A Year of Change, and a New Sandwich

I rang in 2016 with visions of change. Change for the better. Growth. Development.

Well, 2016 is going to be full of changes alright. I’m trying to finalize my divorce, considering joining the dating world again, finding new feet after being partnered for such a long time. So, why does the tenor of this post not hold all the hope and light and optimism it should? My move mostly across the country for medical school, residency and career was not coincidental. It was therapeutic. Right now, my self created bubble is being tempered by reality.

I knew I’d be the child to take care of my parents. Neither of them have planned for golden years. Both have made poor financial decisions. I’ve tried to learn from their mistakes. Many of the decisions I’ve made in my life are a direct result of trying to exactly the opposite of what either of them have done. I’m the only child between them. Their other children, my half-siblings, are in no position to help.

I did not estimate that by trying to learn from their mistakes and deliberately making other decisions, I’d put myself in the supreme position to catch them when they fell. Of course, I love them deeply, fully. They are my parents. They supported me emotionally through my journey to get here, they brought me life, they gave me the genes to create the synapses that allow me to make the decisions I make which hopefully translate into quality patient care and contribute positively to the world. They have loved me, advised me, chastised me, praised me. They were fully responsible for me for seventeen years of my life… that means I’m responsible for them, right? Not now, right?

My dad has been diabetic for about twenty plus years now. It ran in his family. He was overweight. He knew it was coming. He ignored the polydipsia, polyuria, fatigue, headaches, weight loss.  When he finally presented to his physician with the aforementioned constellation of symptoms, they confirmed the diagnosis. His response: Eat a gallon of ice cream and drink a two-liter bottle of Coke. He tows his own line and nothing is going to happen unless he’s ready for it to happen. No one knows his diabetes better than he does. He knows how it “feels” to be 245. He also knows how it “feels” to be 120. He’s got this.

Visited for my youngest brother’s graduation from high school. I was in residency at the time. That’s the first time I saw my dad have a low. Pale, diaphoretic, eyes glazed over, tremulous, almost myoclonic jerks. Orange juice spilled from the corners of his mouth as my adrenaline coursed through my veins, heart pounding. He finally came around. My ex-step-mother rolled her eyes, sighed in disgust. My brother sighed in relief. I was stunned. They had seen this before. They were well versed in dad, the brittle diabetic. I went back to residency and my life and put my dad’s hypoglycemic episode in a compartment. I went back to my other life. You might recall my compensatory compartmentalization if you read my first post,  The End... and the Beginning. 

More recently, I visited my dad’s town for a conference, took the little one and my mom (my dad’s first ex-wife) came to visit as well so as to spend time with the grand-baby. We all stayed at my dad’s house. I wake up around 3am to my mother screaming with surprise as my once again diaphoretic, hypoglycemic father, confusedly tried to crawl into bed with her. They’ve been divorced since I was two. She’s got not medical background, has no idea what’s going on. Here’s my internal monologue over the next 5 to 10 minutes:

I know he’s low. Don’t freak out or your mom’s going to freak out. Give her a task. Tell her to find his glucometer. She doesn’t know what that is. Tell her to find his shaving kit. There’s a little blue plastic machine inside. And a plastic container with strips. Tell her to look for the glucose paste. God, I hope he doesn’t wake the kid up. I’ve got no idea where his glucose paste is or whether he even has glucose paste. What’s in the fridge? Kiddo’s juice boxes. Great. Sit down dad. Sit down. Oh, super, your legs don’t work and you won’t cooperate. This is excellent. Drink the juice box. Seriously, Dad? Just swallow.Crawl into bed with mom and scare the shit out of her? Thanks for that. How much did you drink last night? How much sugar is in one of these organic reduced sugar things? How many is this going to take? What else is in the fridge? How much insulin did he take? He’s not drinking it fast enough. Shit. I’m an ER doc and I can’t fix my dad. What in the absolute fuck?!? What’s his renal function? More juice, Dad. Tell Mom to get a chair. Put it behind him. We have to make him sit so he won’t fall. Ok, Dad, you’re not sitting down… I’ll sweep the leg, just like Karate Kid. Great, now you’re sitting. This is taking too long. He’s not turning around fast enough. He’s not swallowing. He’s going to seize. Fuck it. Tell Mom to call 9-1-1. Tell them you have a diabetic who is hypoglycemic and you need help.

The paramedics arrived and by then, my dad was starting to come around. “I know exactly what happened,” he said. “I took my Humalog and forgot to have a snack. No big deal. I’m all set. No, I don’t need to go to the hospital.” Sure Dad. You know exactly what happened.

