Baby City

There are only three things in this world that are certain: death, taxes, and babies.

Nobody knows this truth better than Emily McCoy, a third year resident working in Baby City, the affectionate nickname for the busy Labor and Delivery unit at a New York City hospital. On a typical day in Baby City, Emily delivers more babies than the number of hours of sleep she manages to squeeze in that night. And definitely more than the number of dates she's been on since she started her training in OB/GYN two years earlier.

As Emily works tirelessly to safely herald baby after baby after baby (after baby) into the world, she becomes well acquainted with the three hard facts of Baby City:

1) Babies never come when you want them to.

2) Babies always come when you don't want them to.

3) You don't know who your true friends are until your baby is sliding down the birth canal.



Baby City was a joint effort, written by myself and Dr. Whoo of OB/GYN Kenobi. Do you remember the wonderful Dr. Whoo, who used to blog here? Well, now she's back… in book form! This book is all about the real events that take place on a labor and delivery unit, based on true stories.

This book is the ultimate book for mothers and medicine. Because it's about mothers (duh), both new and old, and it's written by two female physicians who are also mothers. It's light reading, but it deals with a lot of issues that are important to women and mothers and physicians.

Buy it today on the Kindle or in paperback!

Side note: We are donating 25% of the profits from the book to the fistula foundation, a nonprofit organization that does great things for women in Third World countries.

Hello from CaliMed

Hello MiM!
I'm excited to be joining this fantastic community that has helped me tremendously from the time I started thinking about medicine to now, 12 weeks shy of starting my first year of medical school. A little bit more about me, my background is in finance, but after a few years on Wall Street I knew I was going down the wrong career path. After having my first daughter in 2011, I realized if I really wanted to go for medicine, I had to get on it. I am extremely lucky to have a supportive husband and thus started my post-bac when my daughter, SK, was 1. Because I was a finance major in college I had to take all the pre-reqs and although I've always loved school, I learned that studying with a toddler in tow was a completely different experience than my undergrad years. (Like that time SK accidentally locked me in the garage like a prisoner before my organic midterm...)

Now said princess is turning 4 in June and we are expecting another in a matter of weeks. It was my plan all along to squeeze another child in before the start of school, but the window was limited and tricky. At one point I was clearly delusional and considered being a "little bit" pregnant for the MCAT, but thankfully came to my senses. I am sad that baby #2 will still be tiny when school begins, but I know I am luckier than most to have the flexibility that comes with being a student.

I am really looking forward to sharing my journey through school with you all. I have to confess, I feel like quite a newbie - I've done the mom thing for a while now, but I've just started the medicine part. And with so many wonderful members in this community who are much more advanced in their careers than I, I am curious what others would like to see from me. Please let me know!

And now I will leave you with my brilliant plan for the next 12 weeks before I take the plunge into medicine:
1. Pack up house and move most of our stuff to new city.
2. Rent out current place.
3. Host fantastically awesome Rapunzel birthday party for SK at 38 weeks pregnant.
4. Pop out baby #2.
5. Move the rest of our stuff and drive down to med school.
6. Get situated (make sure SK likes school, find nanny (!), get to know area, figure out transition from life with 1 kid to life with 2, oh and unpack)
7. Start school and balance marriage, 2 kids and student-life like a boss*

* TBD. May need help with this one, but absolutely thrilled to be pursuing my dream.

Cheers all!

Edit: I wrote this post before I saw Cutter's post from yesterday. After reading it and all the comments below which seemed to offer a resounding and unanimous "no" to her question, I realize my post may sound slightly manic and also maybe naive. But I am honestly very excited for this new experience that lies ahead and think it would be wrong even, to make such a drastic change in my life and not put everything into it. I have so much respect for Cutter and all the women in this community who have taken the path that I am just now embarking on. And I would be lying if I said I was not affected by some of the comments. But I was also very encouraged by the fact that many of you absolutely love what you are doing. I know I have a lot to learn and I may feel differently down the line, but for right now, I can't look back and can only look forward and say yes. 

Would I do it again?

No.

