Greetings from TXgal

Howdy wonderful MIM community!

I am excited to have joined MIM as a regular contributor this year! I’m TXgal, a name fitting not only because I am from the great state of Texas, but also because I have been trying to escape it for years. One thing or another has kept me here: being close to family, landing an awesome job after graduation, the low cost of living, having babies, and now it’s the ridiculously low medical school tuition when compared to other states. Jealous yet? You don’t have to be, it is freaking hot. But I am starting to accept that this is home, and even loving it!

I am 29, and in 6 months I will be 30. This never bothered me until last month when I looked in the mirror and I saw wrinkles. I won't go into how much grey hair I have. I always thought I would age with grace and acceptance, but right now I am longing to be 25, rocking my pre-baby body. I am also starting medical school in 2 months, which I imagine will only accelerate the aging process. (Especially frown lines). Both of these things have got me in hammer mode. Last 2 months of freedom before starting the rigorous path of medicine, and last two months of freedom in my 20's. I have got to get the best body of my life, meditate, read, write, start my blog, finish projects around the house, learn Spanish, do all the hobbies I won't be able to do once school starts, stop wasting time on Facebook, teach my kids to swim, potty train etc. etc. etc.

But I am also beyond excited to start medical school. I am a non-traditional student with a background in nursing. I landed my dream job right out of nursing school at a Level I trauma ER. The first day of my new job the charge nurse gave me some advice. I didn't listen to her. She said don't date ANYONE here. Not the doctors, not the cops, not the paramedics, or firemen. Especially not the doctors. Perhaps I should have listened. But I fell for a resident, and after a year of dating I got pregnant with my son. Thanks Plan B. What a little darling he is. Into my life he came, and out went all my plans. Like many other premed students, I am a control freak. I like order. I like plans. No, I NEED plans to function. I was going to do a year of travel nursing, and spend a year abroad working for MSF, and then go to medical school, and somewhere far down the road, far, far, FAR down the road I would start a family. I quit my job as a nurse and stayed home with my son while completing my pre-med courses. This was a difficult time for me. It was lonely, and isolating. The entire time my head was spinning with thoughts like "how will I be a good doctor AND a good mom?" "How will I go to med school with a baby?" "When should I go? When he is 2 or 10?" "How will I ever work for MSF?" "Maybe I could just be a stay-at-home mom, or a nurse, or a teacher, or a wildlife photographer, or a stripper." The thoughts literally and metaphorically made me dizzy. (This is when I discovered this LIFE SAVING blog)

I have learned a lot since then. I learned that I am not a stay-at-home mom. I learned to let go of control over my kids. That they are OK, and even thrive at their daycare. They are OK with a sitter, and they are OK at grandma’s. They LOVE grandma. I learned to find balance in school/family life. Yes the load in premed isn't anything like med school, but I learned some tricks. Like don't even attempt to study around the kids unless you want scribbles all over your books. And, don't expect to take a 7 hour timed practice MCAT test and score well with a newborn in lap, so GET A SITTER! Also-DON'T. LAY. DOWN. You WILL fall asleep. Oh, 15 months after my son was born, my daughter came along. Another unplanned little darling.

I am also grateful. I originally got accepted into a program 800 miles away. BD (baby daddy) would have had to stay in our current city for work, and I would be leaving two sets of wonderful grandparents. 2 weeks before our moving van was scheduled to whisk me away with 2 toddlers to start med school alone in a new city, I got an acceptance to a school close to home at an institution known for its (relatively) laid back atmosphere, and relaxed schedule. I am so grateful for this. I am grateful I have so much support from BD, my parents, and BD's family. Grateful to my 26 year old self who continued to complete premed classes despite being so uncertain, who started studying for the MCAT with a 2 weeks old (and eventually got a sitter). Grateful for my kids' teachers, and babysitters that fill their day with joy.

So now as I move closer to med school, I am no longer dizzy with thoughts of uncertainty. I know it'll be crazy, and stressful, and hard. But I know I cannot see myself doing anything else. (Even if sometimes I wish I could). I know at times I will miss my kids, but they are surrounded by friends and family that love and care for them as much as I do. And the obsessing over the wrinkles? I know it’s a phase. They are beautiful just like my grey hairs. Who would really want to be 20 again anyway?

-TXgal


The Shorter version:

TXgal is an about to be 30 year old, nontraditional, incoming MS1 with two toddlers (born 2014 and 2015) and a nontraditional life living with her supportive BD (baby daddy). She has spent the past three years pregnant, or breastfeeding while completing her pre-med classes, and MCAT. After years of uncertainty, she is happy to start medical school knowing there is nothing else she can see herself doing, (well maybe a photographer for NatGeo, but that’ll come later) She is forever newly discovering how she identifies as a mom, individual, almost 30 year old, and soon to be medical student, and looks forward to blogging about the joys, struggle, stress, and victories in finding this balance. She also has a gazillion hobbies, and likes that include: gardening, yoga, reading, coffee, rock climbing, running, traveling, hiking, visiting National Parks, photography, healthy eating, Latin dancing, planning her life, re-planning her life after plans fail, family vacations, studying, and watching NatGeo with toddlers, cheering for the prey when they get away.

Stay at Home Starchitect

All Spring my husband researched options. He had a great job, and they loved him so much they gave him leave without pay to get extra vacation time with  me and the kids (standard for architects is 2-3 weeks and I get much more than that), but he was tired of working on multimillion dollar housing projects in other cities - jobs that take months to complete. After exploring other job offers, he met with my financial advisor and decided to take a plunge from the corporate world and form an LLC. He would work from home and start his own business. He gave notice at his job a couple of months ago.