One of my dad's best friends asked me for my number that visit. He said "just in case I need to call you for something." He said there'd been times he'd supposed to meet my dad for golf and he wouldn't show. Then he'd come to my dad's house to find him in a hypoglycemic stupor, "sweaty, turning the lights on and off, not knowing where he was or what he was doing." So, it seemed this was not an infrequent occurrence. 

Ultimately, I didn’t think I’d be taking care of one of them now. My father who’s made some poor decisions has run out of options and was in financial dire straits. My dad was going to be homeless. He came to visit for my kiddo’s 4^th birthday. He’s not the picture of health. He’s stubborn and manages his diabetes between 6 packs of beer, packs of cigarettes and takeout food, often, unintentionally double dosing his insulin, or so he recalls when he comes out of a hypoglycemic episode. He finds himself in a diaphoretic, near seizure stupor which until this last year, I was mostly, blissfully unaware. Sure, I’d been to visit and he might have a low, scare the crap out of me, lead me to feel woefully ineffective as a physician, then he’d confabulate that of course he knew exactly what happened.

He asked if he can come live with my little one and I. I took a deep breath, clenched my jaw, said “of course.” He's my dad. I've got to take care of him. That's my duty as his daughter, right?

My dad's been alone for a long time. He's lived the bachelor life for a long time... probably close to 15 years or so. He doesn't take good care of himself. He doesn't eat properly. He doesn't exercise. I had this vision when I invited him to come live with us that magically some switch would flip and he'd suddenly be inspired to focus on his health and well being. I envisioned he'd start eating properly, start exercising, maybe catch up with old friends who are local, find a job, find his spirit. 

He's now been living with me for about three weeks. He's had at least 3 hypoglycemic episodes so far. I say at least because those are the one's I've witnessed. He drinks too much. Thankfully, he's not a mean drunk, but I do believe he is an alcoholic. I have observed his behavior, listened to his conversations with me, watched his interactions with my kiddo and I wonder if he's actually developing some dementia of sorts. Not sure if it's from repeated hypoglycemic episodes, some sort of microangiopathy due to his health, or if he's showing signs of Wernicke-Korsakoff. There's definitely some confabulation going on.

What I believe I've learned in this short time is that I had no clue what I was getting myself into. So many of his behaviors and attitudes and coping strategies mirror those of my ex, which makes this whole thing even more challenging to swallow. I do know that I cannot be his doctor, his therapist or his best friend. I cannot control his behavior or effect the changes I believe need to be made. He is likely clinically depressed, though this is clearly complicated by his alcohol use. It was naive of me to think by some magic that he'd do a 180 by coming to live with us. I'm trying to encourage him to seek the care he needs both for his psyche and for his health. I can lead the horse to water, but I cannot make him drink... Why can't I make him drink!?!?

Permanent cohabitation is not going to be an option for me and my well-being. I have to make sure that my little one and I are taken care of and that my child's environment is safe and stable. Friends have suggested that I impose rules upon him with the threat of kicking him out. Trouble with that is I won't kick him out. I'm not going to put my father on the street. I'd rather find a way to get him his own living space so he does impinge on mine. How does one make rules for their own parent? 

The DC public school lottery struggle is real!

I will paraphrase my mommy friend C when she said “we literally have spent hundreds of hours on this”.

We moved back to DC June 2015 and since then have spent hours and hours touring and talking about schools. My husband O and I are both products of public education - we know it has many challenges and limitations but we are both committed to having our son Zo in a public school that all children have access to. We were extremely blessed in North Carolina to find our outstanding Spanish-immersion daycare. We never ever ever worried about him while he was there. We hope things will work out with public school, but thankfully being a doctor-mom, private school is a viable option.

WHAT WE ARE WORKING WITH:

Flash forward to public school in DC and we have had issues with lack of supervision in the bathroom for the preschoolers, lack of vision, organization, and communication from the administration, teachers who rely too heavily on strict discipline and quiet, homework for preschoolers, and the disorganized and understaffed aftercare that we promptly pulled him out of. What we have loved about Zo’s school - that he really likes it, the Principal Mr. L (he is truly wonderful, so committed to the students and parents), meeting wonderful families and making new friends, the beautiful playground, being a Parent-Teacher Organization parent (I feel like I’m becoming my mom every time I attend a meeting), and the overwhelming majority of his teachers.

MOVING FORWARD:

In early April we find out the results of this year’s lottery. For those who don’t know about DC public schools - there are public schools and separate public charter schools. Some participate in the common lottery and others have separate application processes. All super confusing and overwhelming unless you live in an awesome neighborhood with in-bound preference which we don’t. We based our rankings on a private session with Educational Consultant EV Downey (I still shake my head writing this cuz’ who thought you’d need to pay someone to figure out where to send your kindergartener but I quickly realized there were way too many schools I didn’t know about and I am all about tapping into my resources so we went ahead and paid her and it was well worth it), hours and hours spent touring schools in our preferred neighborhoods, countless conversations with each other, friends, and school administrators. There are so many different schools. So many different neighborhoods (drop off process and location is of prime importance in DC), school buildings with very diverse architecture, philosophies, discipline plans, and aftercare programs. So many different “vibes”.

