Gratitude

Not my gratitude. My kid's gratitude.

I will preface this by saying that Eve is almost always a delight. She's smart and funny and passionate about her friends and deeply upset about injustice; she usually does what she's asked without (too much) complaint and she is almost completely self-sufficient (laundry, room, homework, etc.)

And she's 16, and so she sometimes asks for things that she's not going to get, and when it becomes clear she's not going to get them, she has the typical adolescent reaction. This includes sighing, eye-rolling and detailing the ways in which her life is soooo harrrd. Our five-bedroom house is too small., Our backyard lacks a pool. We've only renovated one bathroom, and it's not hers. The hundreds of dollars she is given for a clothing budget is inadequate. You get the idea. She's not grateful.

I am not alone. A lot of my friends have the same experience. Our kids are incredibly privileged; they have rooms of their own, clothes with the right labels, and money to spend. At a more basic level, they have loving parents and safe homes and electricity and food and drinkable water. And we are shocked and somewhat hurt that they aren't grateful.

This reaction troubles me. I have the same impulse - tell me you appreciate all this. Tell me you recognize how lucky you are, how many children around the world have nothing, how many children in this country go to bed hungry while you're complaining that we don't have a backyard pool. I hear Eve rail against injustice and wonder why she can't make the connection to her own complaints. And then I answer myself: because she's 16. Because she still thinks she's the center of the universe. Because the terrible reality of poverty and war and famine and racism is too much to bear and she wants to look forward to being a grownup.

I wonder why it's so important that they be grateful. For some reason, this makes me think of Oliver Twist. "Please, sir, may I have some more?" Eve is not a waif on the streets, thank God. I trust she will never have to cower and beg for favors, and be grateful that someone granted them.  Eve was adopted; there's an extra layer of all the people who tell me she's so lucky to be our child, and she should be so grateful that we took her, and how we rescued her. Since I think we're the lucky ones, and I know we didn't rescue her - she has two biological parents who love her as much as we do - I shrink from that idea.

I realize that what I really want is a kid who appreciates - who appreciates her parents' efforts to make a comfortable home, and the work we do that makes the money to buy the clothes, and the thoughtful choices that mean we went to Paris and don't have a pool. I also want her to appreciate her privileged place in the world. I also want her to claim what is hers without apology; I want her to feel that she belongs so that she can use her secure base to advocate for the justice of which she speaks so passionately. She's sixteen. Sometimes her pendulum swings over into the petulant. I will try to take the long view and trust that it will land in the balanced center.

Why I Fired My OB/GYN

I apologize in advance that this story is a little bit TMI. Then again, I live in a world where about a third of the time, a cat or a child comes into the room to watch me pee, so nothing is really TMI anymore.

When I moved to a new town and found myself newly pregnant, I knew I had to find an OB/GYN practice. So I basically googled “OB/GYN” and picked a large nearby practice that popped up and selected a doctor with decent reviews. My first visit was pretty good, and I decided to stick with the practice.

Unfortunately, things went downhill. The worst thing was the wait. I’d come in for increasingly frequent pregnancy checks and end up waiting an hour for my five-minute visit. The most aggravating visit occurred when they called me to come in early because they were running ahead. I dropped everything at work to show up early, and STILL waited thirty minutes, until the time of my original appointment.

Also, they did the worst blood draws ever there. Any time they needed blood, I would end up with bruises all over my arm and severe pain for days. When I objected to doing the glucose tolerance test there for that reason, I felt like I was treated like a criminal by the staff and the very un-understanding OB/GYN.

But the straw that broke the camel’s back happened about a year after I delivered. I was having my annual exam done by a male OB/GYN that I’d seen a few times before and liked well enough. After he finished the speculum exam and the bimanual exam, he said to me, “Now I’m going to do a rectovaginal exam.” And then two seconds later, he just DID it.

I’m sure somebody could present me with a body of literature on the importance of the rectovaginal exam. But I don’t care. He didn’t give me fair warning. He didn’t ask if it was okay. And it was certainly not something I ever expected, considering in my 15-odd years of annual exams, not one doctor ever deemed it necessary to perform. Plus he was a man.

I’m not saying I’m traumatized or anything. I’m not having recurrent nightmares over it. I wouldn’t report him. I mean, let’s be real here—rectal exams happen. But I didn’t like the way it happened, and I would never go see that doctor again. And since I hated the practice so much, it gave me the impetus to finally leave.

(And my current practice has never made me wait more than five minutes.)

I do have to say, if you’re a male doctor, I think you do need to be careful about that sort of thing. You can’t just go around sticking your fingers wherever you like without warning your patients. Not that I can do that as a female doctor, but I think there is a little more wiggle room. (Literally and figuratively.)

A Proposal

I walked into the Dr.'s Lounge this morning and bumped into a hospitalist. I had heard over the weekend that he had been through a rough divorce three years ago. I see him daily and we talk about kids once a month but somehow I missed this.

