Incentivizing Grades

I really don't think incentivizing is a word, but you know what I mean.

My daughter made it through the first quarter of middle school, and she's doing quite well. But I can tell that things aren't coming quite as effortlessly as they were for her in lower school. She seems to have an external locus of control about studying and grades - her friends that study just "know how to do it and I don't." I'm working on changing her worldview here - giving her more of a sense of control. I'm not really worried about her grades so much as her learning that effort brings results. Natural talent can only take you so far. I'm reminded of David Brooks' 2009 opinion article about 10,000 hours.

I get that organization is a learning curve when you go from having primarily one teacher to having a complex schedule that changes every day with seven different teachers. My daughter is very organized and is slowly learning to be tech savvy; the school posts most of the assignments and tests online.

Her dad and stepmom and I have recently been having discussions around putting incentives around grades - just to make her a little more motivated. She gets lost sometimes in back episodes of Glee on Netflix - a recently discovered obsession. I worry about putting incentives on grades but the more parents I talk to I realize that this is common. Some even put incentives on practicing sports and music. I'm primarily bumping into monetary incentives - like $20 an A at the end of each semester.

One mom told me, "I go to work because I get paid. Why shouldn't my kid get something for his/her effort?" I'm not sure I'd like my work quite as much if I didn't get monetary compensation but I do love what I do. And I've got to pay mortgage and bills and student loans somehow.

Any advice or thoughts on this subject would be very much appreciated. My feelings are all over the map.

Taking calls

I love my iPhone.  I take it with me everywhere I go: into meetings, into patient rooms, into the bathroom. (I don't use it in the bathroom, I swear.) 

Part of the reason I am so unwilling to separate from my phone for even a minute is that my phone is the only contact number that the daycare and the school have to reach me.

I assume when I get a call from daycare that whatever they are calling about must be vitally important. I'm immediately filled with terror until I answer the phone and discover that:

--my daughter was bitten by another kid

--my daughter bit another kid

--my daughter has a tummy ache

--my daughter is out of clean pants

--CONJUNCTIVITIS 

But it doesn't matter that the content of basically 100% of these calls has always been non-urgent. If I get the call, I feel like I have to drop whatever else I am doing and answer it.  So I excuse myself from the patient I am with or the meeting, and I take the phone call.  Then I apologize profusely when I return.

I'm sure in the days before cell phones, the daycare would be less likely to call me, knowing they would have to go through a receptionist or page me. But it is what it is.  

I suppose I could not take the calls if I am with a patient. But I'm pretty sure that I would be so distracted, I would be completely worthless. I mean, what if it's not just that they're out of pants? What if something is really wrong?

MiM Mail: Respond to the itch?

Dear Mothers in Medicine,

I am a 29 year old single mother of 2 boys, ages 7 and 3. I'm not in medicine as of yet, but about 6 months ago started getting the itch that my calling is to be a Family Practitioner. I'm so glad to have found your site, as I am torn between following my dreams and putting my childrens' needs first. I wonder if anyone has advice - is there any way to do both?

I live near Cleveland, Ohio and moving isn't really an option (to my knowledge) since I am divorced and share the children with the ex 50/50 (I have them every other week). It also might be good to know that my 7 year old has ADHD. Some people consider this to not even be a true condition, I understand, but my child is severe and cannot even attend school without receiving his medication twice daily. I am really the only one who understands him and can give him the love he needs unconditionally. So I am definitely a huge part of his healthy well being. My younger son needs me too, of course, but is very close with his father. So I worry less about my younger son.

Currently I am a Sign Language Interpreter. For the past 11 years, 90% of my work has involved medical settings. So, I've had the opportunity to shadow just about every aspect of the medical field. It has been an amazing experience! And that's where the hunger to become a physician myself began.

I noticed that for just about any other foreign language you can find a doctor with whom to communicate directly, if you look hard enough. In Ohio, however, there apparently are no physicians fluent in American Sign Language whatsoever. Because of my passion for the deaf community, this saddens me. Even with extremely skilled interpreters facilitating doctor/patient communication, I truly feel that some (possibly cruicial) nuances of the language are lost in translation. I want to close that gap in patient care. We really are behind the times in this, as a society.

Other reasons I long to enter medical school: I have a strong passion for the sciences, math, and especially solving mysteries. What better mysteries to solve than those which could save or better someone's life? I was standing outside a patient room in a dermatology office and happened to overhear the conversation between the attending physician and one of the residents there. I immediately saw myself on both sides of the conversation - first as the resident, sharing the information I had gathered from the patient with my attending and gaining confidence in my abilities to correctly diagnose and treat each issue, taking into account the special circumstances of each individual patient. But I could also see myself as the attending physician. I know I would love using the leading questions to help new doctors grow and learn in their profession. I can see myself there, as if it is as close as tomorrow.

