Feeling like the worst mom in the world...

My introduction post was mostly about how I get to know Mothers in Medicine, which was when I found out I was pregnant. I also talked about where I am today. I never talked about what happened in between those 2 and a half years.

So during those 2 and a half years, I went from first year radiology resident to fourth year radiology resident. I just took my boards last month!! (Ask me again in 1 month how I felt about it, which is also when I'll get the results.) My husband, big C, went from 4th year orthopedic resident to a 6th/chief orthopedic resident. He just graduated last month!! Currently, I started my first month of my last year of residency and my husband is actually, right now, taking his orthopedic boards. He'll be moving to the east coast in exactly 2 weeks to start his spine fellowship.

So basically, I'll be a single mom for a year. But what you don't know about me is that my little C has been with my parents in a city 1 hour away from our  city of training for the past 2 and a half years. That is how we did it. So your recent blog post Anita Knapp really resonates with me! It was an extremely difficult 2+ years. But given my husbands 80+ hour work weeks and my most difficult years of residency ahead (combination of both majority of my calls during my 2nd year of radiology residency and studying for radiology boards/multiple board review sessions during my 3rd year of radiology residency), we felt that this was what was best for little C. 

I have had my share of mommy guilt during this time. I questioned my decision all the time. I felt like a horrible mother. It definitely put a strain on my marriage with big C because who likes being around a negative and sad person all the time? But little C was my heart and soul and it just didn't feel right being away from her Monday to Fridays and some weekends. 

Well little C is all moved down. It's so funny how kids can be so resistant to change at times and also so easily adaptable. I took 2 weeks of vacation to help get her situated. In less than a week, it was as if she already forgot about her 2+ years with grandparents (much to my mom's dismay). During those 2 weeks, she and I attended her 2 week orientation at the pre-school associated with the university, which basically meant spending 1 hour a day for 2 weeks with her at the pre-school. That part went fine. In fact, the entire 2 weeks was awesome for our relationship. I got to just be her mom without even thinking about residency once. 

I thought the transition to pre-school would be easier. She attended part time pre-school during her last 5 months with grandparents almost as a preparation for what's to come. She had a hard 1st month but eventually grew to love it and was out the door to go see her friends as she would say.

However, she must feel like her whole world is upside down now. It's been almost 2 weeks into her new pre-school, which is obviously now full time and every day she cries and cries. Drop-offs are so painful. I spend the mornings just thinking about her crying little face screaming for mommy.

She refuses to eat at pre-school. She's potty trained at home but refuses to pee on the toilet at school. She also doesn't nap. When I go pick her up, she seems okay but I can't seem to shake it off that this is just a transition period. Is she ever going to adjust? Am I just the worst mother in the world? Was this a mistake? Was I being selfish by taking her away from the princess treatment that was given to her by her grandparents? 

I don't know if I can go back to the former life. I love picking her up. I love eating dinner with her. I love putting her to bed. I love that she runs over to me and wakes me up in the morning. But do I need her more than she needs me? Am I not able to give her what she needs? 

It almost feels foolish that I thought the mom guilt that I carried with me for those 2+ years since maternity leave would disappear once she lived with me. 

But right now, I can't help it. I'm feeling like the worst mom in the world yet again.

How am I going to survive once my big C goes to the east coast? 

Days likes this. Cutter's blog post comes to mind on whether this (as in medicine) is worth it? I simply say "no." 

Friendship

Last month I did a dermatopathology rotation, a really interesting subspecialty of pathology (and dermatology!). For both the pathology and dermatology residents who rotate on the service, it is probably the most laid-back and responsibility-light rotation we have... I felt like I finally had time and space to breathe after a few tough months.

My second week on service, I noticed a familiar face around the multi-headed microscope- a mom from day care, a dermatology resident! Our daughter (who just turned 2 last week, sniff sniff!!) goes to a day care our hospital owns, so all the parents are hospital employees- physicians, post-docs, etc. I am constantly lamenting to my husband how unfortunate it is that the parents don't know each other well because, understandably, all the doctors are rushing in and out during drop-off and pick-up... also, when kids are screaming and crying, it doesn't exactly feel like the right time to have a little chit chat! Her daughter is 3 months older than ours, and had been in the same infant and toddler classroom as ours...  I had seen her in passing maybe only once or twice but with only a smile and, "Hi."