I’ve thought about this a lot over the past few weeks.  Residency is ending.  It’s been 7 yrs coming. There have been many ups and downs.  The end is exciting and stressful.  The costs at the end are nearly insurmountable - thousands upon thousands of dollars for boards, licensing and moving.  The worry that you don’t know enough.  The sadness about leaving this family and the excited anxiety about starting the next step.   As I reflect upon this journey, I recognize that it has been amazing.  It is an unbelievable honor to take care of patients. I love what I do.  I love being a surgeon.  I will be starting a fellowship next year back in my hometown and I couldn’t be happier about going home and training in a field that I love.  I’m excited about my research.  I love my future colleagues!  I don’t regret my choice and I love my field and my patients.  However, I also admit that 7 yrs has wreaked havoc on my life, my family, my husband, my child, my health, and my bank account.  The direction of medicine worries me.  I think the business of medicine is crowding out the practice of medicine.  But, I realize that no field is perfect.  I understand that.  But there are other ways to live a life. Other ways that would give me a different sense of control.  There are other ways to have challenging work that is not so hard emotionally, technically and physically EVERY DAY.  Medicine is not just challenging, it is hard.

So, as I reflect upon these years in the few moments of silence and meditation, I think to myself, would I do this again.  I think it’s important to reiterate that I actually don’t have regrets about my choice and I don’t dislike my job, I LOVE it in fact.  My husband is still here, right by my side.  My daughter is a fireball of wonderfulness who loves hearing about my day.  I’ve missed many family functions and have not been there for my siblings and parents in the way I wish I could have been all the time, but they still love me and I have found ways to still be present.  But when I really ask myself, knowing everything I know - Would I leave my job in finance and go to medical school and choose to be a physician?   I think the answer may be no.  What is your answer?

MiM's most viewed posts 2008-2015

Just for fun, thought I would post the 10 MiM posts that have had the most pageviews to date. Mind you, our posts go back for 7 years and number of views is determined by many factors including what shows up on search engines and links from other sites. But, thought it would be fun to take a walk down MiM memory lane.

1. A day in the life of a neurosurgeon - seriously?  by GCS15. This was part of our Day in the Life Topic Week from 2009.

2. When breastmilk isn't best  by Fizzy, 2012. The title alone attracted many views and commenters, including some non-MiM breastfeeding activists who clearly did not read/get the post. Check out the great discussion on "gunk" (on pump parts) in the comments.

3. Guest post: Why it's all worthwhile (or what keeps me going) by GCS15 in 2010. A personal favorite. So inspiring.

4. Why you absolutely need to have a baby during residency by Fizzy, 2012. Another great and provocative title. Again we see Fizzy's signature use of humor to make her points and win over the audience!

5. MiM Mail: (Un)happy match day - It doesn't matter what YOU want, 2015. Our community came together in support of this MiM - we felt her struggle and all wanted to help. Any updates?

6. The opiate endemic and us by Genmedmom, 2013. Thoughtful commentary about a difficult, serious issue in patient care.

7. Why is residency so harmful? (And what can we do about it?) by Genmedmom, 2014. Another thoughtful commentary about medical training and sometimes toxic culture that comes along with it.

8. Maternalism by JC (a cardiologist), 2010. A wonderful post trying to reconcile comfort, evidence-based medicine and the post-paternalistic era of medicine.

9. Guest post: The two kinds of mothers in medicine, by Jess, 2014. Generated great discussion about balance and working mothers' guilt (or lack thereof). We're lucky to have Jess as a regular contributor now.

10.MiM Mail: Anesthesiology or psychiatry? 2014. Apparently, a much-researched question!


Do you have favorites not represented here? Feel free to add in the comments.

MiM Mail: Feeding a family

Another long day in the life of a resident, and I find myself at home wondering what to feed myself and my family for the next week. Hubs is willing to help, but lacks creative energy in the kitchen most days and doesn't like to spend much time prepping a meal. Munchkin is young enough to be happy with basic staples pulled out night after night, though she does express boredom at times and I prefer to introduce a variety of foods.

I found an app with associated website this weekend that will let me plan a menu with recipes and create a shopping list. I'm hoping with less call in the upcoming year that we will be able to eat more intentionally.

