a review through the year(s)

I cannot believe it has been almost 4 months since I wrote the post about my miscarriage, 1 year since I left a toxic work environment and dove into health care leadership, 2 years since residency ended, 5 years since becoming a mommy, 12 years since graduating from college, and almost 30 years since I proclaimed that I wanted to become a doctor.

Through it all I have learned so much and I am truly indebted to the colleagues and mentors who have helped me craft this career. I am even more so indebted to my loving husband and family who constantly teach me that my happiness is worth it and at the end of the day, a job is a job, is a job and when you aren’t in your job, the job goes on, the world does not end.

Motherhood changes you. Partnership changes you. Medical training changes you. Motherhood in particular, puts a new perspective on things. And in my opinion, it makes you question things that you had never questioned before. It makes you prioritize in ways that you hadn’t before.

For example, for my whole life I’ve known that I wanted to become a doctor. I never waxed nor waned in that belief. Though it was hard at times, I knew I would achieve that goal and I did. But I also realize that it might not have happened. My heart cries for the countless young medical students who don’t match into residencies. For the countless applicants who go into super extreme debt to attend post-bacc programs or use private loans to finance medical educations in international schools (I know far too many!) and then to not match?!? I can’t fathom that. But that could have been me, could have been any of us. It has happened to some of my friends. But now as a mother as I reflect with other women physicians, so many of us question our decision. In particularly frazzled moments, we say emphatically that it was not worth and we would not do it again and we would discourage our children from pursuing medicine. What was it that shifted our beliefs? Was it aging? Was it pregnancy hormones? We may never know.  

I started residency with a newly crawling baby. I began questioning things that I had learned, that seemed so dichotomized, so absolute because caring for my snuggly little Zo taught me that everything and I mean everything is shades of grey, covered in drops of breastmilk and smeared in shea butter and kisses. There was no more black and white,no more textbook answers to lull me into a false sense of security.

And the changes continued, each moment and each role took on new meaning. Weekends off from work took new meaning. I had a baby to raise and learn and love. I had an amazingly supportive and successful husband to dote on and love. Each moment became more precious because when I was at work, I had to completely be present caring for and keeping alive someone else’s baby. Time at work took on new meaning. Every time things got rough, I would say to myself “this is someone’s baby! This is someone’s baby! Do your freaking best! Love up on this family and this baby! Do the right thing by this baby!” and it worked. I was able to care for countless patients and their families.

I started my first attending job. The one I knew was going to be my dream job. And it wasn’t. From the very beginning. The burn out was palpable among my partners, the check in staff, the medical support staff, the nurses. In my first few weeks, I was warned by various members of the staff to literally “get out” before the patients lured me into staying forever. I didn’t know how to process it. This was my “dream job” at my dream institution, a top 10 children’s health system in a highly desirable area. The one that I was supposed to stay in, rising through the ranks, being a tireless advocate for my patients and their families. But I looked around at the colleagues who had trained me as a medical student and no one was happy.

Everyone was raging against the machine of big-institution medicine without the tools they needed and without the support of the administrators. There were partners who were months behind in charting on the outdated electronic medical record. There were partners who worked hours from home each night and who spent more time charting than seeing patients. There were incompetent team members, difficult to work with management, and mountains of red-tape and bureaucracy at every level and it frustrated us to no end! We were understaffed at every level but the message from the higher ups was “do more, see more patients! You’re not meeting your numbers!” while we providers questioned the safety and quality of fitting in another patient, of overbooking overbooked slots, of opening earlier and closing later. This scenario isn’t unique. I hear countless stories from other physicians in private and academic medicine, from friends working for nonprofits, I could go on. And when you hear it from so many people in so many industries, you realize that we are all workers. We all struggle with the same things, but it is up to us to find our niche, our space where we can deal with the “particular brand of crazy” of an organization.

My mama heart made me extra courageous, extra fierce. I began to network and met a group of other outstanding physicians many of whom were mamas who had experiences just like. They found the strength and courage to craft professional lives that were more in line with their beliefs and their experiences gave me strength and I began to let go of the made up dream as I began to develop a new dream.

If it weren’t for my husband and my family, I never would have had the courage to leave. But I did. I spent countless time and even significant money on legal fees fighting and it’s not even over yet (always, I repeat, always consult with an employment lawyer early when you first begin to worry about retaliation or have safety concerns, just do it! Human Resources works for your employer and unfortunately not really for you). But you know what - MY HAPPINESS IS WORTH IT! I trained too long and too hard to not be valued, to be underappreciated and you did too! We are worth it. We must advocate for ourselves and our happiness as a matter of survival. Physician burnout is on the rise and unfortunately so is physician suicide. Your life is worth it! You should not be miserable in your job! Being a mama made me more courageous. What would I tell Zo if he was going through this? I would tell him find a new job, it’ll be okay! You’re worth it! I know they tell us it’s our calling and although that may be true - a job, is a job, is a job!

This last year in part-time health care leadership coupled with part-time direct pediatric primary care has been a whirlwind. Scary and beautiful, overwhelming and exhilarating. Exhausting and empowering. I have been getting my lean-in on! And the view from my first big girl office is the bomb!