We beamed at each other and waved, and as soon as sign-out was over we started chatting. I simply felt like the floodgates had opened, haha... I had found a kindred mommy-doctor-wife-woman spirit, and a burden over my heart had been lifted. Our similarities were uncanny, from getting married in a courthouse on their anniversary date (ours at 6 years, theirs at 4 years), to both of us nagging our husbands to stop smoking their incessant cigarette or two a day during times of stress. Finally, another psycho who is reluctant to get a babysitter (us only once, them just twice) because they genuinely want to just hang out together as a family, but also hates themselves for it haha. We also have in common crazy moms, resulting in chronic husband vs. in-law issues. Both of our husbands are equally ambitious and passionate. We are both in day care without extra help, and we talked about how we deal with weeknight routine chaos, fitting in studying, etc etc.

Over that week we overlapped on service, we talked. And talked. And talked. I don't know how long it's been since I've connected with someone like her. Unfortunately, she and her family are moving an hour away so that she can start a position as an attending. I hope we will make plans to see each other and get the girls together. But it reminded me of the power of female friendship, of something I didn't realize had been so sorely missed.

Attending Status: let's go!

I woke up to the sounds of the birds chirping and then “Mommy!” as my almost 4-year old tried to start his day at 6:45am. Quick detour for a potty-break and then promptly back in his bed because, “It’s still too early. Time for sleep.”

As I sit at our desks, I double and triple check that my Epocrates app is up to date so that I can quickly calculate drug doses. Today is my first official day as an Attending. I am returning to my dream health care system to work in the pediatric clinic I did my third year community pediatrics rotations in. The Attendings and many of the front desk staff remember me back when I was a medical student and they, like me, are super happy that I have returned.

We had an all-day orientation yesterday that was truly inspirational - yes, I’ve drunk the Koolaid as they say and am already one of those super happy people to work where I work. Providing care to children in our nation’s capital is truly an honor and one that I do not take lightly.

During times like this I refer back to my favorite book The Alchemist (Paulo Coelho). I was tested immensely in these last few years, but every second of the journey brought me closer to the realization of my dream. Every struggle. Every triumph. And I’m here. In this moment. Feeling the immensity of years of pre-medical studies, MCAT struggles, public health school, medical school, biochemistry challenges, clinical year excellence, pregnancy during USMLE Step 2, birth, and being a mother in medicine.

I am totally ready for this aspect of my journey. I vow to do great things. So let’s go. Let’s get it. Pediatric Attending status 2015! (happy dance, happy dance, happy-praise dance!)

See you in a month, Itty!

A couple of weeks ago, my husband, N, and I found out that we both started our intern year in the MICU.  We soon realized that this meant that we would almost never be able to pick our daughter up or drop her off at daycare. Considering it would be her first month ever in daycare, we were stressed!  Nanny interviews commenced, and we tried to ignore the impending financial doom that our first month with a paycheck would bring (due to the high cost of nannies). 

Soon thereafter, my mother-in-law suggested that we take our daughter, Itty, back home to spend the month with grandparents, aunts, and uncles.  Just for reference, we moved 15 hours away from “home, home” a month ago, and we have no family nearby.  Initially, I was resistant to the idea, as I couldn’t imagine a month without my Itty, but we eventually decided that it was probably the best idea for everyone.  Itty would get to see her extended family, who previously provided all childcare for her, and N and I would have a month to focus on our new roles at physicians.

She’s been gone for 4 days now.  While I was very sad during the first couple of days, I’m now realizing what a great idea it was.  Grandparents are happy, Itty is happy (at least for now, she doesn’t miss us too much), and we do not have to worry about her at all during a stressful day at the hospital.  I had forgotten what it was like to not have to think about picking her up, feeding her dinner, giving her a bath, getting her ready for bed, and putting her in bed.  Not to mention the middle of the night awakenings that still seem to happen although she is almost two years old.  Once you have a child, it is difficult to remember life without one.  