How do you keep your family fed? Do you plan ahead and shop for your weekly menu? How often do you sit down to a freshly cooked meal, and how do you get it done?

-One Hungry Mama, aka Ladybug

To be or not to be.....a generalist

Hello MiMers!

I'm nearing the end of my Family Medicine residency and am struggling with the age-old question: To be or not to be?....a generalist.

I've always loved the variety and scope of FM. To me, there is such great appeal of being a jack-of-all-trades kind of doctor. I love being the first point of care, collaborating with specialists, seeing new and unfamiliar problems, and flying by the seat of my pants. Growing up in Canada and being surrounded by a culture of Family Medicine has undoubtedly shaped my love for general practice.

That being said, after countless hours of studying, rotations, patient care, and hard work, I am sometimes weighed down by the questions, "What am I GOOD at? What's my area of EXPERTISE?" Sure, there are the things that I see everyday and feel pretty comfortable with: Diabetes, high blood pressure, back/shoulder/knee pain, asthma, preventive care to name a few. But this always comes with the knowledge that I'm not necessarily an EXPERT in those fields. Can I really be giving my patients the best care for their problems if I'm not an endocrinologist (diabetes)? orthopod (shoulder pain)? pulmonologist (asthma)? Could I give a thoughtful, professional-level lecture on any of those subjects?

I've been seduced many times during residency into doing a fellowship. At one point, I've seriously considered a fellowship in geriatrics, OB, EM, sports med, palliative care, dermatology and HIV/AIDS (to name a few). But I can never seem to commit myself to narrowing down to one subject. I find myself getting back to the same fear of getting pigeonholed into one area and losing my ability to be a generalist. It is quite a humorous mind-loop that I get into time and time again.

Ladies, lets discuss. What do you love about being a specialist? Or a generalist? I'd love to hear your thoughts.

Sincerely,
HulaMed

Call for new contributors

Update 05.04.15: Thanks so much for those of you who responded to this call. We are going to have an amazing cohort of MiMs joining us over the next year, from all stages of training and representing some new specialties we haven't had in recent times. For everyone else, we always welcome your guest posts and MiM Mail. Next open call: May 2016. Thanks for reading!

It's hard to believe, but Mothers in Medicine is celebrating its 7th birthday this month. We recently passed our 3 millionth pageview. Some of our contributors have written here since the beginning, and others we have welcomed along the way. Your guest posts and MiM Mail and all of the posts (over 1200 to date)  have made this a community where we can reflect, share, support, and grow.

In honor of May, the home of Mother's Day and MiM's birthday, we wanted to try something new to add to the voices that have been on this site: an annual, open call for new contributors to join as writers for a (renewable) one year term. The only requirement is the willingness to share a part of your journey as a mother in medicine with this community over the next year. No blogging experience necessary.

If you are interested, please send a note to mothersinmedicine@gmail.com with why you would like to write for MiM and a little bit about yourself. We would love to welcome some new MiMs to the roster!

Thanks for reading!

Thank you MiM

MiM seems to call me at the strangest of times.  And everytime I go to it, a post that 'talks to me' awaits!  I've learnt many things from MiM, but the thing that stands out the most is the sense of community.  Sharing my stories and hearing others, I'm struck by how similar many challenges we face are.  Across continents and specialties, ages and stages, whether we are single, divorced, widowed, mothers of one, two, three or more, there is always a single thread that binds us all.  Sometimes it's a spider thread.  As the voices start answering (no, I'm not crazy, I mean the responses) that thread turns into a rope, and then a cable.  A skip comes back into my step, some hope into my heart and I throw myself back into the fray, strengthened and centred.

Thank you MiM.  I think you're wonderful!

What have been your lightbulb moments, things learnt, precious memories of MiM?

MiM Mail: Planning for baby #2

I'm a resident, wife, and mom to one, hoping to have one or two more children. My first was born during intern year, and we're planning for a second during residency. With my first, I ended up with multiple third trimester complications that eventually led to 2 weeks of bedrest and delivery a month early. I've been an avid follower of MiM since before my first pregnancy, and I'm hoping for advice and encouragement from some of you.