And because I have been courageous enough to sit myself down at the big-kids’ table I realize that we really do have expertise when allow ourselves to do what we are good at. Working with a major managed care organization, I understand why providers are asked to check off certain boxes in our patient assessments and I realize that this information must get back to the providers.  I realize how essential physicians such as myself are in re-envisioning health care.

Everyone has a boss, every organization has a parent organization and auditors to respond to. The system is such that major revision is needed to truly improve outcomes. Though my overall happiness has increased tremendously, the job is still a job. And I don’t think enough physicians, especially those in training, fully grapple with that. You still have people who are burned out; though honestly, much less here in my new office. You still have issues with incompetent people and I had to terminate my first staff member a few months ago. But “this particular brand of crazy” is one that I can deal with and is one I am thriving in. It’s one that my family can deal with.

Thank you for sharing in my self reflection.

Have you done your own personal review lately? If so, please share. What have you learned? How have you changed?

Work Family

I entered the Doctor's Lounge shortly after arriving for work to get coffee and bottled water. It's newly renovated, homier than the old 1950's linoleum version, but still full of mostly white male doctors. Most of whom are excellent at what they do, but my hospital is still not very diverse after ten years of my own practice.

I wave and smile at the ones I know as I am preparing my coffee, and am stopped by a heart transplant doctor as I'm walking out the door. "Oh, yes, my partner told me about an urgent biopsy today. I'm covering."

"It's turned into a postmortem. He died yesterday afternoon."

"Oh my. Oh no. What happened?"

"There was a rare familial genetic disorder, we were about to test him."

He laid out the details.

"I'm the only AP doc here for the rest of the week. Autopsy falls to me. I'll call the gross room right away to give them heads up. Then I'll call Mayo Clinic and get the details of what they need to get the family the information."

"Thank you so much."

I triaged my difficult needles from the day before quickly, ordering immunos to get the diagnosis, then spent an hour on the phone with Mayo learning about what each of three departments needed from us to help them look for the disorder. Skin. Blood in EDTA. Paraffin embedded tissue.

I learned from a partner mid-morning that he was a relative of one of the most prominent employees in our work family. Internally, I doubled over and fell to my knees. Externally, I resolved to work even harder than I already had. Called Mayo again to verify the details. Gathered the schedule of needles from OR, Bronch Lab, and radiology and decided to schedule the autopsy for 11 am to avoid interruption. Called the work family member and told her I had just heard, why was she still here, I was so sorry, and I was praying for her and her family.

A couple of hours later she learned I had done the autopsy. I knew she knew, because we were problem solving an old case with the lead transcriptionist and she put her arm on my shoulder. I sideways hugged her tight, and gestured for her to follow me into my office. I listened to her talk about the shock.  He was young. He has two children heading into prom and graduation. He looked like the picture of healthy life interrupted. I've done a lot of autopsies, but none has ever hit this close to heart. I can usually detach myself clinically, viewing the body as a vessel that the soul has left behind, but during this one I kept thinking that this was a father and a son and a spouse who had left the world prematurely. The emotional connection deepened my already strong commitment to the leagues of tissue I regard daily with the comfort of my detachment from the lives involved.

Luckily a mind-jarring workload kept me from ruminating too hard during the day, but on the way home I lost it, sobbing uncontrollably all the way into my house. The kids noticed, so I enlisted a larger prayer team over dinner. It took me two hours to wind down enough - cleaning and organizing - to finally sit down.

As I was catching up on social media on the couch, I heard my son talking to his friends from downstairs. He was so animated - a girl he liked liked him back and there was something there, not dating - he's in fifth grade - but a connection that wasn't there before, spurred into public with the encouragement of his friends. He excitedly told his sister, then told me as I was tucking him into bed. I wasn't surprised - he has been talking about her for months. A girl who likes the same video games as he does. That's kind of rare, at his age. Mostly boys in that arena.

I told him I remember liking a guy in fifth grade at Montessori. We didn't call it dating back then either, we called it "going together." Which consisted of buying each other gifts at holidays and being totally awkward at school. His name was Clay, and I was Elizabeth, and I had these Liz Claiborne pink sneakers that I thought foretold the relationship. He had brown hair, and eyes so blue that if he caught me looking at him I had to avert mine in order to preserve my senses. Then Summer came, and he went to another school, and that faded as most of those do.

As I tucked Jack in I thought of how strange this world is. One that can yank a father prematurely from his children and throw joy of first love into it on the same day. I texted my work friend and told her I would do anything to help her and her family. Then I sent prayers. What else can you do? There are days I feel so powerless, but I try to remind myself that we are all on a path, and it's our own, and we can't be responsible for other's path, but we can lend the utmost support and love.

On the ropes, it's a balancing act

Finding the balance.  Taking a deep breath.

Changes abound at work these days. Just when I was looking to lean out, the circumstances are urging me to lean in.  Just when I was getting into the new groove, there's a newer groove.  I suppose that keeps things exciting. "But still," as my daughter would say. 

Just when I was learning the ropes, the ropes get entangled with new knots and twists.   Such is academia.

Standing on the platform, I look around.  I like being on even footing.  Do you?  Some prefer the climb.   There are many paths ahead, many directions, some much more challenging, steeper, and uncertain.  What to do when an opportunity that is challenging, steep, and uncertain comes calling?   How to reclaim the balance?  Do I lean in, lean out, or lean in to something else?