A few of my favorites (in alphabetic order):

- Capital City, a well-established charter school with the most perfect natural outdoor space and great reputation. Too far out of our preferred neighborhoods, but if I could it would have been in my top three

- DC Bilingual, a well-established Spanish-immersion charter school. In a really nice building, but they might have to find a new site next year. Ranked low for us as not knowing where the school building will be was a deal-breaker for us.

- Mundo Verde, a Spanish-immersion charter school focused on environmental justice and study of world cultures. We love their vision.

- Two Rivers, we preferred the Young Campus as its closer to our preferred neighborhoods and O really liked the Principal

- Tyler, a public school with a Spanish-immersion and arts program that O loved

- Van Ness, newly renovated and reopened public school in Navy Yard (prettiest public school I’ve ever seen though in need of a new playground; which I hear is in the works)

Guest post: Why I can’t be Mom and Doctor to my own kids

A few years ago, my eleven year-old came down with something. He felt horrible, and after a long day in the clinic, I dosed him with ibuprofen and tucked him into bed. I reassured him that he would feel better soon. I’ve got this, I thought. I’m a doctor. I wasn’t going to panic about a day of fever and malaise. I pulled out the Gatorade and chicken soup and enforced naps. My quarantine was effective, and no one else got sick.

Four days later, he was still vomiting. He stopped drinking. He had no interest in his favorite ice cream. Soon, he was barely making urine. Kicking myself, I imagined simultaneous appendicitis and rhabdomyolysis, Occam’s razor be damned. Or instead, rashless HSP. My quarantine mocked me: no one else had caught it because it wasn’t contagious. I called my pediatrician and showed up in the office with a child whose moaning broke my heart and accused me of neglect. Had I waited so long his appendix had burst? What good was all my training if I couldn’t even trust my own abdominal exam?

I shared my broad and crazy differential diagnosis with our pediatrician, who gave my son one dose of ondansetron and sent urine, blood and a rapid flu to the lab. While we waited, the magically dissolving tablet did its job, and my son sat up, asking for a drink. When our doctor came back in with the lab results, the patient was begging for apple juice and Dairy Queen. I hung my head in shame. Ready to do an appendectomy for Influenza B, I had become the hysterical mother I routinely saw in my own office.

Once the sting of fear wore off, I realized that while being a mom has made me a better doctor, being a doctor hasn’t necessarily made me a better mother. I have yet to locate the elusive sweet spot between the extremes of doctor and mother. I cannot be objective when it comes to my own children. Which is why I keep my pediatrician on speed dial and a supply of ondansetron in my cupboard.



--Ann Dominguez, mom to four children, writer and Family Practice attending. I have been in community health for 16 years. My novel, The Match, came out in November, and is available on Amazon, iTunes and Kindle.

Surviving long distance

It's been awhile since my last post so a quick update before I go into this topic. I am currently 11 weeks away from finishing my radiology residency! I will be continuing on at my home institution for my breast imaging fellowship. My little C just turned 3 in January and is doing very well in pre-school (and an update to my prior post, she is finally pooping in the toilet!! It turned out she was just very stubborn and decided one day to do it and never looked back.). My husband big C is finishing up his fellowship in spine surgery on the east coast and will be coming back home at the end of July. He got a job on the west coast, which is about 2 hours north of my home institution so we'll be doing another year of "long distance" but I don't consider a 2 hour commute "long distance" after a year of "west coast and east coast, 3 hour time difference, and 2 flights and a layover to see each other long distance."


I am by no means an expert on long distance relationship and this year has been my first year of ever being in a long distance relationship. I was definitely a hot mess for a good part of it but now that we're less than 4 months of it coming to an end, I am starting to see the light at the end of the tunnel and wanted to share how we, me and little C, survived a year alone.


1. Communication. This is the biggest part of any relationship especially in a long distance relationship. Big C and I talk every single day usually via text message. It's hard at times especially when he is doing a 9-10 hour case but he always manages to text me in between cases. It's important that we check in on each other and know what we're doing even thought there is an entire country in between us. This is our way of maintaining our adult relationship and marriage because when we do FaceTime in the evenings, we try to make it about little C. Usually from the hours of 6 to 8 PM (west coast time), we have our FaceTime on. We usually aren't talking the entire time but big C is able to see us eat dinner and our usual bedtime routine. This way little C gets to at least see her daddy almost every day. No matter how busy we are, we always check in on each other!