Part of me almost feels badly that I’m enjoying this “me” time so much.  I miss her tremendously but also feel that a significant burden has been lifted, at least temporarily.  Has anyone ever done anything similar?  This is probably the only time that we will ever send Itty away for a whole month, so does anyone have any childcare tips if we are ever in a similar situation again?  We were so worried about having multiple new caregivers in such a short period of time, especially with the limited amount of time that she would be able to see us anyway.  I can’t tell you how many times I’ve asked myself, “How are we going to do this?  What did we get ourselves into?  Why did we move so far from our families?”.  However, I’m confident we’ll figure it out, little by little, with a lot of help from others (hint, hint!).

On another note, I was a physician today :)  Crazy!

Moving and credentialing are like oil and water

The last 3 months my husband O has been packing while I have been working on getting credentialed. His boxes are brown and filled with books and mine are checkie-boxes that I slowly work through. His boxes move us toward relocating while mine push us further and further away from our goal of saving money ($731 for DEA license, $130 for DC Controlled Substances License, the list goes on and on) but closer to my first job as a Pediatric Attending Physician.

The only one of us who has had fun packing is our almost 4 year old. His favorite activities include: throwing empty boxes, making forts out of boxes, and sliding on boxes. One day O and I heard a loud crash as he and his friends decided to pack his room; they did a pretty good job of placing all of his toys in a large box and then they proceeded to drag it into the hallway so he could move. It was endearing for about an hour until he began rummaging through it to get toys that he now decided he just had to have.

I am writing now so that I can take a break from packing another box of dishes. Packing dishes has helped me realize that we have a ton of dishes we don’t even use. I am purging these unused items because I refuse to pack them and I’ll be happier with less clutter. We have made so many trips to our local donation center I cannot even count them and each time I wonder where all of this stuff came from, while controlling my desire to “just hold on” to that thing I haven’t used in months but that I absolutely “need” (like the expensive Dr. Brown’s baby bottles, they are totally keepers!).

The last 3 months have shown me that working, while doing on-line orientation modules and handling credentialing just don’t mix. There isn’t enough time in the day. Thankfully, credentialing is all done and in less than 3 weeks I will be a full-fledged Attending Pediatrician! Unfortunately our movers come in 3 days and I now can’t seem to motivate myself to press on and I have no more credentialing to use as my excuse. It’s game time. Relocation here we come! But for now I’m just going to sleep.

Book Review: Burning The Short White Coat by Eve Shvidler, M.D.

I love reading books written by other doctors. Especially when I actually have time to read them. When I read the P.R. blurb on OB/GYN Eve Shvidler's Burning The Short White Coat: A Story Of Becoming A Woman Doctor, I knew I HAD to make time to read this book:

"What happens when Sex and the City meets Grey's Anatomy?… A medical chick-lit novel, Burning The Short White Coat exposes the personal battles that single women must overcome in balancing a demanding profession and the desire to find a trusting and loving relationship…"

I've been waiting my whole life for the female House of God. I was very excited to know: Could this be it?

Well, not quite. But, this light read is definitely engaging, funny, and fun.

The story follows relatable Elle Gallagher (and BFFs) through four years of medical school, and much romance. The action of the prologue draws in the reader (Overnight call! Crash c-section!). The first chapter, "The Gross Lab", is so gross, it's great. I was having formaldehyde flashbacks, myself. There are such nice touches here: the dissection of the penis by the retired surgeon is worth the price of admission.

But, the issues that plague this book also begin here: spelling and grammatical errors. Lots of them.

Now, I also write for publication, and I hate when some reader expresses extreme annoyance over a couple of typos. But there are ALOT of typos, misspellings, and incomplete sentences throughout this book, so many that even I was extremely annoyed. If I wasn't almost at the end of the book, I would have put it down at "introidus". Which appears twice. These errors make the book read more like a rough draft.

There is also heavy use of clichés, which I can forgive because at the same time, there is also plenty of fresh, unique material.

