Maybe Later We'll See

I could go on and on about the ways that becoming a mother made me a better doctor. It's much easier to build rapport with families when you can throw a genuine, understanding "yup, my kids do that, too!" into the conversation. It helps me to give much better, more realistic, advice, especially to parents of very young children. (How I wish I could apologize to every new mother whom I advised to just "sleep when the baby sleeps.") Not to mention the fact that I didn't need to study developmental milestones for my General Pediatrics boards.

But until recently, I felt hard-pressed to list any ways in which being a doctor has made me a better mother. It has made me a more tired mother, a more guilt-laden mother, a mother who excels at multi-tasking, though I'm not entirely certain that that's a good thing. Because of my specialty, my kids are growing up with an exorbitant emphasis on safety (Safe sleep habits! Rear-facing car seats past age 2! No riding down slides on grown-ups' laps!). This will likely make their lives slightly less exciting than they would be otherwise, and might even be a detriment to their social skills; at two and a half, Bean regularly points to people biking through our neighborhood and shouts, "Ridin' bike not wearin' helmet! Need get helmet!"

The other day, however, I witnessed an interaction that shook me and has already changed, in no small way, an aspect of my parenting. As a fellow in Hospice & Palliative Medicine, I frequently participate in family meetings and discussions surrounding goals of care. I'm there when people learn that their health or that of their loved one is declining, that the remaining time is likely measured in weeks to months; when they hear for the first time that their end-stage organ failure isn't simply a chronic condition but one that will drastically shorten their life. When they learn that they are no longer a candidate for cure-directed treatment. Oftentimes I am the one to deliver these emotional blows. Regardless, whenever I am involved, my job is to help patients and families understand their clinical conditions and the options that remain - the pros and cons, best- and worst-case scenarios. Their decisions and goals don't have to make sense to me or coincide with my own values and beliefs, but my job is to try to ensure that the choices they make are well-informed.

I recently met a man and his family who quickly became one of my favorites that I have worked with. The couple were in their seventies, with several grown children and young grandchildren living nearby. His diagnosis was one that most in the medical community would consider devastating, though he and his wife maintained an upbeat attitude and an intention to pursue any form of treatment offered, no matter how severe the side effects or how slim the likelihood of benefit.

The first steps in his treatment knocked him down hard. He suffered debilitating side effects. He began to recover bit by bit, but then, still miles away from his pre-treatment baseline, he landed in the hospital with another complication.

I began to explore with him and his wife the potential paths that lay ahead. There was always the possibility of declining aggressive treatment and focusing on comfort, though he insisted over and over again that he would keep fighting his disease. But after yet another complication, it became clear that he might not, in fact, even be a candidate for any further treatment.

They had many appropriate questions, and I tried for days to get the primary team to sit down with this couple and give them some answers about what might lay in the patient's future. When they finally did, the meeting began before I could arrive, and I entered the room to hear them discussing a plan to wait one more week and then meet to assess whether or not he might be able to tolerate further treatment. The patient and his wife pressed the physician further. "How likely do you think it is that he will be strong enough to get more treatment?" the wife asked.

"Well, we'll have to wait and see," replied the physician.

And there it was. The line that I had been using as of late to side-step Bean's requests, to put them off in the hopes that he would forget, to deny without officially saying no. As he rounds the bend from two and a half to three years old, he has become quite a skilled negotiator; a frequent refrain is, "Later, nappy time over, do good listening, watch Cars [his current favorite movie]?" He'll ask even if he's just seen it the day before. And because I feel bad denying his request - and also because I would prefer to avoid a meltdown - I use a variety of stock Mom-phrases that I hadn't even realized I relied on until he began repeating them back to me in response to requests of my own: "We'll see." "Maybe later." "Wait and see."

When I heard it from a fellow physician in such a loaded setting, I grew angry. Of course nothing is certain in medicine and our prediction skills are often poor. But when I looked at the patient before me, knowing his course and his current condition, I knew that I would be utterly shocked if he recovered to the point of being able to press onward with treatment. And the other physician - as he admitted later when we spoke outside of the room - knew it, too.

It made me think hard about the responses that I present to my own child. Yes, it's easier to give some hand-wavy answer in an attempt to move on, change the subject, dodge the thing staring you in the face. And yes, a toddler's request for more screen time is exponentially less serious than a family's request for a clinical prediction. But in both cases, I think that we as humans should show one another the respect that comes with an honest answer, no matter how uncertain, no matter how difficult to deliver and to hear.

So I have started explaining to Bean what we are waiting to see. "It depends on how much time we have after we shop for groceries and take baths," I'll say. Or, "Well, let's see if it's nice outside; if it's sunny, we should go to the park instead." He doesn't always love my answer, but he knows where things stand and what it is that we are waiting to see.

*Cross-posted at The Growth Curve (www.thegrowthc.com).*

Some day I knew I would write this post.

Last year I posted about trying to cope with my moms breast cancer recurrence.  Four years ago my mother was diagnosed with Stage I breast cancer.  Less than three years after her diagnosis she recurred as Stage 4.  She did not make the 5 year survival mark.  If you look up Stage 1 Breast cancer on the American Cancer Society website, you will find this quote: "The 5-year relative survival rate for women with stage 0 or stage I breast cancer is close to 100%." Irony.

This last year has been spent with me trying desperately to treasure every moment while also trying to stop a boulder.  I have made appointments, had family strategy meetings, endlessly researched and relentlessly picked the brain of her oncologist.  I have tried to make moments out of every pause.  I would often sneak away from my clinic to sit in the infusion room.  We would watch soap operas and chat about bits of everything while I would chart.  My mom worked from home for the last year, and I would occasionally spend my administrative time in her home office. We would gossip and look at shoes online while trying to work.  These moments are some of the most cherished, just the two of us.  Our family tried to band together.  We reinstated family Sunday dinners.  We all visited as much as we could manage.  We organized family outings.  We took advantage of all the grandparents days at the local museums and kids theaters.  But many days were post chemo days or too much pain days, and on those days we just talked and sat.

Thanks to our move, my daughter got a full year of Grandma time. A year I pray she is old enough to remember and cherish.  I will fight to make sure she doesn't forget.  Their love for each other was magical.

My daughter was with us in the hospital intermittently up until my mothers death.  On that final trip she saw something in our urgency to get back.  She asked me, "Mommy, did Grandma's cancer get stronger than the chemotherapy?"  In her pure and innocent love, she drew a final picture of Grandma holding all of our hands, each of us smiling.  At our daughters request, we buried that picture with my mother.  She said, this way we would always be with Grandma.  I am continually in awe of the simple wisdom of children.