I'm in a field that requires a separate intern year and am now working with people unfamiliar with my first pregnancy. All they know is what I choose to tell them. I think my current PD knows I had complications, but not the specifics. Thanks in part to an amazingly supportive PD my intern year, I finished PGY1 and started PGY2 on time. From a residency timeline I'm right on track, and I have some sense of when the "best" times could be to have another baby during my program. We'd end up with about a 2.5 year spacing. Our preference would be somewhere closer to 2 years rather than 3.5+.

My spouse is great with baby #1, does a lot around the house, and picked up a ton of slack during my first pregnancy. It was hard, but we made it through, and my upcoming schedule will be easier than it was last time.

Medically, my odds for the healthiest possible second pregnancy considering my complications are higher if we choose not to wait until after residency. Besides, at that point I'll have written and oral boards and be trying to establish myself in a practice, so I'm not convinced it would be much easier.

In many ways, I feel like I'm between a rock and a hard place. When I think about attempting #2 during residency there's a part of me that wants to believe we'll make it through just fine, but the realistic side of me expects a great deal of physical, emotional, and mental strain. I wasn't deathly ill, but it wasn't fun, and both baby and I could have gotten very sick very fast. I expect to deal with some problems again, but hopefully not all, and hopefully not the one that led to bedrest. I'll be meeting soon with a new OB to talk through everything.

I don't want to sell myself short, and if I feel like having a second soon would risk compromising my training. On the flip side, ultimately we don't want to stop with one kid, and waiting would only compound my risks. Jumping to adoption is not the right answer for us.

Where we are now, we have a lot of support outside of residency. Even if we move after training, it makes sense to have another baby while we're here. I think there would be support from my program, but I don't think it could be as robust as it was with my first. My previous PD was amazing; few could measure up. My peers have verbalized a mutual intent to help cover for each other when circumstances arise including babies, but I haven't gone into details of my first with them and don't care to unless it becomes necessary. I don't see how they could understand what I was up against, or how it would help to talk about it right now. I sure hope I don't need weekly or twice weekly appointments until the last short stretch, but we might end up there again.

I guess I have an idea in my head that if I do decide to pursue a fellowship and don't finish residency on time, I can look for a job for a year, maybe a couple years, and then continue training. I may also be happy without a fellowship. I know people say it's hard to go back to a resident's salary (or worse) after being out for awhile, but we could knock out a lot of debt in a year or two and be in a better place for me to take a pay cut, even with 2 kids in daycare. I don't think the financial side would prevent fellowship down the road if I wanted it.

Anyone have advice for how, when, and what to communicate to my program and my co-residents if we do get pregnant again? Thoughts on trying during residency with high probability for some (manageable) complications vs waiting and dealing with recurrent and possibly worse complications? What else do we need to consider? Anyone else make it through a difficult pregnancy without feeling like you lost your competence as a physician?

Ladybug

Guest post: Gender equality?

I generally LOVE my job. I work part time as an anesthesiologist at an academic medical center in the Midwest. There are several other part-time faculty in my department, both male and female, which has created an atmosphere where the commitment of part-time workers to their careers is not typically questioned. My department recently scheduled an all day seminar on an upcoming Saturday, geared for and limited to our own department's clinical faculty, with educational topics ranging from reviews of clinical care, giving feedback to residents, and research resources. I decide not to go, as Saturdays that I'm not on call (I'm typically on call one weekend/month) are generally reserved for family time, my kids have some new activities starting this Saturday, the weather is (finally) getting nice, and with the exception of about a 2 hour period, I'm not that interested in the agenda. So I have a discussion with my husband (who is generally wonderful and supportive of my career) about our upcoming weekend plans and I mention that I may go to the 2 hr period of the seminar that I'm actually interested in, depending on what else he has planned/would like to do with the family. It turns out he is not at all in favor of me going to only the 2 hours of interest to me- he thinks I'm making a big mistake by not going to the entire seminar- commenting that I will likely miss out on networking opportunities, face time with higher leadership, etc. The discussion continues, and he comments, "3 out of the 4 women who directly report to me behave just as you're doing, not taking after work hours events seriously...and it is negatively impacting their opportunities for advancement." Side note: he works as an upper-level manager at a major business and typically spends at least 2 evenings/week out of the house attending either work related activities or board of director activities for local non-profits. At this point, I was pretty angry, reminding him that the 3 women in question all have young children (as do we), and I ended the conversation telling him, don't take it for granted that you are able to spend multiple nights/week away from home for various purposes- it's only because I am at home caring for the family that you get this opportunity- these women that you work with that don't make it to all the evening activities- who is caring for their families?- that's why they're not there.