The chapter titled "Psych" is a fascinating little story-within-a-story featuring one of the creepiest cases I've ever heard. If what is described really happened, that's crazy disturbing. If it didn't, that's crazy good imagination.

One surprise for me is that my favorite character in this book isn't one of the female protagonists at all, it's the slightly immature but lovable surgeon Samy. We all know that attendings who hang out with medical students… well, that's just wrong. But this guy, he's complex, and he has some great lines. His advice to Elle on booty call vs. relationship girls is right on, and I'm not sure I've seen it done so well in a book that wasn't intended for teenagers.

The best part by far, though, was the chapter titled "Good Vibrations". I believe I had a similar hilarious conversation with my medical school BFFs. I would never have dared to write about it, though. I'm impressed!

In the end, I thoroughly enjoyed what was overall a refreshing, real-deal, feminine take on the modern medical school experience. (Yes, people, med students DO party that hard.) I just wish someone had run a spell check and an editor's eye over the text prior to publication.

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Hot off the presses! Addendum! As of 6/27/15 I have just heard from the author that she had already realized there were many errors in the original manuscript, and she put the whole thing through a copyediting process. There will be a new release in about 2 weeks from now, sans errors.

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As an aside, I have to say, the author's blog on Wordpress (https://burningtheshortwhitecoat.wordpress.com) is VERY good reading. Her articles and essays are enormously informative and entertaining. Moms in the audience, do yourselves a favor and read her post Where's My Orgasm from June 8, 2015.

Girls Don’t Cry

I have been following the response to Sir Tim Hunt’s incredibly sexist comments on women in science and thinking about how it relates to a working mother in medicine. If you haven’t heard of Tim Hunt, he is a Nobel prize winner who made headlines earlier this month for saying “…three things happen when [girls] are in the lab…You fall in love with then, they fall in love with you and when you criticize them, they cry” at a lunch for women journalists and scientists in Seoul.

Not surprisingly, the response has been overwhelming.  Some of my favorite tweets:

and…

and my all-time favorite…

But all joking aside, sexism still exists in science and medicine.  And as a working mom I’m very sensitive to issues of sexism, ambition, and differences between men and women.

This may be because I am constantly pulled in two directions (career versus family) and wonder if my ambition is ever questioned. On the one hand, I don’t want to draw attention to the fact that I am very much pulled in these two directions and must balance work and life.  But on the other hand, I do want to draw attention to this struggle to help support other women and help others understand decisions working moms need to make.

The fact is that I make very conscious decisions that incorporate both my work ambitions and my motherly ambitions. No, these decisions do not involve being distractingly sexy or crying in the lab but they do involve taking a slower and, sometimes, more convoluted paths.

I have rejected significantly higher leadership positions because they would squash my flexible schedule, I consciously avoid travel, and I am not willing to move my entire family for my career. To some of my male colleagues, these decisions may seem crazy, but, for me, these decisions are very calculated. 

I’m very conscious of burnout and hope to keep a level of balance that helps me work full time, find satisfaction in what I do, and keep me on an ongoing trajectory so that when I am no longer in the weeds of motherhood, I will still have interesting and meaningful career opportunities.

That being said, there are times when keeping the reins on my career is hard. I wonder whether I am being left in the dust when I see male colleagues make different choices and move up the ranks faster than me. And as a working mom, I never want to compromise other women by having my ambition questioned. 

But even with these doubts, I am incredibly proud of the difficult career decisions that I and every working mother have to make.  I know I will only have a short time with my kids at home and I want to cherish that time.  I’m sure there will be time in the future to turbo charge my career if I want.

In terms of Tim Hunt, I’m not sure if #distractinglysexy and #crybaby necessarily come up as issues for my career but ambition, choices, and timing certainly do. I think if we keep open dialogues and try to respect for each person’s decisions then I think we can push the conversation.  What do you think?

MiM Mail: Medical school timing

I have wanted to pursue medicine since first being exposed to it in nursing school. Throughout nursing school and my career as a nurse I have had a desire for the knowledge, skills, decision making and leadership that comes with being a physician.

