Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.

-juliaink

MiM Mail: Med school with young children

My name is Megan. I have 2 children. My son is 2 1/2 and my daughter is 7 weeks old. I am only 20 years old.

When I was younger my dream was to become a physician, specifically an OBGYN. When I had my son at the mere age of 17, I figured that dream was over. I decided to settle on nursing with the hopes of becoming an L&D nurse. I started going to school; while taking pre-requisites for the nursing program, became a CNA. I started working as a CNA at a hospital and had my daughter when I was 19. Having a second child while still being a teenager didn't stop me from going to school. However, working in the hospital made me realize: I DO NOT want to become a nurse. Most of the nurses complained about their jobs, seemed bored, and I did not want that to happen to me. I want a fulfilling career that makes me reach my full potential in life. I didn't want to just settle.

So I decided to go back to what I really want to do in life: become a physician. I am really determined, and very excited, but it seems like everyone around me can't stop telling me how hard it's going to be.

I guess I'm writing this to ask for support and advice from mothers who went to med school with young children. My kids will be 5 and 3 by the time I start med school. Any support and advice is appreciated. And another question, did anyone with young children have anymore kids later on in life? I'm not sure if I'm okay with being done at 2.

Thanks in advance.

I'm too old for vacation care!

It's arrived.  The 12.5 year old boy child who already thinks he's 22 and in charge of his own life. Occasional glimpses of my sweet, tender, gentle boy peek out between the lashes of the billy goat gruff.  Sigh, always knew it was coming, still a shock when it's here!

 My problem, however, is not BGG, for I know it too will pass.  It's actually vacation care.  Entering high school next year, vacation care no longer exists!  The problem is, not only does he have a 9 year old sister, who will still require vacation care, but I actually think he's too young to be spending vacation days at home alone.  All that unsupervised internet at the very least.  He wouldn't be allowed out of the house, so I'm not so worried about his wandering the neighbourhood, although it's a slippery slope, and I'm sure it wouldn't be long before "Mum my can't I meet my friends at the wherever?"  The other issue of course is little girl then feels hard done by, if BGG is allowed to stay home, and she has to go to vacation care.  Another Mum at my work faces the same dilemma - her eldest is a girl, and she has two younger siblings.  Her daughter is already telling her she's too old to go to vacation care - at least my son hasn't cottoned on to that just yet, but I know it's coming (I wonder if I can still sneak him into vacation care with my daughter?)

I know many have trodden the boards before me - what does one do when vacation care disappears?
Or are the apron strings too tight?

Vacation care is an Australian version, I think, of Summer Camp - run by the YMCA (and other places), for days when school is not on, and held Monday to Friday of all school holidays (breaks?).  It's for ages up to 12 years and held at your child's school.  It's day care only, dropping off each morning, picking up each evening.  

Group think: What is the solution to the overwhelm?

It's 5:51am and I have 9 minutes to write this post. Well, I just spent a minute thinking about what I want to say and so now I have 8 minutes.

Lately, it's been feeling like I just can't do all the things I want to do, let alone all the things I've already committed to do, let alone all the things I have to do. This last year of residency has been a great one and I've become involved in many different projects that I feel passionate about: research, education, resident wellness. I feel an increasing sense of clinical mastery, which basically means I know what I know and also how much I don't know but it doesn't scare me as much. I've been active in my synagogue and at my daughter's school. I feel like all the pieces of the puzzle are, if not falling into place, at least face up on the table and waiting to find their place. But it seems like there is at least 100% if not 200% more to be done in every day and week and month than I can do.

Every email I write starts with the phrase "Sorry for the long delay in my response." Balloons that were up for my daughter's birthday party two weeks ago are still up and the stack of Thank You cards for her gifts still sits blank on the cluttered ledge between our living room and dining room, along with unopened mail and other flotsam from our stitched together life. I've been getting up one hour earlier than I have to for the last month to try and get on top of some of the research and scholarly work that I want so much to get done, and this has been helpful, but I'm so exhausted by the nighttime that I feel like I am not the kind of parent I want to be to my daughter in the few hours we have together during the work week -- I'm easily frustrated, less playful, and distracted, just waiting for the moment when I can lower myself into bed. I fall asleep in literally 5 seconds. The cost of starting a couple of new projects -- all of which I am excited by -- is that I'm spread thin on all of them, taking weeks longer than I promise to get things done, always twenty or thirty items deep on the to-do list. If I feel like I'm a leg up on the work side of life, I'm one step behind on the parenting side of the equation, with friendships and marriage and housecleaning and family always tap-tap-taping at my chamber door. And did I mention the emails? Oh, the emails. How and when will I master the emails?!