"I'm sorry! I must have been living under a rock. Divorce is so awful I wish I had known."

"Oh who told you? Your new neighbor? I met her at a crawfish broil last weekend."

"No, not her but she is sweet we had a big neighbor cookout two weeks ago love her. It was dance moms - Cecelia's (13) big recital was last weekend. And don't tell your son you heard it from me but C told me he's the hottest ticket in town."

"His head is getting so big we are having trouble keeping his ego in check."

"The dance moms were showing me a picture of your girlfriend on social media she is super cute."

"What?" He looked confused.

"Short blonde hair?"

"Oh where the heck did they find that? That was over a while ago. It's so hard, dating and divorce. There's so much baggage."

"Yeah, I had a year of hell on match.com but finally got lucky. I met a great guy almost four years ago. He has never been married and doesn't have any kids - not that I would have minded if he did, but it is easy. The kids have their chance for a sibling with my ex and stepmom's toddler." I smiled, "he just moved in a month ago I'm so excited."

Last Saturday I caught up with an old friend I hadn't chatted with in 15 years. We talked on the phone - she's in DC - until 12:30 am. I sat out on the back deck.

"So tell me all about him!"

"Well, he's lived all over. Born in Arizona, elementary and middle school in Plano,Texas, high school in New Jersey where he started biking - rode with George Hincapie up there, biking and art school in Kansas City, then the Twin Cities and Seattle to pursue his photography. Once he delivered a pizza to Eddie Vedder in Seattle!! He decided to go back to Kansas to pursue architecture and finished his degree when Wall Street crashed in 2008. He worked in L.A. for a year then came to Hot Springs. Now he's in a nice office in downtown Little Rock with a large national firm based in Memphis - they did a lot of work in downtown Memphis. They had their Christmas party at Graceland it was so fun! We did a night tour. I had been lots of times growing up but it was his first."

"So are you going to get married?"

"Well, yeah, we talk about it but. . ."

"But what?"

"He hasn't asked me yet. I mentioned never getting married again so many times early in our relationship I think he is afraid to ask. I would be."

"You ask him."

I was flabbergasted. "I can't do that!!! You're crazy!"

"Yes you can. Do it. Ask him."

I've been thinking about it non-stop for the past two days. It would model great bashing gender stereotypes to my children. We have talked about it a lot recently, especially since things have been working out so well since he moved in.

Thinking about it has made me reflect on our time together, and on him. How we both disagree on our first date to the tour the U.S.S. Razorback submarine - July 22 or 23? Luckily he saved the tickets so he can usually find them and prove me wrong. How we disagree on our first kiss anniversary two months later - we spent a lot of time hiking and going to movies and getting to know each other before that. September 22 or 23? Depends on when midnight struck neither of us were paying any attention.

He met the kids late that fall at a picnic at Pinnacle Park - one of our favorite hiking spots. I still remember Jack grabbing his hand while stepping down a bank to the creek and his surprise then ease with the contact. The kids and I later took him to one of our favorite hiking spots that has the Cat in the Hat painted on a tree stump. He did art projects with Cecelia - a Valentine's box in the shape of a nose (her wacky idea). They painted the girl and boy mascot clay statues of the Nashville Sounds in a tux and fancy dress and won box tickets to a game - his dad and stepmom were in Nashville at the time. He easily blended into our weekend lives and a year later got a job closer to Little Rock and an apartment two blocks away, so he has been a fixture for the past two years.

There are so many things I love about him and I am really bad about expressing them to him. It's a lot easier to think about them in my head and type them hiding behind this computer. I love how he points things out to me with his photographer and architect eye that I would miss buried in my books or music or thoughts. A coal barge on the river. A detail on a building. A rock to watch out for on a bike ride. A cardinal in the backyard. I love how he collects watches and gave me one on our first trip out of town to New Orleans. I still remember him telling me he wanted me to wear it. It's a Tissot - very clean and classy - he told me then that Grace Kelly wore this watch and I was amazed he knew that.

I love how he is with kids, so easy and quiet and agreeable. How he jumps on the trampoline with Jack (10) when I worry he is stuck in his iPad too much. How he goes over Cecelia's study guides with her the night before tests - he is her favorite study buddy and calms her down much better than I can. How he rides all the roller coasters and goes on all the waterslides that I am too scared to do with them. How we take turns wishing them goodnight when they are here. Some nights Cecelia keeps him down there talking way too long and I love hearing what they were talking about when he comes back up.