I will be finishing my prerequisites in the fall and can take the MCAT in the spring with the potential of going to medical school in 2017 with an almost 3 year old and 16 month old. (I am currently 8 weeks pregnant!)

My question is, should I apply as soon as possible or should I spend a few years with my babies while they are still babies? Would it be easier to complete school if my wee ones are are at least potty trained?

A handful of physicians encourage me to do NP, CRNA or PA but I know I won't be satisfied as a mid level. On the other hand I'm not thrilled about all the time I'll be missing with my babies!

I'm 27 years old and my husband is very supportive. We could also get a nanny at any time if needed. Looking for some words of wisdom from those of you who have gone down this path! Thanks!

MIM Intro - It gets better and better

I finally did it.  I wrote a blog.  I have been dragging my feet for weeks!  You see, I had been told that I had stories to share, and I have always been a champion for mothers in medicine, but I have always told myself that I wasn't a writer.   I am going to change that this year.

I can't remember when I started reading some of the posts of the MIM blog.  When I was in  fellowship I had my first daughter,  and I used a breast pump behind a shower curtain in the small nephrology fellows office.  Often times, the other fellows (all male) would come in and talk to me over the rhythmic whirring of the pump while I was behind the curtain.  I have to give it to those guys - they were brave! And respectful.  I had a hard time making enough milk, mostly due to fatigue, and so I joined my first listserv, PumpMoms.  My online community experience had begun.  I learned so much, and felt so supported by other moms that I was elated to find the Mothers in Medicine website.  It does seem to be so very different being a mom in medicine rather than not.

Fast forward thirteen years.  I know, I wouldn't doubt that I am the oldest blogger on the site.  My oldest daughter just celebrated her 13th birthday.   I have three daughters ages 8, 11 and 13 and two bonus daughters ages 10 and 13 and a husband who is a pilot and not keen on blood at all.  Most people's jaws drop and then pat my husband on the back giving him kudos for living with so much estrogen!  We have two small boy dogs, but I have to say that they are  prissy dogs and don't add a whole lot of testosterone to the mix!

Many of you may be visiting this site trying to find peace or solace about your choices regarding when to get pregnant, how to breastfeed, find child care, whether to work full-time or part-time and  how to shape your career along the way to accommodate the ferocity of motherhood that can overtake you.  I have been there, struggled through all of those events, had many, many funny stories, buckets of tears, and loads of self-doubt as I worried it if were all going to turn out ok.

But here I am, thirteen years later, pretty well settled into a full-time position at an academic university with all these girls to raise.  I still have a lot of great stories, still cry from time to time, but I am reassured that all will be well if I continue to listen to my heart.  It has guided me pretty well along the way.

As part of my first blog, I wanted to share the story of my daughter's 13th birthday party.  It was a rare day.  Seems like all 4 of the other girls had something to do that day, as well as my husband - that NEVER happens.  My oldest had invited two of her best friends to shop, visit the makeup counter and head to dinner and a movie for the evening.  My presence was requested at the make-up counter as my daughter was nervous about approaching the sales lady for a makeover for the three of them.   I met them that afternoon, made the requisite introductions between the makeup artist and the girls and gave minimal instructions about "light" makeup.  I headed off to browse the jewelry counter and give her some space.  At the end, three lovely ladies emerged only slightly lovelier and we proceeded to dinner.

You know, once your daughter is thirteen, you struggle with the fact that she is slowly separating from you.  You know that this is necessary and unstoppable, but you so desperately want it to be like when they are little and want to always sit in your lap, fix your hair or climb into bed with you.  When your daughter is thirteen, you anticipate the  increasing possibility of eye-rolling, one syllabic answers to your questions and that your presence will be undesirable. So, I offered to sit at the bar so that my oldest could be with her friends alone.   Instead, my daughter said she really wanted me to sit with her and her friends.  What a rare opportunity to participate in her life and see her interact and engage with her friends.  I had the best time at dinner, and my fears of ugly adolescence were totally put out of sight.  My mother heart was overcome listening to the three of them talk about difficult relationships with girls at school, their occupational dreams, where they would like to travel, and what they thought of the charcuterie board we ordered.  It was an experience that I shall not soon forget, and one that I hope I can have with all the girls individually along the way.  She is growing up.  I cannot stop it, but I am going to enjoy the heck out of it!