It is always the loves of my life in my partner and our kids that keep me grounded, renewed and refreshed. Leaning on each other, for just the right amount of support.

Social media

I have conflicting views on social media.

In order to describe my pro and cons of social media, it would have to reveal my age. I'm 3 weeks away from 32--meaning I was a college freshman in 2003 as I went straight through college, medical school and residency without any gaps.

Facebook was founded February of 2004. I was a college freshman. I remember signing up for it with my college roommate but back then, it was still very much in its early days. There was no photos to post. I don't even remember if there was a wall. I do remember "poking" people. Who knows what that even means?

Even though, it was still around, it really wasn't a huge part of our day to day college life. I believe by the time I started medical school come 2007 that it was when it became bigger and more promiment in our every day lives. I remember getting "friend requests," and thinking "wow, I haven't talked to that person in years!"

As I got older and became a mom, my take on social media has evolved. I do love its convenience. When I was busy with residency, I loved how accessible Facebook was for my relatives as well as my husband's relatives. We both have huge extended families as I still have a lot of family in Korea and he does in Taiwan. The last time we went to either country was before we had little C so it was a great way to share our lives with them. And of course, I would have never been a part of this wonderful MiM community without social media either!

However. as I got older, I find myself, posting less and occasionally going through my friends list and de-friending people that I really haven't spoken to in awhile.

I have a cousin who is 5 years younger than me, a sister in law who is 4 years younger than me and another cousin who is in high school. I look at their social media account and see how I got so lucky. I just missed the era of social media predominance during my childhood as well as my college experience, which I believe is the most vulnerable period in our lives. I believe, at least by grad school, you have a sense of who you are and what you want to be--in my case, I really wanted to be a physician and somehow along that path, I became a mom. It was still definitely a path of self-discovery but by that point, I think what other people posted on social media had less of an effect on me. I knew what I wanted and I was on my way of figuring that out. (Don't worry, I"m still human! It does bother at times too! Like for example, whenever I see photos of a mom postpartum looking like a runway model, it's like how does that even happen??)

However, I see the world of social media through their eyes and it kind of pains me a little. Because I have a little girl and I don't want her to feel this way. They look at Facebook, Instagram and Snapchat and don't realize that these are just snippets of people's lives. They don't realize that nobody posts a bad photo. Nobody shows their bad days. If I spent my weekend at home with my parents in middle school, nobody knew about it and I also didn't know what everyone else was doing. I didn't log onto social media and see some other girls at school doing something fun and exciting. It could have just been a photo but a photo speaks a million words and can be misinterpreted and lead to feelings of loneliness and insecurity.

I see Instagram accounts of people that I know are home but yet, they'll post photos saved up from vacation to make it appear as if they are traveling and leading this exotic, adventurous life. I look at those photos and wonder if they actually enjoyed any time of their vacation if they were so busy, creating such staged, "instagram worthy" photos.

As I'm getting older, I feel like the inevitable is happening. I'm becoming more cautious, more worried and definitely more anxious of what's to come.

As little C gets older, I'm realizing I can't really protect her from everything especially in a world of social media but I can help her deal with its consequences. I'm going to do whatever is in my power to keep her my confident, opinionated, tomboy yet princess dress wearing little girl!

Any thoughts?

X-ray Vision

Who Am I?

So I've been a little - scarce around here lately. My last post was in July, and that was just a link to a piece I had published on Pulse*. My last substantive post was in June, nearly nine months ago. I feel as if I don't have any material.

I still have a kid at home. Writing about her has become more challenging as she's grown older. Eve is 17 now, with her own social media presence and a keen awareness of being talked about. "Mom, you can post that on Facebook if you want to." Her story is her story, and while I have a piece of that story, it's challenging to figure out how to tell my parenting story without invading her privacy.

So I'm still a mother - but am I still "in medicine?" I left my clinical job at the end of July and since then have done a variety of different things, none of which feel much like practicing medicine. For the first time since 1986, my days are not primarily concerned with diagnosis, treatment, and notes. It's - odd. And disorienting.

I've always been determined to have an identity outside of my work, unlike some of the other docs in my family. My grandmother referred to my grandfather as The Doctor, as in "The Doctor won't be home for dinner tonight." My mother didn't do that, but she was The Doctor's Wife first and foremost, and we were The Doctor's Children. I worked fewer hours than they did, although my call still interfered with family life. I took more vacation; my dad took his first week of vacation in 1968. He started practice in 1961. I don't ask Eve's friends to call me Dr. Jay; they mostly call me by my first name. In the end, though, I still defined myself as a doctor first. Everything else is "spare time" - "In her spare time, Dr. Jay hangs out with her husband and daughter and enjoys crossword puzzles and mystery novels."

I guess now my whole life is "spare time." I'm not retired - I still need to contribute financially, and I'm figuring that out - but I know I am done with full-time clinical work. Or even significant part-time clinical work. I'm generally OK with that. I miss talking to patients, and I miss the intellectual challenge. I do not miss having to schedule my life around every third weekend call and I do not miss dragging myself out of bed after being woken up four times over night.