The first week he was home it was as if the boil of logistics that was our life, a life I knew no variation of in this marriage or my last, was lanced. He has always pitched in as much as he could, but this was different. Someone to be there to get packages. Let the bug guy in the house. Get one of our kids to the impossible 2:00 in the afternoon orthodontist appointment. Grab the cake for the birthday party. Get the honey we forgot at the grocery store last weekend that left my morning eggs unbalanced and naked. As end of school transitioned to summer, it became even more rewarding. My kids at 14 and 12 are old enough to be alone now, but having an adult at the house to check in with before they walked to the local pool to meet their friends and receive them when they return is a huge bonus. Someone to drive them to a sleepover earlier than 5:00. Someone to eat lunch with them. And we agreed, most importantly, the bonding of their relationship, stepdad to kids, as the kids are reaching an unprecedented age of independence.

He has already turned our guest bedroom into a sleek home office and is starting to craft a business card and do some research. The many contacts he made in the past have already landed him side gigs. And he is happier - getting a long bike ride in every other day. Not having the pressure of 8:30-5:30. That happiness makes our house happier - not that we weren't before, but it's better in a way I could not have imagined. So much so that I suggested he take some time off. Take it slow. We are traveling much in the month of June, so maybe wait to gain traction until July. He is more than amenable.

I don't want him to become the carpooler come Fall - we both want his business to succeed. So I'll put boundaries around his time - maintain an aftercare driver to get the kids from school and to all their activities. But this level of support is nothing short of mind blowing. So I was surprised one night last week when jealousy reared its ugly head. I didn't share my feelings with him at the time, but it was 12-15 hours of why do you get to do this and I don't circling my angry brain and it came off as crankiness and being short one evening. I was jealous he had lunch with the kids. I was jealous of his time during the day to exercise.

Now, to be fair, last week was one of the hardest weeks I've had in a while - call duties, high caseloads every day, terrible work drama, some family drama, and autopsy drama of all things. So I was grinding my teeth getting work done and working very hard to center myself and approach every issue with as much grace and calmness as I could muster. And I think I succeeded, and am happy I sold away my call weekend so I could get in some much needed chill time. But I knew I needed to explore this jealousy thing, so I did one morning at the scope.

He is very different than me. He tends to work better without boundaries around his time. He can adhere to our family schedule, and plug in to work at night when the kids are not with us. Not me. In the past, when I had time off between my first marriage and med school, I quickly lost myself to entropy. I watched Lifetime all day long. I quit exercising. One or two hours on the couch turned into one or two months. So much so that my then husband worried. "I think you always need a job. Please tell me you will always have a job or be in school." To be fair, I didn't have kids back then, and I was in my twenties, but I think he was right about my personality. I need to be responsible to someone or something in order to feel personal reward. Schedules anchor me. My cases, the patients behind them, the frozens, bronch lab, interventional radiology, it's a fuel that keeps me going and performing. Last week was too much, but most weeks aren't filled with all of that. I would not want to be a stay at home pathologist, not only because I don't think that's possible yet but I also need space away from my house to be productive at what I do. The hospital is my sacred space.

So I breathed and apologized the next night for my crankiness and told him about where it came from. He agreed to make space in the evenings for me to work out like we used to together on nights without kids instead of wanting to eat as soon as I get home. And he brought the kids to work one day to eat lunch with me - the kids hadn't done that in a long time and I know we will do it again this summer we all had a blast.

I remember when I was going through my divorce or maybe a new single mom KC won a well deserved prestigious award for starting this blog. In an acceptance speech she was tasked with advice to being a successful mother in medicine. Her first piece of advice was to marry well. I'm proof that if you don't get it right the first time, for whatever reason, it's possible to get it right the second time.

Is it time for me to break up with nights?

I am post-call, yet again. Which is short-hand for the mild-to-moderately disabling condition my family knows too well at this point -- foggy-brained, labile, cotton-mouthed, impatient, irritable, overwhelmed by the smallest unexpected twist in the plan. I have difficulty making decisions, even tiny ones. I eat way too much, my body confused by the question of whether it needs sleep or food. Instead of answering an important email or using this precious time while my child is at school to sleep, I watch a movie I have watched 40 times before and scroll mindlessly through the perpetually unfulfilled promise of the internet, catching myself a hundred times as I almost nod off and drop my phone onto my own face. I feel like a pint of ice cream with only a film of sticky soup remaining at the bottom: not good for much. My body aches. My mind, if such a thing is possible, aches. My view into the future is suddenly bleak, and even though I know that all these sensations and thoughts and feelings will resolve after a good night's sleep, I have to live through them all day and they are not pleasant.

I love nights in the hospital. A quiet purpose takes over -- the formality of the day softens and people are focused on what is most important. I am united with my patients' families in their sleepless vigil. I have had some of my most profound moments of intimacy with my patients and with the practice of medicine between the hours of 7pm and 7am. People are born and die at all times of the day, but at night there is an aura of primordial magic to it, both light and dark -- the baby's first cry as my ears are still ringing from being woken up by the delivery pager, the mothers sharp sobs as she holds her sick child for the last time. The night feels like life's secret workshop and despite all the sorrows I have witnessed there, I have loved my time in its shadowed chamber of turning gears.

