When I grow up...

It's residency application season! ERAS opened a few weeks ago (coinciding with the sudden onset of palpitations among fourth-year medical students across the country...) As I work on my personal statement and gather letters of recommendation, I've been doing a lot of thinking about why I came to medical school and why I'm choosing my particular specialty.

I came to medical school fueled by a love for biology and a deep desire to help people in need. I'd always liked studying and was willing to work hard to learn how to best help my patients. Yet, after my daughter was born, I began to seriously consider whether or not I wanted to finish medical school. Suddenly, all of the caring energy I'd poured into my patients was directed toward one tiny little human. Morning rounds were replaced by silly songs and walks to the park; sign-out by baths and bedtime stories; overnight call by q2 hour feeds and diaper changes. There are plenty of people who want to be doctors, I thought, as I cradled my daughter in my arms. I'm the only mother she has.

When my daughter was 8 weeks old, I went back to school to finish my third-year clerkships. Those first months were harder than I'd expected. I hated being away from my daughter, hated scrounging for time and space to pump, hated feeling like I was less than half the mother and student I wanted to be. I had a hard time switching between hospital-mode and home-mode - it seemed that by the time I'd settle back into being a bumbling first-time mom, I had to leave again to be the clueless third-year medical student who couldn't remember the names of nerves or the proper technique for position patients on the operating table.

Many nights were spent with me crying to my poor beleaguered husband (who was taking on most of the childcare responsibilities while I was back on rotations) about how I hated all things medical. We went over all the possible scenarios we could imagine, looking for an exit strategy: maybe I should just drop out and save us all a lot of misery; maybe I should graduate but not pursue residency; maybe I should keep going and hope it would get better.

On many occasions, I came close to choosing one of those first two options. In the end, though, I always stuck with the third. And as time went on, it did get better. I finished the rotations I'd been less fond of, the world miraculously emerged from winter, and life began to look a little more hopeful. When my daughter was five months old, I started an Acting Internship in the specialty I'd been planning to pursue - and to my relief and even delight, I found that I enjoyed it just as much as I had before she was born. Although I still felt sad when leaving in the morning, I was quickly engaged in pre-rounding on patients and discussing management decisions with the residents and attending. I looked forward to seeing my patients each morning and found it exciting to collaborate with other providers to find the best diagnostic and treatment options. I began to feel a sense of professional identity that had faded somewhat in those first postpartum months. When I came home, I was eager to talk with my husband about the diagnoses I'd made, and even more eager to throw myself wholeheartedly into feeding, bathing and snuggling my daughter until bedtime.

Those four weeks of Acting Internship - during which I felt for the first time that being a mother in medicine was not only a possible option but actually a life-giving one - are part of what has kept me motivated to finish medical school and complete post-graduate training. I feel that I have rediscovered the passion that brought me to medical school in the first place, and am grateful that it has been proven in the testing fire of new motherhood. I know that residency will bring many challenges, both familiar and novel, but I am encouraged by the fact that as I advance in my training, I will move increasingly into the areas of medicine that I most enjoy - the areas that give me a sense of purpose distinct from and complementary to that which I find in motherhood.

What about the rest of you MiM? Were there times when you questioned whether medicine and motherhood were compatible? What motivated you to become a physician, and what keeps you going in your field?

Just like mom

My daughter Mel has one of those annoying friends at school who always has a bunch of things to say to me when I pick up my daughter. Before I met this girl, I thought annoying friends like Skippy, Kimmy, and Boner weren't real and just added in for extra laughs during 80s sitcoms (for bonus points, match the annoying friend to the 80 sitcom).

The other day, when I was picking Mel up, her annoying friend came up to me and said, "I fell down and scraped my leg today!"

"Oh, too bad," I said, trying to act like I actually cared about the fact that this random child had fallen and scraped her leg.

The friend smiled. "But Mel said that since her mom was a doctor, she knew exactly what to do to help me. So she did!"

My heart swelled with pride. There's nothing that makes you feel better about yourself than when your daughter wants to be like you. "So what did she do?" I asked.

"She brought me to the teacher," she said.

Hmm.

Well, it's the sentiment that counts.

Now is as good a time as ever

Hello, dear mothers in medicine! There's nothing special about today, other than blogging for the first time. (Yay, I'm posting!)

I am so happy to be a contributor to this group of incredible doctor moms. I've been a reader of this blog since the beginning, which was about the time I became a mother and was a fellow. Now I am a faculty member at a prestigious medical center in the South. I spend most of my time doing research to improve the care we provide and reducing errors. The balance of my time is spent teaching on the general medicine wards while we care for patients--maybe reducing the suffering they have just a bit.