I have seen many people die.  I have cried with families in the hospital.  I have sat vigil in the unit trying to will patients back from the precipice.  I saw the scans, I knew this was coming.  But, there was no preparing for this feeling, for this moment.  I have never felt this.  I have no words for it.  As I move past the initial shock I am just trying to exist in this new reality.  I am trying to be normal because it's been a month and now people expect me to function and be "back." But I am still in phase 1 and I have no idea what to do.  I am constantly searching for something...a memory, a piece of her jewelry, a picture, a video, anything to fill this chasm.  I have filled my house with old purses and pictures and clothes and plates and spices and cakes she made from her freezer and each thing is like a single speck of sand. I talked to her every day.  I texted her between cases.  I dropped by to see her on the way home.  What do I do with all of these things I would have told her, what do I do with all of these words that are words only for her.  Who do I give them to, where do I put them.  I re-read every e-mail from her.  I started at the present and just kept reading until the e-mails ran out.  This little journey just confirmed why she is so important to me.  There were encouragements from every moment - before big operations that I was nervous about during residency, before interviews, presentations at conferences, client pitches from my finance days.  She called me before EVERY SINGLE test in medical school.  Somehow she never forgot a single one and she would call me on the morning of the test, making sure to wake up early (she was on central time and I was on eastern) in order to catch me before I left my room.  She was my cheerleader.  She believed in me unfailingly and with such purity it was impossible to not just believe her and strive to be what she saw in me.

I will end with this.  I have been so moved by the outpouring of love in the final days of my mothers life and since her death.  It has come from friends old and new.  Friends who I haven't talked to in years but have reached out to me in a way that erases those years.  New friends and colleagues have been there, supporting me in ways I didn't even realize I needed.  Women I don't even know in Facebook mommy groups have sincerely reached out because they too have experienced the loss of a parent.  These women have been a wall for me to lean against when I felt I couldn't stand.  I am so grateful and thankful for this love.

Love is what feels most like my mother.

Guest post: Our scars are our torches

Women are mothers, teachers, healers, and crusaders. We are slowly entering a revolution for women where sexual assault and abuse are a topic of national conversation now more than ever before.

Let me tell you a story about myself. When I was 14 years old, I had my first chaste kiss at a summer camp where I was volunteering. When I was 15 – I was a junior in high school that year, moved ahead for academic reasons - I was asked to a Christmas formal by a 17-year old boy who had just transferred to my school from another state. I was shy and introverted and hadn’t dated much so was thrilled; he was very handsome. We went to a party after the dance where there were no parents and alcohol was in abundance, but I wasn’t very experienced with it so I only had a few sips. Any slight head change was immediately extinguished by excitement when he asked me to go to a park with him in his car and make out. I hardly knew him but was heady with youth and the clear starry night and the possibility of fun.

In the car on the way to the park – a park that happened to be across the street from my house, we had the windows down and the wind was whipping through my hair. He put Bad Company in the tape deck and I was pleased because I knew the words to a lot of the songs and I have a decent singing voice I was proud to show off. We pulled into the parking lot and awkwardly started to do what a million 15 year olds do every day and it felt wonderful.

Then something happened; it took a turn for the worse. He got rough, and I wasn’t prepared for that – what to do, what to say. I don’t even think I knew there was a name for it at that age. I tried to push him away. My clothes were torn. He became violent. I remember staring off into the trees, trees I had run and played under when I was younger, trees that had sheltered me from the sun at the adjacent swimming pool for many years, trees that still shelter me now from the memories of that experience. I disappeared into the moonlight as it shone through the trees. As an adult I know this is dissociation. As a teenager it allowed me to go on.

When it was over he offered me a ride home but I opened the door of the car and ran. I hid behind some bushes and stared at the front door of my parent’s house until it was light enough outside to go knock on the door, pretending that a friend had dropped me off after a sleepover. I have no idea how long I waited, but it must have been hours in retrospect. I remember aching with pain and dripping blood on the ground as I leaned against a fence and peered through the leaves, still frightened since I was alone in the dark. I finally gathered the courage to knock and when someone opened the door, I hid the areas of my torn clothes with my hands as I rushed up the stairs to my room. I cleaned myself up in the bathroom with the door locked. I called a friend from another school in another town and told her that all men were brutes, and that I would never trust them again. I was too ashamed to tell my parents.

I convinced myself that it was my fault; that I had asked for it. I wore turtlenecks to school for weeks until the bruises healed – luckily it was winter so it was easy to hide them. I managed to make his presence, one that persisted until graduation, invisible to me. I beat myself up inside my head for singing “Feel Like Making Love” on the way to the park – I still cannot listen to that song and have to change the station or remove myself from the situation if it starts playing on the radio or at a restaurant or bar. My singing that song felt like giving permission for what had happened, even though the words were in no way a description for what occurred.

I beat myself up even worse when a six-foot tall confident blond tennis player asked me how my date with him went – he had asked her out. I told her it was fine, didn’t meet her eyes, shrugged my shoulders underneath my turtleneck, then turned around and walked away. She angrily sought me out the next week because he had tried to lock her in a room and assault her and she had to kick and scream and fight and forcibly push him away and run through a door to escape. “Did that happen to you?” She asked angrily. I shook my head no and burned with shame. She got away, I thought. She is stronger than me. I’m a failure.

Predictably, my mental health deteriorated. I became so thin and pale I looked like a ghost of myself. I became a career bulimic. I started having suicidal thoughts. A teacher was worried about something she saw in my private journal for writing class and alerted me that she was going to talk to my parents. This was my breaking point. One of my parents walked in on me trying to slit my wrists with a steak knife that morning. I didn’t want to end my life, they were just chicken scratches; a cry for help. It was a necessary turn of events to get me into counseling.

I finished my senior year of high school and graduated at 16 as Valedictorian. I went to a month of inpatient rehab for bulimia and learned that I was raped and was able to tell my parents. I still carried the shame, but started to gain some weight back. I found the courage to go to the police station and report the incident with my mother by my side, and was happy that the statute of limitations was up so I could not prosecute; that would have been too painful just as I was starting to heal. I felt I owed my statement to other women: to the tennis player I wasn’t able to protect from his violent advances, to any future woman he might assault. I was proud.

I started college close to home; I wasn’t strong enough to move away. I learned by word of mouth about two other women my perpetrator had sexually assaulted. I watched the Clarence Thomas/Anita Hill trials and patted myself on the back internally about not speaking out. I walked on the sidewalk the morning after a No Means No demonstration – they had painted it in colorful sidewalk chalk all over campus. A group had snuck out in the middle of the night and wrote “unless she’s drunk” after half of the statements, and I patted myself on the back for keeping silent and not going to those demonstrations.

Once I learned that my perpetrator had come to a college party I was attending and my normally passive self physically fought my college boyfriend to keep him from going to beat him up. “Take me home now,” I screamed at him while pulling his arm. I didn’t want a scene I wanted out of the situation. It took four of his friends to help me hold him back. He finally took me home and I cried in a closet.