2. Don't forget about the light at the end of the tunnel. I am guilty of forgetting this at times. As a single mom this year (minus most weekends when we go an hour north to my parent's house), my days just revolve around surviving. I am just trying to make it to bedtime but it's important to realize that there is an end goal. There is reason why we are doing this. It's easy to get caught up in the stressful moments but whenever I am feeling stressed, I think of our family living under the same roof once again and being able to provide for little C all the things we talked about and hoped for in the near future and the stress does melt away some. It definitely helps to know that it is only temporary because there is a bigger picture in mind!


3. Making each moment count. I am not brave enough to travel with little C alone to the east coast, mostly because where big C is training, there is no direct flight and it's a whole day ordeal to get to his place and his place = bachelor's pad. I've been out to the east coast a couple times this year when my mom graciously watched little C. We didn't get much sleep but in its sacrifice, we got to treasure these few days of adult time and made memories to last us to the next visit. When big C visits us here, which is about once every 6-8 weeks, we will fill every minute with family time for little C whether it be going to an amusement park or something as simple as going to the playground. We just strive to create memories and experiences for little C as a family of three.


4. Be considerate. Sometimes it's very easy in a long distance relationship to get caught up in your own life that you forget to think about what it's like to be in your partner's shoes. I am very guilty of this as well. I often lash out at big C about how he has no idea what's it's like to be a single parent doing residency.  But at the end of the day, I am so grateful I get to snuggle little C in bed and how she gives me 3 kisses, 1 on each cheek and 1 on lips right before bed and she calls me her favorite. I get to pick her up from pre-school every day and I get to come to a home filled with pictures and memories of our family. There are hard days but I am not alone. I remind myself that he might not be here but he has his own battles. He lives alone and away from his family. He's experiencing a rigorous fellowship that often involves 5AM days that sometimes end at midnight. He's on call constantly. All 3 meals are often from the hospital cafeteria. He's in a new environment where he doesn't know anyone. And at the end of the day, he's not just doing this for himself. He's doing it for our family and for that, I am truly grateful to have such a hard working, selfless husband.


5. Make short-term plans. This was more relevant when we first started our long distance relationship. I would make a big deal at each 10 week mark. I still continue to make a big deal for each time he gets to visit. There is a light at the end of the tunnel but we still need something to look forward to get through the day to day. Now, we're days away from April and making plans to attend each other's graduations. I still can't believe we have survived this far!

Doctor Day advice

The teacher at my younger daughter's preschool says that they're going to start a unit on different careers, and she asked me if I could come talk to the kids about being a doctor. Of course, I said yes.

While I did this once before for my older daughter's class many, many years ago, I feel like recently what I do has diverged significantly from what little kids think of when they think of a doctor. I still have the equipment, but I can't even remember the last time I took someone's blood pressure. (And that person was probably my husband, who is always convinced his BP is high.)

Has anyone else done a Doctor's Day for your child's class? If so, what did you do? What was a big hit?

The Most Intimate of Jobs

A random Saturday earlier this month marked the first time I provided sedation anesthesia for patients in the same IVF clinic where I was a patient for 3 years. It was surreal and a little emotional driving up the hill to the clinic and thinking about the many times I went there as a patient myself. All the shots, the blood draws, the ultrasounds, the procedures... Also all the letdown and disappointment that was flanked before and after by hope and excitement. I now have a beautiful baby girl to show for my time as an IVF patient!

A friend of mine who is also in the medical field said to me, "I bet it took a lot of courage to do that. Creepy and scary". While I instead had viewed the experience with gratitude and excitement at the ability to give back to a group of people who had given so much to me, I can understand what she meant. As physicians, we are faced with daily reminders of unpleasant things. Things that have happened possibly to us or to our loved ones, or things that are at the very least reminders of our own mortality.

I think these reminders are a gift, one that doesn't come with many other lines of work in this world. They keep us appreciative of what we have, what we've been through. Has anyone else had an experience like this in their practice? Share your thoughts with us.

I matched!

Match Day has come and gone, and I have to admit that life looks so much brighter on the other side of that big white envelope. The months leading up to last Friday have been filled with more ups and downs than I care to count. I know I'm not alone in feeling grateful that the entire process of residency applications, interviews, ranking programs, and waiting, waiting, waiting is finally over!

Now that I've got that Match letter in hand, telling me that I matched at my first choice program (my home institution - hooray for not having to move across the country with a toddler and baby-on-the-way!) I am feeling humbled, grateful, and honestly somewhat astonished to be at this point. There have been so many times in the past 4 years that I wanted to walk away from medical school - studying for Step 1 while trying to conceive, battling first trimester nausea during my surgery clerkship, leaving my baby girl in the care of others when it was time to return to rotations, pumping when I'd rather be nursing her, hearing from my husband or mother-in-law or babysitter about the milestones she reached rather than experiencing them first-hand, tiptoeing out of the house before she awoke in the morning and coming home long after she'd been in bed...the list could go on.