Sometimes I wonder to myself: Are we busier than people used to be? Am I uniquely incapable of multitasking? But wait, all I do is multitask. And is the overwhelm an external reality or is it a reflection of something about me? Would I be overcommitted and frazzled even if I were shipwrecked on an island with nothing but palm trees? Should I be doing fewer things? Or maybe this model of living is a successful one -- after all, in the end I do manage to do a lot and much of it at the "good enough" or even "good" level. But I long for a little peace.

I'm already over time by 9 minutes and 9 minutes and late for the shower that leads to throwing some kind of lunch in my bag that leads to hitting the road, so I'll pose my question and see what your thoughts are. Does anyone out there have creative strategies for getting on top of the overwhelm?

Thanks in advance for your thoughts!

MiM Mail: Year off

Hi MiM Community!

I am in the middle of a year off, and at a bit of a crossroads. I got pregnant with my second child in the middle of MS2, took the Step 1 7.5 months pregnant (not recommended), and gave birth at the end of August. My school told me that I would only be able to take 6-8 weeks off max (8 was stretching it) if I wanted to continue with MS3. If I wanted/needed more, I had to take a year LOA and come back next July to start rotations with the next class. When I had to be off my feet during my 9th month, I decided to just take a LOA and enjoy my year off with my new baby and toddler.

I'm now 4 months into the time off and unsure what to do. I have been dabbling in continued research, but my heart is not as into it as I thought it would be. I do miss school and really look forward to going back and finishing, but all the plans I had for this year pre-baby (research, volunteering) just doesn't seem as exciting. Is it so terrible to just be a mom for a bit? Am I selling myself short for future residency applications?

I did OK on step 1. Not great, not terrible. I am not necessarily interested in a very competitive specialty, but I am very geographically limited (to basically the one big city I am in now) due to the abundance of family and support, and my husband's job. I know that this is my last chance to take my older daughter to ballet, join mommy groups, take my baby to music class, etc. Can I just enjoy my time without feeling guilty about not progressing my medical career? Or is that just not realistic and I should "get my act together?"

Thanks again for being an amazing community!

-Boxes

I am a MS3- to- be with a 2.5 y/o and a 4 month old. I love having an active lifestyle and looking for interesting things to do with my family around our wonderful city.

I Don't Know How To Dress Myself

And I know I'm not the only one...

I was thrilled to see a physician-mom address this in the Atlantic: The Clothes Make The Doctor, by Anna Reisman. In this thoughtful and humorous piece, she describes how she met with a potential new primary care doc, and was put off by the sharp-dressed woman's stiletto heels and expensive suit. She then explores how physicians should ideally dress, and thus, present themselves.

She hit on a perennial topic of discussion and debate amongst my colleagues, both male and female. Male colleagues bemoan that they are expected to wear a collared dress shirt and tie, day in and day out. But female colleagues complain that they have no real "dress code", and thus, no guidance, on how to dress for patient care.

In my office, which is an all-female practice, the "work uniform" runs the gamut from: clean and pressed white coat over smart dress suits and heels, to dress suits and sensible shoes without the white coat, to business-casual with or without the white coat, and then, to me.

I'm usually in whatever Bargain Basement Clearance Store pants with less-dirty knit top and scuffed sensible shoes I can match when I get dressed in the dark at 5:30 a.m, with a reasonably clean white coat pulled over it all, like a disguise. I can't remember the last time I ironed anything; I think it stretches back a decade or more. I buy all permanent press or knit clothing. If something needs to be dry-cleaned, it's a once-a-year piece. Sweaters, slacks, scarves- they all must go into the washer and dryer, or be relegated forever to the back of the closet. This all is, I feel, most practical. Who has time to fuss over clothes?

I also LOVE a bargain. And while there are women who can browse Nordstrom Rack or Marshall's or TJ Maxx and put together respectable, even snazzy, professional outfits, I am not one of them.