After graduating Magna Cum Laude, I had a brief stint as a psychiatric counselor at an inpatient child and adolescent ward before starting medical school. I read the files of 5 and 6 year old children who were being used for child pornography by family and friends and then went to tuck them in for bedtime. I remember one little boy grabbing my head and forcibly kissing me on the lips and trying to put his tongue in my mouth. I tried to hide my shock not to hurt his feelings, teaching him gently with my actions how to give a proper good night hug and peck on the cheek. Two days later I held him in a basket hold in the safe room for over an hour so he wouldn’t hurt himself or another child. My relief was palpable when he finally fell asleep in my lap.

On the adolescent side, I met a girl who was 13 and pregnant. This young girl the same age as my daughter is now was so proud of the pregnancy because she had been “sexed” into the gang. I learned this meant she was gang raped, and that because she got pregnant during the gang rape that the child was a child of the entire gang, and her status was elevated above other women in the gang.

I went to medical school. I listened to a friend talk about being sexually harassed by a surgeon, all the nurses around rolling their eyes as if to say “that’s just him we put up with it,” and decide not to report to protect her future career. I watched her decision reinforced when a student reported a notorious sexually harassing doctor, one that I intentionally stayed away from, only to become the butt of every joke on campus. I became a doctor. I listened to a friend share in residency about an attending who was sexually harassing her in a creepy way and the department’s solution was to keep her away from him – to not put her on any rotations with him. I later learned the creepy attending was transferred to another academic institution after a surgeon learned from his tween daughter that he harassed her at a school bus stop. So this is how they take care of this, I thought. This is so crazy.

I became a wife. I became a mother. I got divorced. I went to therapy, again as an adult. I’ve never asked or heard what happened to my perpetrator. Thankfully he has not attended any class reunions.

After a few years of dating my current boyfriend, we became engaged. I’ll never forget the first time I told my fiancé about the rape. We had been dating about 6 months and things were getting serious. I was terrified of his reaction; terrified he wouldn’t love me. It was the middle of the night; we were on a long weekend away. I went to the porch of the bed and breakfast and stared into the trees watching the moonlight. I drank a glass of wine and gathered the courage. I crawled back in bed with him, woke him up, and we started a conversation where he told me he loved me. I awkwardly confessed that I had been raped. He looked into my eyes and said something no one has ever said. “I’m so sorry that happened to you. Want to tell me about it? I’d love to listen whenever you feel like it.” Tell my story instead of sweep it under the rug, or awkwardly dismiss it? I felt like I had been doused with a bucket of cold water. I found the courage to tell him I loved him back, and shared a truncated version of this story.

It’s not men’s fault that they don’t always find the right words when hearing about sexual assault, or women for that matter. It is hidden in a cult of guilt and shame, passed down generation after generation. Women are speaking out now more than ever before: carrying their mattresses across campuses, trying and more often succeeding in prosecution. Every time I read a story about a woman with a successful prosecution, I cheer silently on the sidelines as a member of her team. Every time I read about a woman who is penniless and suffering from mental health disorders after being kicked out of the military, her bright and promising future doused by rape, I cry silently on the sidelines as a member of her team.

In therapy I mourned my lost innocence. In solitude I forgave the little boy who grew up in a house where the possibility to do what he did to me was transformed into a reality. My therapist told me that my empathy did not need to extend to my rapist, but I couldn’t help it. And in some small way, it helped me heal.

We need to remind men and boys that the porn they can so easily google as a teenager at a sleepover is not reality. We need to tell them if they are in a gamer chat room online and a girl walks in they cannot verbally assault her just because everyone is anonymous. They cannot rape her at a college party, even if she drinks too much. They cannot call her bad names and treat her with disrespect, even if they witness it growing up in their own house.

This is a cultural ill. We need to change the fact that women on Indian reservations are so easily raped by men who know they can escape prosecution. We need to change the fact that sports institutions objectify women and value the achievement of their college and professional athletes over disciplining those that have no boundaries with women. We need to change military culture around women. We need to stop human trafficking. It’s a worldwide disease, and our country may be healthier than some, but it is still very sick.

Last week the election of a president that boasts of sexual assault and promotes intolerance and hate struck my core as a human being, but also hit me on a much more personal note. I woke up at 5am and the confirmation of what I dreaded was happening at midnight spun me into outer orbit. I sat on the back porch, had a glass of wine, and sobbed. It felt like decades of achieving and therapy and reaffirming my worth in society was erased by half of America.

A few days later I sat in a Sunday school class with a group of strong, mostly single mothers and was reassured. The current leader (we all take turns – well, them anyway I’m a slowly reforming atheist looking for faith who does not yet feel qualified to lead in this arena) spoke of a Saturday spent in a prayer house. She, a Methodist, said that she was reminded by an Episcopal leader that all lives have value, and that we spend too much time, especially in America, measuring our value by our achievements and our wealth.

She spoke to my 15 year old soul. That girl had promise and value – no different from the doctor I am today. That incident no longer defines me, but it does shape my future actions. I vow to revolt against hatred, not with anger or blame, but with love and action. I vow to value every human being I encounter no matter their origin or political inclination. I vow to use my scars to help heal others.

-Anonymous

You don't need me to go pee and other 4am thoughts

I am at a crossroads with my 5 year old. It’s 4 o’clock in the morning and I have just been woken up from some amazing sleep for the countless time with a scream of “mom, I have to go to the bathroom”. I grumpily yell back “go by yourself” and my husband mumbles “that’s not nice!” and said 5 year old yells at me from the bathroom. I get up and our little tyrant is perched on the toilet going to the bathroom by himself. The bathroom is lightly illuminated with a night light. He pees as I gently say “please stop waking mommy up. I’m very tired and it makes me cranky when you wake me up.” “Cranky?” he says. “Yes, cranky because I’m tired” I say. I tell him he’s a big boy and can go pee by himself. He says “okay” then walks to his room leaving the door cracked. I tell him it’s okay to leave his door cracked and he says “okay”. I lay down in bed, he says “please close the door” I don’t respond, hubby gets up and closes the door. I lay awake in bed recounting all of the things that I am doing wrong with him, the things I am worried about with professional drama, good things that are going on (woo hoo congratulations on the new professional leadership program acceptance!), but sleep eludes me and I am so tired. 

This and worse accounts (one particular evening I had a screaming match with him because I wouldn’t come back and put his covers on him just right) document our nighttime ritual. He sleeps completely through the night less than once a week. He pees on himself at least once a month. Me remaining awake for several hours after being woken up is much more common than me going peacefully back to sleep. My husband is usually not woken up, but when he is he rarely has a problem going back to sleep. 

And I am at a sleeping crossroads. Being woken up for months and months and years and years makes for an unhappy mommy and I can feel the effects of my sleep deprivation. I am cranky when he wakes me up and if the sleep is really good I am downright angry. I know he needs sleep, he goes to bed at 7:30pm and wakes up between 7 and 7:30am. If he goes to sleep after 8pm for more than a few days, things don’t go well for anyone. I on the other hand know I need more sleep, but getting in bed before 9pm is rarely an option, but if I could just sleep uninterrupted it would be so much more restful. Tonight though I was in bed watching TV by 8:30pm. 