The others in my family? Well, I'm married to an happy-go-lucky, always positive attorney who spends his days solving problems. He's my partner in the adventures of life. We have 2 kids who keep us busy--not sure how I'll refer to them here--maybe daughter and son is good enough! One is in elementary school, the other in preschool. We don't have family nearby, but our parents can travel here to help us out sometimes with childcare. No pets at the moment...

For all of us mothers in medicine, we definitely did not pick the easy route in life, but I feel lucky to be where I am. I certainly didn't imagine I'd be where I am 15 years ago when I started med school as an 'older student'. Seems like I may be one of the older bloggers here...I'm definitely ok with that. I feel like I'm a better mother and doctor as I learn more about the world.

How do other mothers in medicine out there feel about getting older?

MiM Intro: Anita Knapp

The first thing you should know about me is that my real name is not Anita Knapp.  This was a name that I penned for myself during residency interviews, and it describes how I feel most of the time.  If only my daughter would sleep in once in a while!

This intro has been difficult to write, mostly because I am going through a time of huge transition in my life.  My husband, N, and I just made a 15 hour move from our home state to our new home where we will complete our residencies.  And we made our move just one day after graduating from med school!  My residency will be in radiology, while N's will in ophthalmology.  However, for the time being, we will be interns in the same transitional year program.  Yay for working with my husband!  Sort of :)

If you would have asked us five years ago what we imagined for ourselves in the next five years, becoming parents would not have been on the list.  Nevertheless, we became proud parents to our daughter, A.K.A. Itty, at the very end of our third year of medical school.  Itty has changed our lives, certainly for the better, although the daily stress we feel has been multiplied exponentially!

I am so honored and excited to be an MiM contributor this year.  During the past 2-3 years, I have relied so much on this blog as I have forged my own path as a MiM.  The path has been very difficult at times, and I find myself in my darkest and most difficult place as a mother right now.  The sadness and loneliness I feel over moving so far from my family is great, but the guilt that I feel from moving my daughter so far from her extended family is overwhelming, as mine and N's parents have played such a large role in Itty's life so far.  I am worried about finding childcare, spending time with Itty, and spending time with my husband, all while trying to figure out how to be a physician.

I am looking forward to getting to know all of you this year.  It is sure to be an exciting one for me!  Any encouragement that you could throw my way would be greatly appreciated :)

Change in Schedule

As an Emergency Medicine physician, I work weird hours, 8-10 hours at a time. I prefer the evening and overnight shifts for lots of reasons. This complicates my “outside life,” as I call my home life and I need a small army of babysitters and the daycare to accomplish this. This summer, Blur1 is out of school for the first time (he just “graduated” pre-k) and we’ve added camp to the mix of my arsenal of childcare. With camps and school and daycare, why do I need the babysitters too? Hubby’s job starts at 5a and he has to leave by 4a. Babysitters come to my house at 4a on nights I work overnights and he has to work; I pay ridiculously for this.

Having done this for 10 years now, I have figured out what I need to do the overnight, schedule-wise. 7a wake up the morning of the first one (The Blurs’ fault), do a heavier than normal workout, a pre-shift nap (1 hour or less on the couch), overnight shift (11p-7a), get The Blurs to school/camp/daycare, get to sleep by 9a, wake up by 3p, maybe preshift nap, and repeat until the overnights are done. I abstain from alcohol this entire time and don’t worry about my diet or working out. I also try not to schedule anything important for the morning-early afternoon hours because I know I won’t make it. Sometimes, before the 3rd or 4th overnight, I’ll go into work early and get some administrative or academic things done, especially if I’ve flipped good or have a pressing deadline. After the last overnight, I have a beer or two with dinner and only one cup of coffee when I first get up to help reset me to going back to days. With this regimen, I flip back and forth from days and nights as easy as one can.

For the most part, this regimen has worked with The Blurs and Hubby. They are at school or work while I sleep and vice versa and we spend our evenings together. However, this summer has put a cramp in our schedules. School is out and camp doesn’t cover the entire summer. I have had to adjust my routine and it sucks. This week I had an isolated overnight but no childcare for Blur1 during my prime sleeping time. I tried taking a much bigger nap preshift and it worked by giving me 2 additional hours of feeling awake after my shift. Too bad I needed 5-6; Hubby can’t get home until 11a at the earliest for special things and this wasn’t one of those days. The shift happened two nights ago and I’m still hurting. I know what I need is more sleep but I also know that is not going to happen.