Now, I don't know if my background will be a hindrance, as I was home schooled, and only have my Associate's degree so far. I pressed forward and earned my degree from a local community college despite my family's protests. My family is very grass roots and took offense to me wanting to go farther in my education than anyone else in the family ever has. But I did it. I am a very determined individual, so I know I could get through medical school. Afterwards, I would strive to be the very best of physicians by always being willing and ready to learn everything I can - never being satisfied with my current knowledge.

So I guess what it all boils down to is this: Would it be possible for me to be a medical student and a good mother to my two children? I know my life will never feel complete if I don't reach my full potential educationally/vocationally, but I don't want to ignore my childrens' needs either, as my parents did. They should come first.

At first glance it might be easy to say, "Well, its too much if you have children. You'd never see them," and that might be the bottom line. But currently, my income is barely enough to survive. Being a med student would actually increase the funds I have to use throughout the year substantially as compared to working all that I can currently.

So I'm just looking for options and advice. Is there a way in Cleveland to be a part-time med student, perhaps? Or set your own schedule somewhat, since I have every other week without the children?

Thank you so very much for your time and consideration. I truly value any gems of insight you can provide.

Sincerely,

Torn

Would You Care For A Patient With Ebola?

Genmedmom here.

Last week, a patient with risk factors for Ebola exposure, and who had medical issues, walked into our office.

Kudos to our N.P., who handled this very well. Upon learning of the potential exposure, she called infectious disease at our hospital, and they walked her through the appropriate screening interview questions. It took awhile, but she was able to determine that this patient was extremely low-risk for direct contact with the Ebola virus, and was not exhibiting any suspect symptoms. She was given the all-clear by infectious disease, and proceeded to take care of the patient.

Of course, this drove home very quickly the fact that any of us could be called upon to make a similar evaluation at amy time. I know I opened our hospital-issued Ebola risk stratification and action guidelines and read them over several times.

All day and on the long drive home, I imagined what I would do.

My first instinct was: Of course I would step in and help, no matter what any patient had or may have. I'm a healthcare provider. That's my job.

But.

There are now two nurses who contracted Ebola through caring for an infected patient in Dallas, despite knowing the diagnosis and wearing all the recommended protective gear. This is a virus with a 40 to 50% case fatality rate (now reported as closer to 70% in West Africa, due to lack of resources and care).

I'm a mother to two very special little kids. Could I justify knowingly exposing myself to a highly contagious virus with a grim fatality rate?

I went back and forth in my mind.

There are many healthcare workers in this country... But my kids only have one mom.

On the other hand, I do think that nurses and nurses' aides are at far greater risk of exposure, due to the inherent nature of their jobs and the mode of transmission of the virus. Now that I am an outpatient attending, I am rarely exposed to patients' body fluids.

But.

It only takes one, tiny exposure.

Of course, we have had a providers' meeting about this, and we did review our office protocol again. If needed, we have the "moon suits" and a designated isolation room. We have all the phone numbers to call to arrange transport of a suspected case. We have solid resources, so unlike our counterparts in West Africa. My heart goes out to them and to all the poor people suffering with this. We are lucky over here.

But.

I don't know much about donning layers of protective gear. I would likely screw it up. It only takes one, tiny exposure.

How would I then limit contact with my family, not get too close with my kids, for twenty-one days? I'm always clearing noses, changing diapers, wiping binkies... it would be near-impossible, and nerve-racking.

Ugh.

I don't know what I will do, given the choice.

I know that many hospitals are compiling lists of volunteers, staff who are willing to care for patients with Ebola, including aides, nurses, physicians.... I understand that most of these lists are pretty short. I have no idea what our hospitals' list looks like. I know I am not on it.

I am very curious what others have thought about this, especially the hospitalists and nurses out there, who would likely have more direct and frequent contact with a case should one come in.

Healthcare provider-moms, what are your thoughts?

And if you haven't thought about it, you should....


--Genmedmom, also at www.generallymedicine.com

Journal Club: Women in academic medicine

In March, the Annals of Internal Medicine published a study by Jolly and colleagues  demonstrating that women in academic medicine -- those holding K grants, or career development awards -- do more domestic work than do their male counterparts. There are a lot of reasons: more women had working spouses than did men in the same position, but that didn't explain the whole difference. The article itself is quite interesting, but the editorial that went with it (accessible by same link) -- written by two women in senior academic roles -- was what really got my attention. They suggest that the differences are really a matter of choice, and that disparities are not as disturbing as the study authors suggest.

They ask: "...is the fact that talented women may choose to shift a few hours from research to their family roles until the youngest child is in high school a threat to academic medicine? We certainly do not think so."