As one may surmise, working at an academic center means that there are frequently lectures, town halls, discussions, seminars, etc to which faculty are invited to attend. Once in a while these sound interesting to me and actually don't conflict with my clinical responsibilities. However, I usually feel stressed when I decide to go as it means either arranging evening childcare or childcare on what would normally be my day off with our nanny (she is great and very flexible but out of respect for her I do my best to minimize requests for super early mornings, evenings, and significant schedule changes to what is truly necessary) or trying to explain the importance of it to my husband so that he will be home at a reasonable time (it is not uncommon that his evening activities come with only a day or two of warning). In the end, I usually just don't go- it's much easier that way. I am long past the "Mommy guilt" that I felt for working at all when my first child was born; I truly love what I do, am proud of my work, feel reasonably respected at work, and feel like I honestly do have a good work-life balance. I am able to make some time for myself without guilt- I go to the gym semi-regularly and spend time with girlfriends about once/month. However, I admit I continue to struggle with guilt in situations such as the one I mentioned.

So, I'm interested in the opinions of others- how much should our attendance be expected at after hours work activities? How much guilt do you feel about going (or not going) to these types of events? Do you even feel like you really have a choice to go given family responsibilities? If you regularly go to these types of events, how do you manage to get there?

MiM Mail: Part-time residency?

Dear Colleagues and mothers,

I'm a final year IMG who, just like my husband, soon am about to apply for residency. The thing is that I am also a mother, and that's why I'm now writing here. I consider myself ambitious and strive to become a well-educated and good physician one day. However, my role as a mother is also of great importance to me and the responsibilities and duties I feel towards my daughter is something I cannot ignore. I strongly believe that I should not have to choose between career and family, which is why I wonder if anyone has any experience of so called "part-time" residency? Is it possible to get such an agreement anywhere? Where could I find more information about this? Also, would these requests lower my chance to match?

I'm interested in paediatrics, and with "part-time," I mean about 40-50 work hours per week instead of up to 80. Naturally I understand that such a "reduced schedule" also means a longer residency and lower salary, which I do not consider a problem.

I really appreciate all the help and information I could get!

H.P.

Hurtling toward the next phase

I have searched but I cannot find the flying trapeze story I read a few years ago that explains my life, so I’ll paraphrase and add to it here:

I swing back and forth preparing for my next take off. I have prepared, but I know that this leap is longer and more challenging than ever before. In spite of a long line of successful jumps, there have been some near-misses, some full on misses, some blood, scrapes and even some still healing deeper wounds. This time I jump, my husband is watching and waiting readying himself for his jump into dissertation land and as we prepare Zo waits by ready to take off with us.

Well MiM friends, it’s official, I have accepted a position as a Pediatrician in my dream clinic. I’ll be back in DC working at an academic center-affiliated community clinic. I did my community pediatrics rotation there as a medical student and so many of my respected supervisors and medical school friends are still there.

Interviews were a whirlwind. I met so many nice people, got lost countless times, learned even more about what I need, want, and will compromise on.  

And now onto school finding. Every day I have a mini-freak out when I think about Little Zo starting pre-k. Our cherubic toddler has been replaced by an almost 4 year old hilariously funny and extremely sweet rib-protruding knock-kneed ball of energy. And then I freak out more about making pick up and drop off work and I pray so intensely that we find the right environment for him and that we will find balance so I can rock my boards and O can finish his dissertation expeditiously. I wish I could transplant his daycare to DC.

And house hunting on a single income in a very tight housing market is not my favorite thing to do but I guess house hunting without the beloved Property Brothers will always be lackluster. We have several leads on promising houses and are heading up next weekend prepared to make an offer. Can’t wait to have our first home secured and then on to do-it-yourself projects for years to come.