I am curious how others cope when their normal schedule, abnormal as it may be at baseline, is disrupted. Do you have things in place to help you adjust? I thought 10 years would have been enough to figure this out but The Blurs keep adding new wrinkles I never previously considered.

Ps. Those of you with older kids than mine (5 & 2 yo), what wrinkles should I be on the lookout for?

Hi from Keekster

Helllllooooo fellow medical mommas!

I am so excited to be a new voice in this community which has been such a haven for myself and countless others. 

A little about me... I'm a "military brat" (specifically a Marine Corps brat!) from a very non-medical family, and grew up moving around all over the place every couple of years. I'm one of those annoying people who just KNEW that I was destined to be a doctor- specifically a surgeon- since elementary school. My early inspiration? I am embarrassed to say it was Dr. Nancy Snyderman... yes, I was inspired by Dr. Snyderman on Good Morning America as a small child. She was so smart! And I was told by my parents that she was a surgeon! I had to be one too. And a medical correspondent, at that.   

My 7th grade careers project? How to remove a brain tumor, complete with step by step instructions in how to perform a craniotomy. Gray's Anatomy was my middle school bedtime reading (a birthday present when I was 12). For Christmas one year, I received The Visible Woman model kit (even with a special insert for pregnancy!!), perhaps the most beloved gift I have ever received.

  

You get the picture. I shadowed surgeons in high school. In college I had the enormous fortune of being mentored by one of the most accomplished pediatric plastic surgeons in the country, and spent many early Saturday mornings in the OR. I also happened to fall in love with the world of academia, basic science research, and PhDs, all completely foreign to me. 

Fast forward to medical school (after working abroad for a couple years with my now-husband). The pre-clinical years were tough for me. Why couldn't I get credit for narrowing the correct answer choice down two answers? Is it really my fault I always picked the wrong one?? Standardized tests were not my friend. I prevailed, however, but began having doubts about surgery. Was there something else for me? I am a major self-help book addict and found this book:

 

Hmm... general surgery was actually not really sounding like a good fit for me. Maybe ENT? Or derm? The one chapter that piqued my interest, however, was pathology. Pathology?? Wasn't that just a course in medical school? Had I ever even met a pathologist? 

I mentioned I love research. I received a wonderful fellowship that allowed me to take time away to work on a project. One year turned into two, and at last I returned to my clinical years. Surgery was my first rotation and I was in absolute heaven in the OR. However, I happened to have strange circumstances with the surgical specialties to which I was assigned- no overnights and even two months without rounding (no residents on-service)- not exactly a reflection of reality. I continued to plan for applying to surgical residencies (met with the program director, started getting letters, etc) but as my third year went on and I gained more clinical experience, little voices started popping up in my mind. Taking care of patients was not as gratifying as I always imagined. When specimens were removed for surgery, I wanted to follow them and slice into them and feel them. I wanted to diagnose disease, think about mechanisms of disease, find causes of disease. And as selfish as it sounds, I also plain and simple just wanted to sleep in the same bed as my husband! And I finally remembered pathology. I remember I was hiking alone one day after being post-call for psych, and said to myself, that's it. I have to pursue this... and I took the plunge.

As I've alluded to, I have a husband- we met when I was only 19 and here we are a decade later! He has a PhD and has his own lab (academia). And yes, there is a little person in our lives too... a daughter. She is perfect in every way of course :) Her 2nd birthday is coming up right around the corner. She was born at the beginning of my 4th year... lots of stories surrounding that experience and the interview process! 

I think my family is still in mourning that I am not a surgeon- I am convinced they believe I changed my mind because of my pregnancy. I know in my heart that is not true. I did take a leap of faith though and trusted my instincts- now that I am at the end of my first year of residency, I know I made the right choice, though I initially had doubts. We all have to find our little niches in medicine- I am convinced more than ever that there is a place for all of us. 

Over the weekend, we took our daughter to a big science museum, where there was an exhibit on the marvels of the human body. We watched videos of bronchoscopy, held models of brains, looked at disease aortas, and pieced together a skeleton. It took me back to my teenage self and my obsession with the Visible Woman model kit... I felt proud and happy that now, decades later, I am doing professionally what I loved so much all those years ago. I may have never dreamed of being a pathologist, but that's only because I didn't know what a pathologist was :) 

Looking forward to sharing stories!