I think the perspective of these very successful editorialists is one of hindsight rather than foresight: we made it work, in traditional or non-traditional ways, and so why are you so worried about a few hours here and there? The answer is that we won't have the jobs we love if we can't make it by the standard criteria -- these being acquisition of grant funding, publishing papers, and providing patient care. I certainly appreciate, and have taken advantage of, the flexibilities of my research time -- but flexibility is an illusory concept. The hour I spend (or that my husband spends -- I think this equally applicable to both genders in many ways) taking the kids to school or getting home earlier is at some price, either in late nights or in projects unfulfilled.

You can see my response, written with two colleagues in similar positions (we are all women with K grants, patient care responsibilities, and families, trying to make it in academia) with the original article.

What is fascinating to me about the dialogue that goes on in these letters is the span of decades of women's perspectives that are included among the letter writers. This is a pesky problem and it won't go away soon.

Dena

Guest post: Taking a year off before medical school

I found MiM while studying abroad, trying to decide between PA and medical school, and being thoroughly terrified of not being able to spend time with my future family if I became a doctor. Reading all of these amazing stories from mother doctors helped erase my fears. I just wanted to give back to the blog, if possible. Also, I thought there might be some other undergraduates out there who can relate. So, here are some recent thoughts:

Had anyone asked me three short years ago what I would be doing after graduation, I would have immediately replied, "going to medical school." After three long, but fun and enriching years at a small liberal arts college known for it's rigorous science reputation, I'm ready for a break.

How did I get from that young, enthusiastic 18-year-old to a 21-year-old who self-professes her exhaustion from school? How did I decide that I am probably going to delay motherhood for an entire year, since I'm planning on waiting to have a family until post-residency? (that was a pretty large factor in my thought process) No, I didn't have a horrible college experience. I didn't have to retake classes, or even get "lost" along the way. Honestly, I just grew up. Needing a break isn't something I'm ashamed of. In fact, as my aunt said, it's probably one of the smartest things someone looking at graduate/professional school can do. I realized I'll have one year in my 20s not in school-- whether I take a year off or not, so why not make it now? A year off will grant me the opportunity after 18 years of education to stop stuffing equations and facts into my brain and fit in some life experiences to look back on and utilize. I will be able to start medical school refreshed and ready to learn, not just going through the motions to add "MD" to my name.

So many people reply, "Oh," when I say I'm taking a year off. I practically have to convince them that I'm genuinely excited to have time to experience more of the world. I believe it's perfectly acceptable to do whatever is right for you, whether that's powering through, or taking a break! However, I think some people need to realize that we don't always need to be in such a rush to get done with something to move on to the next phase. Slow down and enjoy today because tomorrow may be completely different.


From a "traditional" college senior at a small liberal arts university in the Midwest who plans to become a pediatrician. 

Flowers for KC

Our fearless leader KC organized a meet up - first IRL (in real life) for MiM's in DC this past weekend. I can't remember the birth date of the blog because I wasn't here but I've been around for a few years.

It was small - we are a busy group so many couldn't make it but I got to meet T, Mommabee, Juliaink, m, and KC.

KC sandwiched us between two conferences - one in New Hampshire on education and another in Chicago on blogging. She coached soccer Saturday morning for her son then met us at the Smithsonian Museum of Natural History. It's her I want to write about here.

Although I hadn't yet met KC in person, she is an incredibly supportive ringleader for our unruly bunch. If I e-mail her a question at midnight I have an answer waiting on my phone at 6 am. She has guided me in the perils of people trying to pull you in to advertising a seemingly worthy cause just to promote a marketable item. She has listened to e-mail rants I would like to make online about working situations or frustrations, knowing that it would be inappropriate because they were too fresh in my head. It's better to turn that anger into thoughtful pieces once the mood has passed. And she probably does that and more for all the other MiM's here - that's a big responsibility.  She protects us like a guardian angel - she saw too many negative comments a few years back and made the commenting process less anonymous, not only for the writers and guest posters but to keep the community supportive and the commenters accountable.  When I write on MiM I'm writing to an audience, but I also feel like I am writing to KC since she invited me here in the first place.

Mentors are people that you encounter in your life that create a space for you to grow and flourish and learn. I've been lucky to have many, and I definitely count KC as one of them. I had seen her picture in our Big Tent discussion group, but I wasn't prepared for her huge presence. I say huge, but she is a petite beautiful woman whose Chinese roots are evident in her features; dark hair, tea-colored skin. She has a bright smile that made me feel instantly welcome in DC, a city I was becoming acquainted with for the first time. Her fashion sense is impeccable. I learned she grew up in a New Jersey town not far from where my boyfriend, who accompanied me on the trip, attended high school.