Most of all I love how he is with me. He's dragged me out of my books into TV series and we are having so much fun with Ray Donovan right now I can't wait to settle kids at night. He hikes with me and bikes with me. Lately we have been getting into cooking with Blue Apron. It's so fun to put on the classical music he grew up hearing at symphonies with his father and wind down the day preparing a meal together - both of us learning how to cook. He fixes all of our computer issues there are lots! Last Friday night he volunteered to be one of the drivers with me in a Scavenger Hunt birthday party with fifty kids we had so much fun. We got kicked out of the mall by a power tripping cop; I loved that he enjoyed it as much as I did. He puts up with my singing when I've had an extra glass of wine. He's my knight in shining armor when I've had a terrible day. And he's helped me focus more on the right in me than the wrong, which I have a tendency to do.

I love that when he catches me looking at him he gets defensive like there is something wrong but really I just love to look at him. He is so handsome. I want to live in the corners of his eyes when he smiles. I want to breathe in every time he breathes out so I can catch his breath. I want to be buried in the smell of the crook of his neck. I want to spend the rest of my life with him.

So, SPS, here's the question that has been making my palms sweaty and my heart anxious, ever since my friend put it in my head to ask. It can be a small wedding, no frills - I know you don't like being the center of attention - me neither. Just you, me and the kids. I'll console Cecelia by throwing a huge party inviting all our friends and family with a band and good food and wine. I've got no ring but I've got these words and I know you value art over things so I think it'll be ok. And I'm not down on one knee but I'm hiding behind this computer on mothers in medicine which was my safe spot and my outlet in one of the hardest times of my life. So here goes. What do you say? Will you marry me?

 At P.F. Chang's - a top spot with my kids, awesome friend histotech and bestie P.A.

 Hiking a black sand beach in Hawaii at a path conference on the Big Island

Click the link below, babe (Elle King)

Make You Smile

MiM Mail: RN considering medical school

Hi MiMs,

I would first like to say thank you for sharing your stories and your day-to-day experiences and challenges of being mothers and physicians. Your stories have been helpful to me as I consider making a change in career paths. I am 25 years old, unmarried, no children at this time. I work as an RN in an ICU in the south. Prior to becoming a nurse, I studied biology and psychology and then obtained my MSN to become a nurse. I'm considering returning to medical school and becoming a physician. One of the reasons for this is that I question whether I will live up to my potential academically by remaining a nurse, and I have a thirst for greater knowledge than what I currently have. On the flip side, I enjoy my work as a nurse, taking care of patients, leaving work at work when I come home, and having a flexible schedule that allows me free time to travel and have a life outside of work. My sister is married and is in her intern year of IM and most of the time seems miserable and can attest to the strain placed on a marriage by residency. Although I'm not to the point of motherhood currently, being a mother with multiple children is something to which I have always aspired. My concern is that if I become a physician I wouldn't have the time to spend raising children and taking care of them like I hope to. I would love to hear your thoughts on this. Thank you!

Sincerely,
Laura

What does it really mean to be a mother in medicine?

As in, in real life, day-to-day, down and dirty?

Genmedmom here.

I'm working on a writing project about being a mother in medicine in practice. This is going to be the everyday stuff: the logistics, the scheduling, the practical aspects, the balancing, the conflict. Funny stories, lessons learned, suggestions, and mistakes.

As I was thinking about this project, I realized that my experience in clinical practice is drastically different from women in other specialties. There's no way I can write this without input from moms in every area of medicine!

Things I was wondering about:

When I was pregnant, it never occurred to me not to tell people. I can't keep a secret to save my life. But I have colleagues who kept their bumps hidden for as long as humanly possible, for many different reasons: worries about discrimination; fears of being passed over for promotion; superstition. What did folks out there do? If you felt like you had to hide your pregnancy, how did you, and for how long? Looking back, what do you think, was it necessary?

What about those specialities where there is risky occupational exposure, I'm thinking radiology, surgical subspecialties… How did you manage that in pregnancy? If you needed to step out of the room, how did your colleagues react?

A lot of doctor-moms don't take a full three months of maternity leave. Some take more. Does this vary a lot by specialty? Did folks feel pressured to take less than three months? Did anyone have to fight for three months?

I never pumped at work. (Long story.) For the moms that did, can you share some of the good and the bad? Were offices and hospitals supportive or not? Were facilities acceptable or not? What were your worst pumping experiences? Would you do it again?

As a general internist with no inpatient duties, my call weekends involve, well, phone calls. What is it like for doctor-moms who have to go in? For the surgeons and anesthesiologists out there, is it better to be on call from the hospital or from home?

My office clinic is low-key enough that if I need to, I can step out and answer a phone call from my kids' teachers or the school nurse. But what about for moms working in the operating room or the ICU or on a busy inpatient floor? If you need to step away to take care of your family, are you supported?

My husband travels, and occasionally, I've had to cancel a clinic day to stay home with the kids: blizzard closed the schools, kids throwing up… Have others needed to cancel their workdays for childcare? Did colleagues make you feel bad, or did they step up? For those who haven't or can't, how do you manage those unforeseen events, the school cancellations and nasty illnesses?