MiM Mail: Adoption advice

My husband and I just found out via my new, shiny, residency contract that my program (4-years long, medical (not surgical)) offers a significant perk of paying about $10k in adoption fees for employees and their families. We've always talked about becoming foster parents or adopting in residency or just after, but we never realized it might be to our advantage to consider doing it a bit sooner (maybe around PGY-3 or PGY-4?). I'd love some advice from anyone who's done either of these things.

Some background -- my husband is a superstar; he's in education and has been a teacher or school leader throughout our marriage, and found an awesome job in the city we're moving to. He's also planning on starting a doctoral program part-time online, to finish when I finish residency. We're open to staying for a chief year or moving for a fellowship, although I want to do primary care and so doubt I'd do that. Obviously, all of this stuff (my husband's schedule, his doctoral stuff, being a resident) is flying around in my head, and this decision is certainly not urgent, but we got excited at the idea that we could pursue something that's long been a dream of ours, and during residency training! Anyone have any advice for an ideal time to do something like this? Has anyone else ever done so! (Obviously, there is no "ideal" time, but some are better than others, and I figure 2-months into intern year isn't one of them!).

Thanks for the tips!

So thankful for this community.
- Future mom and east-coast resident, currently box-packer and barely-a-physician in the midwest

My Life as a Call Girl

I spend 1/4 of my life on call. With 10 years of private practice in OB/GYN under my belt that's 2.5 years that I've been tied to my phone. Some nights I sleep peacefully through the night, but more often than not, I get to trek in at 3 am to catch a baby or two. Over the years, I've come up with my own set of on call rules to help navigate the chaos that can be a call night.

"Don't"s:

Don't dread it. Obviously, I don't wake up on my call day with a spring in my step, open the windows and shout for joy for all to hear "Yeah, I get to be on call today!" But I don't dread it either. I've learned to deal with it and enjoy it the best I can. If I didn't make peace with being on call then, I end up wishing away a quarter of my life.

Don't complain about it. When I chose OB/GYN I chose a crazy, sleep deprived life. Sometimes when I'm working postcall I will "explain" to people why I look hot mess of disheveled craziness (ie I delivered 17 babies last night). I try to keep it in a upbeat joking tone and not a "Woe is me! I work all the time" tone. We all know those providers who claim that every single call is the"Worst call ever" and that is simply annoying.

Don't indulge in the 3 am donuts. When you are up all night, the 3 am donuts can look so very tempting. Sometimes I delude myself into thinking "I deserve a treat" for having to work all night, however my 40 year old metabolism does not agree and I regret it later. I always keep healthier snacks like almonds and trail mix with me for just such emergencies.

Don't schedule appointments. After getting called in half way through a haircut once, I learned this lesson the hard way.

Don't socialize. If my leaving the event will be awkward, I won't schedule it when I'm on call; like dinner with just one other couple. If it's a bigger group of friends, I will sometimes try to go if I can. Also having people over is definitely out as well. Having to rush out half way through cooking dinner is not a great plan.

"Do"s

Do live your life. I can't put my life on hold completely when I'm on call. I still go to soccer games and church, I just drive separately in case I get called in. I still exercise, I just make sure when I'm running I have my phone on me and am always less than 10 min from my house. Sure this means that occasionally I have to race into the hospital all sweaty and get amniotic fluid on my Lulu tights but there are enough excuses not to exercise and I won't let call be one of them.

Do keep some entertainment close by. A lot of call can be "hurry up and wait." I often spend time waiting for an OR to open up or waiting for patient to deliver. I use this time for catch up charting and CME and reading.  This is actually my one bit of call superstition: I always keep a novel with me in hopes I won't need it.

Do Bathe. My biggest pet peeve is getting called to the hospital stat when I'm in the middle of a shower. Yes, the ruptured ectopic pregnancy is far more important than me having a bad hair day, but still it's annoying. I wish I could get away with not bathing on call but that would not be socially acceptable. Instead, I keep extra toiletries handy to throw in bag a the last minute as needed to get ready at the hospital.

Do know your limits. I am human. Occasionally, I need to ask for help. If a call is particularly awful I will get one my NPs to field phone calls. There are times I've cancelled part of my afternoon postcall to go home and rest. So no, I don't complain about every single call, but when I'm dangerously tired I listen to my body and rest.


So there are my call survival tips. I'd love to hear from the other MIMs on how they maintain sanity while juggling their pagers.

The end?!?

