." They had super cool first names that complemented their appearances, which were not all Caucasian (I am Caucasian, but of the dark-skinned variety, so I'm not being prejudiced against that. But finally University melting pot in the doctor's lounge!). I learned that they were both new PM&R docs at my hospital. They trained all over the country. I thought of my friend Fizzy, and resisted the urge to say, "So what exactly does a PM&R doc do?" Because I knew. Thanks Fizzy. But I still don't entirely understand. No offense. My job is weird too.

After we chatted and I learned a little about them and they learned a little about me I really had to go. As I was leaving I said, "Looking forward to seeing you around here more often. There has been a dearth of estrogen around here for years. I think we need to create a balance. So that we can initiate our eventual takeover." We all laughed. Kidding. Sort of.

Being tough while pregnant

I was recently talking to a friend of mine who mentioned that another mutual friend was eight months pregnant and he was impressed that she was still walking around. Of course, I was offended because I was still working when I was in active labor.

But then I realized that maybe that wasn't something I should be proud of.

When I was eight months pregnant with my oldest, I totaled my car in a highway accident. I wasn't seriously injured and only required a night at the hospital. The worst thing that happened was I hit my head and had a concussion and a really bad black eye. I felt like with my pregnant belly, I looked like an abused wife. This was pretty much what I looked like:



My chief resident called me and told me he thought maybe I should start my maternity leave early. I didn't. Instead I went back to work only two days later.

When I went back, I was convinced that everyone was angry at me because I missed a call due to my accident. In retrospect, I'm pretty sure everyone felt really sorry for me.

Was it dumb to push myself that way? Possibly. I got through it and made it until my delivery day. And then I got the benefit of my six weeks of maternity leave with the baby instead of home alone.

Your turn. What's the dumbest tough guy move you made as a pregnant lady?

MiM Mail: Pharmacy vs MD

Hello Mothers in Medicine,

I came across your blog while researching whether female physicians could balance a family life as a working mother. Your blog has been very inspiring and I commend all of you.

Regarding my situation, I have just finished my first year of pharmacy school and have job shadowed in both the retail and clinical setting. I found the retail setting to be boring and tedious for the time I was there and figured the hospital setting would be more... upbeat. However, I was disappointed during my time at the hospital.

Now I am faced with the decision do I stick with pharmacy hoping to find some sort of specialty or other path in pharmacy that I will like that accompanies the stability and amount of schooling that pharmacy takes or I was considering a career in medicine.

My parents and friends haven't been very encouraging for the doctor route saying how could I have a life outside of school and then my work. When I bring up the issue in conversation I feel insulted because I have always been driven and decently gifted intellectually (I was Valedictorian) and yet I feel like the only person who believes I could do this, and I definitely have my own doubts, is myself.

I know you posted a blog similar to this, but I suppose the gist of my question is would you choose medicine as the same career path? And what is your recommendation for me between pharmacy and MD?

Thank you for your help!

K

Apical Core

I was looking at an apical core a few weeks ago. The surgeons take these cores at the apex of the heart when they are putting the patient on mechanical heart support. Most of the time there is bizarre cardiac muscle nuclear change from hypertrophy. Fibrosis. Iron accumulation. Amyloid. Pathologists look for different things based on the clinical history we read in the chart. This core was clean as a whistle. No fibrosis, tiny box-shaped nuclei. I looked at the patient age - 20's.

I delved into the chart to read about it - a 20 something year old that needed mechanical heart support? Was this viral? Genetic? The history showed no clue. A previously vitally healthy human being had gone downhill to this moment in just a few weeks. She was a student, a daughter, a musician.

A couple of days later I was rushing to finish my cases to leave early for my daughter's fifth grade graduation. I wanted to do something for her - something simple and sweet and manageable. I walked over to the hospital flower shop to chat with the florist. It was under new management and I enjoyed talking to the young energetic successor to the former manager. I explained to her what I was wanting and she pointed to a small basket of flowers.

"I was thinking more along the lines of a single flower. Something that would be easy to carry and give. Maybe a Gerber daisy?"

Her assistant came out of the back room. "What are the school colors?"

That's a good question. I had to reach. "Green and yellow."

"We have one yellow Gerber left."

As the assistant began to package the flower and tie a beautiful dark green ribbon around it I chatted with the manager. She was asking me about what I did at the hospital. The assistant suddenly joined in.

"Do you ever look at hearts?"

"Yes, actually I have an interest in that area. I see lots of explanted hearts and look at biopsies for rejection of transplanted hearts."

"I am asking because I have a friend in the hospital. It's her daughter. We are very close. I'm wondering if you would have seen her pathology. She was just put on support and is waiting for a transplant."

Oblivious, thinking about my schedule and my daughter and my day, I answered, "Oh yes we look at apical cores for mechanical support all the time. I saw one just the other day."

"Oh I wonder if it was hers? She's young, in her twenties, and we are all praying for her. Do you think you saw it?"

I suddenly put two and two together and became hyper-aware of HIPAA in my head. I told her, "Well, a lot of us look at those and we see them all the time. I doubt it was your friend's, but it could have been."