I am eternally grateful that I can work part-time. I know that not all physicians approve of that. For those working full-time, how do you make that work? What supports and systems need to be in place for you?

And of course there are more questions, more scenarios… We can all learn from each other!
All specialties should have representation. I would love to hear what you have to say.

Don't feel comfortable commenting here? Email me: mauroratello2@gmail.com

Story of My Life

Do you ever feel like your life is like a TV show, but not in a good way? More like a Seinfeld kind of way, when all you can do to keep from crying is shake your head and laugh?

Episode one. I present for a labor check at 38 weeks (determined to be false labor), and find out baby boy is BREECH when at my appointment the week prior, he was firmly declared vertex! The plan is to do an external cephalic version immediately, as I am an ideal candidate. I wait nearly 11 hours, NPO, cranky, uncomfortable, and tethered to an IV pole, and at last the Ob team assembles to do the version. AS they are putting on gloves, all their pagers go off. Oh no. No. No! It’s a gyn surgical emergency, a stabbing!! A resident returns to give me the choice to wait several more hours with no guarantee of doing the version, or to schedule it for first thing the next morning. My hangry state tells me to postpone… which in retrospect is likely the wrong choice. My “false” contractions progressively and subtly transition into excruciating ones over the next 8 hours at home (I’ve lost confidence in knowing what’s real after the false alarm earlier), and at 2:30am I find myself driving alone to the hospital, jaw clenched, sobbing, and pulling over for contractions (my husband is at home with our daughter). I am 9 cm dilated - time for emergency C section - and our perfect son makes his debut with a bang thirty minutes later.

Episode two. I find out a week after our son was born that, by some miracle, I’ve received a research grant I applied for last winter. The catch? I’m required to attend the organization’s national meeting in 4 weeks to accept the award at a formal dinner. After weighing all the options, we decide to go as a family. It’s a fun city, only a 3-hour flight, expenses are partially covered, and I‘d have the opportunity to attend an awesome conference. A two year old and a 5 week old in a small hotel room together? No problem! The reality? Every day we desperately invest hours in the possibility of achieving overlapping naptime so we, too, could sleep.

Needless to say, I don’t get to attend much of the conference. I try going to talks, I really do. It’s a lot to ask my husband to watch both of them, so I go to a few presentations with the baby strapped on, hanging out by the exit door. The night of the awards ceremony finally comes. Milk pumped, baby topped off, toddler excited, husband feeling strong. But alas, this is how the evening ultimately ends.

Episode three. The number one question I’m asked during prenatal care? By multiple people at every single appointment, from 6 weeks through the bitter end? “What method of contraception do you plan to use afterwards?” This is to the point where I can only assume they think I got pregnant on accident and are doing anything possible to prevent me from letting it happen again. Every time, without fail, I say, “IUD.” Even while being prepped for my emergency CS, crying in pain, someone manages to come around and ask me if I’d like the IUD inserted... “NOT. NOW!!!” I scream. Finally, the big day comes to do my IUD insertion, at my 6-week postpartum visit (which of course requires me to bring my newborn along). When I make the appointment, they ask again if I want an IUD inserted so they can allot enough time. Mid-way through the appointment, my Ob tells me, “I’m sorry, but the administrator who gets insurance approval for IUDs is out for the morning unexpectedly, so we actually can’t do the IUD today. But don’t worry, we’ll schedule you for next week, no problem!” CUE FOREHEAD SLAP.

The stories go on and on. I will share a few more.

Feeling the sweet warmth of a blow-out spread across my sleeve as my son, who won’t nap in the crib, sleeps in the crook of my arm as I frantically try to get through the RISE exam before he wakes up (I don't stop taking the test, by the way).

Watching cake batter overflow and drip down the oven rack gratings in a million little chocolate stalactites at 4:30am while baking a birthday cake for my mother in law.

Dropping said mother-in-law off at airport. So out of it and exhausted, I accidentally drive in the buses-only lane at departures. I have never ever done this in my life. An airport official runs over and tells me to leave immediately before I get fined ($500!!) and I get out of there… but alas, a cop is waiting for me at the very end. Sigh. (But with a wailing newborn in the backseat, I fortunately get off with only a formal warning.)

We have a few warm days last week. I smell something weird. I am fearful it is something with the sump pump or crawl space (we live in a renovated brick rowhome). Long long story short, there is a dead rat in the crawl space. Yes. A. Dead. Rat. Next door had an infestation, exterminators came, rats ate poison, and one managed to get through a crumbling brick and into our crawl space. And died. No words. This is an ongoing saga. Involving the services of a mason- I never imagined I'd need a real mason, but apparently I do. But it will be ok.

 

And the clincher. What inspires me to sit down and write this. What drives me to actually throw my head back and laugh with tears in my eyes. Baby has his 2 month immunizations this morning, and poor thing is angry and uncomfortable… he just needs to take a nice long nap. And THIS is what I come home to- view from his window.