My emotions surrounding the weekend were enormous - I imagined breaking down upon meeting her but it was just like meeting the popular girl in high school you were so intimidated by but she turned out to be a really cool person. Her accolades, at a year younger than myself, are astounding. Woman Physician of the Year for creating this space. Three amazing children - I delighted in conversing with her older son about animals and following her daughter through a museum crawl space that took us to a display about common insects we reside with in our homes. Mommabee instantly charmed the youngest boy; if she was here in Arkansas I'd recommend her as a pediatrician in a heartbeat. KC's supportive husband whom she met in medical school was entirely focused on the children and not at all interested in being the center of attention at our meet up at the museum.

Dinner with KC and m Saturday night was incredible - we chatted about posts and long time followers whose comments we loved and future directions and personal goals. KC seemed to take the back stage - she did all weekend - I convinced myself it was by design to let us shine. When drawn out in conversation her words were sparse but invaluable. More substance than fluff. M asked her, "What is your favorite outcome of starting the blog?" Her answer was immediate. "The readers. Whether encountering them face to face, or through e-mail. When they tell me how much it means to them to have found it. How it helped them." It was almost 11 pm when I met my boyfriend at the Metro to head back to our hotel.

I reflected on some of KC's words at dinner on the Metro. "I am invested in creating a space for our contributors and guest posters to write about what they want, when they want to say it. I don't want to control the content, I want to support creativity. A space for people to just be themselves." I must admit, I've been angry at KC. Misplaced anger, derived from guilt over not writing for months when I have had trouble writing. Anger that she didn't hold me to my pledge to post once a month. Then intense gratitude when she welcomed me back into the fold when I was ready to write again.

After some fun spa time on Sunday morning I learned a little more about KC. She has blogged in the past about her husband's year long deployment to Afghanistan when her youngest was two weeks old and her older two were toddlers, but I learned more about the challenges and fears surrounding that time. Another mentor-worthy feat - the insurmountable becomes existence and manageable day to day. Because if you look at it from a distance, how could you handle it? I asked her, "So is it done? Is he home for good?" She replied, "No, he could be called out any time."

When T showed up for brunch Sunday morning with us, she was full of regret. "I wanted to stop by a florist. But it was closed. I wanted to bring you flowers in appreciation for all you've done for us." T lives close to KC - they have published many articles about social media and medicine together since they have met. Juliaink was a pleasure to meet - I got to tell her in person how much I loved a poem she wrote years ago. I couldn't help thinking during the brunch, what a perfect idea for a gift for KC. A flower. A mirror image of her - something that packs a powerful punch with its image and color and strength, all the time belying a fragility that lies within it - within us all.

She is more than a flower, though - she is the gardener here. She planted the seeds. She waters us and helps us grow and find our own voices and learn from all the amazing voices in this community. I have had many mentors in my life, fabulous in their different ways, but none shares the quiet but unyielding support of KC. Now that I've met her maybe I can get her off of this pedestal and be her friend.

Happy birthday KC. You deserve much appreciation. My emotion didn't come out in waterworks this weekend, but hopefully it can be conveyed in this post. You are an inspiration.

MiM Mail: A married college senior deciding between NP and MD

Hey Mothers in Medicine! First I would like to say how much I have enjoyed reading your blog. I found it about 6 months ago and I find myself reading through posts weekly. The writers have so much great insight and encouragement for women in the medical field. I have a question that I would love to ask on the blog!

I am 21 and a senior in college. I am also just recently married to my wonderful, loving, bright husband who I met my freshman year. He is 22 and in his senior year of college as well. My husband and I are both biology majors and will be graduating in May 2015. On top of that we are both athletes at our Division 1 University and got married this past summer. My husband has already applied to medical school for the coming year and we are waiting to hear back from schools once they start reviewing applications. I entered college as a Biochemistry major, wanting to pursue medical school (or at least I thought I did?) Around my sophomore year of college, I began to feel a lot of unrest as to what career path I was going to choose. Medical school seemed so daunting and like it would hinder my ability to be the future wife and mother that I had the desire to be. I felt pressured to pursue the absolute highest degree (medical school) or that I would disappoint my family. I now see that they were/are just encouraging me to follow my dreams and pursue my highest potential (but still it can feel like pressure, you know?) I have always had a strong passion to help and serve others, love international mission trips, and volunteering in my community. One of the biggest reasons why I wanted to pursue a career in medicine in the first place was so that I would have a skill that I could offer to help others in need, whether in the US or abroad. But when I began to sit down and really think about my future, as a wife, and mother (we hope to have a big family and adopt!), I really began to feel anxiety about medical school. I grew up in a home where I was in daycare from 3 months old, my mom was a lawyer, and always working, even staying up until 3 am to get work done to provide for me and my siblings as a single mom. I love my mom with all my heart but I learned from her and my childhood that I want to be able to have more time and emotional energy to invest in my children, and my husband.

