How did you manage pregnancy symptoms at work? Share your stories!

Pregnancy is not an illness. It’s usually a joyful time in one’s life. But man, can it make you feel AWFUL. Morning sickness, fatigue, swelling, brain fog... Everyone experiences these things differently, but almost everyone is going to have something. Rare is the mom who can rosily exclaim “Gee, I felt WONDERFUL throughout my entire pregnancy!

Even in the same person, pregnancy can present differently. With Babyboy, I had very little nausea; rather, I had weird intense cravings for salty things (like sardines). So, when I learned I was pregnant with my second, I went out and bought cans and cans of sardines. Surprise! Not only did the mere whiff of sardines make me nauseated, that’s how I felt for the whole nine months.  

“Morning sickness”, which, in my experience, can last all day, is different for everyone. It can mean queasiness, or hurling. I have friends who required admission for hyperemesis gravidarum. All the ginger tea and Zofran on the planet doesn’t help, sometimes. 

I got through by only eating what I could tolerate: carbs. Sixty pounds later...

Swollen legs, incredible fatigue, brain fog... these are some of the other symptoms I experienced. I finagled "pregnancy parking" close by work at the end of my first pregnancy, when the summer heat made walking unbearable. I've heard of doctor-moms who managed to steal naps here and there... And for brain fog? I don't have any ideas what can help. 

What about you? Share what symptoms you had, and how you managed them. The info can help another doctor-mom!

MiM Mail: Neurosurgery and "accessory" mother?

Hello writers/readers of MiM,

I have been a long-time reader of this blog and I absolutely love the content — thank you for being honest about both the highs and lows of being a physician-mother. I am currently a medical student, and intent on pursuing a career in neurosurgery. I would also like a (small) family, though currently I’m very single (other than my books ;) ) so any possibility of a family is at least a couple years down the road.

I come to you wonderful ladies asking for advice/encouragement/hard truth —whichever you feel is most appropriate. I was talking to one of my attendings today about my interest in neurosurgery and consideration of various residency programs/sub-i rotations. He gave me a lot of good advice about preparing for residency applications; however, he also brought up the lifestyle of neurosurgery and the difficulties being a female in neurosurgery entails.

I have long realized that having a career in any medical specialty, yet alone neurosurgery, will make the experience for my (future) children different than what I experienced growing up — I had a stay-at-home mom. I had (almost) completely accepted that, but today one of my attending’s choice of words really hit me — he said that I would be an “accessory” to whatever family I have, rather than playing an integral role. This has been quite distressing emotionally as I try to process both 1) if this is truly the case, and 2) if so, if I’m okay with that. I really cannot see myself doing anything other than neurosurgery and so it’s hard to reconcile both my love of this field and my desire for a family.

I appreciate any thoughts you take the time to share. Best wishes for 2017!

Gratefully,
Perplexed Med Student

Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work?

Genmedmom here.

Let's talk about sex, sexual orientation, race, religion, and disability, and being judged by those things, in the workplace. Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work? 

It's definitely an appropriate political climate to be discussing this issues. Even aside from the blistering rhetoric of the past year, let's face it, for many folks, a "real" doctor looks like Marcus Welby, M.D. You know, a white, gray-haired, suited man who exudes experience and wisdom. Not that there's anything WRONG with that...

These negative attitudes can manifest differently, and span a wide range of experiences. 

The way I see it, assumptions can be innocent. These can be sort of insulting things said by well-intentioned people. They may be based in inherent bias and unconscious attitudes. Like, for example...

How many times during residency training did I walk into a patient's room, and they assumed I was anyone BUT the doctor? I was asked to clear the cafeteria tray more than once. Even after introducing myself, I was often referred to as [insert non-M.D. staff title here] and asked to fetch things: a glass of water, blankets, a urinal.

Sometimes, those assumptions annoyed me, and I acted annoyed. Other times, I tried to be cheerful and helpful regardless. I have also been guilty of making assumptions about others, and have had to retrieve my Dansko-clad foot from my mouth...