But lately, I feel like the nights are killing me. It takes me longer to recover. My fatigue and disorientation stretch into my post-post-call days. I can never establish any kind of routine. My schedule is never the same twice and the nights fall on different days and in different configurations and it feels like I am inventing my life from scratch every single week. On paper, it doesn't look so bad: I "only" work overnight about 3-4 times per month and 1-2 of these are 24 hour shifts. But the weeks when I don't work a single night feel so much better, like I am finally climbing out of the canyon. I eat better. I exercise regularly. My family is able to settle into a consistent routine of time together in the evenings. I get to play the piano and talk to friends and read books and taste my food. I feel like myself again. And then another night looms and I slip back into survival mode -- the life of just trying to get through to the other side in one piece.

In order to give up nights, I would have to give up the ICU part of my job which would feel like a huge loss. The muscle of acute care that is strung taught and strong across my frame would atrophy. I would miss the real-time critical thinking through the most pressing problems of physiology. I would miss the sense of internal strength that comes from running towards instead of away from disaster. I would miss my colleagues so much. And most of all I would miss the patients so much. I know there would be other patients and other satisfactions, but I have stroked so many little heads amidst the wires and tubes and lines and a part of my heart will always be hovering over an isolette, cheering a tiny life into the future.

Is it even appropriate to step away, I wonder? I harbor some machismo about the self-sacrifice of nights and call and when I imagine giving it up my inner voice says things you might expect a drill sergeant to say to a new recruit. In other words, not nice things. I compare myself to people who have accomplished incredible things and who seem to sleep much less than I need to -- surgeons, authors, CEOs, innovators, politicians, my colleagues who have even more children and even more responsibility. And I think to myself: Was I put on this earth to sleep? Why, I wonder, do I need rest and consistency and slow mornings and the Goldberg Variations over a hot cup of tea and the colors the afternoon sun makes in the trees to feel like myself when others can be animated solely by the imperative of their work? What, I wonder too many times a day, is wrong with me? Or perhaps more kindly framed: What right do I have to prioritize my own needs over the potential to serve the needs of others? And then other questions, usually held in shadow, emerge: Does the poet part of me deserve the same airtime as the doctor part of me? What if I love being more than doing?

As you can see, the question of nights has become about more than than the question of nights, which makes it all the more difficult to decide on the right course of action. For the moment, I have shifted my responsibilities for the coming academic year and will be doing less time in the ICU and by extension fewer nights. I will see how that feels. Likely, no choice will ever feel 100% right, but I hope that a bit more sleep will allow me to attend more closely to my own intuition, that a little piece of that primordial magic will glow in my own life and light the way.

Tell the truth, as soon as you know it

It was a Thursday evening and I had just gotten off from back to back shifts, first a full day in private practice and then a hospital training for my new gig. Zo was riding his bike up and down the street. My husband O catches me on the porch and says, “have a seat, I need to tell you something”. My heart sank, I knew this wasn’t going to be a good conversation. He proceeds to tell me about how Zo had stabbed another student in the neck at school. This is one of those students who is always crying, always dramatic, always asking for a hug. The student had cried and gotten a band-aid and Zo had gotten in big trouble.

I began crying. Ashamed. Scared. Worried. More shame. Guilt. Fear. I had flashbacks of when I had gotten into a fight in high school and the look of worry and concern on my parents’ faces. I didn’t understand then, but in that moment, I fully understood. You work so hard to raise well-rounded, empathetic, gentle humans and then they go and do something so utterly stupid that you lose your breath, you lose all sense, you feel like a failure.

O proceeded to explain to me how he had managed it. He decided to handle it while I was at work between the men-folks. He had picked Zo up early. He had talked to him first and then he even met with the the School Psychologist, Assistant Principal, his Teacher, and the Teacher’s Aide. My husband had cried once they returned home due to fear, shame, guilt, and an outpouring of emotions. He called one of our friends who has an 8 year old son and they walked through an appropriate discipline plan. O talked to Zo a lot and explained how we have to have “gentle hands” all of the time. By the time I got home things were smoothed over. I was saddened that yet again I was at work, but I was proud of my husband for the way he handled things. O is the more calm and collected parent and I begrudgingly admitted that it was good that he was the one who had picked Azola up.

Zo finally came down the street and saw me on the porch. He came to give me a hug and then put his head down and said “did you hear about my behavior?” and then we talked about how he had hurt his friend at school. I explained that I was very disappointed. He promised never to do it again.

I texted the other parent, a stepmother, who had been a little flighty in the past. I asked if we could talk about what happened and we set up a time. That time came and went. I reached out again. Same thing. Apologies. The weekend went by. We continued to talk to Zo about being gentle and that it was important never to hurt others.

Then on Monday I get a text from Zo’s teacher asking had I heard what really happened. I quickly texted back and learned that Zo HAD NOT stabbed another child in the neck, but that on Friday they had learned from the stepmother and father of the little boy ON FRIDAY AFTER SCHOOL that Zo had been dared to break a plastic fork and that a tooth of the fork had popped up and hit the other boy in the neck. The kids had thought this meant that Zo had stabbed him.

So after an agonizing weekend feeling like failures of parents, all the stepmother had to do was text me and say something like “hey, you know Zo didn’t really stab my son, right?” and that would have changed things considerably. Zo wouldn’t have been disciplined. Why didn’t the family tell the truth as soon as they learned it? I would have! Why schedule a time to talk and then miss it and not say anything?

I wish those parents had told the truth as soon as they’d known it.

MiM Mail: Can I wean baby before medical school?

I am a 33-year-old MS0. My husband and I welcomed a beautiful baby boy October 2016. I have loved my time with him and I am also looking forward to medical school beginning in the fall - with nervous excitement!