I began to think about nursing school instead, and even PA, but I just didn't feel peace about either of those paths. I felt like I wanted the knowledge and ability to care for others to the best of my ability, and the autonomy to be able to make decisions and have flexibility in my schedule, and just felt like I couldn't reach my potential as a nurse or PA. (I love nurses btw, my sister and best friend are both nurses). So, I bounced around from major to major for a semester, even looking in to speech pathology and special education... but something about the medical field just has a place in my heart. The two paths that I am now trying to choose between are NP and MD.

After a lot of soul searching, prayer, and talking with my husband, I am seeking your advice on a career path between Nurse Practitioner or Medical Doctor. I am interested in primary care. My situation is a little unique, because I am married in college and my husband is also pursuing medical school, and also has the potential to be drafted as a professional athlete (he was drafted this past year but declined to finish his undergrad education first). We have a lot of "unknowns" in our life right now. I want to be with my husband, support him in the path he chooses wherever he may go, and start a family in our mid to late 20s. But I do not know what door will open for him or us in the next year. I want to be there for my children and have time to spend with them. I want to also have the ability to contribute to our family income, and heaven forbid if anything happened to my husband, to be able to provide.

Right now I have applied to accelerated nursing programs (BSN) in the same areas as my husband's potential medical schools. The benefit of NP for us is that I could start making money after a short 12 month BSN program (working as an RN, relieving some of the potential financial stress of his medical school), and could move anywhere with him and work if he does play his sport professionally. I can also continue my education, either during or after starting a family, and can even do part time DNP programs which I think would allow me to have more time at home/to support my husband and better manage our debt (we will have no debt after undergrad but will have to take out loans for grad school). One more benefit to having the training of a nurse, is that those skills translate really well and are useful in all areas of care which would be great for medical missions, or even working with my husband later in life.

If I chose to pursue medical school, I would have to take a few more classes (could finish them all in 1 summer) and apply for the following year (starting in 2016). That would mean I wouldn't graduate medical school until I am 27, IF I get in my first try, and then a 3-4 year residency. So 31 before I'm really working). I would love to be completely autonomous, have the ability to set my own schedule, and have the knowledge and skill set that comes from medical school to provide excellent patient care. Also, if I wanted to work part time later in life, it would still provide a great salary, giving us the ability to give generously, travel overseas, adopt, provide for our family, etc. If we both go to medical school, however, we would be up to our ears in debt. I am also worried that medical school would make it very difficult to be have children in the first place (in my mid-late 20s), and be involved in their lives. But, I can't predict the future and when God might bless us with children, so I try not to get too ahead of myself. ;)

The question I have is, are there any pros/cons to NP and MD that I haven't thought about? Do NP's feel like they are well-respected among medical professionals and patients, have autonomy and flexibility, and the academic background they desire to provide excellent care? To MD's, do you feel like you have the ability to be there for your children/support your husband during and after medical school? Do MD's think they would be satisfied with NP, or wish they had chosen the NP route to primary/family care? How is the care they provide different (patient interaction, knowledge, skills, etc?) How is debt managed during and after NP and MD school? And lastly, how did your husbands feel about your schooling/work life? My husband is so supportive and wants me to pursue the career path that will make me the happiest, but I just really want to know if medical school (or DNP school for that matter..) had an affect on you ability to love and support your husband?

I want to be very wise in the decisions I make now, because I know that they will affect the rest of my life, my family, my career, and the people I care for. I hope to be able to find a way to serve God, love my husband, be there for my kids, and provide excellent patient care. Or is that all too much to ask?? ;)

Thanks so much! I hope my question gets chosen!

Anonymous :)


Editor's note:
See also:
MiM Mail: Two doctor families
MiM Mail: Regret going into medicine?

Moving Misadventure

This one's not about mothering. Or medicine. But at least it has an "M" in front of it, so I'm plowing ahead, competing for the worst moving tale out there.

I've moved a lot in my life. My ex was pretty ADHD about buying houses, and I went along for the ride seven times in our thirteen year marriage. All in the same city; but it was pretty chaotic in retrospect, although simultaneously exciting and exhausting at the time. So I consider myself an expert on moving. No degree, but lots of experience. These last four years in the same house after the divorce were the longest years I've spent in one place since high school.

My boyfriend found this new house for sale while wandering the neighborhood - it's only two blocks from my old one but the space layout is much more efficient for me and the kids - and it has a large backyard with a creek running through it. It backs up to green space. We see a doe and her fawn from time to time - once while eating breakfast. The backyard alone is worth the price of the house, which was a lateral financial move.