Then, there are more obviously negative/ hurtful/ damaging experiences.

During residency, a senior physician (a Marcus Welby type) whom I respected greatly and had been working with for some time chose a younger, more inexperienced, pretty unreliable male trainee to lead an endeavor that I had been interested in leading. Oh, that hurt. I wondered and fretted, Why didn't he choose me? What secret glee I felt when the young lad never followed through, and the project collapsed! Karma, man. Karma.

A woman I trained with had a miscarriage, and the supervising physicians would not allow her any time off. It was a first trimester loss. "Think of it like a heavy period," they said. "Would you call out for that?"

What I observed throughout all of my medical training was that women received very little understanding, consideration, or flexibility during pregnancy, maternity leave, or breastfeeding. The prevailing attitude was "suck it up, buttercup."

Then, I remember as a fellow, when I was interviewing everywhere for jobs. I was singled out by a senior physician (Yup, Welby again) for being half Latina. I was asked to take on a faculty position in part "because then we'll be closer to meeting the requirements for minority recruits. You can really help the department to look more inclusive. That'll be such a bonus."

That felt weird. I did not take the position.

In that job search almost ten years ago, I sought out a flexible position in a positive environment at a progressive institution, and I am satisfied that I found all of that and then some. The few negative experiences I had prior definitely informed my decision, and helped me to recognize what I didn't want as an attending.

I'm aware that many of you have had much worse and many more negative experiences than I did, and I'm wondering:

What did you encounter?

How did you manage, supercede, overcome?

What did you learn from the experience?

Do you see things getting better, or worse?

I Want To Hear Your Voice

I had a dream when you were only six months old that your first words were the complete sentence, "You can't tell me what to do!" You babbled so early and so prolifically that I figured you'd be talking by the time you turned one year. But now here we are two months past that, and I'm still in the dark. At least you've started pointing, but many times I still don't know what you want.

Why are other babies your age using words when you're not? Aren't you the child of a doctor and a lawyer who speak to you constantly in both English and Baby-ese? Who read you books every night? I Google the milestones, and you're definitely lagging in the language department. Have I done all the right things? What did I miss? Is this how it's going to be, you giving the overachiever but unsure parent in me an anxiety attack at every developmental step? I know comparison is futile, but I still fall prey to it sometimes. It's going to be a long parenthood if I don't learn how to stop now.

My thoughts of worry really are just fleeting; all I want is to hear your voice. Your real voice. Not just "mamama", "dadada" and "uh oh". As your mother, I keenly know your cry and your coo, but I want to know what you sound like when you express yourself with words. The lilt in your voice when you're delighted. How the words come out when you're angry. The tones you release when you're sad. I want to talk to you, to hear your thoughts and feelings and desires. Right now all I can do is wonder, but I'll bet it's going to be a beautiful voice.

Mandatory meeting...CHILDCARE PROVIDED

I have posted before about how much I love my job.  I am honored to work with so many amazing people.  Quite recently a revolutionary change has occurred for our late departmental meetings…childcare is provided (as well as dinner).  Such a simple offering means SO much. These special surgeon kid playtimes are now one of the highlights of my daughter’s social calendar!

Below I have posted (with permission) the beautiful and inspiring blog post of our amazing Clerkship Coordinator after the first childcare night. I am so proud of us.  I am so proud of who my daughter (the 6 year old described below) is becoming.  I am proud of this department, of my profession and the future that we are creating for our girls as Mothers in Medicine…

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From the blog of JP -

When I was a kid, about 25 years ago, I overheard my mother repeating a riddle that had been told to her. In short, a young boy and his father were in a car accident. The father died immediately upon impact. The boy was rushed to the hospital. Once in the OR, the surgeon stands over the boy and simply declares, "I cannot operate on this child. He is my son." So the riddle goes, if the father was killed in the accident, how on Earth is this possible? Keep in mind, the riddle is at least 25 years old.