But I count myself blessed to have had the support of my husband, parents, in-laws, and wonderful community of friends during this time - I know from reading this blog that many mothers in medicine are shouldering far heavier burdens with far less help. And it's largely because of those supports that I made it to Match Day. They are the ones who listened when I was frustrated, cared for me when I was exhausted, and lifted me up when I was discouraged. They are the ones who made sure that my daughter always had a safe and nurturing environment to be in (and that mama always had plenty of pictures to keep her going through the longer days and nights). My Match Day belonged to them as much as it did to me.

Even though we are staying put for residency, there are big changes on the horizon. I am thankfully finished with all of my clinical requirements for medical school, but there are all those little administrative odds and ends to take care of. And Baby #2 is due in less than 5 weeks! I still need to dig out the newborn clothes and bassinet from the first time around, maybe review our birth plan/what to expect during labor, think about preparing some food for after the birth (emphasis on think about rather than actually prepare) and pack that hospital bag. Now that the stress and excitement of the entire Match process has subsided, I'm grateful to have the time to prepare, physically and emotionally, for our transition to a family of four.

Congratulations to all the other medical students out there who matched last week - I hope that you are enjoying some well-deserved relaxation after passing this milestone in medical education! I know that Match Day is not necessarily a joyful occasion for everyone, whether it be due to an unexpected placement or not matching at all. So to anyone who is not celebrating this year, I wish you strength and courage for the discernment that lies ahead.

Please share your own stories of this Match Day and those past!

I'm a grown woman and my work bag needs to represent that

What do you do to celebrate yourself? How do you toot your own horn?

I am a part of several very lively on-line support groups for mothers. I love many of the posts and I have especially started to really enjoy the posts that talk about how busy mothers reward themselves with things like fancy purses, fabulous trips and paying off their loans. I don’t think we do as much as we should to celebrate ourselves, to be gentle with ourselves, to love up on ourselves. After the first 8 months of being an Attending, I sometimes realize that besides going to the gym I haven’t done a single good thing just for myself in a week; that’s when I schedule an eyebrow shaping or pedicure appointment (I am overdue for both by the way, uggh!). I am going to start with the purse, build my way up to a trip next year, and before turning 40 - these loans will be paid off!

Back to the bag - the work bag my mother bought me at the beginning of residency has been through a lot. It’s a nice, large personalized LL Bean bag but it has begun to look weathered and frayed. I’m too young to look sloppy and unkempt and I need an upgrade. I went out with some of my Sorority Sisters recently and I noticed how all of the Lawyers had beautifully sculpted, supple leather bags - they were gorgeous! 

That’s when I decided - I’m upgrading myself as soon as I get my first check from my new position (more on that later). My budget is modest and several friends recommended Coach (my favorite is the Coach Mercer Satchel in eggplant) due to their durability and timelessness and some sister-doctors recommended the Dagne Dover (I like the roomy Charlie Tote the best). And now I’m ready for my own, not-a-hand-me-down, grown lady work bag. One that I’ll feel like singing Beyonce’s “Grown Woman” out loud as I carry it into my new office. 

Any recommendations for your favorite work bag or purse? One that will not be flashy while commuting on the DC metro? One that will allow me to easily go from work to picking up Zo from kindergarten?

Money Talks

I've been reading The Grumpy Rumblings of the (Formerly) Untenured blog lately. Their personal finance posts make me kind of uncomfortable because I don't think we've done a good job of planning or saving. We're not frugal and we haven't paid down our mortgage (although we did refinance to shorten our term) and we won't be able to retire early. Which mostly I think is fine...except when I read their posts.

But anyway, I read this post about how we communicate about money and I commented. Sam and I communicate fairly easily about money; we discuss major decisions, we have similar values, we have enough money so that we can each buy the things we want. I'm not surprised to read that money is a source of conflict for a lot of couples, or that one member of the couple manages the money. I was astonished to see how many commenters say that they give their partner an "allowance". 

I give my daughter an allowance. I had an allowance when I was a child. I don't give my husband an allowance and he doesn't give me one. I understand the value of having money you can spend without accounting to your partner for every penny, and I can see the reasons for deciding ahead of time how much that will be each month. But an allowance? As an adult? That just rubs me the wrong way.

Is it just me? Do you have an allowance? Do you give your partner an allowance (if you have a partner)? Am I completely over-reacting to a perfectly reasonable word?