 All those decisions about how much I was working, whether I was always present in the moment at the playground while answering calls from the office, was it ok to skip that meeting to go home early?, did anyone think I was crazy for pumping behind a curtain? It was one of those experiences where you tell yourself - I did ok.  Self-doubt getting smaller by the year.

The hug that keeps going

Growing up, in my dreams of my future family, I always had two children. Two seemed like the perfect number. We had two in my family, my brother and me. There was that nice 1:1 ratio of parent to child. I also grew up hearing stories from my mother of growing up with 3 siblings - and her feeling squeezed out sometimes as a child who was not the eldest, not the youngest, and not the lone son.

I keep that in mind as I raise our three children (10, 7, 4), always conscious of fairly doling out my attention and time. Whenever I am on-service (which means leaving earlier and getting home later each day), I sometimes notice an increase in "needy" behaviors especially in the younger two. There's more clinging, whining, and other attention-seeking antics. I am also particularly sensitive to the contentment of our middle child who is most prone to feeling left out. He occasionally gets into these funks where he is down on some quality he has - such as that he's the only child in our family with glasses, making him feel different and more unlovable, I guess. (Mind you, he is adorable with those glasses!)

Unfortunately, coincident with being on-service is feeling more worn out at the end of the day. The kids' bedtime becomes one last hurdle before glorious rest. That means no long books. No delay tactic tolerance.

One day, when I was feeling a QT deficit with our middle child, I decided to give him his good night hug and not be the first one to let go. Just to see.  I just hugged him and kept hanging on. After awhile, I felt his little arms loosen and relax, enjoying the moment so, but still hugging. The hug went on and on. I did not let go. Finally, I felt him let go first. His arms fell to his sides. He had a huge grin on his face, sated and sweet.

I've generalized the hug that keeps going to the other two children, just to be sure they are all getting enough hugs from mama. It's not every bedtime but sprinkled in there for good measure. Often it ends in a spurt of giggles (especially if accompanied by a neck nuzzle), but always I feel glad to have hugged so slow.

MIM Intro: Doctor Professor Mom

Hello, I am Doctor Professor Mom.  No, that’s not my real name but it’s a name that makes me really proud.  My oldest son coined it a few months ago when he learned that I am not only a doctor but I am also a professor and I am also a mom.  He seemed genuinely proud when he coined the name and, of course, I was equally proud both at his creativity and at some of my accomplishments.

Even as a Doctor Professor Mom, it’s hard to feel accomplished.  Maybe it’s something about academic medicine where I feel pulled in a million different directions. I teach; I do research; I see patients – it’s easy to feel like a jack of all trades and master of none.  Add on a busy family life and mastery is not in my cards.  But academic medicine has given me incredible flexibility, variety, and satisfaction.  Plus, I get to proudly say I am a doctor and a professor.

Of course my proudest accomplishment is not that I am a doctor or a professor but that I am a mom to three boisterous, energetic, and absolutely wonderful sons.  They are ten, eight, and six (gasp - how did they get so old).  After ten years of motherhood I have a lot to reflect on in managing a household with two equally ambitious working parents and ever changing challenges of parenting. 

I became interested in writing about my experience as a doctor and mother after my first son was born.  I spent 18 months crying every day when I went to work and decided (with the incredible support of my husband) to leave my job and stay home.  Then I struggled trying to find my identity as a stay-at-home mom (I wrote about this experience in an essay called Dr. Mom).  I returned to work and decided to focus on research and a career in academic medicine.  For me, it was an excellent choice.  That being said, the struggles of being a working mom, finding meaning and satisfaction in your work, and all the other challenges of life never go away even when you feel like you’ve found the perfect job.