I hope to remain a contributor and figure out what I have to say as we prepare to help Eve launch into college, and launch ourselves into the next part of our life. Most likely, we'll all have to navigate this transition. Perhaps I can start thinking of myself as a trailblazer.

___
*I had another short piece published on Pulse during my MiM hiatus

Documentation

Do you keep a lot of mementoes related to your kids? What about other aspects of your life?

I tend toward the less-stuff end of the spectrum, but I want to keep the special stuff. At home, I prefer calming spaces that are cozy but aren’t teeming with trinkets - it gives me sensory overload. It’s been said that we shouldn’t document our experiences too much, and that with time the most salient features of an experience stay with us, while the lesser details or perhaps the aspects we’d rather forget dissolve with time. I tend to think this is the best approach to take with the past. That’s not to say I never document, but I don’t get caught up in cataloguing everything. And with smartphones, I find my phone pictures act as a diary themselves. 

At work, of course, we document EVERYTHING and often in great detail. As a family physician, my notes range from a sparse, simple visit to a long and detailed assessment. It’s no surprise, then, that with the amount of documentation I do daily, I feel exhausted at the thought of further documenting. 

Long ago I accepted that I didn’t feel the need to journal on a regular basis, as much as I admired those who did. Writing was often what I turned to during challenging times. It still fills that role, and has also become a way to process different kinds of experiences. Recently I did an online writing course that reflected on motherhood that I would highly recommend. But the constant recording of exactly what I’ve done, when — no, that’s too much.

I recently went through old papers at home and found a card from one of my closest friends, written just three months after we’d met back in university over fifteen years ago. Just seeing her handwriting was such a treat, with most of our current communication occurring in fonts. 

With my young kids I’m saving special artwork in binders with page protectors - it’s quick and easy to slip them in and to look through them that way. I let a stack build up then put them in, in my best attempt at chronological order. Overall, though, I'm trying to focus more on the moments.  

Redefining Dr. Mom - A Review of the First PMG CME Conference

If you're a mother in medicine and you haven't heard about Physician Moms Group, you might be living under a (social media) rock. PMG, which started in 2014 as a Facebook group for exchanging advice and support between women physicians who are moms or moms to be, has morphed into a community of more than 60,000 women with an influential internet presence. Any group of women that can sell out the entire stock of Instant Pots on Amazon in minutes or lobby to get discounts on coveted clothing or other products has some serious clout! As part of the group's continued evolution, founder Hala Sabry, DO and her best friend Dina Seif, MD recently held their first CME Conference in Las Vegas on April 1st, 2017, entitled Redefining Dr. Mom. And I was lucky enough to be able to attend!

Let me start out by saying that this was by far the most interesting and engaging CME activity that I have ever witnessed. There is the tendency at such events to plop down in the back row, pour yourself a large cup of coffee, and whip out your phone to scroll email or social media. Instead, this conference was chock full of useful and relevant information, presented in a dynamic and interactive format. Presentations ranged in topic from recognition and prevention of burnout, to financial planning strategies, to nonclinical paths in medicine. To top it off, there was a female physician entrepreneur panel moderated by ZDogg MD (Hala's friend and local Las Vegan)!

ZDogg in the house!

When I looked around at the other attendees, I was struck by the diversity of women in the room. I saw many ethnicities, shapes, and ages. Some women wore jeans while others were clad in suits. Some had bouffants, others had beach hair. There were bare faces and full makeup. Yet we were all physician mothers, present to discuss what might be lacking in our careers and learn what might enhance our current work-life balance. Each excellent presenter shared a personal experience as part of her talk that represented a watershed moment in her journey, something that had led her to question or change her presumed path in medicine.

Another common thread throughout presentations was the emphasis on identifying core values as a way to assess happiness and drive future direction. The presenters also prompted attendees to think outside of standard paradigms - regarding self-care, business, and leadership or mentoring roles. Included as well were optional organized social events for the two nights surrounding the conference - a spa outing and dinner, plus a dinner and Cirque du Soleil show. Being somewhat of a "local" to Vegas (I travel there frequently in the winter), I also led a small group of PMGers and their families on a hike in the Red Rocks the next morning!

PMG is definitely planning more CMEs for the future, and I would highly recommend attending. Also, if you are not a member and are interested in joining, visit MyPMG.com to supply your own credentials, or have a Facebook friend add you to the closed group.

"Creative Block"

When do you find time to be yourself?   The self you are outside of medicine and parenthood? (Maybe the glimpse of a self you were before medicine and parenthood?)  Outside of being a pathologist and parent I also derive joy from making art.  Well, maybe not immediate joy, but it is a sort of deep satisfaction.  I see making art like I see working out: Sometimes it sucks when I'm doing it, but afterwards I always feel better that I did it.  When I finish a painting and I’m happy with it, I feel the same deep satisfaction and pride that I do when I look at my beautiful little boy.    