This is when all you can do is laugh. And be grateful for health and for even the capacity to laugh. And embrace all of this self-inflicted chaos, the q2-3 hour wake up calls that still aren't stretching out after 8 weeks, the blow-outs, projectile vomit, and laundry. So much laundry. Laugh at the fact that your parents, who had lived just an hour away, decide to move to Asia a month before baby is born, leaving you again without family support postpartum (we tell each other it's building character). Accept the frustrating feeling of hard-earned knowledge seeping out of your brain even after a few short weeks, trying to have the will-power to study and attend resident didactics and research seminars (sometimes with a sleeping newborn hidden under your jacket), but often failing. 

But there are some TV/movie moments. When I sink my lips into the soft pillows of my son's cheeks, also becoming aware of my daughter's pudge melting away silently. The indescribable joy of seeing our daughter transform into a sibling. When my heart explodes witnessing first smiles and giggles. The sacredness of feeling the body of such a vulnerable little human relax in your arms. Awe that I can muster up secret stores of energy and patience that are fueled only by love when I have nothing left. And awe at the magnitude of this love. So it's time to celebrate- although it hasn't been pretty, we've made it through the newborn trenches once again.

Claim your space!

Equal pay, sit at the table, ask for what you're worth!

All of the above are often part of the dialog concerning women in the workplace.  Women ask for less, do not request promotions/raises, do not sit at the table.  As a big Sheryl Sandberg fan these mantras have been my mentoring rhetoric for years, starting from my own brief time in investment banking when these concepts were instilled into me through a womens group at our firm.  So, when negotiating my first contract - I asked for more and I got it, I asked for time and I got it.  I made sure to ASK ... I felt well trained.

However, just moments ago, I was chatting with one of our attendings and he was congratulating me on my job (I'm very happily staying at the place where I am doing my fellowship) and he asked why I hadn't moved into the vacant office yet. There is one vacant office in the department.  It is clearly going to be my office.  Its the small one near the bathroom that all the junior faculty get until they move up the ranks.  I walk by it longingly every day and go sit in my loud cubicle and try to work while sitting next to all the administrators constantly answering phones.  I fantasize about this office...mine in only a few short months.  Just this morning as I walked in from the garage, I was making mental plans of which pieces of my daughters art work I need to get framed to put up in my new office. I envision my name on the door.  But, NEVER had it occurred to me to "just move in."  This thought was just second nature to my male attending, meanwhile I'm sitting in the background and waiting for my turn. Maybe I'm making a mountain out of a mole hill, but I do think that we have to never stop striving to be seen and recognized and heard.  I see it in myself all the time.  I feel it. I often have to remind myself that I worked hard for this job and every job.  I walk around suppressing my impostor syndrome on an daily basis.  But, today I realized I can't be complacent.  I have to keep claiming my space.

Quality Time: What Is It, and How Can I Create More of It?

Genmedmom here.

Typical morning clinic day: I'm up at 4:50 a.m. and out the door before 6 a.m. to catch the train. The commute is prime time to skim the news/ blogs/ email/ social media, or, order groceries for delivery. I arrive at work early to prep charts. My patients are scheduled from 7:40 a.m. to 12 p.m. (and clinic usually runs over). Then, it's patient calls/ prescription refills/ results/ all kinds of paperwork/ maybe some writing until somewhere between 4 and 6 p.m. Then, I run for the train, ride back, run to my car, pick up kids at my mom's. Wrestle kids out the door, stuff them into the car, and herd them into our house. If Hubby is not working or traveling, we make a good effort to sit down to a nice dinner, usually warmed up leftovers from a weekend pot of soup. We tag-team on the evening stuff: get kids to eat if they haven't eaten, feed the cats, unpack schoolbags and yucky lunch boxes, identify any major school communications or homework, make lunches for the next day, wash dishes. The kids start getting super-silly and disobedient around this time, so I cattle-prod them up the stairs, out of their heinously dirty clothes, and into the bath; attempt to wash their hair (which usually has food in it) and yell at them for splashing water all over the place. Get kids out of tub, then chase after them as they actively evade me, giggling and taunting. Pull pajamas on, force them to brush and floss teeth, read books. Read more books. Read JUST ONE MORE BOOK PLEASE MOMMY?

Sigh. By the time the kids are asleep, I'm exhausted, and I realize with great sadness that I've spent most of our precious few hours together yelling, nagging, scolding, threatening, and counting to three about fifty times.

The few minutes we have snuggling in bed reading quietly (well, truthfully, it usually stretches into thirty minutes reading quietly) is the only real "quality time" we've got.

I know there are doctor-moms out there with busier schedules than mine (I only work four days a week).

Busy doctor-moms, how do you create quality time with your kids? What does it look like? When do you fit it in?