We are relocating for school, but, fortunately, my husband is able keep his current job. However, he will have a 90-minute commute each way. We found a great daycare and my mom will live in town for backup. My school starts with gross anatomy, which means we are on campus all the time. I love nursing my baby but I struggle to imagine pumping/nursing in medical school.

Fortunately, I have not had issues with milk production and have started building a freezer supply. Does it make sense to wean baby and utilize the freezer supply and supplement with formula if needed? Is that okay? The pressures to breastfeed exclusively are harsh and I just want to care for my baby the best I can. I haven't started school yet, but the mom-guilt is already eating away at me.

P.S. - I am so thankful for this community! I love reading your stories and feeling the support between moms. I recently received a public nastygram on Facebook from a 'friend' who said she believes my choice to attend medical school is a "mistake" because I am a new mom. I want to not care, but I will admit my confidence is shaken.

-Anonymous

The Devil You Know

Being a working mom who's also a physician isn't easy, as most of us know.  KC made a blog about it.  I have now written a fictional book about it:

(Available on Amazon on the kindle for only $2.99 or paperback.)

This is an almost embarrassingly autobiographical book about how it's tricky balancing a busy career and family, and how it can do a number on your marriage.  It's a sequel to The Devil Wears Scrubs, but I wrote it so you don't have to read the first book to enjoy it.

Not sure?  Here's an excerpt:

When the package from Amazon arrives at our front door, I am so excited.

I immediately carry the huge brown box into our living room, where Ben and Leah are sitting together on the couch. Ben’s got his laptop, as usual, but he’s looking at it with Leah this time. They’re on YouTube and he’s showing her videos of animals doing funny things. Leah is having a great time. I hear her giggling nonstop, with occasion interjections of, “Aw!” or “Oh no!” and once, “Do you think it’s dead?”

Ben straightens up on the couch when he sees me dump the package on the floor. “What’s that?”

Leah’s eyes widen. “A present?”

“Yes.” I brandish a pair of scissors in my hand. “It’s a really special present for Leah!”

Technically, that’s true.

“Is it a birthday present?” she asks.

“It’s not your birthday yet,” I tell her.

“Happy birthday to Mommy, happy Mommy to Mommy,” she chants as I grab a scissors to cut the tape on the box. Leah is practically climbing on top of me to get to the contents. She doesn’t seem entirely thrilled when she sees what’s inside.

June

June.

Breath.

June is here... that time of year when the weather is finally consistently warm, the sun is out until after dinner, the grass is green and the trees are lush, and... "the end is near."  What I mean by that is, that for my entire life, I have been a student/resident/fellow working on a year that starts in July (or September, back in the good old days) and ends in June.

1st-12th grade, June=summer fun, hooray!

College years, June=finals are over, I can finally breathe for a couple of weeks before taking on whatever pre-med torture I had decided to inflict upon myself that summer

Med school, 1st year, June=I can't believe I finished the first year of med school! I better soak in this very last summer I will ever enjoy as an extended break

Med school, 2nd year, June=Whoa... you mean I won't come back to the classroom?  I'll just be out on the wards?  (fear, panic, elatedness)

Med school, 3rd year, June=I better decide on a specialty and apply to residency! 

Med school, 4th year, June=med school is done, graduation is over, residency is beginning soon.  "I can't believe I am finally a doctor..."

Each year of residency, June=I'm almost done with another year.  This is insane!

Fellowship, June=in a month I'll be an attending.  This is all kinds of emotions, from happiness to panic to despair and back to happiness.  I really cannot.believe.it.  

As I reflect on the past and my extended schooling, I am happy with the decisions I've made.  I am happy I picked my specialty choice.  I am glad I matched into my residency and my fellowship (although the start of it was rough!)  I am grateful for the experiences I've had, and for the knowledge that I've been fortunate enough to attain.  I am scared for the future but am looking forward to it.  

This is bigger than a chapter ending.  It's the end of a book!  But the book is in a series.  The next book is starting, and it will be filled with just as much fun/excitement/joy/sadness/fear/etc that the previous book entailed.

I will be sure to keep you all posted about my new journey!

Guest post: My secret

I have a secret to tell you. I love dropping my daughter off at daycare. Shhh...let's not tell anyone. There are people out there who will frown at the relief I feel when I drive away from the daycare. People who will shake their hands and cross their arms. People who will accuse me of being a bad mother.

Don't get me wrong. I love my daughter like I've never loved anyone or anything before. Her smiles in the morning. The way she puts her arms around my neck to kiss me good-bye. The way she tries to wink at me but closes both eyes instead. She just melts my heart.

But her headstrong personality. The incessant cries of mommy. The tantrums. The potty training messes. Those things wear me ragged.

Work is so much easier. My schedule. Examining joints. Diagnosing patients. Prescribing medications. Sitting in front of my computer in my quiet office. No baby talk. No chasing after a screaming toddler. I am the one in control, not subject to the whims of an adorable, stubborn two-year-old.

Weekends are difficult. From the minute she wakes up at 5:30 am on Saturday morning to 7:30 pm on Sunday night, I am running around frantic. Everything revolves around her schedule. When she eats, when she takes a nap. Keeping her short-attention span toddler self entertained. I cannot remember the last time I slept in. I am exhausted after I put her to bed Sunday night after reading her favorite book two times. When Monday rolls around, I happily rush to bring her back to daycare.