I don’t know what to do. It’s 4:10am. My shoulders hurt, it’s cold (autumn in the mid-Atlantic in our 1938-built home mean it’s chilly literally all of the time). I want to be asleep, but I can’t go back to sleep. So here I type after sending my husband a “I can’t do this anymore” email that I’m sure will make for great breakfast conversation and texts back and forth all day. 

I know I have options, but in my 4am research I can find very little about nighttime awakenings. Lots about 5 year olds being scared of the bathroom in general, but nothing specifically about what to do when he wakes you up at night and won't go back to sleep. Should I start sleep training again; this time using the same techniques of slowly responding less to his demands each night (but it takes so long!)? Light his room up with an additional night light to illuminate the dark corners? Make my husband do it alone? Refuse to get up with the tyrant anymore? Ship him in a box to my parents? Put a small potty seat in his room as my girlfriend, also a Pediatrician recommends (this seems so gross to me though and all I can think of is tripping on it and pee flying everywhere)? 

Please help! I’m so over this. It’s now 4:25am and I’m going to see if I’m tired enough to fall back asleep.

What's This Week Been Like For You?

I’m sure we all have an opinion about the election outcome; most likely, a strong one. I was following with intense anticipation as a Canadian. I am utterly despondent with the result. The day after, I met a friend for coffee and together we tried to process the reality. It felt much like the morning after 9/11, where we knew we were facing a ‘new world’ and an uncertain future. 

Our national public radio station’s coverage was filled with interviews with Americans relaying their uncertainties about the future. One gentleman felt a sense of betrayal by his neighbours; that he did not feel he really knew his city as he thought he did. I know that some of you are heartbroken, as I am. Others may be elated, or at least satisfied with the outcome. Some of you may feel conflicted. Still others may be Republicans who feel dismayed that Trump was their candidate. Maybe none of these captures your sentiments. I know many people are struggling to talk to their children about the outcome. Many American citizens and residents of colour and other vulnerable populations are especially worried about the “Trump effect” on their children, and perhaps some of you are seeing its effects in your daily life in medicine. In Family Medicine, it's not uncommon for some patients to bring up political topics, but I try to stay pretty balanced and general.  Personally, I found inspiration here, which cites this great article about talking to your kids about the result. Reading personal accounts and opinion pieces by those who are processing the results thoughtfully is helping me deal with the result. 

I realize that politics in general, and this election in particular, can be polarizing to discuss, and I know this blog does a great job of being a safe space. A refuge from the constant barrage that was so consuming during this campaign, perhaps. I think we can maintain that safe space by respectfully sharing our own personal experiences, fears, and worries. Because no matter your political stripes, I think it’s fair to say that the months ahead are uncertain for the United States, and the world.  

I have great faith in the American people, and the American system, to uphold their democratic values. I believe that most people are decent and that political and social tides ebb and flow throughout history. Let's help one another navigate the best way forward for our families, communities, countries, and the world. 

The Soul Condition

The day to day practice of General Internal Medicine can be particularly challenging and trying, but also thoroughly rewarding. I have found that the most incredible moments of privilege and wonder in this profession come in the most unexpected times and places. Especially during this past year, which has been particularly trying for me personally, just when I think I can’t bear any more suffering, there is a surprising glimmer of light that penetrates the darkness. I’m thankful for those moments, and being mindful of recognizing them when they present themselves.

One morning recently, I entered an exam room to see a patient of mine during a busy Tuesday morning clinic. He was sandwiched in my schedule between a lovely middle aged woman with a newly diagnosed metastatic lung cancer (sigh) and a young adult patient with a sore throat. I saw him on my schedule for that morning and smiled – he was a lovely elderly man that had a difficult past few years with depression, obesity, and was ever skeptical of my western medicine approach to his longstanding hypertension. Despite it all, we always found a way to have a good talk, able to cross the chasm of our cultural and religious differences and find a way to speak a common language with each other. I take care of his wife and his adult daughter, as well, so I have a multi-dimensional sense of his life at home.  In the flurry of the day, I closed the door finishing with the patient across the hall and stepped in the doorway of his exam room to say a big hello. I looked up and barely believed my eyes – “Oh my goodness, how are YOU?!” I said. There he was, big sparkling smile, bright eyes, “Hello there, doc!” He looked twenty years younger than his 74 year old self, and strong and happy.  This was such a stark contrast to our last meeting, about year ago. “Well, doc, I thought you’d be proud. I lost 70 pounds.”

I smiled. I paused. I looked at him lovingly and proudly and then squealed with excitement as I gave him a hug. “How did you do it? And how do you feel?”  He went on to tell me how he feels terrific, both physically and mentally.  When we last saw each other about a year ago, he was sad, lacking motivation, irritated with his wife who was ‘nagging’ him, and about ready to move away to a warmer climate.  He was morbidly obese, had aching knees, and just didn’t feel like himself. I recall distinctly (one of these moments that just are quite captured in the EMR documentation!) at that visit we talked about “why are we all here?” –I had referenced a friend who had recently passed away at the age of 49 and I was feeling great loss at the time – he too was feeling loss and disappointment about moments in his life and was reflecting on his 73 years, having an existential crisis of sorts. We hugged at the end of that office visit. And now here we were, a year later, and he is bright and happy and has lost so much weight. 

A year has changed so much of who we both were. I was about to hear about his year long journey. Over the last year, I had seen hundreds of patients while I tried to keep my own tattered life afloat. My marriage broke up, I sold my house, I moved, and have tried to weather the storm of a messy divorce while parenting two little kids who were trying to understand it all. I couldn’t help myself as these thoughts rushed in--the year since we saw each other last had affected us both so profoundly. And here we were, again. And I think we found unspoken strength in each other.

“Well doc, this is all about my ‘Soul Condition’.”  I looked up, saying nothing, but my eyes gesturing ‘tell me more.”  He went on to tell me that he thought a lot about his life after our last appointment. He realized that his poor health habits, for him, were about failing to care for himself and his ‘soul’. He realized at some point he is worth more than his poor health habits, so slowly he started eating better and exercising. He said “Doc, you told me to go for a walk. So, I’ve gone for a walk everyday ever since I saw you last.”  Wow! I admit I had a moment that I couldn’t believe someone actually listens to me!  We went through the rest of the visit, me with genuine joy for him, him with the pride of a child reporting back a good deed to a parent.  And then we finished, as he and I somehow always do, sharing tidbits of our lives and hopes, and he teaching me more about the Soul Condition. He said “Doc, if you are unhappy, just work on your soul. You should tell your other patients that. I’m not even tempted to smoke or drink alcohol, or eat ice cream. Why would I now that my Soul is so happy in this body?”