Annual call for contributors

It's May - the month of Mother's Day and MiM's birthday (8 years old this year!). It's also time for our annual call for contributors to join MiM as writers for a one year term.  We didn't know what to expect last year, trying this for the first time, and were thrilled with the response!

If you are interested, please send a note to mothersinmedicine@gmail.com with why you would like to write for MiM and a little bit about yourself.  No blogging experience necessary - you just need to be willing to share your journey as a mother in medicine with this community on a regular basis. We are looking forward to adding some new MiMs to the roster!

Call will close one week from today - May 8.

Thanks for reading!

More Important Than Your Marriage, or Lessons from Old TV Shows

I've been re-watching The West Wing lately - my Netflix version of re-reading a favorite novel, which I also do frequently. In the episode Five Votes Down, early in the first season, Leo (the Chief of Staff to President Josiah Bartlet) forgets his anniversary and comes home at 2:00 AM in the midst of a crisis with Congress. The next day he sends his wife a pearl choker and plans a catered dinner, but it's too late. His wife has packed her bags and has a taxi waiting.

Jenny: I can't do this anymore. This is crazy. I don't want to live like this. I just can't.
Leo: I'm sorry about the anniversary. I just...
Jenny: It's not the anniversary. It's everything. It's the whole thing.
Leo: This is the most important thing I'll ever do, Jenny. I have to do it well.
Jenny: It's not more important than your marriage.

We all know what the right answer is here, don't we? We do. Leo knows, too - but instead he gives her the honest answer.

Leo: [emphatically] It is more important than my marriage right now. These few years, while I'm doing this, yes, it's more important than my marriage. 

Every time I watch it, this scene brings me to tears. This time, though, I watched it while I was doing the dishes at 10:30 at night on a day when I'd missed dinner with my family because I was at work until nearly 8:00 PM. That's not unprecedented; I'm lucky that it doesn't happen very often. One of the reasons we put off having kids was that I knew I would have a hard time leaving work at work during residency to be fully present for a small child. Sam was in graduate school at the same time and it was even more difficult for him. For many years, I was Jenny in that scene - I was afraid to ask Sam if his work was more important than our marriage. I was afraid he would say it was.

And now? Now I am almost always home for dinner, but I know I'm preoccupied with stress about work and thoughts about patients. I have to say "no" to my kid every third Saturday because I'm on call and I can't commit to whatever it is she wants me to do. There are a lot of mornings when I don't hear what's said to me because I'm in a fog from multiple overnight calls. Am I behaving as if my work is more important than my marriage? If I were answering honestly, how would I answer that question?

Overall, of course I would say my marriage is more important. Sam and Eve are the center of my life; I adore them and I want to be with them. I want them to be able to depend on me. In any one moment, though, I make choices that clearly put my work first, and those moments add up.

There's an episode of M*A*S*H in which the members of the 4077th invite their families to a party in NYC. Hawkeye assumes his dad won't leave, because he won't want to leave his patients. The elder Dr. Pierce writes back that of course he will go; "Yes, I'm attached to the patients I've brought into this world, but I'm more attached to the son I brought into this world." Hawkeye, brushing away tears, says "Funny, I always thought they came first."

I don't want my daughter to grow up thinking my patients come first. I want to show Sam and Eve now, in the moment, that they are important to me. And I want - I need - to keep the sense of myself that is only satisfied when I'm doing my work the way I know it needs to be done. Is my work more important than my marriage? No...and yes.

How Re-Taking the Pathology Boards Ruined My Year

With all due respect to the American Board of Pathology last year sucked.

I am both lucky and unlucky. I only have to re-certify every 10 years (so sad for my 6 year OB/Gyn friends and my 7 year Peds friends). Lucky. I was the first class in pathology - they were a little behind the rest of the specialties - to have to re-take my boards. Unlucky. I could combine my general and subspecialty re-certification into one test. Lucky. I think this whole process is a ridiculous money making scheme like most other doctors in the country. Unlucky.

I started studying in early 2015 on a plane on the way back from a lab inspection. I wanted to take it a year early in case I had to do it again. I was really frustrated that I would have to take it in Tampa - most other specialties could do it at a testing site in their city. I signed up to take a half a week off and fly there in August. My path bro-in-law was going to do it with me, and a friend. We learned early on that there was a study guide online, which made me so happy I took a deep breath and a couple of months off. Path boards are very comprehensive, and while I sailed through the first time, I've never studied so hard for a test in my life.

I geared back up again in the Spring until I got an e-mail from the Board at the beginning of June. They were offering for me to be a part of a pilot program to take the test online. Not in August, but probably in September. I was so excited (no flying to Tampa!) I signed up right away and took a breather. Still, having that test loom over your head is like that kid in Peanuts with the rain cloud over his head, even on a sunny day.