I applaud those moms who are stay-at-home moms. Spending all day every day at home with their children. Being a mom is the hardest job anyone can do and they do it all the time. They are super human beings. Stay-at-home moms are not recognized enough.

I could never be that stay-at-home mom. It would drive me crazy. I need to sip my coffee in front of my computer in my office. I need to read scientific journals and not just nursery rhymes. I need adult stimulation. I need to be away from my daughter to be a better mother.

So, shhh... that's my secret. Let's just keep this between you and me for now.


Karen Yeter MD

Annual call for contributors

Dear MiM community,

As we celebrate MiM's 9th birthday (!), it's time for an annual call for contributors. We would love to add a few new voices to our blog. This would be for a renewable 1-year writing term. If you are interested, send a message to mothersinmedicine@gmail.com with why you would like to write with us, and a little bit about yourself.  Call closes one week from today - Sunday, June 4.

Thanks as always for reading and being part of our community. We have some surprises in store that we are really excited about. More to come on that!

Best,
KC

Mother's Day?

I'm not even posting this close to Mother's Day, and that's just fitting. My second Mother's Day as an actual mother came and went, and a pattern has begun to emerge... I am realizing that this Hallmark holiday is a bit of a joke among many mothers. I read a funny post in an online moms' group where a woman described her Mother's Day with biting snark. She was "allowed to wake up early" while her husband slept in, enjoyed "a peaceful few hours of cooking brunch items for my family with a toddler attached to my leg" after rounding in the hospital, and then ended her day with a hot shower that was interrupted by her husband asking her to scrub the shower walls with his "fun new electric cleaning brush. So. Blessed." It got me thinking about my own two Mother's Days so far.

Last year, we had a plan to go visit my parents for the weekend. My mother makes a big deal of the holiday and holds an annual pool party, the yearly unveiling of their pool for summer use coinciding with agreeable Arizona weather right around the May date. She had a big event planned, as it was my first Mother's Day, and yet things were strained between us. At 43 and with disposable income plus a new baby, my husband and I had decided we were no longer going to stay in my parents' cramped extra bedroom on their uncomfortably small bed (replete with foot board) in their poorly ventilated home. The nearest bathroom is down the hall next to their master bedroom, and last Christmas my mom caught my husband running to the toilet in his underwear in the middle of the night. "Never again," he had exclaimed with stern eyes. Anyway, this decision to stay on our own had unexpectedly hurt my mother's feelings, given her memories of her own young married years visiting their own parents. Painful conversations had occurred, I had put my foot down, and a plan for alternative accommodation was in place. On the morning of our flight, my husband woke up feeling under the weather. I thought nothing of it and continued packing the car with myriad baby equipment, as this trip was also going to be our 6 month old's first flight. He is the picture of health, lean and muscular with no medical problems except for some recurring hemorrhoids. A week prior, I had talked him into having a band procedure, which I thought might solve the problem. In between schlepping loads, he stumbled, perspiration poured from his face, and all 6'6" of him slumped onto the couch. It took a scary minute to revive him, so we rushed to the ER, and in the harsh fluorescent lights I finally appreciated how pale he was. Hematocrit was 20%, and he was admitted overnight for a blood transfusion. I spent my first Mother's Day bringing him barbecue and magazines in the hospital (as if I don't spend enough time there already) and of course apologizing for suggesting the banding in the first place, in addition to playing single parent to my child. Trip aborted and difficult conversations sure to arise again at the next Arizona visit.

This year, Mother's Day happened when I was in Spain on a long trip... which might sound to some like an idyllic scenario. I understand that many people crave an escape from their work and hectic lives at home, but being long time rock climbers and slow travelers, my husband and I normally plan longer trips abroad where we fully immerse in a micro culture for periods of time. We had chosen the Chulilla area for its long climbing routes on tall limestone walls and its balmy spring temperatures. Only we hadn't gotten much climbing done because traveling with an active, headstrong toddler was turning out to be more difficult than we expected. The first week of our trip involved the rental car keys being thrown into the toilet by someone and then - recurring poop theme - me using said toilet before realizing where the keys were. I will spare you the details of the retrieval procedure. A couple of days later, I made the catastrophic mistake of filling our (unleaded) rental car's gas tank with diesel. WHY is the handle for diesel black and the handle for unleaded green in Europe?? Even though our pickiness and frugality usually keep us from eating out much even on trips, we decided to go out to a Mediterranean buffet in Valencia for Mother's Day. The hours for lunch in Spain are 1-5, while the hours for dinner are 8-midnight. Our normal eating time? 5-6 of course, like every other American family with a child. So lunch it was, and it was busy. We waited forever for a table in a sizeable crowd of Spaniards (we are very tall, so envision this as two giants with a giant baby swimming in a sea of tiny Europeans) on the sidewalk outside the glass doors to the buffet. The hostesses didn't even take our name; they just asked how many were in our party and we stepped back, hoping for the best. Over the course of waiting, baby grew tired and hungry. I read her stern face: What's with this late lunch business, during my naptime? We tried to calm her, but the whining grew louder, and then suddenly they took pity on us. We were seated at a cramped two-seat table near the buffet, knees touching under the table and backs of chairs touching the people behind us, and when I asked for a high chair they gave me some sort of booster seat contraption. I fussed with it for a while and then laughingly realized I had situated her in it just perfectly looking like the picture on the side - the red one with the big "X" over it. She ended up on my lap, and I barely ate anything. Hubs came and went happily many times while I entertained our crazy girl, who proceeded to fling paella and jamon in a several foot radius around our table (luckily no other diners but me became covered in food). Lunch came to a hault when she threw a plate that shattered into many pieces and then leaked through her diaper all over my lap.