I’ve thought of him a lot since that day. I could certainly learn a few tips from him – or at least my Soul needed a new kind of condition after all I’ve been through this year.  I couldn’t help but wonder if he saw it in my eyes, if he knew I needed this advice.  Divorce is ugly and bitter and deeply devastatingly sad – it does break a soul as it breaks a family.  I bear witness to so much human suffering on a daily basis in my role as physician, and sometimes the only thing I can do is sit with a patient and listen and hold his or her hand, offer a supportive word or a hug.  I have found it an incredible burden to also carry my own suffering into the room with my patients as I listen to their stories, offer kindness, support and advice. I’ve often wondered over the last year if I’m good for any of them and if I could possibly bear any more. During that 20 minute appointment, I earnestly rejoiced in his improved health and happiness and learned from his wise counsel. 

Just like my patient worked to make his Soul happier, I’ve learned I need to deliberately take steps to do the same. I savor my kids’ giggles, and give more hugs, and spread more love, and have learned my own needs count.  I have long taken care of others, and I’m just now learning the skills to recognize my own Soul Condition, and tend to it.  Today I went out of my way to spend time with a long lost friend, take a walk, and bake banana bread. I went slowly through my day, took note of how I felt, and listened to what my Soul needed today.  I also held my son, as he cried in my arms for a half hour after coming home from a weekend with his dad. He wanted to know “why can’t mommy and daddy just live together?”  And so I hold these things, some so difficult, some so beautiful, and think about what we all need to care for ourselves and our Souls. In this moment, my heart ached wide open for my sweet child, and was also warmed by his earnestness and his openness and his absolute softness in my arms.  My Soul has a little farther to go to feel healed, but I’m listening and trying. My patient is a beautiful man and a special, special Soul. May both our Souls triumph in a beautiful year ahead of us, until we meet again.

Childcare Options for Doctor-Moms

Genmedmom here.

Childcare is such a huge issue for working parents. It can be so expensive, and it is so important. With me in outpatient primary care and my husband traveling for his work pretty frequently, we needed to figure it out.

Thankfully, we have my mom who lives close by and provides the bulk of childcare for our little ones. We have also used daycare, as well as nanny services, both to give her a break and to provide socialization for our kids.

Family help is the best, but it can't always work, for many reasons. Daycare has the advantage of providing key socialization, as well as building relationships with other working parents, a bonus that I didn't realize would be until it was. However, if we didn't have my mom to pick up our kids at the end of the day, we'd be pretty miserable. It probably wouldn't work at all.

I found nannies to be the most difficult. It was almost a part-time job to find a decent nanny, even with Care.com. And, they weren't always decent. Plus, that option can be very expensive, prohibitively so. Upwards of twenty dollars an hour in the Boston area, for a nanny with experience.

Other docs have written about au pairs, and that options sounds wonderful, but one has to have a place for the person to sleep, and we just never had that. It's a small house, barely enough room for us and the two kids. Au pair, sadly, was never a possibility for us.

What childcare options have worked best for others?

Help with attending job interviews!

T minus 8 months until I join the real world.

I am now 4 months into my breast imaging fellowship. It's about that time I start looking for my first attending job!! As someone who went straight through in my medical training, I have no idea what a job interview truly entails. Yes, I've done plenty of interviews. I know what it's like to sell myself as a medical trainee but as for joining the real world, I have absolutely no idea.

My experience looking for a job might be a little different than some because I am geographically limited. My husband started his (first) attending job in a city 2 hours away from where I am doing fellowship. On a side note, this situation is so much better than our west coast east coast marriage while he was doing fellowship last year! As much as I am looking forward to joining the real world, I am really looking forward to our family of 3 to finally be living under the same roof!

I went on 2 interviews so far. The first one was not the same location but same group as my husband's place of work. Given that it's part of the largest managed care organization in the United States, questions outside of who I am, what I can offer were really not asked. Details of what the contract would entail, how much I would make, what my benefits were and etc. were not discussed. Mostly because I already knew the answers to these questions and the fact that I was told that there was no need to go over a contract from this place as it was standard across the United States. I came back from this interview thinking it went well and that it wasn't much different from a fellowship and residency interview. A downside to this job is that it will be a 45 minute commute to where we will most likely settle down.

The second interview I went on was a large private practice group in the city where my husband practices. It's a group of approximately 80-90 radiologists. We talked about my dual boarding in radiology and nuclear medicine. We discussed the possibility of working within my preferred subspecialties (breast imaging and nuclear medicine. We discussed the possibility of working part time, which got me really excited. I also met some of the radiologists in the group, who all seemed very nice. However, I came back after my interview most of my conversations with my attendings at work went like this.

"How was your interview?" "Good. I really liked the practice"

"What is your base salary?" "I don't know..."

"What is your retirement?" "I don't know..."

"What benefits are offered to you?" "I don't know..."

"What about maternity leave? " "I don't know..."

"Do you get paid overtime for call?" "I don't know..."

"How many years until partnership?" "I don't know..."

Basically, I felt like an idiot. And now, I am waiting to hear back from both jobs but I feel like I cannot really compare and contrast since I don't know the answers to these questions!

How do you go about asking these questions during a job interview? Do you ask right away? Do you wait until there's a proposal? Is these anything else I should be asking? Do you need a lawyer to review your contract?

Thank you in advance for your help!

How Do You Do It All? (i.e. The Art of Being Imperfectly Perfect)

Genmedmom here. 

Let’s face it: working moms have alot on their plate. A patient recently complained to me how guilty she felt because she couldn’t be a perfect mother, wife, accountant, and friend, all at the same time. If she felt really good and strong in one area, she was slipping in another. “No matter how much I try, I’m a failure!” she declared. 

Okay, look, despite the expectations on us, no one can achieve perfection 100% of the time. No one is going to excel in all of the areas of their life always. But we can manage. We can do our myriad jobs well enough. And we can be happy. 

On a weekly basis, I usually manage: four clinic sessions a week (approximately twenty hours seeing patients), one morning precepting in the firstyear medical students’ interviewing and communications course, co-parenting our two school-aged kids (with lots of family help), regular blogging on three separate blogs, kids’ dinner/ bathtime/ bedtime virtually every night, about three good workouts per week, church and big family dinner on Sundays. 

Is it all done perfectly? Hell, no. I wish I could get to all the patient phone calls, emails and lab results every week. It would be great if I could do the reading before the medical school course. Our kids are late with homework probably at least once per week. We never seem to know what's going on at school until the last minute. My blog posts often have typos, and could have used a little more editing. My workouts are sometimes really short. We don't get to church or have family dinner every Sunday.

But I can say this: We fit in what we need to fit in. We do what we feel needs to be done. It's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

I am often asked “Geez, how do you do it all?” 