This jump seems epic. Push-pull-push-pull, forward backward forward backward, take off.

MiM Mail: Having children with both parents in training

Hi Mothers in Medicine,

I am a longtime reader of the MIM blog, and really appreciate being able to read your stories. You are inspiring! I am writing to request advice, especially from those who had children during medical training with a medical spouse (or spouse with a very demanding career).

I am nearing the end of my 1st year of med school, and my husband is a resident in a surgical subspecialty, with 4 more years to go. We would love to have a large family (4-5 kids), and are a bit older than the average med student/resident so waiting to have kids until after training isn’t realistic. We are ready to start our family, but I am a little nervous about being the primary caregiver (with outside help) as a medical student. I know that my husband will make a wonderful father, but given his 80 hr weeks at the hospital he won’t be able to contribute as much time-wise. Having kids is super important to us, and some days I question whether medicine was the right choice for me, but I am doing well academically and I think I am on the right path.

Our tentative plan (acknowledging things don’t always go as planned!) is as follows, and I would love to hear your thoughts about pros/cons, other ideas and tips on how to make it work! We are considering aiming for baby #1 at the end of 3rd year. I would like to take a semester of maternity leave, then complete my year of elective rotations (daycare or a visiting Grandma for childcare), have baby #2 and take another semester off for maternity leave before starting residency. Has anyone tried to/ succeeding in taking 2 separate semesters off rather than a year at once for maternity leave? Is completing 80% of my clinical rotations while pregnant realistic? Any advice about the timing of clinical rotations? I hesitate to talk to my school’s administration, when did you approach them? Is starting residency with a 2 yr and 6 mo doable? Is it really possible to do a “part-time” residency? How difficult is it to take the full 12 wks of FMLA for maternity leave during residency? Am I crazy for thinking that this sounds like a reasonable plan? Have you been through something similar and barely survived, or were you able to thrive? Any advice would be greatly appreciated!

-K

Guest post: Oral boards anxiety

Tonight I ran a Google search "thoughts about the oral OB-GYN boards" and your site came up. I read all your comments in the hope I will find some relief of my anxiety. I did not.

You see, I passed my oral OB-GYN boards 6 years ago. I can't remember being this petrified prior to taking them and I felt ok after the examination has ended. Now, it's time for round two: my oral subspecialty Boards. I can't figure out why, but this time around I am mortified. Everything about it, the clinical part - am I thinking like a subspecialist? am I dissecting this disorder process in 10 different way for analysis? The research part (the scariest of all) - am I going to survive the probing questions regarding the study design and power, the statistical significance of my results, is my data "worthy" and my results "meaningful" to their scientific expectations? An then, the genetics - will I remember what findings fit the puzzle of what disorder, how well am I counseling my patients? I wish I could find my answers before I walk into that room to go through it all for yet again, the second longest three hours of my life.

I hope I will survive them next week and not have to repeat this ever. Although I am as prepared for it as much as I will ever be, I still feel "On a wing and a prayer."

Speaking about a prayer, I think I could use one in just a few short days.



A little bio about me:
IronGirl practices Maternal-Fetal Medicine in Midtown America, mother of two beautiful children Jek 13, and Lui 10, wife to Mr. Bold, non-MD guy that likes to play with fire and ice for a living, awesome hubby, caring partner, and multitasked oriented sports-dad.

IronGirl likes to spend her free time (is there any time that's free, hmm...) running, biking, swimming, racing, and sometimes just chilling by a bonfire listening to Flamenco music. And now, getting initiated into blogging.

Guest post: ADHD or ASD?

My oldest child is eight years old. He is funny, super-smart, and charming. He once made up a song about how much he loves me.

He has also recently been diagnosed with ADHD.