But when I say “time” I’m not talking about the hours and minutes.  I have hours and minutes.  My toddler goes to bed at 8 pm every night.  My husband splits the housework and childcare with me.  I go to bed at 11.  That’s almost 3 hours each night that I should technically have to myself.  But I find myself too tired to use it effectively.   I have the time but not the energy to be creative.  I feel like it’s all drained from me by the time our baby is in bed.  And maybe that’s to be expected.  I work full time.  We have an 18 month old.  To be creative you have to have a certain amount of energy.  Those three hours are also the only time I have to get my ADLs done...shopping, taxes, doing the dishes.  Even as I sit here writing this at 9 pm, I’m so so tired.  My eyes hurt.  I’m tempted to throw up my hands, give up.  Make my tea and read a book (sadly sometimes merely Facebook).  I even have a studio and a painting I’m currently working on (sporadically).  But the time I’m in there is often so infrequent that I can’t remember what colors I was using each time I return.  I have completed precisely one piece of art since our son was born.  When we bought our house I picked out the room I would use as a studio.  My husband is proud of me that I do this other thing outside of medicine.  But sometimes I tell him that it’s silly that I have this whole room to myself when I barely use it.  I have had other dry spells in my life that were not related to having a baby.  So maybe having a baby is just an excuse?  Or maybe there is something to this feeling of being spent, dissipated at the end of the day that leaves no room for creativity?  

I haven't written on MiM as much as I planned to either....Sometimes a blank word document is just as terrifying as a blank canvas.  What do other MiMs do to keep themselves creative?   How do you find the energy? 

Last Week

My little family had a tough week last week. In addition to the usual chaos of single-working-mom-with-two-kids life, which includes (but is not limited to) two morning drop offs during the week, ballet, play rehearsal, soccer, swim class, my own personal interviews for a potential promotion at work, and a snow day during the week (oh how I could do a single lengthy post on the chaos of being a doctor mom with two kids on a snow day!), three year old E got sick. And we landed in the hospital.

I should mention that my seven year old daughter, M, has immunity of steel. She had the usual colds, fevers, early childhood sicknesses until roughly 18 months old, and then she’s been rock solid since. I can’t remember a time in 5 years that she’s seen the pediatrician other than for a wellness physical.  

And then there’s E. He’s had an ongoing solidly built relationship with our pediatrician which has landed him in her office so many times we all stopped counting. Sometimes I see her so much (and I like her SO much!) I think I should take her out for coffee or something!  For a while it was bi-weekly, for a new cold, fever, cough.  Between the ages of 6 months and 16 months, this kid was hospitalized three times for respiratory problems.  The frustrating thing was he would get overtaken by a cold which would turn into brochiolitis, land in the hospital with hypoxemia, get treated with oxygen (and time) and get better, but no one could really put a name on it.  It wasn’t asthma. He got tested for CF (oh, that was a harrowing day!), amongst other things, and the pediatricians landed on a diagnosis of “tracheomalacia” and told me he’d grow out of it.  So for 2 solid years, we walked on eggshells with this little guy and his tenuous health.  And, slowly, he seemed to get better and the “colds” got less frequent, and I slowly let go of some of my anxiety about him getting sick.

Last week, he wasn’t himself on Monday and had a low grade temperature. I didn’t think much of it because he wasn’t coughing and thought he’d rest a little on our “bonus” snow day. On the morning after the snow day, he still had a low grade temp so I kept him home from school but I needed to be at work. I was precepting for three residents, two of my colleagues were away on vacation, and there was just absolutely not a single soul (believe me, I racked my brain!) who could precept those residents for me. So, I brought E to work with me -- he was psyched! He sat at my desk, drew pictures, played on the computer, got fawned all over by my colleagues, and enjoyed the bonus graham crackers and apple juice in the ‘supply’ closet! He was really acting fine, even a little energized by being at my office, but a slow, barking cough began to emerge.

We left my office midday and went to the pediatrician (it was a covering doc as our usual pediatrician was out that day! Sigh.) to find he had since spiked a fever, and his room air pulse ox was 92%.  He had a right lower lobe pneumonia [ok, this is the part where I confess I listened to his lungs when he was in my office -- which I try to NEVER do, except I did this time -- and thought I also heard a pneumonia but tried to leave that to his real doctor to decide!]. They gave him nebs in the office (I told them they never work, but they always say it’s worth a try) and his pulse ox remained at 92%.  So, we left with our amoxicillin prescription and a word of caution: “You know what to do. You are a doctor. If he gets worse overnight, don’t even call us. Just go to the ED. If you are worried tomorrow, bring him in again.”

I should have known. It always gets worse.  This kid gets sick fast.  So he got his first dose of amoxicillin, and I waited.  You know that waiting -- the kind of waiting moms do -- where we are so worried, need to be distracted so we don’t obsess, then we second guess our judgement, try to convince ourselves it will be ok, exercise some magical thinking that all will be fine as soon as the antibiotics kick in, and the time can’t pass quick enough.  I put E to bed at 6 pm because he was so tired and miserable, and the next 3 hours were unbearable. He would sleep for 5 minutes, cough uncontrollably, wake up and cry, and then be so tired he’d fall asleep again, and then do the same thing over and over. It went on like this for so long. Did I mention I also was getting my 7 year old fed, showered, ready for bed? Oh yeah, that too!

At 9:30, while holding E in my bed, trying to get him to calm so that he could get some much needed rest, he woke and cried and said “Mama, I need help. I need help.”  So, that’s it.  I sped into action: clothes on, coats, boots, hats, gloves for kids, I woke up M, I put both kids in the car (10 degrees outside!), dropped off M at a friend’s house to sleep over, and drove to the ER.  E’s dad eventually met us there -- another story.