Well, if what you're aiming for is happiness rather than perfection, then I’ve thought about this. It will be different for everyone, but generally, I suggest: 

Identify your time-wasters and eliminate them. What time-consuming things in your life do not help you to achieve your goals, and do not serve a healthy purpose? For me, that’s television. I do not watch television unless there is a really good reason. I’ll watch a Disney movie with the kids once in awhile, all snuggled on the couch. And, of course, once a week our whole family watches my husband’s football team play. Other than that? No sitcoms, no news, no movies. Social media can also easily become a time-sucker, so I limit that to my train commute.

Hire cleaners, if you can. Yes, we all know that we are capable of cleaning. But how much is your time worth? You are an M.D., and if you were paid by the hour, you would earn $100, at minimum. Multiply that by a thousand- no, a million- and that’s how much your hour is worth to your kids. Though we couldn’t afford it when we just started out, as soon as we could, we hired a cleaning service. They are worth every penny.

Order anything online that can be ordered online. We have groceries, pet supplies, clothes, shoes, furniture, books, et cetera delivered right to our front door. 

Stay local. Need to run an errand? If possible, avoid driving time, and support local businesses to boot. 

Schedule carefully. There are so many options for kids’ activities around us. It would be very easy to slip into driving-everyone-all-over-the-place-for-this-or-that-thing. We were forced to hold back quite a bit, as our son with autism doesn’t handle a busy schedule very well, and doesn’t do drop-off events at all. So, we have a music teacher who meets them in my mom’s home after school one day. And we choose family activities like hikes, trips to the farmer’s market, and scouting (Boy Scouts), rather than kids-only classes like dance and tae kwon do. We’ve realized that this quieter, easier, more familiar approach results in less hustle and bustle, and doubles as “family time”. 

Identify toxic relationships and avoid them. Okay, I'm wandering into therapeutic territory here, but the truth is, people who make us feel bad are a real drain on our precious time and energy. Conflict and negativity are distracting. We can't be our best selves now if we're re-living an argument or re-thinking that weird conversation from yesterday. If there's a person around who consistently brings conflict and negativity into my day, I avoid them as much as possible. Likewise, if there are good, psychologically solid people who support me and boost my mood, then hey, I want to spend more time with them.

Keep reasonable goals. I’m not striving for crazy achievements in any area. I’d like to take good care of my patients, be a solid teacher for my students, raise emotionally well-adjusted kids, keep on writing until it goes somewhere, stay as healthy as possible, and be actively engaged in our community. Like I said, it's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

What about other mom-docs? How do you "do it all?" What do you do to save time? How do you keep you and your families happy?

[Watching our friends get] Married... with [our] Children

Let's bring the boys to the wedding, we said.

It will be fun, we said.

We were so cocky. Bean had been to several weddings and loved to dance, we reasoned. And Teeny, though young, was just so chill that it wouldn't be a big deal. An outdoor, afternoon wedding of a laid-back couple with tons of family medicine and pediatrics residents in attendance. It would be like a weekend away without needing to pay for a baby-sitter. What could be more perfect?

We rented a house through Airbnb so that we would have plenty of space and the boys would have their own rooms. We beat traffic on the way there and spent the next morning exploring the cute town. We stumbled upon a farmers' market and ate ice cream for lunch. The boys even went down for a pre-wedding nap.

On the way to the wedding, we talked about how we would need to be very quiet. (We had no illusions that we would actually sit down for the ceremony, but planned to watch from a safe distance.) As we rounded the side of the beautiful inn where the festivities were being held, the bride was just starting to walk down the grassy aisle to the strumming of a guitar. Bean pointed to the musician and began shouting, "Man playing 'tar!!!!!"

We retreated. A staff member inside kindly pointed out a large picture window overlooking the lawn where we could watch without disrupting things.

At that point Teeny let us know that he was hungry, so I settled into an armchair in the corner to nurse him. My husband headed to the window with Bean, but there was a problem: the parlor of the inn was filled with so many nice things and Bean needed to investigate all of them. There was a large birdcage containing actual birds and a stone fireplace and so many trays of seashells and trinkets and shiny objects. In other words, it was a room we had no business entering.

"We really need to rethink whether we bring the boys to weddings," my husband noted a few minutes later in a tone that struck me as irritable, though he adamantly denies having felt annoyed. I sighed and internally (or maybe externally) rolled my eyes. We were in another state and the celebration that we had traveled here to attend had just begun. There could be no second thoughts.

As soon as Teeny had finished nursing, my husband pounced. "My turn to hold him!" he exclaimed, which was code for it's your turn to chase the toddler. But Bean was in great spirits, happily occupied by tracing the contours of the stone fireplace with the car key that my husband had handed him to play with. I relaxed a bit and began to really take in the gorgeous setting. On the other side of the fireplace, I noticed a basket filled with books and a plush stuffed lobster. As Bean began to edge too close to the hurricane jars lining the hearth, I lifted him up, intending to plop him down by the [unbreakable] lobster. While in the air, he started to protest: "Hold key! Hold key! Hold key!"

Which is what he says when he wants to hold something that he is not holding.

I looked down at his empty hands. "Key? Where's the key, Bean?" I asked in an urgent whisper, not wanting my husband to hear. "Bean, what did you do with the key?"

"Hold key!!" he wailed, and I left his side, hurricane jars be damned, to retrace my steps, scouring the floor.

"What does he mean, 'hold key'?" my husband asked, because of course he was right there and had heard and now realized the predicament.

"Don't worry, I'm sure it's here - " CRASH!!!!!! 

I spun around, expecting to find my family covered in shards of glass. My husband, with Teeny in his arms, had sprung to action trying to find the key, but in doing so had knocked over an end table. An end table that had held a glass dish of beautiful, fragile seashells.

Of course that was the moment that the inn's manager entered the room.

"I'm so sorry! We're so sorry!" my husband yelled, frantically gathering shells in one hand while cradling Teeny in his other arm. 

"Hold key! Hold key!" Bean continued to wail.

"Just let us know how much we owe," my husband huffed, still scrambling to scoop bits up off the floor. "And also, we're missing a car key."

Outside, the ceremony came to a close. The bridal party and guests began to make their way back up the lawn toward the inn. Having already crawled along the floor to peer under the couch, I stood up and spied the key nestled behind a throw pillow. Somehow the glass and shells and whatever else were picked up off the floor. My husband and I gathered our things and, each taking a child, stepped out onto the back porch where guests were now mingling over cocktails. In the kind of frustrated yet silent agreement that comes from more than a decade and a half as a couple, we parted ways, each joining a separate section of the throng.  

By the time dinner started, Teeny was napping contentedly on my shoulder and Bean had begun to make his presence known on the dance floor. We had caught up with old friends and made new introductions around the table. And for the rest of the night, our family was happy and smiling.

I had thought that some time would need to pass before we could speak of - and certainly before we could laugh about - the scene at the inn. But as he pulled our car out of the parking lot at the end of the night (well, the end of the night for a family with small children), my husband grinned. "Well that will make quite a story."