Even with the study guide it wasn't easy. There were three hundred topics. Some of the topics on the general re-cert were so broad - "drugs and their metabolites" and "cerebrovascular disease" - that it left a lot of material to cover (in the case of the latter - it left me wondering what the heck to cover). On the cytology subspecialty exam guide it listed topics like - "thyroid, benign nodules" and "thyroid, malignant neoplasms" - um ok, so pretty much all of thyroid. I took notes during the summer.

It is a lot easier to study for your boards when you are coming out of your residency and you are so stoked to finally be doing what you set out to do and getting a decent salary for it after years (10 in my case) of training. Stuffing tons of minutiae into your head for months is a challenge but hey! You are at the end - so close to the carrot. Ten years later you have the carrot - you are living the life. And it's hard, it's different than what you expected, there are unexpected challenges but if you are like me you also get really excited by what you do and that helps you get through the hard days. Studying ten years into your practice is hard because you know that all that minutiae is at your fingertips whenever you need it and it is so pointless to stuff it all into your head again just to spit it out and get a certificate saying you can continue to do what you are already damn good at doing. But we doctors are mostly type A by the book individuals. So we do it anyway. But it doesn't mean we are happy about it.

August came and went and I got a call from my brother-in-law, who did fly to Tampa in August. I was so jealous of him being done. "You'll do all right, but I'm sure glad I studied." When he found out he passed and elatedly called me in October, I was still waiting to get my two week window to take it online. The computer program they were using was delayed, still working out kinks. The woman in Tampa I corresponded with in frustration was very kind and empathetic, but still. Rain cloud.

October passed into November and we pilot computer people finally got a nice extended window right around the holidays. Again many apologies and an offer to let us take it in March this year because of the delays and inconvenient timing. Hell no. I was getting that monster over with. I downloaded the program with the link - can't remember now why but that process took hours. And I did it on my own mac laptop - no hospital PC would take it. My brother-in-law had a partner taking the same pilot and their group had to buy her a laptop with a camera because she did not have one.

The technology blew me away. I was able to sit at home - they recorded me taking the test and there were all these rules for bathroom breaks and such. I was sitting in the exact same room I am in now typing this blog. I did set up a desk and chair instead of sitting on the couch because it felt more official and I was so nervous. It was nice to be able to have a glass of water next to me, and being at home was a lot easier than being at a testing site. I took it in late November. I felt really good about part of it but not about others. Anyone who has ever felt like they aced a general exam I'm jealous; I always feel like crap after they are over.

Here's another beef and I know I was a pilot but come on ABP 6-8 weeks??!! My friend who took the peds boards re-cert a month before me knew she passed within that week! It's on the computer how hard can it be to grade? I waited over the holidays and finally got an e-mail in mid-January learning that I passed. I was so elated I couldn't get my work done for two hours and had to stay late.

When I look back at last year - skipping weekly lunches with my partner to squeeze studying in, ruined weekends of cramming because I refused to study on vacation or on my time with kids, and overall being more testy in general and pessimistic about life I get really angry at this whole process. I know that pathology is closely following what internal medicine does, and I hear rumors of making this process a lot more palatable (shorter intervals, smaller tests, more related to your current practice), but the nice woman at the ABP who was my phone buddy last year tells me that is years down the road. I hope not ten. I don't think I can do that ever again.

Thanks to my sweet boyfriend and wonderful kids for putting up with me last year. And congratulations to my friend Trishie who found out she passed her MOC boards today (that she took at the beginning of March!) on the way to Disneyworld. She got me thinking and inspired this rant.

Guest post: The Wandering Mind

The way my mind works as of late is akin to that of the ‘Tasmanian Devil’. I am constantly shifting focus. As a hospitalist, and probably like a lot of other types of physicians, I find myself switching my train of thought often every minute. Triggers of course are the barrage of pages, cell phone texts, acute patient care issues and the list goes on. Honestly, I was fine with this pattern because it has been going on since the beginning of my residency years, but now that I have a child….the rules to my crazy game of life have changed.

My baby girl who is now two years old is at this incredible age where every moment is of significance. She’s discovering her mind and the world that she is in. I realized I must focus and ‘be in the moment’ during the limited time that I have with her throughout the day.

So these past few weeks I’ve dived into the field of focusing. Strangely enough, after scouring the Internet and stumbling upon a TED talk about ‘happiness’, one main finding that I thought was intriguing is that the mere lack of focus or shifting of the mind can lead to unhappiness. The other activity that I’ve started are guided daily ten to fifteen minute meditations. It’s helping to drown the noise in my mind, and practice being aware of what is now.

I’m starting to see the effects of some of this and I’d love to hear what the rest of you brilliant moms out there are doing to hone your focus and truly be in the moment.



I'm an academic hospitalist at SFGH/UCSF. I have a 2 year old daughter. You can follow me on twitter @psanyaldey.