Still, I can't let go of my old habits. In medical school, we had an informal group of women about the same size who met occasionally to "swap": everyone brought a bag of clothes they didn't want, all higher-quality stuff, and we had a party as we tried on each other's stuff. Everyone left with a "new" item, and the leftovers went to charity. If someone I knew suggested this today, I would so totally be there!

I even found my wedding dress, a 100% silk designer ball gown with an impressive train, for $250.00 at the Filene's Basement Run Of The Brides Traveling Sale, back in 2008. I considered it the find of the century, a total coup, and I told anyone who seemed like they cared how much I had spent.

I still have had no qualms with rooting through school fundraising secondhand clothing sales, and leaving with large bags of the clothes of people who are probably my neighbors.

I think some of my reticence on spending money on clothes stems from the fact that I've gone up and down ten sizes within the last five years. Yes, there were two pregnancies in there, but the ballooning waistline was not due to gravidity. It was due to the fact that I gained an unbelievable amount of weight with each pregnancy, on the order of sixty pounds, EACH TIME. Three months after my second baby, my daughter, was born, I realized that I had even GAINED weight while breastfeeding. My BMI was over 30. I was OBESE.

Then, with a two-year-long concerted effort at a low-carb diet and exercise when I could get it in, I lost fifty pounds. Babygirl is now almost three years old, and I've kept the weight off for almost a year.

Despite being back to my pre-pregnancy weight and size for this long, my closet is still filled with a mishmosh of sizes, and alot of "more comfortable" pieces, like Ponte slacks (read: knit pants). A friend and colleague recently pointed out to me, in a humorous way, that Ponte slacks are in the same category as yoga pants. Meaning, not acceptable work attire.

Unfortunately, in order to dress well, one needs two things: Time, and Style sense.

I know I will never have the time or inclination to study fashion magazines or follow style blogs. And for some reason, when I see someone who I think is dressed really well, meaning, how I'd LIKE to dress, I can't seem to replicate their look (probably because of my clothing care learning disability.)

But, I still want to look like a real, respectable, clean, practical yet SOMEWHAT stylish physician. Someone who is aware that it's almost 2015, but who is also willing to kneel down on the exam room floor to look at a patient's diabetic foot ulcer.

I know, I know. Time to grow up, learn how to iron, make the dry cleaners a regular weekly errand.

I also need a personal shopper. I have seen this mentioned on prior MiM posts (that I cannot locate right now), and people have suggested Macy's, as they offer those services free of charge. Of course, to take advantage of that requires several things: Making an appointment, taking some time, and investing in attire.

Sigh. With two children under age five, a working husband who travels alot, and boards study on the agenda every day, these things are not likely to happen anytime soon.

Tomorrow will dawn, and I will likely be pulling on a wool blend turtleneck, my black slacks with a little elastic in the waist, and Danskos.

But I will be comfy...

-Genmedmom

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!

T

Daycare better than me?

Last year, when I was on call a lot and very busy at work, I couldn't get enough time with my babe.  I always wanted more, more, more.  And I still feel that way--about the time I spend with her.  But lately, I've been feeling like I just don't do enough.  When I'm home, I sometimes just want to relax--I don't always want to be doing educational activities, or practicing walking, or force-feeding her.  Sometimes I just want to be at home with her and I don't want the work that comes with it!

But because we now have a nanny who does not provide much educational content during the day, when I get home I feel that I need to do more with her.  And because she is home all day, it's always up to me to provide healthy nutritious meals that are variable enough for her that she actually wants to eat them.  I frequently don't feel that I do a good job in either of the above aspects and I wonder if I would be better off sending her to a daycare where she is exposed to learning and a variety of food and time to play outside and when we get home, we can just spend time together and cuddle and kiss and love.

I know now for a fact that if I was a stay at home mom, I would not be a good one.  I just don't have the energy it takes to provide my Doll with all that she needs!  I'm grateful for my job, and I always want more TIME with my baby, but I just want it to be quality time where I'm not stressed with her.

Does anything I'm saying make any sense?

I am starting to hate the holidays

A few years ago, I made a post that really bothered some people, suggesting that people who have small children get first picks for holidays off, because it may be difficult (or possibly impossible) for them to find childcare. Several people suggested to me that I was a… well, I don't want to use language on this blog, but let's just say a selfish female dog who should probably be fornicating with myself.