I did the reverse of what all the books tell you to do - I bought the house, put mine on the market, and had a stressful Summer. But at the midnight hour I had some buyers come in with a good offer and I unloaded my old house before I had to pay two mortgages. They were living in a hotel, moving from another city, and wanted me out so quick I didn't have time to pack. I worried, but my neighbors said, "We always hire packers, you are going to love it. They bubble wrap the most ridiculous things, like toothpaste." A bit of a splurge, but considering I had no free time until the move I hired a packing and moving company with a decent reputation around town - I learned it was under new ownership since I last used them.

They packed so quick I figured the owner must have dispatched 10 workers. The day of the move, not this past Saturday but the one before, my boyfriend, kids and I were back and forth between the two houses. I had spent my Friday off lining kitchen and bathroom drawers. At around three in the afternoon I got a call from the movers - I was making a quick grocery run. "We have two trucks loaded and will be there in about thirty minutes, after a quick lunch." Game time.

On the way back from the grocery I drove by the old house on the way to the new - smiling at the lack of moving trucks. When I got to the bottom of the street to turn left toward my new house, I encountered a scene. Ambulance, fire trucks, police cars, tons of gawkers in the street. Everyone was looking at this:

It was a moving van, crashed into the corner of a house. I tried in vain to wrap my head around how it might not be mine then decided to pull over and check it out. Apparently the truck's brakes went out ("We serviced them in house three weeks ago!" the owner assured me) and the truck careened down the hill at 40 mph. The passenger mover bailed out onto the street in fear, damaging his ribs, and the driver went to the ED with back and neck problems. One of the head movers I had gotten to know pretty well told me it was all my boxes, the furniture was on another truck. 

The owners of the house that was hit - they were inside watching a Razorback game - said they thought a tree had fallen on their house (it happened to them two years ago during a winter storm - tree narrowly missed killing their son. They wondered aloud if this was a sign to get the heck out of the house). All the living room pictures flew off the wall onto the floor. The front door frame was off; a sure sign of structural damage. Windowpanes were cracked upstairs and down. I'm not sure I started off on the right foot as a new neighbor. 

My stuff was finally offloaded to another truck at about 10 pm so the wrecked truck could be towed. My daughter and I brought the movers dinner. They had a messy job - crushed vinegar and bleach dripped onto their legs from wet boxes. My anxiety creeped in over what further damage was being done to the contents of my life. My daughter took this pic at the front of the van - scattered with my and my kids scarves and mittens; many boxes ruptured and contents flew. "Mom, look! The ultimate Elf on the Shelf. Funny it ended up on the dashboard."

The owner blew in for about five minutes during the evening blustering and blowing off the event, worrying over his troubles, "Another of my vans ran over my employees' car last week! And now this!" without much empathy for my stuff. The next day no one showed up until 1:00 - my boyfriend and I worked for three hours until they arrived. We both got cut - there was tons of broken glass. I learned why the packing happened so fast - it was the most slipshod job I've ever seen. Unpacking was like an emotional roller coaster - joy at what made it and sorrow at what didn't. Hopes and talk of repair. Kid gifts over the years, vacation mementos, art, picture frames; all shattered. For the first time in seven years at my job, I thought of calling in. But work was comfort Monday compared to the chaos of the move. 

Caption: Cecelia baby footprint butterfly plate broken in four pieces: this is in the repair pile.

As the week wore on insult was added to injury. The entire contents of my bathroom was poured into one large box. Cleaning busted make up meticulously off of curling iron cords and plugs rendered unpacking each box a glacial event. Soy sauce off of every food item. As I opened each box, I kept expecting someone to pop out and say, "Guess what, you are on Candid Camera!" When the owner asked for the money for the move on Tuesday, "I thought you would pay me and then I would reimburse your damages at 60 cents per pound," I told him my damages had already far exceeded the cost of the move (I did tip heavily and buy dinner for the movers both nights). Twenty to thirty percent of my dishes and glasses and vases were crushed. I was so angry at the beginning of the week I was calling lawyers but by Thursday and Friday I was just sad and tired and defeated. 

And now I am ready to move on and put it in the past.

Good news: 

My new house is awesome Jack has a zillion new friends they all play outdoors and ride bikes and run up and down the creek - he is in Heaven and not on his ipad quite so much.

My just as OCD as me artist/architect boyfriend and I spent the entire weekend making my house look amazing.

My daughter showed amazing empathy - giving up her goal of going to the new local popsicle shop that weekend (I snuck her there late Sunday in gratitude) for helping arrange, after her room, my medicine cabinet and kitchen. 

Other moving tales I've heard that rival mine:

One of my partner's friends were moving out of state to Wisconsin about ten years ago; the truck caught on fire and they lost 90% of their stuff.

One guy I told knew someone who hired a not mainstream company - the movers took their car keys and came back in the middle of the night the next night and stole their car.

Funniest quote from the hell weekend, as told by my boyfriend:

"When you called me and told me about what happened from the scene of the accident, I was sitting on the back porch with C and told her. She said, 'I guess this means we aren't going to Le Pops tonight.'"