MiM Mail: Pumping while on call

Dear MiM,

I am nearing the end of my glorious maternity leave. As my first day back in the OR draws near, I would love any and all advice on how to make breastfeeding work while having to do 24-28 hour calls. Obviously I will be pumping as much as possible while on call, but have been warned by all (including lactation consultant and pediatrician) of the likelihood of dwindling milk supply given the long times away from my baby.

Thanks in advance!

Dear stay at home mother...

I recently came across this article and it really struck a chord with me. As a working mom, I have often felt the divide between the working mom and the stay at home mom. This is the article and this is my own article to the stay at home mother.
http://carolynee.net/a-letter-from-a-working-mother-to-a-stay-at-home-mother-and-vice-versa/

Dear stay at home mother,

I just wanted you to know that there is absolutely no judgment from my end. In fact, I think what you do is infinitely harder than what I do. Sure there are moments such as when I have to wake up little C earlier than she would like, force feed breakfast down her throat while trying to apply sunscreen all at the same time only to be late to work once again that I might think for a millisecond that it would be great to be a stay at home mom. However, the minute I do get to work and get to enjoy my morning coffee in silence. The thought crosses my mind for much longer than a millisecond that I don't know how you do it.

I am sure you are intimidated by me but I want you to know that I am also intimidated by you. I didn't breastfeed my little C the entire year. In fact, I had to hand off the role of primary caregiver to my parents for the first 2 years of her life. I had to be okay with not being the person who knew what her cries meant at all times and I had to be okay with not being the one she wanted at all times. Even now, I try but there are times we often settle on mac and cheese for dinner and I let her watch TV one too many times just so I can finish the work that I brought home with me.

I see you at the playground. But the minute I mention my occupation, I see that look in your eyes. It's as if we no longer have anything in common. But we are both mothers. I identify myself so much more as a mom than I do as a physician. So please don't be shy. I often find motherhood to be a sorority that requires an unending pledging process. How we do it is our own personal decision but we are all linked in our role as a mom, our role to take care of these little human beings and every day we wake up a superhero because what greater power is there than caring for the next generation?

So stay at home mother, please know I have nothing but respect for what you do. I had the most incredible stay at home mother growing up and often find myself at a loss, feeling unsure of how I can provide the love and security she gave me during my childhood to my own child. I had the best childhood because I had a stay at home mother so judging you would make absolutely no sense because I had the best childhood and the best mother.

However, I chose to work for reasons that are important to me. Just as I respect and understand your decision to stay home, I hope you can do the same for me. I love my child just as much as you loves yours. I constantly struggle with the working mom guilt and every day as I tuck my little C in bed, I question whether my decision to work will be worth it in the end.

Let's support each other. We are all united in the sorority of motherhood. Most importantly, I wanted you to know I get it. I really do.

Love, this working mom

The Return From Maternity Leave: Rusty or Rested?

This article on KevinMD was published a week or so before the end of my maternity leave. As I read it, steam emanated from my ears. How dare the author insinuate that physicians lose their technical skills from taking time off equivalent to more than a mere weekend? What about those who must take prolonged time off for sick leave? And what about maternity leave? Are all physician moms, by the sheer reasoning that they had babies, now deemed incompetent?

It goes without saying that we physicians are humans who need adequate time to heal physically in order to perform well mentally. We all need vacations (longer than a weekend) to help stave off burnout, and we all become sick from time to time. During my training and career as an anesthesiologist, I have taken significant periods of time off for vacation, maternity, and sick leave, and yet I've never had a problem integrating back into the basic flow of my job. In fact, on my first day back to work after three months of maternity leave, I had a patient go into anaphylactic shock in the OR - a very rare and deadly event. End tidal CO2 dropped from 37 to 10 and blood pressure was 50/30, but once I identified it I knew exactly what to do. I counteracted the reaction and saved his life with the fortunate and timely assistance of a couple of colleagues who I immediately called into the room (having extra hands is obviously essential in these kinds of situations).

I recently posed this question of competence to physician moms in an online discussion group. Most respondents agreed with me but cited other issues they had returning to work. Some had to regain their prowess with the EMR, others stated that they had a little trouble multitasking, but all felt confident in their abilities to do their required work tasks. I would say that the hardest part for me has been transitioning each day from Mom to MD and back to Mom again. Preparations the night before a workday seem endless, and morning routines take longer than they used to. Picking up my daughter from childcare after work increases the commute time and anxiety depending on how late my OR day has become. I have yet to be the last parent to pick up their child at night, but I'm sure there will be a day like that sometime. Evenings go by so quickly, and I feel I have barely seen my daughter before bedtime comes. Add in being a part-time physician, and suddenly I feel what some moms warned me about: not enough at work, not enough at home.

So Mothers In Medicine, I ask you: how did you feel returning to work after maternity leave? Rusty or rested? Share your experiences here.