I turned the conversation back to the manager as she was ringing me up. The assistant became increasingly desperate with her questioning. She seemed to really need to know if I had seen her friend's heart core biopsy. She didn't need to know about it, but her entreaties and interruptions into my conversation with the manager were too much for me. I didn't want to violate HIPAA. I didn't want to give out any information. The manager seemed to feel my pain and supported me. "She is a pathologist. She doesn't know the patients, she just reads the tissue." I recoiled in defense.

"Well, that's not exactly true. I read every patient history. I latch onto the stories. Of course I am reading the information to get a better handle on the tissue, but every clinician adds a new piece of personal information to help me see the patient. I don't meet them, but I feel like I know them - some more than others. I'm just a voyeur, but I'm present."

The manager and I started talking again and I did something I'm not entirely proud of but it seemed like the right thing to do at the time and I am glad in retrospect. To placate the assistant I managed to slip in the 20 something year old's musical area of expertise innocuously into the conversation I was having with the manager. Whatever I said or didn't say worked. She relaxed and smiled and interpreted my silent acknowledgement as some sort of reassurance. Suddenly she said, "I have to show you a picture of my friend's daughter. I just want you to see her, even if you weren't involved in her care."

The manager said, "She's busy and she is in a hurry."

I told her to take her time I would wait. I would love to see her friend's daughter. She pulled up a photo on Facebook on her phone and showed me. I was totally unprepared for my response. She was incredibly beautiful, and suddenly and surprisingly tangible in a way so much of the tissue I see isn't. I had seen a piece of her heart just the other day. I never get to see the patient. I read and read and read but there is never a human face connected to the tissue. My eyes welled up and I choked back a sob.

The manager told her assistant, in a loving but chiding way, "Look what you did you made her cry!"

I replied, "No, it wasn't you. I am a little emotional about my daughter." I looked the assistant straight in the eyes as mine were trying to clear of tears. "Thank you."

Guest post: Two points for knowing what you don't know

I’m driving the kids home from school, winding along Dollarton with afternoon sun glinting off Burrard Inlet, and Saskia’s telling me about the Gauss Mathematics Contest she wrote that morning.

“I left one question blank,” she begins. It’s a confession: a perfect score is off the table. She doesn’t add up test scores, she works back from 100. She goes on, “But I did that because of how the scoring system worked. You got six points for a right answer, two points if you left it blank, and zero points for a wrong answer. I wasn’t sure about the last question, so I just left it.”

I make her repeat that, making sure I have it right, because I know I’ll be chewing on this for days.

They were rewarded for leaving alone what they didn’t know.
Making a wild stab at an answer was worth less than no response at all.
For once, it wasn’t about doing one’s best, but about acknowledging one’s limitations.

* * * * * * *

I was assigned to a family practice when I began residency in 2000, for several 4-week blocks over the two year program, and callback every Thursday afternoon. It was an established practice on Broadway and Granville, and a good group of doctors, but I dreaded seeing the patients, mostly well-heeled reproductive aged women.

Making a diagnosis and treatment plan on my surgery rotation, or in the emergency room, wasn't a problem, but these women kept presenting with issues that weren’t in any textbook. One couldn’t interpret her baby’s cries; another needed advice on dealing with strangers’ remarks on her child’s birthmark; the next had discovered her teenage son’s porn collection. Working at this family practice was by far my least favourite rotation, and I was doing a family medicine residency. That worried me.

My preceptor and her partners took the entire clinic out for Christmas lunch that first year, between morning and afternoon clinics packed with patients wanting to be seen before the holidays. I remember Sarah pausing during the meal and saying to me congenially, “You know when we knew you were okay?”

I had no idea, but I was relieved they’d arrived at that conclusion.

“Remember that rash?” she asked. “The four-year-old with the vesicles on his legs who’d just come back from camping?”

I remembered. Yet another patient that had had me stumped.

“When I asked what you thought it was, you said ‘I don’t know,’” she went on. “That’s when we knew we had a good resident.”

The other physicians agreed. “We don’t care what you know,” said Joan. “We care that you know what you know.”

* * * * * * *

I teach residents myself, now, and it’s true - I don’t pay particular attention to how comprehensive their knowledge bank is, but to whether they recognize what’s missing. Nothing raises a red flag like a learner who already has all the answers.

And then there are the patient encounters where you can’t turn to UptoDate for backup. Sometimes there really isn’t an answer, in that brisk bullet point way that physicians love. Sometimes the P of SOAP feels terribly inadequate; writing ‘counseled’ or ‘conservative’ or ‘follow’ feels like a fail. Physicians get the God-complex jokes all the time, but from where I sit, we're keenly aware of our limitations. Medicine teaches you how very much is unknown.

That's using the Gauss scoring lens to look at one field in one profession. Imagine if we approached everything from a place of humility.

I read comments on news articles on refugee matters, vociferous ones, that are ignorant of the basic facts of the system. I’ve heard someone predict the eternal destiny of another person’s soul with the same degree of certainty that they state their summer vacation plans. I’ve seen someone with no more than Biology 11 comment with the authority of an immunologist on vaccines.

I can't say that those lessons I've learned in medicine have overflowed into every other part of my life, either.

So how about each of us, the next time we’re in a conversation - with a client, in a staff meeting, on social media or out to dinner - consider whether we truly know the answer to the question at hand.

And if not, take two points for keeping our mouths shut.


Cross-posted at www.freshmd.com and www.mothersinmedicine.com