A glorious day spent at the gas station after my "oh shit" moment

Like lots of mothers this recent holiday, I just might have posted some cute pictures on social media of my family frolicking on the beach (not on the day shown above), followed by comments about how lucky I am. Given the fact that for years I wasn't sure I was going to ever be one, I really do feel grateful to hear that faint little voice say, "Mama". But the sunny travel photos don't necessarily reflect the un-glamorous reality of motherhood that happens every day, with or without a dedicated holiday. Next year on Mother's Day, I don't know exactly what I'll be doing but I'm sure I'll be mothering again. And I'm sure that poop will somehow fit into the picture.

Why haven't you had your second child yet?

This is a topic that I'm sure other moms with only one kid can relate to--it's the never ending questions of why haven't you had your second child yet? It seems as if you have two children, every one assumes you're done and then if you have four, people start to question why you aren't on birth control. First of all, it's nobody business the number of children your family should have. But I feel compelled to share my thoughts so here goes.

I was beyond clueless when I got pregnant at the age of 27. I was 9 months into my internship, general surgery no less! and soon after about to start my 4 years in radiology training. At the time, my husband was in his third year of his 6 year orthopedic residency program. We were about the enter the monster of hot messes but we just had no idea. So come January 2013, 6 months into my first year of radiology residency came C. She was perfect. I was not. That is the short version of the story.

I was the epitome of hot mess. I cried a lot. My husband had to go back to work in less than week after her delivery. I was with my parents. I had help but I still couldn't get my act together. C was a good baby. She slept 3-4 hour stretches from birth. I could not sleep at all. I was overwhelmed with anxiety, guilt and basically a state of "WTF did I get myself in?" I was an emotional zombie. I was in a cycle of nursing, crying and attempting to sleep but never really getting any. It took about 4 weeks to realize that maybe I have post-partum depression.

I had all the symptoms. Feeling overwhelmed. Check. Feeling guilty. Check. Feeling empty and not bonding with baby. Check. Feeling even more guilty about that. Check. Not knowing why this is happening. Check. Check. Check

Even though, I was aware. I couldn't get myself to do anything about it. I just powered through the end of my seven week maternity leave. I went back to work. I pretended like nothing happened. But these feelings did not go away. Given the schedule of residency and the shame of postpartum depression, I did not tell anyone nor did I get the proper treatment. I went to a maternal health psychiatrist once, who talked to me after hours, off the record. She wanted to start me a low dose antidepressant but I never took it. I think these feelings never really went away. They did fade over time as I adjusted to my schedule of constantly driving back and forth between San Diego and Orange County (1 hour commute) and doing residency in between that time. I was so busy that I didn't really give myself to process my emotions. I just kept chugging along and watching C grow up was the silver lining. She transformed from this tiny infant to a toddler who was a force to be reckoned with.

When she finally moved to live with me, we encountered several other hot messes but I do believe that is what it took for me to rid of these postpartum blues. I still have the occasional feelings of working mom guilt and anxiety especially when it comes to big changes in my life (such as moving and starting my first attending job!). But I do feel "cured" but for the most part. It took time but I was finally her person. I was the one that she wanted in her time of need. I was the one that could figure out what was in that little head of hers without her saying anything. I knew then that I was definitely put on this earth to be her mom.

So yes. That is why I don't have my second child yet. I knew what triggered my postpartum depression with C. I was overwhelmed with a husband in training, my own training and my feelings of inadequacy as a mom. I told myself if and when we have another child, I will do it when I'm ready so my mental health isn't at stake.

My husband had to leave for the east coast for his fellowship training right after C moved and now he works in LA. We've done long distance for two years now. We are finally at the end of this long distance journey. I will be moving up to LA in less than 6 weeks after I complete my fellowship in breast imaging. I knew I could not handle a pregnancy, C and another baby while he was away. I learned from my first postpartum experience that  a lot of my anxiety was not having my husband around. I understood why he wasn't there but it didn't change how I felt. So I knew that time was not an option for child #2.

And right now is still not a good time. My poor C has not lived with her father yet. She spent the first 7 weeks of her life with me and grandparents. She then lived until 2 and a half with her grandparents in Orange County with seeing me almost every weekend but her dad maybe twice a month. She then experienced life with me in San Diego. She suddenly had to do full time pre school, new home and a new primary care giver. She went from being the center of the universe to being a toddler of a "single" working mom in residency. She saw her dad maybe once a month while he was on the east coast. Now that I'm in fellowship and her dad is an attending in LA, she spends most weekends with both of us. She's gotten used to that now and every Sunday, she hugs her daddy and says "see you next weekend!" It breaks my heart at times that she thinks this is "normal." I want her to experience life with both parents. every single day. before we add any more changes.

So there you have it. I know I'm getting older. My ovaries may be shriveling. My uterus is crying every time I see another baby. But I am grateful for these experiences. It made me stronger in the end. It made me a better mom, wife and physician. It taught me what I needed to know to grow as a mother and maybe one day that will be a mom of two. But for now, I am perfectly content as a family of 3.

Not everything that ends is a failure.

I’ve been gone for a while. A lot has changed in my life and some of the more peripheral activities within it (like writing for this blog) have necessarily been on pause. But I’m returning to this space now that I have the time and energy for it. In the past many months, our one family has morphed into two families --my marriage of 12 years ended. This was after a couple years of marital therapy, a trial separation (in which we lived in separate homes) a few years ago, and a lot of tears, gut wrenching atrocious fights, heart ache, issues within ourselves, issues between us, commitment, recommitment, more therapy and then…our marriage needed to be over. I truly feel that we turned over every rock looking for a solution to it all, and one could not be found.