S said, "I'll bet going to Le Pops tonight is the last thing on your mom's mind. Our biggest job right now is to keep her head from spinning off of her neck. Let's not mention Le Pops."

To his and her credit, she didn't. Which is why I was moved to take her Sunday night - snuck away while the boys were eating pizza with the movers. She had salted caramel dipped in milk chocolate and finely crushed cookie crumbs. I had salted caramel dipped in dark chocolate and crushed almonds. We both declared, moaning between amazing bite after bite, that we very much deserved it.

Not a Soccer Mom

If I don't enroll my daughter in soccer this season:

1) she will not make friends

2) she will not get any exercise

3) she will not get a scholarship for college...

4) if she gets into college at all

5) I am just generally a bad parent

It's all about the extracurricular activities once your kid is in grade school. When I was a kid, it was somehow enough that I, you know, went to school. Not anymore.

I've spoken to several parents who have their kids involved in a different afterschool activity every day. Some of those parents work, so I'm not sure how they manage it. They do tend to have jobs where they can work from home. None of them are doctors.

I already have my kids in an afterschool program/daycare every day. Being able to pick them up in time to shuttle them to an extracurricular activity is not really within the realm of reality.

Of course, soccer is on the weekends. So that can't be my excuse. But we already do two different dance classes on the weekends. Is it possible for me to not be shuttling my kids around between extracurricular activities all weekend? I'm tired on weekends, for god's sake.

So my daughter isn't going to be doing soccer this year. I guess I have ruined her life.

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Guest post: What's your plus one?

I love the honesty of Mothers in Medicine. I feel compassion for women stretched so thin between two callings. But I’ve got to ask you this: is there more to your life than motherhood and medicine?

I know, I know. For a lot of years, it’s about sleep and survival. But at some point, you’ve got to do you, right? You’re more than a stethoscope, a uterus, and a pair of lactating breasts.

Maybe I’m not saying this right. I definitely don’t mean to act smug. But I know I always wanted to write. I just didn’t want to starve to death, and I liked helping people, so…boom. Medicine. I studied my little heart out. I loved it. Until I lost the residency match, and I had to decide, am I going to keep chasing that ever-elusive subspecialty dream as hard as I can? Or can I do emergency medicine, see my husband sometimes, start a family, and pick up my pen and write again? I chose the second one. Either road would have been fine, but I’ve built a happy life with my childhood sweetheart and two kids, I’m writing, and I want to tell you not to forget yourself, that secret self that doesn’t necessarily earn money or praise or nurture others, it just is.

Medical-wise, I’ve got privileges at four different hospitals now, and one chief of emerg told me, “No. You can’t do it. You can’t work at four different hospitals. It will kill you.” He also limits his staff’s total number of shifts because he doesn’t want them to burn out. Autocratic? Sure. But he’s the only one I know who treats other physicians like human beings instead of widgets who have to see patients faster and more cheaply every day and night and night and day. We’ve been talking about how not to lose yourself, not become suicidal, not treat each other like garbage. Thinking about yourself as an individual and not just a service—I’d say that’s the first step. Plus, I thought it would be fun to talk about our secret selves.


Melissa (aka ACLS)
Emergency doctor/writer, mother of an 8 y.o. boy and 3 y.o. girl, in Canada
http://www.melissayuaninnes.com/blog

MiM Mail: Getting the milk home

Hi MiM,

Avid follower of five years (you got me through training...almost! Last year of fellowship. Thank you!).

Very concrete question:
I have to leave my nursing nine month old for two days and two nights for a conference (he is currently seven months old and I am anxious about this process). I will have to bring my pump, but I need some suggestions about getting the milk home. Carry on airplane with ice (does this entail a bigger ordeal since I won't have an infant with me)? Mail with dry ice? What has worked for fellow MiMs? I really appreciate your advice. I'm worried about the separation and channelling my anxiety into figuring out this milk transportation situation!

Appreciatively,
Dedicated MiM follower

Why Is Residency So Harmful? (And What Can We Do About It?)

Genmedmom here.

I'd like to thank "J the intern" for her post on physician depression and suicide on 9/9/14, as it prompted me to read Pranay Sinha's excellent New York Times Op-Ed piece "Why Do Doctors Commit Suicide?" He discusses what may have contributed to two recent intern suicides, namely, the shock of graduating from well-supported medical student to overburdened resident drowning in the macho medical culture. He describes his early intern year as "marked by severe fatigue, numerous clinical errors [], a constant and haunting fear of hurting my patients, and an inescapable sense of inadequacy."

Ah, yes. Residency.

In the comments to J the intern's post, OMDG brings up as additional factor to consider: "the elephant in the room... sometimes doctors treat each other like garbage".