I listened as folks stumbled over themselves with the most absurd answers, "The dad hadn’t really died." "The surgeon was the boy’s step-father!" "The father was not his biological one and the surgeon must have been the boy’s sperm donor." The answers came and went and when the person finally threw their hands up in defeat, the person telling the riddle simply replied, "It was the Mom! The boy's mother was the surgeon!" Gasped responses immediately followed; these gasps were made as if to imply extreme bewilderment that a woman, A MOTHER, could be a surgeon. Nonetheless, the folks on the receiving end of the riddle felt embarrassed for not offering the most overlooked obvious answer even if they could not fathom a female with a scalpel.

Fast forward 25 years, I just spent my evening at work doing arts and crafts with two children of surgeon faculty members so that said parents could engage in an after-hours faculty meeting.  I brought all of my craft items from home so the young girls could make various winter holiday crafts. At one point I noticed one of the girls (6 in age) was making a gingerbread man. I quickly praised her on her great artistry, "Hey! That’s a great gingerbread man!" I pointed out. "That's not a gingerbread man!" she quickly declared. I was caught completely off guard. Y'all. I'm telling you. It was a gingerbread man!  Before I could ask her what it was (since I was so offensively incorrect), she proudly exclaimed, "It’s a gingerbread GIRL!" Immediately, a grin washed over my face. I'd only met this child within the hour. Our time was consumed with learning each other's nicknames, teacher's names and favorite colors. Feminism 101 had yet to make it to our arts and crafts agenda. I wanted to high five her. I wanted to spin around in circles and dance giddily in only the way excited 6 year old girls do. But instead, I nodded, and told her it was the most amazing gingerbread girl I'd ever seen.

Within the next hour, the other little girl (8 in age) casually announced that she was creating a top hat for her snow woman. SNOW WOMAN! Did I hear her correctly? Snow woman!! Yes! And she'd said so, so nonchalantly. It's as if Frosty the Snowman wasn't the first... the only...the standard! “Every snowwoman needs a top hat!” I replied.

If I'd told that 25 year old riddle, now, to both of these young girls, they would have quickly and without hesitation answered that the boy's surgeon was obviously his mother. I am confident of this.

It was in that moment, and for the rest of the evening, I stood proud; proud of the progress women had made in the last 25-30 years. Proud to have been able to witness, in my lifetime, such dramatic change, albeit long overdue and with still so much progress yet to be had. I was proud to be a female working in surgery education. I was proud to work for a team with so many female surgeons. I was proud to work under the leadership of a successful woman, whom not only was a General Surgeon, but also the Program Director of the General Surgery Residency program.  I was proud to work for and with a group of smart and successful women who greatly value their profession and equally, their role as a mother. I was proud that these young girls were exemplifying everything I’d known to be true as a child, but always felt so disconnected with. Perception was no longer reality. The reality had finally become perception! These mothers, these brilliant successful female surgeons, they are paving the way for the next generation of gingerbread girls and snow women to achieve greatness.

This is how we lift each other up. We create an environment in which we welcome one another's children so that we and they grow enlightened, encouraged, educated, inspired and excited by possibilities. We embrace the difficult balance. My God, the balance is difficult. We dispose of the box that which we were placed in and we become assertive in our ideas of becoming both brilliant and successful professionals as well as invested mothers. And it doesn't just begin and end with women, my friends. We must embrace our professional fathers as well! We are only as good as our counterparts. Our strengths are magnified when we surround ourselves with other strong, confident and supportive human beings.

I am grateful to be able to contribute to their (our) mission.

Happy 4th Birthday C!

Little C is turning 4 tomorrow. I am not quite sure how that happened but I just wanted to share a letter I wrote for her.

Dearest C,

I seriously cannot believe you are now 4! There are times it feels that these past 4 years flew by but it also seems like you've been with us forever and what was life before you?