I don't want to stir the pot but I will give my experience trying to find coverage for the upcoming holidays when I will be working:

--me: working
--husband: working
--Schools: closed
--afterschool program: closed
--daycare: closed
--babysitter 1: Will be in church and at family functions
--babysitter 2: traveling for the entire holiday
--me: screwed

I'm currently putting together a piecemeal of various elderly grandparents coming by to watch the kids, and working out a plan to come to work at odd hours. It's hard, to say the least, despite the fact that I actually have a very flexible job.

I know I can't be the only one with this problem, yet it's clear that everyone feels really angry about the idea of making any accommodations for people with childcare needs. Maybe a better plan would be for there to be some sort of reliable group childcare out there for people like us (e.g. healthcare workers) who will be working at least some of the holidays. Because right now? The options suck.

I'm Thankful for a Bridge

photo credit WSMV

Three months ago, I woke up to the buzzing of news helicopters over my house. This is not a common phenomenon in my secluded suburban neighborhood. I quickly checked the news and learned that a terrible tragedy had occurred. During the night, a tanker truck full of gasoline had crashed into the bridge that connects my neighborhood to the interstate, causing a massive explosion. Only a month from retirement, the driver of the truck sadly lost his life. As I said a prayer for his family, I also said a prayer of thanks that the accident hadn't occurred during rush hour when hundreds of lives could have been lost.

Later that day, I learned that the explosion caused structural damage to the bridge. It would have to be replaced. Fixing this wasn't merely going to take days, but 3-4 months.  As the reality of being "bridgeless" sunk in, the feeling of dread deepened. This was the bridge that linked us to all the elements of our life: work, school, shopping, church. Our world was about to change. 

I normally have an 8 minute commute to work. With the bridge out, I now must take the winding back roads for 25-30 min. to get to the hospital. Getting the kids to school would take an extra hour a day. Many of you are rolling your eyes at this, as your commutes are likely much longer. However, my location is a big part of my well oiled routine that keeps me sane. 

Early in my "bridgeless state," I had a premed student who shadowed me for a couple of days. The small community hospital where I practice, isn't a teaching facility so I don’t interact with students very often, but this young lady was simply delightful. She was reapplying to medical school this year after failing to get a spot last year. She was compassionate, intelligent and her MCAT scores were higher than mine had been when I applied. I couldn't believe that she hadn't gotten in yet. 

I realized that I've been at this long enough, that I have forgotten about the angst filled years of simply trying to get into medical school. I determined to use my extra commute time, to reflect on gratitude, rather than wallow in self pity over my silly inconvenience.

I have, for the most part, kept my good attitude. While still annoying, the commute hasn't been as bad as I thought. It makes me triple check my grocery list, because there are no convenience stores nearby. And rarely do we eat out for dinner, because it takes too long to get home. The worst part has been missing extra time with my kids. My short commute usually alloys me to run home and tuck my kiddos into bed, even when I'm on call, but no so much these last few months. 

  

In this season of gratitude, I am thankful for two very simple things:

I am thankful that 17 years ago, a committee somewhere said yes to my medical school application and gave me the privilege of being a doctor. 

I am especially thankful that this morning {insert drum roll please}I drove across the NEW BRIDGE. I'm thankful to have my short commute back. I promise to never take that silly bridge for granted again.

What seemingly mundane items are you thankful for this year?

An extra cup at the Thanksgiving table

As a pediatrician-mama, I find that Thanksgiving is -- to use a timely cliche -- easy as pie. I don't have to search my mind for even the shortest moment to access my gratitude place: My child is alive and healthy (*gods, do not be tempted by this statement*). The ocean of gratitude I feel for this has no bottom. I am aware of it dozens of times in the course of my day taking care of sick children: How lucky my partner and I are. How tenuous and temporary and fragile our luck is. How we can claim no credit for this fortune. There are many, many other things I am grateful for, but even if all those other things evaporated, this one thing, this everything, would still fill me up on Thanksgiving day and every day.