When I wrote Dr. Mom in 2007, so many women contacted me and thanked me for sharing my story.  I promised myself I would write more, but, not surprisingly, life got busy.  I’m thrilled to have a place to write, to be a part of a community of women in medicine and hope that something I write will resonate with someone else. 

Pregnant in the OR: When to Tell

I was 5 weeks pregnant and working in the spine room. Just as I finished my intubation and secured the airway, I turned to set the ventilator and administer some important medications. The surgery fellow started to position the fluoroscope near the patient's cervical spine, about a foot away from where I was working. "Please don't use the Xray right now; I need to put on a lead shield first," I said. "Yeah, ok... whatever..." he said, as he continued to fine-tune its position. Thirty seconds later he sighed, then started pushing some buttons and eyeing the screen. I looked at him sternly and said, "I'm serious. Don't do it. I'm pregnant."

After coos and congratulations from the fellow, resident, nurse, and scrub tech, I felt a bit awkward. Of course, I myself had just learned of my pregnancy; I hadn't even seen a heartbeat on ultrasound yet! This wasn't the way I expected to tell people my good news, and I really wish I hadn't been forced to do so in that situation. That being said, I really didn't want the radiation exposure at that time. I suffered a miscarriage a few weeks later and then had to engage those same people in some very awkward conversations.

The decision of when disclose a pregnancy in any situation is a highly personal one. Unfortunately, there is a lot of misguided shame surrounding miscarriage in our culture, and thus many expectant moms often wait until their first trimester has passed in order to disclose the good news. But in my line of work, there are clear benefits to telling others earlier rather than later. First, anesthesiology (like surgery and many other specialties for that matter) is a relatively physical practice. Say you're feeling faint during a procedure, battling nausea, needing frequent snacks, or have a constant urge to urinate. People are going to think you're having issues and might worry about your work performance... unless of course they know you are pregnant, in which all of these situations are commonplace and understandable.

In terms of shift scheduling, call assignments and specific work days for any given week are often determined well ahead of time. Usually, requests for days off or vacations are done so about 1-2 months in advance; however, because I work in an academic hospital, the summer poses a major scheduling challenge due to new resident orientation/training. If a baby is due in the summer, special arrangements need to be made so as to not impact the delicate balance of staffing during the transition period for brand new residents. In a private practice situation, far advanced notice might be necessary if the due date is around a major holiday. Therefore, alerting the appropriate vacation/call schedulers to a pregnancy earlier rather than later may affect your entire practice group.

In addition, pregnancy status may impact daily work assignments. At my institution, the schedulers try to avoid giving pregnant women assignments that involve consistent or high doses of radiation, such as what is encountered in the interventional radiology suite or cath lab. (I hope to address this more in a future blog post.) It's difficult to avoid assigments in orthopedic rooms since these cases are so ubiquitous, but you might want to also alert the nurse and scrub of your status so that when they mix the methacrylate joint glue, you can step out to avoid the fumes. And you definitely want your protective lead suit if a fluoroscope is in sight!

Just like disclosing a disability at work, it's a "know when to hold 'em, know when to fold 'em" situation. The right point to fold will be different for each individual. Because my first pregnancy (the one in the story above) ended in miscarriage, I was initially keeping things much quieter with my current pregnancy. However, a similar situation with the fluoroscope still happened again at 7 weeks! I got zapped twice in one day despite my veiled warnings, and after the second time I frustratingly blurted out my news to everyone in the room. Of course they paused, congratulated, and then took things much more seriously in the radiation department. It shouldn't have to be that way, but unfortunately most people are very nonchalant about radiation exposure.

Aside from that incident, I waited until about 10 weeks before I was open about my pregnancy. After I had a couple of ultrasounds under my belt and my IVF docs told me that my miscarriage chance was very low, I notified our anesthesia scheduling partners of my status. They have respectfully given me lower-exposure, lower-stress assignments (like fewer, less physical cases per day with limited fluoro, etc.) As far as other pregnancy symptoms are concerned, I have had my days of nausea and moving slowly, but it hasn't seriously affected my performance at this point.

Has anyone - trainee or practitioner - experienced issues with disclosing a pregnancy? Share your thoughts with us!

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?