If there was one word to describe you, it would be that you are a fighter. I knew from the very beginning when you were in my tummy. Being my first pregnancy and all, I wasn't sure if what I was feeling were your kicks in my second trimester. However, when I went into the ER at 26 weeks for abdominal pain and you went in with me to get a MRI, you let me know you hated it! I didn't blame you as it was so incredibly loud for an entire 60 minutes and the images were being taken right where you were! But you definitely let me know that you were pissed off. You kicked me the entire 60 minutes and it was then I knew what they meant by fetal kicks.

At the time, I was so worried about what would happen to you while I went under general anesthesia but you nailed it. You were literally there when I had my appendix removed and you did exactly what you were suppose to do. You stayed inside and cooked for another 14 weeks.

When you were born, you were perfect. I was not. Tears still come to my eyes when I think back on that period of your life and I feel this insurmountable amount of guilt of what I put you through. I had no idea what I was doing. Instead of focusing on my perfect and healthy child, my mind kept going on how the heck I was going to balance motherhood and my career, which was in its infancy as I was only a PGY2 in my 6 years of training.

You nailed it again. You were the most perfect baby. You went from 7 pounds to 17 pounds by the end of my 7 week maternity leave! By the time, I had to go back to work, you were basically sleeping through the night except waking up once to eat and would right back to sleep. You thrived under the care of grandma. As I watched you grow into a happy healthy baby and eventual toddler that guilt started to lessen but never completely. You let me know in your way that you were doing well even though, I wasn't your primary caregiver and I knew my decision to keep you with grandma was the right one.

Fast forward to June 2015 and your move home. We only had about 4 weeks as a family of 3 until daddy had to go away to the east coast for fellowship. It was our first year as just the 2 of us. Once again, you were beyond patient with me. I struggled with balancing my last year of residency with being your primary caregiver. It wasn't easy for you to go from being the center of the world at grandma's house to going to pre-school full time and having a full-time plus working mom. But once again, you nailed it. You shut down all my fears in 2 months. You thrived at pre school. You learned English in a matter of weeks. You made friends. You formed bonds with your teachers. It was one of the most hardest years of my life but it was beyond gratifying to finally be your "favorite" and the one you wanted in your times of need.

And here we are today on your 4th birthday. We survived the first half of mommy's fellowship. Daddy is finally back on the west coast but he's still 2 hours away. (On a side note, we are so incredibly proud of him!) It's still just the two of us but we have so much to look forward to as in 6 months, we'll be joining daddy and mommy will be starting her first attending job. We have a lot of firsts to look forward to this summer as we start a new chapter in our lives. But until then, I'm going to enjoy these next 6 months of just you and me. I will always look back at these times and the difficult memories will fade but the memories of picking you up from school while you run to me, the memories of eating dinner just the two of us and the memories of all the mommy-daughter dates after school will always remain be in my heart.

I know I say this all the time. But I had it all wrong. You continue to teach me something new every single day. You show me a love that I didn't I know I was capable of and you show me that love is not finite. My heart grows in places that I didn't know existed. Life has never been the same since you entered 4 years ago and I am beyond blessed to be your mama.

It is truly an honor, C. Thank you and happiest birthday to my firstborn!

Love, mama

In the dark quiet of the last day of 2016

Oh, no. Not a New Year's Resolution post. Who needs another "Live healthier, Be a better doctor, Be a better mom" post?

Well, I do.

Genmedmom here.

It's 6:30 in the morning on Saturday, December 31st, 2016, and I'm sitting typing in the quiet dark of our house. No one is stirring except for our two big spoiled cats, who relentlessly knocked things off of my nightstand until I got up.