This morning I walked into my final official overnight call shift of residency. It is surreal to think that just 3 years ago, I began residency. I had absolutely no idea what it took, but having been a pretty good medical student I thought, “I can do this!”

Premedical studies, medical school, marriage, motherhood, and now residency have taught me about my ability to persevere, to thrive, to love and be loved. More so than the extreme highs and lows that come with providing care for a broad range of children from the critically ill to the chronically affected, you realize it is the day-to-day provision of care that is the most long-lasting. What you do on the average day at work, if your colleagues feel supported or unsupported, if your work leaves patients feeling cared for, if you managed whatever major things they were seeing you for, that’s what matters the most.

I think at the end of my shift tomorrow I’ll do a little happy dance to mark the end of an era. I am a lover of daytime work, of seeing the sunshine in the morning, of being at home when my family wakes up. I gladly mark the end of leaving home in the dark and trying not to wake up our toddler as I hustle to find my shoes. I gladly mark the end of back-to-back consult calls from the Emergency Department or outside hospitals for admissions. I sadly mark the end of seeing my favorite overnight nurses and of running efficient rounds. I sadly mark the end of being the “Senior Resident on call” answering questions for outside providers.

The end of residency overnight inpatient call and the beginning of Attending at-home call. Sounds nice to me.

How Much Do You Share With Your Patients?

Genmedmom here.

In my practice, there are two kinds of doctors. There are those who don't display even one personal photo in their exam rooms, and then, there are those that do. Me? I proudly display a collage of recent kids' photos. Occasionally, a photo will include me and/or Hubby, or our cats.

I've found that the photos can "break the ice", meaning serve as benign fodder for a softer, friendlier discussion in an otherwise sterile, somewhat scary environment.

Let's face it: a bleachy-smelling standard-hospital-grade exam room, where the cold speculum and bristly Pap brushes are laid right out on the chux, is not a fun place to be sitting twiddling your thumbs. No People magazine can change that.

How do I know this? Hey, I have a doctor, too.

What I've personally experienced is that decorations or photos can help to create a warmer, more inviting environment. I'll immediately feel like this provider is confident enough to share of themselves; that they're open to connect with me as a fellow human being.

The exam rooms that don't feature any kind of personal touch may as well be alien spaceship exam rooms: What part of me is going to get probed?

The worst exam rooms I've encountered are at my GYN's office: almost completely tiled without any objects left out in view whatsoever. I feel like a lobster in a pound. They may get high marks from OSHA and The Joint Commission, but I sit there increasingly uneasy, freezing in my flimsy paper gown. Even our dentist does better job with environmental emotional regulation.

Our pediatrician wins the prize for personal adornments. He's got family photos, his kids' artwork, obviously his choice of decorations (all sports-themed), and entertaining items like books and toys strewn all about. Not only am I made to feel more at ease, but my kids are, as well.

Of course, items and photos invite questions and conversation. I think this is good, and I tend to be very open and honest with my patients. Hey, I'm querying them deeply about their relationships, jobs, bad habits, fertility plans, and private parts. These are all topics that are socially prohibited in usual, out-of-the-doctor's-office conversation. I can at least share that my kids are in preschool and my husband works for the Patriots.

Some patients ask more, and I have real conversations with these folks. My general rules of thumb are: no personal chit-chat until the patient's issues and concerns are addressed. No shooting the breeze when I'm running behind. No sharing of my own medical issues. (Well, I'll sometimes share that I used to smoke cigarettes and that it was hard for me to quit, too.)

In seven years of practicing in this style, I haven't had anyone complain that I waste their time or overshare. My colleagues can tell you that I run on time, more or less. (More than most.) At this point, my regular patients excitedly ask for updates as soon as I walk in the door. How are the kids, how old are they now? Still have those huge cats? What does your husband thank about Deflategate?

Obviously, I'm all for sharing. heck, I blog.

What do other docs think?

MiM intro: X-ray Vision

Hello MiM!

I am so excited to contribute to a community that has been my lifeline during residency and motherhood. I figured my introduction should include how I got to know MiM.

Rewind to approximately 3 years and 1 month ago, I was at the end of my surgical intern year. (I know. I'm a radiology resident. Why did I do a surgical intern year? Long story short. My husband, big C, was already an orthopedic resident at the institution of my medical school before I matched. I was pretty set on staying on for internship and residency at the same institution. There is only 1 transitional program in a 2 hour radius of where we are from and that particularly 1 was heavily medicine and ICU. I don't like long rounds. So surgery it was!) At that point in my life, I was pretty darn happy to be at the end of my surgical intern year and ready to start my radiology training.