In the ER, E’s room air pulse ox was still 92% but when he fell asleep, he got hypoxemic to the low 80s.  I’m guessing it’s why his sleep was so fitful.  So, we got admitted. And we spent 3 days in the hospital. From the gurney in the ER, I sent emails and texts to my clinic manager, medical director, and colleagues to cancel all my patients and my meetings, and the interviews for the promotion that I’ve been working toward.  The rest of the week was a wash.  In fact, all the stress and chaos of ‘everything else’ just melts away when you have a sick kid. I told myself, “I’ll catch up. It will be ok. Everything else will wait.”  And it did. Time stood still with him in my arms. All I needed was him to get better.

E is fine now. He is back to preschool, and back to his usual self. M had a few days of being bonkers because her routine was off as we figured out how to move all the pieces of the family puzzle while I stayed with E in the hospital (thank goodness for good friends!). But, she was truly a champ during it all. And, we are back to ballet and soccer and swim class and play practice and birthday parties and the crazy of morning school drop off, and I’m back to patients and meetings and interviews. And somehow we are all staying afloat. And we are making sure to do it all with lots of hugs and giggles and a few dance parties mixed in -- the chaos is there, it’s never going away, and we are trying to keep it ‘light’ for now because that’s all this doctor mama can take at the moment.

Guest Post: Finally

I have been tired since May 2015. I am so, so tired. But the sleep deprivation proved to be worth it today. You see, today was Match Day. The results were good. Outstanding, really. Not only did I match to my number one ranked program, but my future institution is one of the most prestigious medical centers in the world.

My journey to get today was not easy. It took me three application cycles to get accepted into medical school. The emotional toll alone of receiving dozens of rejection letters is enough to make anyone go a little crazy. But with application cycles also comes time, and as we all know, with time comes a decline in ovarian function. Women physicians are all too familiar with that line graph comparing ovarian reserve to a woman’s age. I was finally accepted into medical school at 27. By that time I was married to a man nine years my senior who was very eager to start a family. So we decided to have a baby… while I was in medical school.

After a pregnancy complicated by complete placenta previa, studying for Step 1 in the height of my third trimester, and a major placental bleed during third year orientation- my beautiful Ben was born. I have loved my son with every ounce of my being since the second I heard him cry. He has brought our family indescribable joy and not a moment goes by that I am not thankful to have him.

But being a parent is even harder than I imagined (I still have PTSD from the newborn period). Being a parent while in medical school seems like an almost insurmountable challenge. It has been exhausting and challenging and there were times I did not think I would make it to today. But today is proof. When I celebrated the news of my match, I got to share that moment with my loving husband and our smart, wild, daring, and sweet little boy.

Yes, I am still exhausted. And no, I do not believe I will get to catch up on sleep anytime soon. But just as my increasing age correlates to my declining ovarian function (that damn graph), it also represents the passage of time. My grandmother used to say that the days were long but the years were short. So to all the women who wonder if they can be a mom while in medicine... the answer is YES. Do whatever is right for you and your individual circumstance. And if you do have a baby in medical school (or at any point in your medical career), there will be times when it’s awful and times you genuinely don’t believe you can do it anymore… but it is so worth it. And whatever you do, enjoy every second because my grandmother was right. There were so many long days, but these sweet, sweet years are ever so short.

~Maria

Itty bitty ones and screen time

Screens! There are so many. And they are everywhere. Even AAP relaxed their screen time recommendations in recognition of the ubiquity of screens. I remember when my little one was born, AAP recommended no screens for children under 2. Current recommendations relaxed the no-screen age from 2 years to 18 months. Like many other things related to parenting, I have been flying by the seat of pants, and experimenting as I go along. Here are some observations from our ongoing screen time adventures.

Under 18 months? No screens for you: We did not adhere to that. Part of it has to do with very different approaches that me and my husband take to screens (and parenting in general). I was the stickler in the beginning, determined that my child would view no screen until 2 years. Husband is several notches more laissez faire than me, felt screens were fine birth onwards. After several battles, a compromise was reached. I don't recall the exact age, but it was somewhere between 12 and 18 months.

So many screens and so little time: At first, I didn't distinguish between different kinds of screens and let the toddler do as he wanted. TV? Sure! iPhone? Why not! Laptop? Here ya go! But then I dialed it back quickly after seeing him flip from one video to another at a dizzying pace on the touchscreen phone. My toddler has pretty good attention span for doing tasks, but watching him with that level of stimulation gave me future ADHD nightmares. For now, I have stuck to less interactive screens like TV. Watch a show. Finish viewing. Turn it off.

Screen as a pacifier: Kids and restaurants don't mix well together. "Twenty minutes in a high chair is about all you can reasonably expect from a toddler... Little bodies need to move" When he was having a meltdown, initially a smartphone seemed like a very effective pacifier. Avoid the angry stares from other patrons. Enjoy our meals in peace for a little bit. But then our child became Pavlov, and we were his little rats. When every meltdown was rewarded with a phone, they just became more frequent. Eating out is an important social skill. Sowing seeds for that ineptitude so early didn't quite sit right with me. So I stopped caring about strangers stares. If the meltdown was too intense, one of us walked out with him until he calmed down. Now instead of playing with a phone at a restaurant, he plays with his food. Baby steps!