You know how you get really busy, barely any downtime to even answer the texts from old friends, never mind call them, and all the very small spaces in your life are stuffed with overflow tasks, like making shopping lists on your phone on the train, and never going up or down your stairs without having something in your arms that needs to go up or down, like dirty laundry down and folded clean stuff up, empty tea mugs down and toilet paper rolls from the basement up, wrapped gifts down and unwrapped stuff up, so many goddamned toys and factory-new clothes and the boxes, tissue and gift bags that you can't bear to toss that will clutter your home until next year too, and even with your superior physician multitasking skills you realize you're screwing up, like forgetting to RSVP for that thing and being late paying that bill and getting lame last-minute crap for the important staff member you totally spaced out, and then even the doctor stuff starts slipping (which is always last to go, right?) like that you promised to personally get back to your longtime dear patient on a result that wasn't critical but it was important to HER and you totally intended to check that on the holiday weekend and simply send her a quick message through the online portal and you just did not do it.

Then the kids get sick, and you get sick, and any delusion of control you had goes down the toilet with the first bowl of vomit. Your Christmas agenda: poof.

Barf.

But life marches on and there's still things to do and when everyone is (mostly) better you try to keep going, get yourself and the family to rescheduled gatherings and pick up where you left off with the gifts and the cards and the outings for school vacation. Maybe you start losing track of what's really important and what's just life and lose your cool, show your frustration, yell at your kids when the situation just doesn't merit a freakout. No one is running towards a busy street or about to drink drain cleaner, they're just jumping on the couch and throwing pillows and wrestling and, well, not listening to you when you order them to get their shoes on because you're late or pick up that banana peel and take it to the trash or SETTLE DOWN already. And when they react to your red-faced temper with sass and disrespect, maybe you throw the remote control across the living room and when it lands on the hardwood with an unexpected clatter, your kids stare at you with a sad, silent combination of shock and wonder and fear that you hope you never see again.

You know you're out of balance and that this is not right and this is not you.

So in the dark quiet of a holiday weekend morning when, miraculously, there is no event planned nor pressing task nor other thing of perceived great import, you sit and breathe and resolve:

This year, I will live healthier, be a better doctor, be a better mom. I will do this by uncluttering my headspace. I will leave the little breathing spaces empty. For breathing. I will remain thoughtfully committed to my medical practice and remember the high standards I hold for myself. I will love my family, my children,  always reflecting on how blessed we are, how much we have and enjoy in this very difficult modern world. I will pray for those who are struggling and suffering, every day, I will not forget them.

Happy New Year and God Bless.

(all is not) lost

There was a heartbeat. I saw it on the ultrasound, but I knew immediately something wasn’t quite right. Was it too slow? Yes, the ultrasound tech said she noticed that too and gave me the wise, all knowing look of a Black grandma who can’t quite tell her granddaughter that something is wrong.

And then there was none at the ultrasound 2 weeks later. I asked the next ultrasound tech to angle the screen when I didn’t see movement. Saw the look on the Radiologist's face and then the Fellow. No heartbeat. The tears began to flow. My body began to shake. I held in the sob knowing if it began here with these strangers it wouldn’t end until I was safely tucked away at home.

You were there. I saw you. You were there. And now you’re not. When did you leave me? My heart breaks. I type through my tears.

I am at home. Grieving. Surrounded by loved ones.

I cry now as I type.

“Mama, are you crying? Did you have a nightmare? Are you frightened?” I stifle my tears. Say to Zo through closed door “I’m okay. Mama’s okay.” He calls out for me and O from his room after bedtime. O goes and comforts him and calls me into his room.  I gather myself, wipe my tears, blow my nose. Zo rushes into my arms “Mama, are you okay? I was having a good dream but then I woke up. Why are you crying? Everything will be okay.” As he gently rubs my face with his amazingly soft 5-year-old hands. As he pats my back. As he rubs my belly. As our family holds one another.

All is not lost in spite of this major loss. You were there. I saw you. You were with me. Now you are not there. But my husband is here. And my Zo is here. Their hearts are strong. My heart is strong.