Since that time, I have referred to it as "The Wedding Where We Almost Got Divorced," though he swears it was never that serious and he was never that annoyed. And as for bringing the boys to weddings? We haven't done it again. 

At least not yet.

Money and mothers in medical training

Children are expensive. So is medical school. Children take up a lot of time. So does medical school. Unfortunately time and money are two things in considerable shortage during medical training. Mixing children and medical school can be an unhappy combination. We had our baby halfway through medical school (me) and residency (the Mister). There has been lots of discussion regarding the timing of procreation in medicine (eg here and here and on this blog). My general takeaway can best be summarized with this license plate.

I have found some serious life wisdom on vehicle license plates.

My general takeaway 1.1 regarding the subject of timing babies in medical training is that there is no perfect time. Each time is good in some respect and not so great in others. Having spent my 20s in pursuits of other advanced degrees, I didn't want to wait until I had a "real doctor job". But that meant that financially it was not such a great decision. Residents stipend is not enough for supporting a family, especially when one member of said family is incurring expenses of medical school. More than a third of our income goes to childcare expenses, and that's not even including food, diapers, and a multitude of other child related expenses. We are always worried if we'll be able to pay all our bills at the end of each month. I am in debt up to my eyeballs. Financial worries are always lurking in the background of my thoughts, and money has been on my mind even more as I am looking into taking out more loans for upcoming residency interviews.

A friend offered me wisdom from her interview experiences, telling me about some common interview questions, one of them being "Tell me about a difficult experience you had in medical school". I said (almost half jokingly), urrmm pretty much the entirety of medical school since having a baby has been one incredibly difficult experience. It is difficult to separate the experience of being a parent from that of being a medical student, and money has been one of the connecting threads between the two.

Daycare was the only affordable childcare option for us, and we are lucky to have hospital subsidized daycare. It was amusing (not really) when one of my classmates thought that "hospital subsidized" meant that all costs were covered by the hospital and it was free of charge. No, it just means there is a small discount. Though it is a "hospital affiliated daycare", but like most other daycares, it is not a 24/7 facility. Having both spouses in medical training means that both of us have very little control over our schedules. There are plenty of times that we are both working outside of daycare hours. And trainees may have an 80 hour a week work limit, but a child requires care 168 hours a week.

This same classmate who thought that daycare was free, was also surprised to learn that I hired baby sitters to study for medical school exams. "Wait, so every time you have to study, you have to pay someone to watch your kid? Can't you just put him in a playpen and do your studying?" Before I had a baby, I envisioned this picture of getting home from the hospital and spending daily finite hours of "quality time" with the little one and then he would, I don't know, put himself to bed or maybe I'd read him a little bedtime story at the end of which he'd dutifully doze off and sleep through the night, and I'd get more hours of "quality time" studying. Or just like my classmate I assumed that I would be studying while the baby/toddler would be happily playing by himself on the side with his toys, of course, without interrupting me. Those fantasies/assumptions disappeared pretty fast when a real baby (who is now a toddler) showed up.

Talking to other people in our situation (two medical trainees with no family close by) most options I heard of were not financially viable alternatives for us. I have heard people say to not worry about money and keep taking out loans because when I have a "real doctor job", I'll be able to pay it all off. Maybe there is truth to that. But when I look at the enormous amount of debt that I have already accumulated, and when I think about the uncertainty with future physician compensations, I don't feel comfortable taking out loans to whatever amount.

Things haven't always worked out great with this whole arrangement. I have less than perfect grades in medical school. I feel like if it was just the hours in the hospital and then I could come home and eat, pray, love or something, it would be fine. But because work just gets started after getting back home from work, is what makes it so hard. After a particularly rough rotation that had lots of nights and weekend shifts (read: "when daycare is not open" shifts) and an end of rotation exam, I bombed the exam. The course master told me that he was really surprised about my exam performance because the clinical portion of my grade was stellar and there was such a discrepancy between the clinical grade and the exam grade. I didn't know how to explain that for me studying for exams cost money. Whatever little savings we had, had recently disappeared after a family emergency, and as interview expenses had drawn closer, I had scrimped on getting sitters to study for tests.

As a minority it is sometimes difficult to explain or convince people even in the face of overwhelming evidence that social factors control how you experience your life and the color of your skin can change the opportunities and travails you encounter. At some point it is tiring to keep going through the explanations over and over and knowing that unless someone has actually been there, they really won't know what you are talking about. I feel that way about the experience of being a mother in medicine too. I could go blue in the face with my explanations but it is exhausting.

The Woman in Scrubs

Now how's this for stereotyping:

Sometimes when I drop my youngest off at school, I've seen another mother dropping off her daughter in the same class.  And she always shows up wearing scrubs.

I've had a couple of conversations with her.  And of course, I'm dying to ask her what she does for a living that she's always wearing scrubs.  But I don't want her to tell me that she's a nurse.  And then I'll have to tell her I'm a doctor.  And any possibility of friendship will be vanquished.

There are probably a few things wrong with this:

1) My certainty that there will be awkwardness upon discovering that she is a nurse and I'm a doctor.

2) My assumption that she's almost certainly NOT a doctor herself.

As for the first one.... it's likely predicated on the fact that I've never had a nurse friend.  And I can't even get any of the nurses I work with to call me by my first name.  As for the second one... well, just going by the numbers, I'm probably right.

Yet another case of my career feeling like a detriment in my quest to make friends.  Recently, a mom I met at a playgroup asked me if I was a nurse and I was sooooo tempted to say yes.

Would You/ Did You Deliver In Your Own Hospital?

Genmedmom here.

I could not have imagined going anywhere but the OB/GYN office down the hall from mine. My lovely OB was a clinical instructor in the same course as me, and I ran into her at the medical school from time to time, in between my prenatal appointments. She'd seen my cervix and God knows what else was going on down there, and yet we would find ourselves standing around pleasantly chatting about curriculum changes while sipping lukewarm coffee. I didn't care.  

Just take good care of us.

Still, with my first, I went a little psycho around delivery. I created an annoying three-page natural-no-epidural birth plan with all sorts of stipulations: no med students, minimal residents, no male anybody.

Ha. When the meconium hit the fan, there I was being wheeled into an O.R. crowded with every level trainee and both genders well-represented, and I didn't care.  

Just take good care of us.

Babyboy had to be rapidly and forcefully extracted: hauled from above and pushed from below. But he was born and he was healthy and all was good.

For my second, I had no plan. I was so traumatized by how violently OPPOSITE everything had turned out from what I had envisioned the first time around, I couldn't make any decisions at all. So my lovely O.B. firmly (but nicely) guided me through a successful VBAC.

I've seen her around since and we are very friendly. I've probably also run into multiple nurses, residents, and students who were witness to my howling hysteria in one or the other delivery, but I can't remember who was there from either so who cares.