My husband and I just returned from vacation and I was feeling unusually tired. More tired than I usually do. Hard to figure out what my baseline was given that I was a surgical intern! I joked around with him that maybe I was pregnant. I had forgotten my birth control pills during our 2 week vacation but thought nothing of it at the time. I remember distinctly finishing rounds on a Saturday morning and settling into my day of call. I remember texting my poor husband who was post call that I hope he didn't "knock me up." It was a particularly slow morning. I was bored. I walked over to the nursing station and asked for some pregnancy tests. I took 5! I peed on one and I saw 2 stripes. I freaked out! I got some gatorade from the hospital cafeteria and peed on the remaining 4! 2 negative pregnancy tests followed by 2 more positive pregnancy tests! I remember as a medical student on OB thinking how could people NOT know how to read a pregnancy test. Now I knew why.

After my call ended and thoroughly freaked out, I remember going to the pharmacy and purchasing digital pregnancy tests. The kind that said "pregnant" or "not pregnant." Same thing happened! 2 "pregnant" and 2 "not pregnant." At that point, I was still in denial. I wanted a blood test. Except I don't have a primary care physician. Who has time to go to primary care physician as a medical student or a surgical intern?

I found the family medicine department on our institution's website. It was already Sunday at this point and I was desperate. I e-mailed one of family medicine physicians, Dr. B. I never met her. But she e-mailed me back immediately. She said it was no problem and she would put in the lab order for a blood b-HCG. I got my lab drawn the following morning. After rounds that Monday, I got an email saying that new lab values were posted on my online medical chart. There it was. b-HCG 79. Reference Value: >10 pregnant.

I remember taking a screen shot of my labs and texting it to my husband. First and only time he would actually excuse himself out of rounds to call me. We were both in shock. I was an intern! He was a PGY 3 but basically a PGY 2 as his orthopedic program requires a research year as a PGY 2. We were babies in the world of medicine and somehow now we were going to be responsible for a real baby in less than 9 months?

I remember Dr. B calling me with the results herself. She said "Your intuition was right! You are definitely pregnant and very early pregnant, which explains the equivocal urine pregnancy tests." I sat there and tried to calculate my due date. I was going to be mom half way through my first year of radiology training. Once baby comes, I will still have another 3.5 years of residency and 1 year of fellowship. How am I going to do this? I will forever be grateful to Dr. B. I wasn't her patient. I was just some resident that found her e-mail and she was just nice enough to respond. It was then she asked, "Have you ever heard of the website Mothers in Medicine? I think it will be good for you."

I've been hooked ever since! So here I am today. 3 weeks away from taking radiology boards. My little love bug, little C, is now almost 2.5 years old. I'll be starting my last year of radiology residency come July. (We take part 1 of our boards a year before we graduate. Part 2 comes 15 months after graduation.) Big C will be graduating from his orthopedic residency this June and leaving to the east coast for his spine fellowship.

This year will be an adventure for me and little C. I will have to figure out what it's like to be a "single parent" while doing residency among other things. I am very lucky. I have a wonderful support system that mostly involves my mom, which is the reason I even survived up until this point. All topics for future posts! (most likely after boards!) Thanks in advance to everyone in this community for being a part of this journey :)

Sincerely, X-ray vision

MiM Intro: Juggler

Hello! I'm so pleased to be joining the MiM community as a new poster. I'm a rising fourth-year medical student with a fifteen-month-old daughter. I'm currently wrapping up a year of research and will soon be starting my final clinical rotations before the residency interview season commences.

Just shy of two years ago, I took Step 1. I was 8 weeks pregnant at the time and came to the testing center armed with acupressure bands, ginger and saltines in the hopes of keeping my first trimester nausea at bay. Adrenaline turned out to be a more effective remedy, containing my queasiness all the way through the final question. I left the testing center wondering if I'd passed, but mostly feeling relieved to be done. Before long, however, tendrils of uncertainty began to creep into my consciousness. I felt suddenly overwhelmed by all that lay ahead - pregnancy, labor, an infant to care for...all while on my 3rd year clerkships. I was still learning to survive as a medical student - why on earth had I decided to add learning to be a mother on top of that?

Fast forward to today, when I sat for Step 2 CK. This time I came to the testing center armed with tissues and lemon tea (because if I've learned anything since being a parent in medical school, it's that the week of a board exam your kid will get you sick). I made my way through the sections, feeling only marginally more knowledgeable than I did two years ago. As I was signing myself out at the end of the day, the ladies staffing the testing center kept commenting on the cute little girl who'd been popping in. My test-addled brain didn't quite make the obvious connection ("Who's just letting their kid wander around the building?" I wondered vaguely as I waited for the biometric scanner to register my fingerprint).