The stories from friends poured in over the last few years. We are all in our 30s. Gut-wrenching stories of second trimester terminations due to fetal diagnoses incompatible with life. The heartbreaking call telling us of a stillborn nephew. Friends with years of infertility. A family member with seven losses. Stories of rainbow babies after loss. Countless miscarriages. Flashbacks from medical school of being present with sobbing women in the antepartum unit when their ultrasounds showed the absence of heartbeats. I didn’t understand then how the loss of something (a baby? A fetus? I didn’t know what to call it then) not yet realized could cause these women to sob uncontrollably. But I do now. From the moment I saw the positive sign I was hooked. Head over heels. Then the heartbeat. My growing belly. Zo’s “mama, is there a baby in there cuz I think there is.”

I was so excited to tell him he was going to be a big brother but I didn’t because I knew things weren’t quite right and it was all too soon, too early, too many things could go wrong - and they did. But he knew. He knew yet we feigned ignorance.Told him I would go to the doctor to find out.

All is not lost. You were there. We were together. Our family is still here and you will always be with us. We will go on. For we are not lost.

MiM Mail: Fourth year pregnancy?

Hi there!

I am currently a MS3, married to an amazing husband for the past three years, and strongly considering pathology. We would like to have a child in my fourth year. The question for us is when to start trying and hopefully have the baby, and to maximize our chances of having the child before intern year.

Our original plan was to start trying this summer, with the hopes of having a child sometime between March and May. But I'm not sure how that would work out with having a newborn as an intern. I would really like to avoid being pregnant during my intern year (or just residency in general) as well, and so I'm also worried about the short window that gives us to try for a baby.

I do not have any familial support where I live, and I'm not considering residencies that will be near family (they live in an incredibly expensive city and have very few programs around them). Our plan for childcare is my husband quitting his job and becoming a stay-at-home dad - any money he would make by keeping his job would probably not cover the cost of daycare.

At my school, we get two months off for vacation, one of which is mandated in the winter months for interviewing. I believe I can also have two more months of light rotations as well, giving me a total of 1-3 months to spend between my interview period and infant-recovery time.

So here are my current pros and cons for having a baby earlier (Fall-Winter) vs. later (Spring).

Pros for having the baby earlier:

Will have an older infant by the time intern year starts.
May be able to avoid interviewing pregnant.
More time to get pregnant.
May be able to still use my vacation months during interview season if I have my child around that time.

Cons against having the baby earlier:

May have to interview very pregnant or be at risk of giving birth.
Will probably be very pregnant during possible audition rotations.
Will probably need to have my husband quit his job (or scale down to part time) to take care of the child while I am on rotations.
Will be taking Step II pregnant.

Pros for having the baby later:

Husband can keep his job at full time for longer, maximizing our income.
Might be able to stack my rotations so that I can have 3-4 months "off" or with light rotations to be with the baby until residency.
Avoid being pregnant while taking Step II.
Will be less pregnant during interview and possible audition rotations.

Cons against having the baby later:

Will have to interview pregnant.
Stacking my light rotations and vacation at the end of the school year may make it so I have less flexibility when interviewing for residency.
May not get pregnant in the short window we have.
Would go through intern year with a <3 br="" mon="" old.="">

I would love any feedback on my tentative plans - which of these are important vs. not so important? How difficult is it having a 3 month old vs. a 9 month old baby during intern year? - and what you would recommend for my husband and I. Thank you!

Silent Day

Silence.

It’s golden right?

Silence.

I’ve craved it. Haven't we all?  As a busy doctor and mom, there’s always something in the background of daily living -- kids arguing, kids playing, kids giggling (my favorite!), the hustle and bustle of the life in the clinic, a shout of “mooooooooom” from upstairs or downstairs, the radio, the stove, the washing machine, the beeper, the pitter patter of fingers on my keyboard.  But, this minute, it’s silence. This hour, and for all the hours of today, it’s silence.