Screen as babysitter: AAP recommends against using screens like electronic babysitters. Easier said than done! As I discussed some of my childcare challenges with limited financial resources in a previous post, this is the rule I feel guiltiest about breaking, but I continue to break it anyway. In AAP's ideal world, "parents should co-view media with children to help them understand what they are seeing". In my real world, while my child is glued to the front of a TV, that is some precious time to hastily get stuff done. However I did find a workaround through a loophole for that AAP recommendation. Toddlers love to view the same thing over and over. We cut the cord and watch most of our TV via Netflix/Amazon Prime etc. I watch a few episodes of some shows with him, and then play the same ones over and over for him.

All programming is not created equal: I have found PBS to be the highest quality, though even with PBS, not all shows are equally good. By far my favorites are Sesame Street, Daniel Tiger and Peg+Cat. There was a even a study showing correlation between Daniel Tiger viewing and children's emotional intelligence. Adding anecdotal evidence, I have taught my son to apologize using the episode where Daniel Tiger learns to apologize. And to clean up after himself using Daniel Tiger's jingles "Clean up, pick up, put away. Clean up, everyday".


Practicing the preaching: All this fussing about my toddler and his screen habits have made me rethink my own screen time. Excluding unavoidable screen time (work/school related), I tried to take an inventory of the my avoidable screen time. I am not much of a regular TV watcher, my biggest avoidable time sink was checking social media on my smart phone. A strategy that I have had moderate success with involved creating extra hurdles to view social media. You can read about it in greater detail at my blog here. Less time with my face in a screen meant more time being present (actually present) for my munchkin.

It's been a bumpy ride but I feel like we have reached somewhat of a steady state with our relationship with screens... for now. But these pesky children keep growing up, ensuring that the steady state will not stay so for long. Screen time for kiddos has been in recent news, with stories of links between increased screen time and diabetes risk and teens replacing drugs with smartphones. Even without those scary stories, I am dreading navigating the whole wild world of smart phones, video games, internet and social media when my itty bitty one is no longer so little and outgrows PBS Kids. Mothers in Medicine with children of all ages, share your own screen time adventures. What has guided your approach to your children and screens? What screen related rules do you use in your house? Did you have it all figured out or do you fumble around like me?

The Request Case

One of the things I really enjoy about being an anesthesiologist is the wide variety of patients that I see. You never know who you're going to have the privilege to care for on a given day. Although my group is large, I will occasionally be assigned to a patient that I personally know. And occasionally, someone I know will request me as their anesthesiologist.

Last month I took care of a friend who requested me for her surgery. It was a very straightforward case, everything went smoothly, and she expressed abundant gratitude at the end of her experience. I was also asked to do anesthesia by a friend for a surgery that, knowing her history, was going to be fairly complicated. That one gave me pause, but I did it and everything turned out well.

Gizabeth recently wrote about being a doctor to her friend, and I'll bet that some of you have also taken care of friends (or have become friends with some of your patients). I would venture to say that being an anesthesiologist or surgeon to a friend adds an even further layer of complexity because there is an immediate "life and death" aspect to what we do. However, either fortunately or unfortunately, patients don't usually appreciate this.

On the "pro" side, patients can feel a great sense of empowerment in choosing their own anesthesiologist. A good attitude and sense of empowerment going into surgery can translate to less stress on the patient and better overall recovery. During my residency, I had a scary brain surgery. At first, I thought it would be awkward to personally know my surgeon and anesthesiologist, but out of convenience and timeliness, I chose to have the surgery at my own institution. I was able to choose my anesthesiologist - who at the time was one of my supervisors! In the end, I felt great comfort in personally knowing my healthcare team.

On the "con" side, there is a phenomenon in our specialty called VIP syndrome. Taking care of a VIP subconsciously makes people pause and do things slightly differently than they would normally do, rendering the whole process vulnerable to errors. What if your friend suffers an adverse event under your care? And are your decisions objective enough in the situation?

What do you think? Would you and/or do you take care of friends? How about family members? Let us know your experiences with requests for care by friends, acquaintances, or family.

The doctor self-diagnoses again (a delightfully disgusting story)

Genmedmom here.

I've posted about my own recent miserable illnesses on my own site so often lately, I'm afraid to post anything else about being sick there. People will start to think I have some underlying issue, like an undiagnosed immunocompromised state.... or hypochondriasis.

But I have to share the gross details of my latest medical problem! I have to, because it's so disgusting, it's entertaining.

So my kids and I have been SO sick this winter. There was Norovirus at Christmas, and then the flu three weeks ago (despite being vaccinated), which for me, then triggered a horrible asthma exacerbation...

But last week, I was finally feeling better. I remember thinking, "Gee, I finally feel better..."  and probably jinxed myself.

By the end of the week I was really congested and feeling run-down. "Great, a cold coming on, this sucks," I thought.

Then Saturday afternoon, I was more congested, and the mucous was really green. I felt kind of woozy, with mild chills. I ignored it and went for a four-mile run in ten-degree weather. Weirdly, it was invigorating, and the hot shower afterwards was heavenly! The mucous drained and drained.