We are recasting ourselves in our roles as co-parents only, and perhaps someday we will recast ourselves as friends. I firmly believe that a marriage that ends is not a failure, that the standard of “forever or failure” is just…ridiculous.  Does a marriage have to be life-long to be considered a success? No, it doesn’t.  We did not fail. We had a successful 12 year relationship in which we raised 3 awesome kids, bought a house, overall had a damn good time-- and I’m proud of all of that. And I'm grateful for the years we had together and I wouldn't change anything--life unfolded as it did.

But after much soul searching and countless tears, I realized that despite every good intention (on my part and on hers), and despite every effort (from us as individuals, as a couple, and by those in our families/community supporting us), I could no longer be the person that I wanted to be in my marriage any more—and even worse than that, I was becoming someone I did not want to be because I was so unhappy. This affected me more and more, and it was time for a change. I cannot speak to her unhappiness other than to say I think it was profound. And all of our combined unhappiness affected our children, without a doubt. And that was not tenable. 

In the meantime, she has moved out (and lives nearby), and the kids have started living in two homes. There have been bumps in the road, of various sizes—of course there have been. But I have every confidence that we will survive and we will all thrive, as we find a more peaceful existence. Families have survived far greater challenges than this, and our three children have two parents who love them immensely (and grandparents, and friends) and who will support them in whatever ways necessary. I am hopeful. 

ZebraARNP

Looking back, looking ahead

As I hang up my short white coat after my last clinical rotation of medical school, after the celebrations of commencement week subside (I have had more than my fair share of these), and before the reality and terror of starting as an intern starts to set in, I find myself looking back and looking ahead. What a wild ride these past years in medical school have been! Spending all these years preparing for the first day of internship. Along the way, also learning on the job of raising a child. As I enjoy the lull of these last few carefree days between completing medical school and starting internship, every now and then I feel like I should brush up on my clinical knowledge to allay intern year anxieties. Then I remind myself that no amount of preparation could have really "prepared" me for being a parent or a medical student, and nothing will really make me feel "ready" for intern year. Best to savor this time with family and friends.

Recently I came across this article in the New York Times titled "The Gender Pay Gap Is Largely Because of Motherhood". It goes on to discuss not only the impact of motherhood on income, but also career decisions made by mothers to give up job opportunities, inequitable distribution of household and parenting responsibilities. Looking back at that experience of mixing parenting and medical school, I have reflected on how things would have been different if I didn't have my baby during medical school? How would things have been if I had gone through this experience without being a parent? I may have done better in some rotations, or gotten better grades on some tests. In the end, those things didn't matter as much as I thought they did. I ended up matching to what and where I wanted to end up for residency. Even if I had a perfect application for residency, my desired outcome wouldn't have changed.

I am pretty early in my career to measure the impact of motherhood on my career and quantify it in terms of lost opportunity or income. In some ways, I can't imagine the alternate reality of going through the medical school experience without my son, my experience as a medical student is so completely intertwined with being a new parent. Sleepless nights dealing with baby eating into precious few hours to sleep during clinical rotations. Being in a perpetual rush to pickup or drop off my toddler from or to daycare. Dealing with meltdowns in the morning struggling not to be late. Preparing for tests while distracting my toddler without distracting myself from studying. However dealing with the responsibility of raising a little human taught me patience, empathy and humility, which I like to believe, made me a better human being and will make me a better doctor.

Boards, wards and...umbilical cord?

This is going to be one long rambling post. I know I've been mia (sorry KC). After finishing first year I just didn't have anything to write about. All I wanted was time to myself and with my family. Then second year came and went. I was able to stop pumping at lunch and ate lunch like a normal person (read: in the library, eating over my laptop, looking at slides). During winter break this year, we went on our usual family vacation to visit my in-laws and I spent two weeks loving life. I felt rejuvenated and was ready to attack the second half of 2nd year plus everyone's favorite, Step 1. Yes, I can do this, I am awesome and wonderful and multitasker extraordinaire. Want to see my color-coded Excel spreadsheet with my study schedule?

A few days into January, I felt funny. Funny, not like haha funny but rather oh shit I might be pregnant funny. I only had an expired cheapo Amazon pregnancy test. I don't think the second line could have appeared any sooner. It's just faulty, it's expired anyway (note: clearly scientific brain was not working at this moment.) My poor husband ran to CVS at 10pm at night and got me two real pregnancy tests and the first one I took turned positive just as quickly as the expired one. And then, I cried. We both didn't know what to say the rest of the night. We have two kids, we're living in student housing in a 3 bedroom apartment. I'm a medical student, staring down Step 1 and going onto the wards. He works full time and is doing a part time MBA. How would this even work? And for the next few days we honestly didn't know if we were going to go through with it and I found myself dumbfounded that I would be in this position, thinking about termination. Me, pro-choice advocate, having to decide for myself what my choice would be. I'll save you the drama and the back and forth, but long story short, we decided not to go down that route and we warmed up to the idea of having 3 (and by warming up, I mean we've accepted it and we're now excited but have no idea how we are going to deal with it come September). But can I just say how amazingly privileged am I to have been able to make a choice for myself, about my body? And equally important, privileged enough to have the resources to actually support another child. End political rant.