Right now, it’s feeling deep, dark, and deafening. I’m sitting on my couch in my house alone. It’s Christmas Day. I’m Jewish, so it shouldn’t feel sad or lonely. But, this is my first Christmas alone. I’m divorced now and my kids are with their dad. For the past decade, I adopted Christmas and it’s tradition of bringing families together. I cooked and baked and decorated a tree and made new traditions for my then-husband and kids. In those days, when I left work the day or two prior to Christmas, I said ‘goodbye’ to colleagues, wished them happy holidays, and looked forward to making my house warm for my loved ones and kids.  This year, I left on that last day of the work week with dread.  I savored the last few hours I had with my kids before my ex picked them up on Christmas Eve morning -- we snuggled in bed, watched tv, tickled and laughed. And then, they were gone.  And the silence set in.

That morning, I went to work as the ‘on call doctor’, seeing patients in urgent care, fielding pages from the answering service. And then about 1 o’clock, I left the office, got in my car, and wasn’t sure where to go. Others were out and about, finishing last minute shopping, or on their way to see friends and family (I presumed).  I stopped for coffee. And then I went home to The Silence.

Today, Christmas day, I slept in a little and woke to an empty house. I should be rejoicing. Free time to nap and read and sew and listen to music and clean my house is mine for the taking. Except, it just feels sad and lonely. The world is shut down today -- the stores are closed, there is no traffic on the roads, I have no where to be and I feel like an outsider again on Christmas.  My kids aren't with me on a day that is about family.

Late morning, I left the house for a bit to meet a friend and her family for lunch -- they are ‘in between’ religions, unsure how to celebrate this year after she lost both her parents in the last several months. I was glad for the company and an excuse to leave my house, and The Silence, for a little bit.  Her family welcomed me with kindness and warmth with an undertone of understanding that I am feeling like a woman without a country this year. Their hugs were warm, and lingered just a little longer than one might expect -- a subtle acknowledgement of the suffering they knew was behind my smile today.  

I have always known that the holidays are a hard time for people. Facebook feeds and tv ads are filled with the perfect storybook moments of families coming together on the holidays.  They don’t make commercials about the hearts of single parents breaking when their kids leave for the holidays.  They don’t tell you what to do all day when everyone else is home celebrating, and you are alone. No one posts a ‘’selfie” on facebook with a comment, “here I am all  by myself on Christmas. Happy Holidays everyone”. When I got a group text from a friend today, “Merry Xmas to all of you! Hope you are enjoying the day with your families!” I chuckled a little when I read it, and then felt nauseous, forcing myself to ‘stay positive’. My fairy tale family is split up and we don't fit into that cookie cutter holiday description anymore.

I don’t write this with self pity. It is more of a conscious exploration of this uncomfortable state of being. I am in a new chapter of my life. There are new realities that I need to accept about my life and my kids and my former relationship. I’m trying desperately everyday to be a mom who is present, navigating these treacherous seas for my kids and helping them get through it all, with all the usual background noise of work and schedules and a busy life.  While I should welcome today’s silence, I fight it and argue with it, and sit with it uncomfortably.  We are not friends.  

In a few short hours this day will end. We will all slowly get back to our routines. At the end of the week, I expect my house to be loud with the usual noises of kids and this heavy loneliness will abate for a time.  I’m hoping it gets easier someday.  

If you were lonely this season, I know how you feel.  No one has said that yet to me, but I'm going to say it to you. May the New Year bring warmth and light, joy and happiness. May we continue to harness our courage and strength to get through difficult times, and find ourselves better on the other side of them.  May silence someday feel golden and welcome, and envelope us with the promise of self care rather than with the dread of loneliness. I wish that for me, and I wish that for you, if you are out there and you know what I mean.

Celebrating with Gizabeth

Of course I had to attend Gizabeth's wedding party. I mean, the proposal was on this blog! Sure, I had only met her one time before in person, but through the blog and our communications, it's like we have been long friends. So, my husband and I took a quick trip to Little Rock to help her celebrate. We wouldn't know a soul besides her and her husband-to-be, and perhaps that just contributed to the adventurousness of it all. Plus, it would be just us, no kids -- bonus.