Yesterday, as a pre-Thanksgiving treat, my partner came and picked me up from work so we could pick my daughter up together from school. It was a gray, cold day and little specks of icy rain were making it hard to keep my eyes open as I waited just outside the entrance of the hospital. I'm on Jeopardy call all weekend but if I'm not called in, I get to have four days with my family in front of our slightly creepy ventless gas fireplace. (Where does all that CO and CO2 go? Whatever -- pass the pumpkin pie!) So I closed my eyes and sent a surge of warmth towards each of my co-residents, wishing for their well-being and the well-being of their families. Sure, it started from a place of self interest and humor, but then it felt good and right to be sending them little non-denominational blessings in honor of the holiday. There is a special place in my heart forever for the people I am training with -- a certain affection and protective instinct and a huge folder of moments in which these people have awed and inspired me, sometimes unexpectedly.

Then my mind turned to all the families I have cared for who are without a child this Thanksgiving. The babies who never made it into the world, the babies who stayed for only a few hours or days, the babies who left this world after a long struggle in the NICU, the babies who arrived to our ED in the early hours of the morning already cold and pulseless, the children whose otherwise healthy lives were shortened by cancer or trauma, the children with chronic illness who were in and out of the hospital for months or years before a cold or stomach bug proved to be more than they or we could fight. Then I thought of all the children whose lives have been shortened by war or preventable or treatable disease or famine or -- this week especially -- by racism or homophobia or genocide or hate-motivated injustice of any kind. I thought of their parents and the huge, gaping unfairness of what they were given by luck, or the universe, or God, or just random chance, depending on what you believe. I wondered how they go on with things like Thanksgiving. Would I be able to? In Judaism, when someone dies, the thing you say to the people who love them is: zachur li'vracha. May their memory be a blessing. And so, my eyes closed against the rain, I sent this out to all the parents who have lost children: May the memory of your children be a blessing and may there still be things to be grateful for.

On the Jewish holiday of Passover, we leave a cup of wine out on the table for the prophet Elijah. The teaching is that Elijah will one day come as an unknown guest and you want to be ready to welcome him. This year at my Thanksgiving table, I'm going to leave out a cup for all the parents who have lost children, that they may know they and their children are not forgotten. That they should feel welcome back into the rhythm of ritual and community, whenever they are ready. Also, that we may never take our good fortune for granted. And that we may fight in whatever way we can to prevent parents from losing children needlessly.

Happy thanksgiving to you and yours today, from one mama to another! And a special shout out to all the mamas who are taking call today so that others can be with their families -- Thanksgiving is whenever you get home!

-Also posted at whatbeginswithm.wordpress.com

Vacation sans bebe

I read a few articles recently about Americans and vacationing. Of the only 25% of Americans who have paid vacation days, they have an average of 3.2 days left unused each year (OECD, 2013).

Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.

Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).

Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!

(scrambled eggs, french toast, and large mimosa from Slim Goodies)

Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.

(crawfish on grits, from Cafe Reconcile)

And the tie for best dinner - Bacchanal Wines and Houstons.

Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.

My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.

And then the CHICKEN arrived.

Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.

(courtyard at Bacchanal Wine, image from http://fleurdelicious-nola.com accessed 11/1/2014)

Beignets - and on our last night in NOLA, we toured the city, stopping in shops. Eating. Drinking alcohol-containing beverages in plastic cups while walking (crazy that you can do that legally in NOLA). We ended the night on the banks of the Mississippi eating beignets from Cafe DuMonde with B and R. We heard approaching music as a first-line band leading a wedding party approached. As is the customary, we all stood up and joined in dancing and singing “As the Saints go Marching in” under the twinkling night sky.

Here’s to the best vacation sans bebe, NOLA, we love you bebe!

(Voodoo Tour, St. Louis Cemetery #1)

Our recommendations for excellent food in NOLA:

Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).

Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.

References:

An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.

Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.

Work-life balance. Accessed Oct 16 2014.

MiM Mail: Middle of career life crisis

I feel like I am in the middle of a career-life-crisis.

I am a mother to an almost-3-year-old, and a 9 month old. I am an OB/Gyn. And, I love being both.

After residency, I joined a large private practice. Even after I had my son, I was fairly happy with my schedule. I worked about 3 1/2 days a week in the office, one day on call per week, and one weekend on call per month. But, I thought it was a pretty good life for an OB-Gyn. I sometimes missed holidays, wedding anniversaries, and important family events, but realized that those things came with the territory. After all, babies don't take holidays from coming into this world.