As I turned to leave, I saw that it was me (or, rather, my husband), who'd been doing just that. My daughter stood in the waiting room, her face breaking out into a huge grin as she ran to meet me. I swept her up into my arms and covered her with kisses. In that moment, everything in the past two years - the weeks of dragging my pregnant body through ORs and wards, the hurried pumping sessions in call rooms and restrooms, the 3 am diaper changes when I had to be at the hospital to pre-round only hours later - everything felt worth it.

Today, with the hardest parts of medical school behind me, and only residency interviews and a handful of electives (plus one pesky Acting Internship) ahead, I'm feeling excited about what the future holds. I'm looking forward to welcoming all of you along as I hit the interview trail, agonize over my rank list, and wait impatiently for Match Day. I hope that I can offer encouragement to other women who are parenting or contemplating parenting in medical school, or maybe just a sense of solidarity during those moments when none of it seems worth it (or even possible). I'll be posting here under the name "Juggler" - a role I'm sure all of you are intimately familiar with.

Thanks for reading and for making MiM such a vibrant, dynamic community for women at all stages of motherhood and medicine!

-Juggler

The Do-it-Again Equation

Cutter’s excellent post and the comments to follow really got me thinking. What factors go into our thoughts about whether we would do it again (become a doctor)? Can this change?

This is just my way of thinking about the question (one way of potentially many), but I think the simplified, general equation may look like this:

Outcome - Sacrifice    =    DiA
                    time

If DiA = positive, you would do it again. If negative, you would not.

And where Sacrifice = time, money, family relationships, moves, etc , thus far

Outcome = present level of satisfaction with career, may include work-life balance (or work*life product), income, career-related meaning, work-related aggravation

And time, because I do think time is a factor because time attenuates sacrifice/hardship. For instance, if you asked me whether I wanted to have another child while I was sleep-deprived and breastfeeding my newborn Q2 hours during those awesome early weeks of being a new mother, occasionally crying in the shower if I was fortunate to have a shower, my answer may not have been a resounding Absolutely! Not that I didn’t think my child was a magical gift, but wow. My pregnancy/labor/post-partum period were not easy. Fast forward a couple of years and that hardship didn’t seem quite as insurmountable relative to the outcome.  That was kind of a terrible analogy (along with math, not my forte), but I think in general, distance makes the heart grow fonder and the memories fuzzier.  Alternatively, maybe the Sacrifice was way too much and no time in the world would make that value small enough.

For me, my Sacrifice to become a doctor was relatively small and feels smaller with time. I met my husband during medical school. I was really fortunate to finish training with minimal debt, and besides being very tired and on-call during multiple holidays (Thanksgiving dinner with my co-residents in the physicians’ dining room; watching fireworks on July 4 through the 8th floor hospital windows), it wasn’t so bad. My Outcome, on the other hand, has increased over time. I now have more control over my schedule (compared to being junior staff right out of residency), higher income, more clinical knowledge, have engaged in new areas that keep me excited (teaching, research, mentorship, leadership) and after working with all different members of the healthcare team, value the role of physician as leader more than ever. Don't get me wrong- there are parts of my job that are the mental equivalents of how I imagine a root-canal would feel, but on the whole, my career is rewarding beyond what I could have imagined right after my pre-duty hours residency. My DiA started out positive from the start and only has grown more positive with time.

It goes without saying that this equation and its variables are individual, and there could be a fatal flaw that I have not considered in forming this equation. But, it’s not an easy path to take, no matter how you compute it.

MiM Intro: PracticeBalance

Full disclosure: I am not a mother... yet. But I will hopefully (finally) be one soon!

Like many women in the medical profession, I delayed my plans for starting a family until late in my residency training. I initially worked as a chemical engineer, and I also traveled extensively to rock climb prior to deciding on medicine. In addition to entering the medical field a bit later than average, I frankly wasn't ready to be a mom when I was a medical student. I found the amount of work ahead of me to be exciting but also overwhelming in the face of a potential pregnancy/childbirth/parenting etc.