We went straight from the airport to lunch with her and her daughter. (This makes out of town guests feel very special!) She was glowing with joy; her daughter was smart and gorgeous. After lunch, we had the luxury of many hours before the big party, luxury to be work-less and child-less.  This included: a run, walking through downtown Little Rock, a pedicure (+trashy magazines +wine) and enjoying the southern sunshine.

Gizabeth and her husband were married quietly and privately at their house and then threw this massive party to celebrate at the Clinton Library.  My husband and I decided that weddings for more established adults are done right: it was so beautifully done from the white tufted banquette seating, to the flowers, to the great music.

In fact, the DJ was so good that after years of being dance-floor inhibited, I could not resist getting out there and dancing! I totally reconnected with my prior dance-loving self on that dance floor. Husband and I had a major blast. It may have helped that we didn't know anyone and thus had zero self-consciousness. (And I have a photo that is witness to this that perhaps should not be shared publicly.)

Gizabeth was stunning. And everyone was so, so happy.

For the send-off, guests were given sparklers and lined the exit. NB: Do NOT put out sparkler by stepping on it since you will burn a hole in your shoe. Note to self: buy husband new shoes.

All in all, I had such a wonderful time celebrating with a MiM sister. Congratulations, Giz! May your joy and love cup overflow.

Richard Michael Nestrud: A Retiring Pioneer

I remember my Dad telling me of those days: the ones in which no blood was screened. A NICU doctor. He said when a baby needed blood, they would just find a health care worker whose type matched up, and would get the necessary vital life source to the baby, siphoning it.

I spent my college days writing checks at gas stations. Occasionally, a worker asked if I was related to my father. I would nod in the affirmative, and they would regale me with stories of how amazing my Dad was. "He saved my baby."

He saved my baby too. My son was born six weeks early. My water broke while I was walking on the treadmill. I mistakenly thought my bladder failed me, but soon realized it was amniotic fluid. I received surfactant on bedrest in the hospital. It definitely matured his lungs. When he was born, my dad kept him from entering the NICU - arguing with his partners to keep him by my side, nursing. I took him home, and when his jaundice required a bili lamp, my dad smuggled one home to me. I remember spending nights bathed in the blue alien light, marveling at my son.

The stories told by the nurses and doctors tonight, at his retirement party, were awe-inspiring. He and his partner were inspirations to his health care workers and patients and their parents. Their methods were unconventional, but vanguard. They saved many lives, some a testament in the room.

I never thought I would see this day. The man that kept me on my toes throughout my life is closing a chapter in his. He told a story, one that I didn't know, that brought me to tears.

Before surfactant, babies were trached, and became toddlers, and spent close to 16 months in the NICU. Many were destined to spend their short lives with that community. He told of a moment when his co-workers became a team. One child spent 16 months fighting for his life. The NICU adopted him, and they all became his parents. His death was inevitable, his life inspiring. They all mourned the outcome, and in their grief they became a team. A vital community that lives on to this day.

The man that I spent my whole life in awe of, aspiring to be like, closes a chapter of his life this week. I sat at a table with his partners - ones that told me I was garnering praise from the leadership of the hospital. After ten years, I am finding time to reach out and give back. "They say you are doing wonderful things. You are just like your Dad."

 I hope to continue the legacy. And I hope my Dad continues his legacy. He's young by current standards. He does and will continue to inspire me. The apple doesn't fall far from the tree. His roots are worth nourishing. He has my love, my adoration, and my aspiration, forever and always. Love you, Dad. You have saved many lives, including my son's, and will continue to inspire me throughout my career and yours, which doesn't end with retirement. You are my favorite doctor. The one that I modeled myself after, the one I will spend the rest of my life trying to emulate.

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