MiM Mail: Share your anecdotes about pregnancy and maternity leave

Hi fellow mothers in medicine, I'm currently a resident and pregnant with baby #2. I must say that the attitudes I have encountered throughout this pregnancy from my attendings and peers have been discouraging. I'm working on writing an op-ed piece about attitudes toward pregnancy and maternity leave among US physicians and would love to have more quotations and anecdotes from your experiences. Positive and negative comments are welcome (please comment below)! Sadly, mine have been mostly negative. Thanks so much!

Conversations With My Daughter

A keeps telling me what to do. She's so mean. It's like she's my mother.

Hey. I'm not mean.

True. It's like she's the mean mother I never had. Why is she so mean, anyway?

Well, honey, you know her better than I do. It sounds to me as if she's really insecure and also pretty envious of you and C.

Why?

You both have a lot more money than A and her family. You two get to travel and buy pretty much anything you want. A doesn't.

I know. And I don't know why she's so mean to her mom. Her mom works really hard. I think she's nice.

She is nice, and she is working really hard. I can't imagine how painful it must be to have to tell your kids you can't afford things they need. And, at the same time, she seems to tolerate B being mean to her. You said once that you knew I'd never let you talk that way, and you're right. I wouldn't.

It would never even occur to me to talk you like that. Or to yell at you that way.

I know. And a lot of that is just the way you are - the way you're wired. Some of it, though, is that Daddy and I have been clear about what the limits are. And we've also treated you like a human being. We've listened to you and explained why we make our decisions and we respect you and your point of view, so you trust us to be reasonable.

Yeah. And then I expect everybody to be like that, and they're not! Other people are NOT reasonable. Like, I keep thinking people will apologize when they've done something wrong, the way you and Daddy do. And they don't!

Let the Mystery Be

Our little man will hopefully make his appearance (hopefully in a much shorter and less painful way!) in the next few weeks… I hit 37 weeks a couple of days ago, and for me, this is uncharted territory as I went into labor with our daughter at 37 days on the dot. This has really felt like a milestone- as residents, we live our lives in month-long blocks, and the past two blocks have been the most intense physically and hours-wise rotations we have in our pathology program. We're all still in one piece though, and for that I am grateful. We met with our volunteer doula this past weekend, finally acquired a car seat, and took inventory of all the leftover clothes I had stashed from my daughter (mostly gender neutral, thankfully!) that we’ll be able to use again. This is finally feeling like a reality.

I wanted to share the strangest experience I had this weekend which I haven’t been able to shake. I’m sure many with multiple children relatively close together can commiserate over how different subsequent pregnancies are from the first…  Beyond our work, our focus has been survival and spending as much quality time as possible with our daughter and being a family of 3. It’s been easy to forget about the pregnancy, and actually I’ve done a pretty good job at ignoring it so I don’t worry haha.. But this time, there have been no photo diaries week by week, no journal entries to my fetus, no shopping trips to buy anything special.

One experience we really treasured the first time around was going to one of those recreational 4D ultrasound places to find out the sex and see her face. We actually went twice- once around 15 weeks and once later on, maybe 25 or 26 weeks. I remember how much we stared at those photos- we even had one framed which I brought to my delivery haha. Her face was so beautiful... I still love looking at those photos in utero and seeing her face in them, her little button nose and full lips. Anyway a couple weeks ago, while feeling guilty realizing how little time was left and how little we had done, my husband and I decided to try to find a similar U/S place in the city we live in now. The place with the best reviews was far- over 30 minutes away- but we thought we owed it to our fetus to be appreciated for a morning and to let our daughter see him, haha. But it was actually disappointing… it was sort of a weird sterile office, not at all a warm fuzzy baby-friendly environment like we experienced back in California. Also, previously, we had to sign that we were receiving prenatal care and write down the name of the hospital and Ob practice in case there were any abnormalities that needed to be reported;  at this place, all they took was our name and EDD. And unfortunately, our little guy was totally covering his face with both hands and feet at the session, so they invited us to come back for another look in a couple weeks.     

So this weekend we went back to test our luck, and while in the waiting room, the doctor/owner of the business (radiology IMG, not practicing here; his wife seems to be the ultrasound tech) came out and asked if I could come help him with translation issues with his current Brazilian client that couldn’t speak English. He knew I had an MD, but I was caught off guard. Without thinking too hard, I shrugged and said, sure, I only had patchy Spanish and Italian to offer but maybe it could be a bridge to their Portugese. I entered the room to find a young couple with their two older sons, maybe 7 and 9. The woman looked scared. I started to feel scared. According to her LMP, she should have been around 10 weeks along. No cramping, no bleeding since. Regular periods prior. Apparently, no insurance and she hadn’t seen an Ob or PCP- only positive HPTs. The problem was that no heartbeat was detected, and she was measuring only around 5 weeks. My heart sank. It was clear they had all come to share the joyous occasion of seeing the baby for the first time as a family. I was so sad for them as I had been in the same position a year prior, the ultrasound planting the first seed in my heart of the possibility of miscarriage to follow. We tried to explain as gently as possible that time will tell whether the pregnancy will continue. But I was upset that I was in this unexpected position. I was upset that she didn’t have a doctor of her own. I was upset that she was receiving this information in this setting. I tried my best to encourage her to establish care with an Ob as soon as possible, but it seemed unlikely that it would happen.