About two years ago, we moved to our home state to be closer to family. In doing so, I changed career paths. I now work as an OB hospitalist, doing about seven 24-hour shifts per month. It's a different role than I ever thought I would have. I see patients in the hospital that have no physician and take care of OB emergencies when their on call physician cannot make it to the hospital in time. In short, I still get to deliver babies and help women in emergent obstetrical issues, which is very rewarding. And, I get to have a lot of time with my children. Now, for example, when we sign up for a 2 week swimming class, I only miss a couple classes, whereas before, I would have only made it to one class. I get to go to the park, the zoo, the mall carousel, and all the daily little things that a lot of mothers in medicine have to miss out on.

I feel guilty even saying this, but when I first transitioned to this job, I definitely had to adjust to being at home so much. I felt guilty at times, because there were definitely moments when I (and my son, for that matter) felt bored. I would call my sisters and ask what they do each day with their kids. But, now, we have gotten into our groove. We have play dates, learning activities, favorite fun spots, and of course, naptime. So, before I know it, the day has passed and we are on to the next. And, just when motherhood starts wearing me out, it is time for me to go to work the next day. And, actually, it is a nice break to get away and have some career time. My 3 year old son asks every morning if I am a doctor or a mom. With this job, most days I spend "being a mom", and only some days do I spend "being a doctor".

So, what's the problem? One of the reasons I went into OB/Gyn was the hospital-office balance. I loved forming long-lasting relationships with patients that continued throughout life stages, multiple pregnancies, and through difficult diagnoses. There is something about delivering someone's baby that bonds you to them. You become important to them. It almost feels like you should be invited to sit at their table for Thanksgiving dinner. And, now, I don't have that relationship. So, I keep looking at job opportunities and wondering if I should return to private practice so that I can have relationships with my patients like I had before. The thing is, that if I make that career jump back to traditional OB/Gyn private practice, I will be giving up a lot of time that I have with my kids. So, I worry that I would end up in a "grass is not always greener" situation. I'm not as familiar with the business aspects of medicine, but to the best of my knowledge, it is difficult to keep a practice afloat (paying overhead, salaries, benefits, malpractice) in the OB/Gyn world and work only part time, so full-time it would be.

I know you guys can't decide my future. The truth is, that getting it all in writing is actually helping me process it all. But, any advice would be nice. Is it possible to have a part-time OB/Gyn practice? Should I just count myself blessed that I get so much time with my kids, even though my particular position as an OB/Gyn is not quite as fulfilling as it once was? How do I not feel guilty thinking all these thoughts?

Sincerely,
Confused mommy doc

McDonalds dilemma

For a long time, I was not willing to take any time for myself. When I had a day off, I would keep the kids home and spend the day watching them, dragging them along with me to errands and doctors appointment, and not taking any time to relax.

Recently, due to my high stress level, I've decided to compromise. When I have a day off, I keep my youngest home in the morning, then bring her to daycare for the afternoon, when she would be napping anyway. (My older daughter is in school)

Initially, this didn't work very well. She would scream and cry during the drive to daycare and be inconsolable when I left.  To the point where I would practically be crying when I left.

The daycare wasn't crazy about this arrangement either. They said it was very disruptive to have her come in and be so upset.

Finally, I had what I thought was brilliant idea. There's a McDonald's on the way to daycare, so I would stop by the McDonald's and get her a happy meal to take with her. I did remove the toy for later, but she got to have the rest of it.

And you know what? It really worked. She was so excited to bring her little happy meal to school with her, and after a couple of trials of this, she was no longer upset about my leaving.

Of course, it's never that simple.

Apparently, there are a couple of kids in the class who cry inconsolably when my daughter is eating her McDonald's happy meal because they are so jealous. The teachers have tried to arrange things so that my daughter won't share a table with them, but it makes me feel bad every time I hear about it.

It's sort of silly because it's not any kind of amazing meal. It's a few chicken nuggets, apple slices, milk, and a handful of french fries.  She doesn't even get a dessert, which many other kids have.  I mean, I have literally seen kids there eating Dunkin' Donuts donuts for breakfast.

The daycare hasn't said a word to me about it or implied that I shouldn't do this anymore. But I still feel a little bit guilty. But maybe I shouldn't worry so much about other people's kids and worry more about my own.