"Ha! I beat that one!" I congratulated myself.

But, Sunday: worsening congestion, thicker gray-green mucous, facial pressure... and then there was this smell.

I smelled it first in our kitchen. A warm, dirty dishwater smell, like when you open an old dishwasher before the heat cycle is done and all that steam with the hot-moist-food-particle odor hits you full in the face. WTF? I peeked all around trying to find the source.

Then at church, I smelled it again. The kids were running around and I was distracted, so I didn't think about it too much other than, "Yuck, what's that?"

Later, at home, still soooo stuffed up, I blew my nose for the millionth time, and got a huge glob of nasty slimy mucous. For some reason, I thought to sniff it.

And there it was. That smell. It was reminiscent of when I worked part-time in our college cafeteria and there was an immense sink for soaking all the pots and pans and serving dishes in super-hot water with some kind of toxic detergent, and the clouds of steam would waft up with the odor of all those food scraps: leftover meatloaf, cherry jello, brown gravy, pea-soup, and harsh industrial-strength cleaning solution all mixed up together in one nauseating and assaulting aroma...

I realized (with a shudder) that the source of that nasty smell was my own face, my own mucous. SO GROSS SO GROSS SO GROSS!!!!

Of course I googled this, trying to figure out what was the principal bacteria responsible for this gray-green discharge with the very particular odor... No luck. Needless to say, I'm on Augmentin and I feel alot better. 

Early dementia

"We have a problem," my daughter's kindergarten teacher recently told me during a parent teacher conference.

"What's the problem?" I asked.

"You forgot to pack your daughter's snack today," she said.  "Also, you forgot it one other time.  I don't know what's going on there."

I pay a small fortune for my kids to get school lunch (which I'm convinced they don't actually eat), but in addition to that, we have to pack a snack.  I don't remember having snack time in elementary school.  I think we got lunch and that's it.  But regardless, snack time is the convention.  And on two occasions in a three month period, I forgot to pack it.

The thing that surprised me is... am I really the only mom in the whole class who forgot to pack a snack twice in three months?  Is that really something that should make the teacher look at me like I'm irresponsible?  I have a lot of things to do in the morning and I just forgot.

I used to have a great memory.  

I don't know what happened.  I can't remember anything anymore.  I have alarms in my phone to remind me to tell my daughter to pack her clarinet on band day, to remind her to study for her Friday exams, because I'd never remember otherwise.  I put reminders and alarms in my phone about every appointment, every social event, everything I do.  

And it's still not enough.  My kindergartner is totally incapable of remembering her backpack in the morning if I don't remind her, and yesterday, I forgot to remind her.  So we got to school and.... no backpack.  I had to call my husband and beg him to bring her the backpack on his way to work, which he did, but I forgot to put her dance clothes in the backpack, which was practically the only thing she needed in the damn thing anyway.

But at least her snack was in there.

On Family Medicine

I wondered during undergrad if I could do medicine and "have a life". I didn't have a lot of first-hand contact with physicians, and had just started to consider a career in medicine, so I really didn't know what a medical lifestyle was like. I knew it could be incredibly demanding and busy, but I wasn't sure how much flexibility there would be. In the end I suppose I still didn't really know, but I figured if others did it, I could figure it out too.

We had the chance to get early clinical exposure at my medical school. I had always planned to do family medicine, so every Wednesday afternoon in my first year, I would take the bus to the family medicine clinic of Dr. B. Dr. B's patients adored her. She truly listened to them, and was clinically excellent too. Seeing patients -- real people with real problems! -- was thrilling. I get a reminder of this from time to time in my office when I have early medical students join me. Looking at a tympanic membrane is exciting to them! It's a great boost. 

During medical school, I went through the "cardiology! neurology! infectious diseases!" rotation in my mind, until it was clear that being a generalist was what I wanted. Internal medicine was tempting, as I actually enjoy learning minutiae, but I loved women's health, pediatrics, and doing preventative care. The flexibility of a career in family medicine was unmatched in my eyes. So from clerkship onward, I continued to feel that family medicine was the right fit for me. 

I now have a family practice of about 1200 patients in a small group practice, and see patients for about 30 hours per week.  Charting, results and other paperwork takes about 8-10 hours a week.  I block one day off every month for self-care or catch-up time - with young kids, if I have to cancel a clinic due to their or my illness, it’s nice to have a day available to re-book patients. I can book off in advance for appointments for the kids or myself, or fit in local CMEs or meetings related to some community health work I do. The demands of my practice - and of home - fluctuate from week to week, but generally it feels like a good balance. 

I ran into a lovely, well-meaning non-medical friend a little while ago. "How's work going?" she asked. "Ah, it's been a long week." I said. "Lots of coughs and colds?" she mused. "If only!" I thought. I tell this to students a lot: family medicine can be very challenging, medically, and very draining, emotionally. So rather than things like a chest cold or plantar wart being boring and mundane, they can be a very welcome break from the challenging things we see at times.  The medically complex cases are invigorating, and the emotionally draining cases, highly meaningful; the "mundane" cases act as a much-needed foil. And above all, when you know your patients like you do in family medicine, it becomes much more about caring for the person in front of you than about the particulars of their issues.