I keep thinking about her today and wish the best. I truly hope this is a dating issue and that her pregnancy will progress. I keep thinking of my own miscarriage, the ordinariness and near universality of the experience and how isolating, unique, and devastating it still feels. I think of the miracle of our family now ready to welcome a boy just a year later. Of all the health we take for granted. I think of the fragility of our children, that this is all the beginning… by gaining so much in love we also have so much to lose. But I remind myself that the alternative, of not opening our hearts to the potential of more love and family, is also a sort of loss. I was reminded of this old song by Iris DeMent, called “Let the Mystery Be,” which expresses her coming to terms with rejecting organized religion (she grew up in a big religious family I believe) in a really beautiful way... I often sing this to myself when I feel like I need to let go and not worry... so much unexplainable mystery in life.     

Here is the brief and only glimpse our little one gave us of his face in the two ultrasound sessions. He wants to stay a mystery and I accept that. I just can’t wait to kiss those chubby cheeks and lips and see what the rest of him looks like… well, maybe I can wait just a couple more weeks :)  

Because I Hated Every Second of Breastfeeding

Genmedmom here.

There have been many times when I have struggled to empathize with the patient. There are certain healthcare issues, and certain patients, that I have found consistently frustrating over the years.

I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99% of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest.

My kryptonite issue has been obesity. I admit, that for many a patient encounter, I've sat there and counseled (for the millionth time) on diet, and exercise, and priorities, and wondered to myself: Why can't you do this? Why can't you just lose weight?

I know that sounds terrible. Heck, it IS terrible. My bias is based on my own experience: I gained sixty pounds in my first pregnancy, and fifty in my second. The weight didn't come off postpartum, and I found myself obese. BMI 30. I dedicated what precious little time I had as a working mom to eating healthy and exercising, and I lost it all. It took two years. It was hard. There were ups and downs. I've written endlessly about it here, and here, and here....

Of course I know that it is totally and utterly unfair to think "Well, if I could do it, why can't you?" but truth is, that's a pretty natural way to think, and many of us think like that.

So I've been making a conscientious effort to do better, to let go of the bias, and the frustration, and meet people where they are, no matter what the medical issue is.

But it was only when I was sitting with a lovely young patient of mine who was upset, grieving, actually, that she had been unable to breastfeed her infant, that I had a real breakthrough.

This poor woman had had a complicated pregnancy and delivery. Nothing had gone the way she had planned. But she held on and held it together, because she knew that if her baby survived, she would do everything right. She would take THE BEST care of this baby. She was determined to breastfeed for a full year. It had never occurred to her that that might not happen.

There were problems with the latch, with the milk supply, with pain, with baby's growth. Still, she was determined. She got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera... for weeks.

But one day when she had spent an hour and a half with the industrial-grade pump and got only about a teaspoon of breastmilk, with her nipples raw and bleeding, with her infant screaming, starving, with the pediatrician's concerns about his growth, with her consultants saying "Just push through! Keep trying!" for the gazillionth time but without any other real suggestions, and without any progress, she broke down.

She gave up.

So the baby got formula. And did fine. And grew. And she thought this burden was lifted from her.

Until the judgments came.

She was part of a social circle that especially valued breastfeeding. Friends and family would comment, say, "Don't you know breast milk is best?" or "Well, if you had only tried X, I bet it would have worked" or "If you had only HUNG ON a little bit longer" or "Those doctors pushed you towards formula, those doctors always push the formula, you shouldn't have listened" et cetera, et cetera.

It got to the point that she hid bottles and formula, or avoided socializing altogether. She felt like a freak, a failure. She worried what awful consequences there might be for her baby. She waited for some severe illness to befell her son, and for someone to blame it on her.

Oh, my heart went out to her.

Flashback. I was pregnant with Babyboy (now five and a half years old). I had a three-page birth plan outlining my natural vaginal delivery. I had a doula. I had Ina May's books on childbirth and Nancy Mohrbacher's books on breastfeeding. I had secured a highly-rated lactation consultant and booked a consult with her BEFORE the baby was born. I bought Medela breastmilk bags and a plastic organizer for the freezer. I arranged a breastfeeding room in my office.

But there were complications. The delivery- that's a story for another day. Emergency C-section for deep transverse arrest. Bradycardia. Meconium. Mayhem. I was discharged with a hematocrit of 22.