About half-way through my anesthesiology residency (coinciding with my 35th birthday), my husband and I decided it was time to start trying. Only one thing stood in the way: I hadn't had a period in several months. I had always been irregular, but those irregular intervals had increased during internship to an eventual standstill of menstruation. After ignoring this warning sign for a while, I finally sought the help of a reproductive endocrinologist. This initiated a long journey with many blood draws, tests, and time off which finally revealed that I had a large pituitary tumor causing severe hormonal disregulation. My experiences managing both physical and psychological stresses during medical training prompted me to start my own blog, PracticeBalance.com, in 2011. I continue to write regular posts there about stress management, being a patient, and self-care issues.

After my tumor removal, I have suffered from continued hormone deficiencies, which means that I need to use assisted reproductive techniques to get pregnant. I started following Mothers in Medicine a few years ago, around the same time that we actively began trying to conceive. I work three days per week as a purely clinical anesthesiologist (no research or teaching responsibilities) in a large academic hospital - what I'm hoping will be the perfect setup for balancing a career and motherhood!

So now here I am, currently expecting my first child - three years, one miscarriage, and thousands of dollars later. I hope to bring a perspective to the MiM community about what it's like to be an expectant mom (and then eventually a new mom) while working in the operating room. I could also write about what it's like to be an IVF patient (who happens to be a medical professional), if there is any interest in that. Currently I am experiencing a lot of apocalyptic worry regarding all that could go wrong in my pregnancy - feelings born out of both having had a miscarriage in the past and having work-related experience with all the "bad things" that can happen.

Please let me know what you'd like me to write about by leaving a comment below. I'm excited to be here and look forward to hearing from you!

MiM Intro: EMMomma

I am an Emergency Physician and Medical Toxicologist practicing in a large academic center in the only tertiary care and level one trauma center in my region. My path here was not typical: undergraduate degree in bioengineering, did not get into medical school the first time around because GPA was "too low" (thanks, bioengineering!), worked for a year using my bioengineering degree clinically, got into medical school, did not match in EM and spent a year as a surgical preliminary resident, got into my first choice the second match go-around, and then did a med tox fellowship. I am at my first real, non-moonlighting job. I prefer evening and overnights shifts and take call for toxicology about 10 days a month. I have academic duties and I love teaching, especially in the classroom or small group setting. My research is focused in toxicology but not a very large part of what I do. I will likely never be tenured and I'm okay with that.

I never wanted to be a mother the way most women seem to want to; I wanted a career in Medicine since always. I decided to become one when I realized Hubby was The One and for him, it was an unspoken deal-breaker. Now I have two adorable boys, Blur1 who is 5 and Blur2 who is 2. Blur1 was born during the first year of my fellowship and was a relatively easy pregnancy. Blur2 was within 18 months of my first real (and current) job and while I was never at actual death's door, I had a hard second pregnancy. I had to tell two relatively new bosses that I was pregnant and I've never taken a written board exam not pregnant.

I would not be where I am without Hubby. He is very much not medical and blanches as some of my stories from work. He has an unusual job that requires early morning hours but unlike EM, they are generally Monday-Friday. We split the household stuff and kid stuff along our strengths and who's available but truth be told, he does more because my shifts are often when the kids are awake and not in school. Currently, we are focusing on my career so we are here, in The South, as transplanted Northerners. We are hundreds of miles away from family so we use a combination of daycare, school, camps, and a small army of babysitters who have to come to our house some days at 4 am (yes, 4 am). We have four Google calendars to coordinate Hubby's, my work, my personal, and our family's schedule; I imagine the kids will each get their own calendar in the future. We do most things as a family, including grocery shop, and we're a bit sports obsessed.

I recently realized I do not do anything for me, as a person, on a regular basis. I enjoy Social Media but primarily use my accounts for education (FOAMed supporter) or keeping in touch with friends and family. I love to read but with The Blurs, that is hard. I bake and cook but there is only so much food we can eat. I started working out more but I view exercise as a necessary form of torture. I was looking for a hobby or something to call my own that is not work, Hubby, or Blur related when this offer from MiM came along, which means the thing I call my own will be my thoughts on work, Hubby, and the Blurs (thanks universe). I have been reading MiM since the near beginning. During my first maternity leave, I had a hard time alone with Blur1. I found momblogs and medical blogs. I found MiM through one of Fizzy's cross-posts. I don't follow many of those blogs from those early days anymore but they got me through maternity leave(s) and early motherhood and career and made me realize many of the things I felt and thought were normal. Now I hope I impart this feeling of normalness to my residents, colleagues, and MiM readers.

And in response to Cutter, I would do it all again. Definitely the medicine. And Hubby. And the Blurs.