Personally, I'm glad that I delivered with a physician I know professionally and admire. I could never have managed going to any other hospital but my own anyways, too inconvenient. 

But not everyone feels the same way. The question occurred to me: Where do OB/GYNs deliver? Do you guys generally prefer your own or a different hospital?

How about other specialties- OB anesthesia, what about you? Does it vary at all by specialty?

Maybe it just has more to do with individual comfort level with the total, supreme lack of privacy, and knowing you will be definitely be observed if not at your worst, then at least, perhaps, not at your best.

I'm very curious about this, as I am covering this topic for a doctor-mom writing project. Please, share your perspectives! Inquiring minds will want to know.

The Versions Revisited

I retired my personal blog a couple of years ago, but at one point, it was a very big part of my life. The importance of capturing the details of my life - with all of their humor, fake drama, and sometimes real drama - loomed large in my priorities. And capturing the details of my children and how they were growing was part of that.

I started a regular series on my blog that took the form of Version Updates. Like software updates, with the latest advancements and continued operating failures. It started with Version 14.0, when my daughter was 14 months old. This, of course, led to some nice creative outlets and photoshop skill development. I eventually felt like my children had "graduated" from having such scrutiny and carried it through until each was around 3 1/2 years old (that's Version 42.0 for anyone counting). I hoped that one day, they would be thankful that I catalogued their journey through the early years of life and didn't think I had exploited them for entertainment and cheap laughs.

I published a book of my daughter's Versions posts to give to her, complete with a dedication in the front. I included that I hoped she knew that I wrote it all down in love and that I was laughing with her, not at her.

Well she's now 11. Almost as tall as me. Her feet are bigger than mine and she borrows my clothes. She's seen the Versions book of her and knows where we keep it in the bookcase downstairs in the playroom. The other day at dinner, she was mentioning the autobiography her class has been tasked to write as an assignment. My husband and I were playfully retelling some of her funnier moments at the table when she leapt up and ran downstairs. She came back with the Versions book and started reading at the table. Every so often, she would read a passage out loud, and we would all laugh. She flipped the pages and soaked up the words. Those words, my words, echoed all around us, delivered with her voice. It all came back - oh yes - you used to say that! The memories tumbled by, and I loved, loved that she was relishing in it.

After dinner as we were cleaning up, and she and I were alone for a moment, she said, "Thank you for writing this. It is very special." After a pause, she added, "Can I do this for my children too?"

My heart leapt. "Of course you can. I'm so glad you like it."

She carried the book off to her room, to later continue thumbing through it while lying on her bed. I'm not sure what I liked more about this: that she'll know herself and how she grew, or that she'll know the eyes her mama saw her with and the humor that narrated her story from the beginning.

Pump Love

A Love Letter to my Breast Pump*

When we accidentally met many years ago, I had no idea how our relationship would become such a central part of my life. As a naïve and very poor medical student expecting our first baby, I scoured Craigslist every few days looking for free baby gear. I remember the brisk foggy morning when I saw the ad for you, the cozy pink oversize shirt I was wearing, how I was rubbing my mini-belly in the breakfast nook in our San Diego cottage. “Near-brand new Medela Freestyle breast pump, accessories, extra bottles, drying rack, etc. FREE to a family in need.” I had no idea what you were, but I knew a breast pump sounded like something I could need. I googled the price. WOW. This was being given away for free??! I quickly responded with my plight- a poor medical student married to a poor postdoctoral fellow (sounds like we shouldn’t be having a baby haha). The poster responded a few days later saying that she chose ME- what luck!- and before I knew it I was driving 45 minutes north to pick up the gear.

She showed you to me- you were surprisingly small and pleasantly yellow. You sat in a shopping bag with a ton of other accessories I had no idea about. With her infant in tow, she patiently explained to me how the pump worked and how she had to switch to renting a hospital-grade pump due to a dwindling supply. I nodded sympathetically and smiled, having absolutely no clue what she was talking about. I felt like I had somehow won the jackpot. We returned home and you sat in that plastic bag in a closet for the next 6 months.

A few weeks after baby’s absolutely chaotic arrival, near-delusional with sleep deprivation/exhaustion and with Step 2 CS around the corner, I remembered you and decided to take you out. What in the world? These funnels go over my tits?!? I googled videos. Ouch! I realized new tubing needed to be purchased. I searched “Medela replacement tubing” on Amazon and a day later new tubing arrived. It most definitely was not the right kind. I started crying and delegated the task of getting the pump sanitized, functional, and figuring out how the *&!@ it worked to my poor husband.

I remember the pride and wonder I felt when I finally tried you and could actually see the milk coming out- it had been such a mystery how much volume was actually being consumed by my little girl. All this fluid is being produced by my boobs?!? Wow! Step 2 CS came and went, with my first taste of what it’s like to pump in a bathroom. I went back to MS4 rotations, and quickly grew to appreciate your portability- your ever-lasting charge was a dream. I could pump in any old closet, exam room, or even in my car in the parking lot, at a moment’s notice. You even fit into my white coat pocket! The real fun began when I started interviewing for residency. I pumped on a crowded Amtrak, on the metro under a coat on the way to an airport, in random chief resident’s offices, and more. We got through it though. You never ever failed me, not once.

When my daughter turned one, you stopped holding a charge. I was sad, because I wasn’t ready to quit you. I had a backup pump through insurance, but when using it, all I wanted was you. With nothing to lose, I called Medela, and a very sweet woman listened to my plight (I left out the second-hand part, haha). Is there any way you could be replaced although I obviously have no proof of purchase?? A week later, a brand-new you showed up on my doorstep, which I packed away for my future baby.

Three years later as a pathology resident, you are still loyally by my side, helping me feed a new chunker. I have the luxury of more day-to-day consistency now, with a wonderful comfortable pumping room at my disposal. But I remember with fondness the crazy times we had. I can never express to you the invaluable gift you have given me, a precious breastfeeding relationship with my babies while continuing my life as a medical trainee. I have you to thank for the memories I will remember forever… ending long nights as an intern while sitting with my daughter quietly in the dark, silently reconnecting with her warmth and memorizing her changing face… being comfort for them when they are sick and need simply to nurse… the little starfish of a chubby hand reaching up for my necklace and resting lazily on my chest. My children have you to thank for all the immunity, comfort, and nourishment you have enabled. And my husband thanks you too for all the extra sleep he’s gotten due to continued nursing, haha. (But he doesn’t thank you for all the bottle and pump parts washing, especially living without a dishwasher.)

So thank you for everything, beloved breast pump. You have your imperfections, but so do I. To many more months of love to come.

*I have no relationship with Medela besides the one described here!!!

**It is NOT recommended to acquire breast pumps second-hand (although I will say that I purchased all new tubing, sanitized everything, and this one was only used a handful of times anyway. Still not recommended, I know!). Pumps are meant to be used for one year and not for multiple babies.