Yup, I agree with that one, too. No one is more cruel to the suffering than the suffering. Many of my own emotional injury during training was at the hands of my colleagues. But, I know that I lashed out as well. We all hurt each other. I'd like to expound on that, if I may.

I well remember being humiliated on rounds, Monday-morning quarterbacked by someone fresh and showered. I cringe as I recall snapping at my intern for waking me up to check on a patient she was worried about. I'd been snapped at in a similar way as an intern. I remember with sinking stomach the disdain and sarcasm I received when I tried to teach a medical student a very simple procedure, and then couldn't do it myself. I still get angry when I think about the patients who suffered as my residents tried to teach me paracentesis, central line insertions, lumbar puncture- and failed on their attempts. I know my anger showed then. When our colleagues rotating at a small outside hospital transferred a sick patient to us in the emergency room, and it turned out to be a case of lab error, no pathology, there was derision all-around: "They dropped us a turkey, guys." When I was worried about a sick patient and called for an ICU consult, the ICU resident came, and told me I could handle it. "Don't be a wuss. Be a real doctor."

The cruelty towards women was pervasive. A pregnant resident had an early miscarriage. Still bleeding, she asked to be excused from her outpatient clinic. The chief, a woman, said no. "Just think of it like your period," she said.

A colleague went out on maternity leave six weeks early, for premature labor. Another resident was pulled from an outpatient elective to cover the rest of her rotation on the floors. The resident who was pulled was very resentful, angry to tears. "Why the f-- would anyone want to have a baby during residency? Why?" Another answered, "I'll never understand it. It's so selfish."

It's well-known that medical training erodes empathy. It took years for me to recover from residency, to feel like I could even begin to take care of people again. Literally. I did a research fellowship for three years, in large part because I couldn't imagine returning to clinical practice.

But, why did I feel this way, when my residency program was well- regarded, with many opportunities to share, reflect, even write? Why were so many of us injured and angered by our experience? So many of us recall their training with a shudder, vowing "I wouldn't revisit those years for all the money in the world."

That's just not right. How can we change it?

Open discussions confronting the cruelty of medical training may help. As a medical student, I was rotating on surgery. A rural hospital transferred a very sick patient to us, someone who had been misdiagnosed and suffered greatly. As the case was reported on rounds, there was loud derision and disgust expressed towards the rural docs. But one senior surgeon, someone so intimidating and revered that just a movement of his hand silenced the crowd, quietly admonished:

"There's no point in criticizing. Your fellow physician took the same oath you did. Assume that they tried, and that they feel terribly. We have all made mistakes, and we will all make many more. Don't waste your time on judgment."

End of that discussion, and it made an impression on me. Don't waste your time on judgment. I think, as teachers, we need to stand up and say that, and live that. Be real doctors.

We also need to dismantle that confusing paradigm of training: You are here to learn, but you should already know how to do it. Sinha also illustrates this in his essay. You were a coddled student in June, and then the doctor in July. You feel like you're supposed to know it all, because everyone is acting like they do know it all. Everyone's got a front. To ask for help is to be weak.

I remember very early in training, asking how, exactly, to write a prescription. I'd never written one before.

Oh, the rolling of eyes, the quick snappish explanation. I was so upset, I didn't catch it all. I spied on other people writing prescriptions and copied them. Seriously, how the heck are you supposed to know how to write a prescription if no one's really taught you?

How are you supposed to know how to be a doctor, if no one's really taught you?

I'm interested to hear what others' experiences have been, good and bad, with an eye towards practical suggestions. How do you think medical training be reformed?

Balancing parts of me

It's time to buy a new car.  Would seem a straightforward decision, but true to my planning nature, I'm trying to fulfil a number of requirements.  My eldest, HG, will apply for his learners permit in 4 more years, which falls within the lifetime of this car.  Although I want to buy a military tank in which to encase him, I realise this is not terribly practical.  So I set about looking for a safe car, the safest car if I'm honest, and find that the European (read expensive) cars have unquestionably more safety features than the locally built models.  But it comes with a big price tag, and whilst I wish to keep him safe, I also don't want him driving around in a luxury car that smacks of entitlement.  To be honest, such a car is not really me either.  I'm not sure if this fixation on ultimate safety is borne out of my work in seeing people smashed up by car accidents, and having a real appreciation for the value of life, or whether it's just me.

Of course, such dilemmas started with his birth - the safest cot, safest pram etc so this dissonance is nothing new.  A car is a much bigger investment than a pram though.  So, do I go with my cautious MiM nature and buy the European car with all the latest safety features, in case he's ever in an accident?  Or something more moderate - good enough in the safety stakes - and more in keeping with my non-flashy nature and what I'm trying to teach him about life?  Has being a MiM ever swayed your buying/life decisions?