Babyboy was fine, but I grieved the loss of my dream birth. I was determined to get breastfeeding right: I wanted to breastfeed for a full year.

But. There were problems with the latch, with the milk supply, with pain, with baby's growth. I was still determined. I got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera.

Miraculously, I was able to breastfeed for a full three months.

But, I hated every single second of it.

When it got close to feeding time, I would inwardly cringe. With his latch, I would outwardly gasp, and clench my teeth in pain. The doula and the lactation consultants gave up on me. It was a nurse practitioner at Babyboy's pediatrician's office who suggested APNO (All-purpose-nipple-ointment), and it was an OB/GYN who prescribed it for me. The APNO cream helped a bit, and it got me through the three months, though nothing really helped.

Inevitably, what would come to mind with EVERY feeding were images:

Of glass-shard covered twine being pulled out of my breasts through my nipples.

Of someone pouring acid over my areolae.

Of my baby with little piranha teeth and malevolent intentions.

Oh, I hated it, and I hated myself for hating it. Wasn't breastfeeding supposed to be this wonderful bonding experience? I would rock and cry, literally cry, while stroking my baby's forehead and begging forgiveness, because I could not WAIT for this to be over.

So when it came time to go back to work, I started on a combined oral contraceptive and took Benadryl, and let that milk supply dry right up. Worked like a charm. I was done. It was such a relief.

When I told my colleagues I would not be needing that breastfeeding room, I got some eyebrow raises, but no one questioned. Many of them had made similar decisions for different reasons.

Most of my friends were understanding (very different social circle from my patient-mom) and for that I was very grateful. As a matter of fact, people came out of the woodwork with their own breastfeeding difficulty stories. I was not only NOT the only person who had struggled, I was not the only person who hadn't enjoyed it, and I was not the only person who had guilt about that.

Yes, there were a few "judgy" moments. People I didn't know well, and luckily didn't give a rat's ass about. A lady at book club gathering, a friend of a friend.

But my patient, my poor patient. Her "support network" was annihilating her. I was outraged on her behalf. I wanted to reassure her.

So I shared my own story with her, and we discussed ways to manage the hurtful comments and avoid the negative people.

For doctors, sharing our own stories and feelings about medical issues with patients is a tricky thing. Sometimes it's appropriate, sometimes it's not, and sometimes it's a mixed bag. In this case, the patient expressed relief and gratitude. She had been initially expecting me to judge her, too, she said. She was so glad to have found validation, reassurance and open discussion instead.

That's when I had my breakthrough: The patient had been expecting me to judge her, and had instead found validation and reassurance.

Wow. THAT is what I need to bring to EVERY patient encounter. Validation, reassurance, open discussion. Because that is what I would want for me, as well. It's what I want to be able to provide for everyone, especially my patients.

That One Time When You Unknowingly Insulted Me

It was normal Wednesday and I was staring absentmindedly at the surgery white board. I searched its unending list of procedures and "ectomies" that stretched the entire length of the wall, until I was finally able to locate my string of minor surgeries. Lost deep in thought, I wondered if there was any feasible way the labor gods would be kind to me. What were the odds my labor patient would deliver while I was scrubbed in one of my many hysteroscopies? As I came to the conclusion that once again my day was hopelessly overbooked, I sighed only to feel a hand on my back.

Turning around I saw the familiar friendly face of a charge nurse. She looked concerned.

"Dr. RH+, poor thing, were you on call last night?" she asked.

"Actually, no. I slept all night." I chirped.

"Oh....." she said as we stared at each other, slowly realizing that she had just accused me of looking like total crap.

When the awkward silence became too much to bear, I faked a page and make a dash for the locker room, where I stat ordered eye cream from one of the 200 people on my Facebook feed who try to sell me overpriced fancy products endorsed by celebrity dermatologist. Maybe I can be the next before and after picture on their web site.

Asking a doctor if they are post call is like asking a woman if she's pregnant: Just don't do it, unless you already know the answer, then think twice. The "post call" look for me often means no sleep, no shower, puffy eyes and hair style that can only be described as "Beetlejuice"-esque.

Time, stress and life itself have had their naughty way with my appearance. My running addiction is great for my legs, but my crows feet have deepened without the extra layer of fat to cushion them.

While I can't remember the last time a patient asked if I was "really old enough" to be a doctor, I also haven't had anyone question my abilities in an equally long time. At 40, I am enjoying the comfort of my own skin. My patients confidence and my colleagues respect are far more important to me than a few fine lines. I look socially acceptable most of the time (at least I hope so). I wouldn't consider trading the peace and maturity of age for a baby smooth face, but also still it's not nice to tell me I look like a tired old bag either.