My first trimester was a blur of keeping up with school and keeping down my food. I had a meeting with my Dean and asked about what would happen to my third year "if one was to get pregnant." Luckily I was able to get a relatively decent rotation schedule and I start medicine during my late second trimester and finish with family and ambulatory before I go on leave. I just have to take my family shelf 2 days before my due date; I've already told my ob not to touch me during the month of September. I finished my last block of second year, which signified the end of my preclinical years. Somewhere along in there I had an NT ultrasound and my lovely doctor indulged me in a potty shot that revealed a penis, which after two girls, was amazing and surprising. I started studying for Step just as my second trimester began and the fog of nausea and fatigue magically lifted as if it was meant to be (but really, thank you placenta).

Alas, after weeks of studying, not seeing my family ever and having to rely heavily on the support of my husband, my mom and my nanny, I sat for the exam with baby belly, braxton hicks and stretchy pants with no pockets (so they don't make you turn them out during security checks!). I definitely felt a few kicks during the exam, cramped up a few times, but surprisingly 7 hours of testing with a fetus sitting on my bladder went by pretty quickly. And now, I have a few days off before 2 weeks of bullshit pre-wards orientation that are mandatory and then we're off to the wards.

I received an email today from the school letting me know I can't go to one of my doctor's appointments during said bullshit pre-wards orientation, that it's against policy. Because, you know, from 7:30am-5:30pm they're going to keep us prisoners with no breaks, no time for lunch or for me to slip out and see my doctor across the street. That I can do my glucose screen and prenatal check at another time (read: while I'm on call. On internal medicine. At the county hospital. An hour away from campus.) because that makes so much more sense. What bothers me most is this. I don't expect any sort of special treatment. Never in my 2 years at this school have I lamented about being a parent in medicine. I've never asked about more time for studying, I've never been absent. I haven't even taken a sick day. I've passed every single one of my exams and I've always made adjustments on my end to make things work on their terms. My school has ironically created a program called Parents in Medicine. Whoever goes to these events I'm not sure. I don't really know what the program actually is because if you're truly a parent in medicine, you don't have time to go to these things. While I appreciate that they're thinking of us, they're really not thinking of us the right way. We don't need to have events to talk to other parents in medicine and commiserate together about the system. Sure, having a fun family day is nice, but I can do that on my own. What we need is academic support and administrative support. I need to be able to go to a damn doctor's appointment, not have a 2 hour get-together in a park that I can't even attend because I'm studying. I need someone to answer my email that I sent out months before the start of said orientation about scheduling a doctor's appointment. End pregnant-lady hormone-driven rant.

Drama aside, I am excited to get on the wards and finally be closer to "practicing" medicine, but I'm also slightly terrified. I'm afraid of looking dumb, looking too pregnant, looking dumb and pregnant. Being away from my family and missing important events. Oooh and giving birth on the wards or during my shelf exam because I insist on finishing. Ironically the first rotation I'm on when I'm back from maternity leave is ob-gyn, so essentially I'll deliver baby boy huffing, puffing and screaming and then join the team a few weeks later - hey guys, remember me and my vagina? I'm already done with my birth plan. It reads like this: "No medical students please." Sorry guys, but let's be honest, it will be hard to pretend I don't know you.

Hopefully I'll have some time to write about being pregnant on rotation. I'm sure I will have some lovely stories to share.

Over exposed

The space that once gave me comfort has become a source of constant pain.  I am a breast surgeon and just  months ago my mother died of breast cancer. At my hospital. 

Before she died, I felt blessed to be here, and to be available for her.  My clinic adjacent to the medical oncology clinic, I checked our shared board and could track her through her day.  I would pop in between patients to go to her appointments.  If I missed one I walked 3 feet from my own workroom to the medical oncology workroom to chat with her doctor, my colleague.  When clinic was over or I had a cancelation, I could walk down the hall to infusion and sit with her. I would stop at the coffee shop on my walk over to grab a cookie or snack for us to share.  We would watch the Today show or some Lifetime movie while gossiping about any and everything.  These were my sacred spaces.  The places where I could be a part of healing, not just for my own patients but for my mom.  A chance to be there for her. She has always been there for me, more than I could ever express.  Even during that final admission, I could run to the cafeteria going the back way, I could tell all my family where to park, I helped navigate this monstrosity of a hospital, escorting everyone where they needed to be.  Her team was my team and it gave me a feeling of purpose, and brought her a sense of comfort.  For that I will always be grateful.  But now I sit on the other side of this comfort.  I walk on coals on the stone path from the parking lot to my office.  Each of her last 4 days began with this walk.  Every place is a trigger, every person I work with is both mine and hers.  

The list is endless. Faculty meeting takes me up the elevator to her hospice room.  I've now just stopped going, clinic always runs a "little late" and regrettably I'm unable to attend.  The long walk down the main corridor to the OR or the wards or the ER, represent a piece of her final journey.  I peek through the open door of the ER as I walk by, as if one time Ill see her there, in her pink pajamas on the night she arrived for that final admission.  Each walk through the ICU I feel my walk to her room, sometimes I feel the weight of my daughters hand as we head to visit Grandma.  I follow my chief on rounds and pray that today, I won't have to see a patient in the very same space - one day I do, and I am undone.  Each day I operate I lay before her, in the same operative room where she once lay, in a moment of hope.  The hope I have for my own patients.  Praying that their post operative story will be different than hers, longer and less filled with pain and fear.  

Soon I will walk down the same corridor for a biopsy of my own, in the same room, the same hall, the same side, the same spot.