You see, ever since he was very young, I knew there was something different about him. I was just finishing my second year of medical school, and he was my first child. But I knew. In infancy, he stared at objects of interest with an intensity of focus that was mesmerizing. When he began to speak, he spoke eloquently (seriously!) and argued his points with logic well before the age of 2. He never joined in group activities, but observed them solemnly and seriously. He slept poorly. He had explosive, long-lasting, inconsolable tantrums about everything from transitions to meals to seams in his socks. He had severe separation anxiety at school drop-off, which lasts to this day. He had (has) exquisite sensory sensitivities. He remains a slave to routine and ritual (and reacts poorly indeed when things change). He can talk for hours about black holes and superheroes. He clearly loves his siblings and his parents, but all interactions must be on his terms.

I thought – I still think – that he has an ASD. Asperger's. It's him to a T.

I could write for pages and pages about my son and his symptoms and his birth and neonatal course and December birthday and GI problems and build my case to you – fellow physicians and mothers – as to why I am so sure that ADHD is the wrong diagnosis. But at the end of the day, in my mind, the letters don't really matter. All I want is someone out there to help us better parent our child. The way he relates with the world is not "neurotypical", that is for certain. But how can I help him, who he is, grow and thrive and make his way in peace and confidence in this world? My husband and I have done a lot which I think has been very good for our son. But we were at an impasse. We took him to the pediatrician because we were looking for help. Guidance.

So now we have this diagnosis. Maybe it is accurate, maybe not. I am truly not writing this as an argument one way or another for his actual diagnosis. The essence of my post relates to my own reaction to hearing the diagnosis. I just thought: no. Not that. NO. I would have accepted "ASD" – I suspected it. I may have accepted some kind of anxiety disorder. Or – no diagnosis! That's just who he is, and here's how we can help you. That would have worked. But ADHD… I absolutely balked. Why?

I feel that in popular media, ASD is portrayed as a diagnosis which is blameless. Autism support groups, parent groups, blogs, articles, and fundraising abound. There are supports for parents, and children can receive evidence-based treatment (at least in my province). We have specific screening tools in Ontario, for use at the 18 month well child visit, specifically to screen for ASD. And don't get me wrong – rightfully so. Early intervention works and should be promoted. Also, I'm NOT saying parents of children with ASD have it easy. Not at all.

Now I contrast with ADHD. I feel that ADHD is portrayed more as blame-able (i.e. on the parents) and less "real." ADHD is often the butt of jokes or widely derided as an "excuse" for poor behaviour. I do not know of any screening for ADHD that is done in routine well-child visits. I do not see articles or blogs about parenting a child with ADHD. I don't hear about ADHD research fundraising activities. I'm not saying they don't exist. But I do not think that they are as "out there" in popular media.

I am not a pediatrician, nor a psychiatrist, but I understand that both ASD and ADHD are considered neurodevelopmental disorders which arise through an interplay between genetics and "environment" (that lovely catchall for everything from prenatal exposure to substance X to pollutants to diet and so on). I do not think the medical community considers one or the other of these diagnoses to be the parents "fault." But I do think, that deep down (and I am ashamed to say this), I am afraid of my son being diagnosed with ADHD. Afraid of the looks. The blame. The rolled eyes. The label. Afraid of the consequences of starting him on medication – or not doing so. Afraid of possible misdiagnosis and its consequences. Afraid of grandparents finding out and having to deal with the inevitable questioning and doubt. Afraid that I will feel less sympathetic, more frustrated, less supported, more alone. Simply afraid.

I know that my child is who he is, despite any diagnosis or lack thereof. I know that one diagnosis is not "better" than any other. Diagnosis won't change who he is. I want to be clear that I am not saying I want or favour a certain diagnosis for my child. Nor am I implying any judgement of any of your children with these diagnoses, or you! Rather, I write to explore my own reaction to this situation, and to consider the reasons behind it, even though in doing so, I seem to have uncovered my own fears and biases.

What do you think of when you meet a child with ADHD? The child might be a patient, a niece or nephew, a classmate or friend of your child. How does that differ from your feelings when you meet a child with ASD? Are you more or less sympathetic? Understanding? Willing to forgive / accept / work with the child's behaviours?

I want to parent my child as best as I can. I want what we all want – I want him to feel loved, confident, and secure. I want him to thrive. I know that the letters won't change who he is. Despite my fears, I also know that the letters won't change who I see, as his mother: a very unique and special child with some incredible talents and some special challenges to work with. The question is: will the letters change what others see?