The Devil You Know - A Book Review

I get really annoyed by those people who declare, "I only read non-fiction." And it's ok, if that's you, but don't say it snootily at a party when someone asks you if you've ever read this great fiction book. That's left me speechless and a bit shameful on more than one occasion - the person acts like fiction is non-fiction's red-headed bastard stepchild. And really, if I could go back in time - let's do that right now - I'd tell that person off. Fiction, I'll argue, is way more difficult to pull of than non-fiction. And I'll be damned if you can draw a straight line between the two. Fiction authors often weave autobiography into their own work, but instead of just spitting out what already happened they birth a new child. And that's pretty impressive, in my opinion.

I met Fizzy on Mothers in Medicine years ago when I first started. We became e-mail friends, she supported me through my divorce, I learned a little about her life. She is a very private person. I've met her for dinner once and I still don't know her last name. I respect that, and it comes with mystery and intrigue. We don't e-mail as regularly as we used to, but when she asked for me to read her new book a few months back and let her know what I think I felt like I had received an e-mail from Madonna (that's a nod to the book, by the way). I read it in one afternoon. Well, it bled into the evening a bit.

I read the first book, The Devil Wears Scrubs, years ago. I loved it, and talked about that here. What I loved about that book was how it captured the angst of medical school and training. What I love about this more is it captures the angst of mothering and working as an attending. It is a stand alone book - you don't have to have read the first one, but it was fun for me to reminisce about old characters as they were brought up again throughout the book.

Warning: This book will make you laugh out loud. A lot. Fizzy has always had a great sense of humor and in The Devil You Know she doles it out constantly. There was this one part about glitter - I almost put in a quote but I don't want to ruin it for you - where I was laughing so hard I had to put the book down. She perfectly combines the mayhem of being a doctor and a mother and a spouse - and doing it very imperfectly perfect. If you are taking yourself too seriously this is the book to pick up. I read it again to make this review better and it was a bunch of fun the second time around. One of the best things about it for me was I got a great big glimpse into my very private friend's - one whose blog - A Cartoon Guide to Becoming a Doctor - I've followed for years - life. No one can write a book like this without experience.

I could go on and on about the hilarious patient interactions and bumbling cast of characters at the VA (one of my favorite places on Earth where I trained) but Fizzy herself would stop me - I tend to get long-winded. JUST GO GET THIS BOOK ALREADY: HERE. You won't regret it!!

Side note to Fizzy - who ribbed me years back for never having read a book on a Kindle etc. - I have now read one book on my computer and phone exactly twice - yours.

Bridging the Wellness Gap

I have to give a shout out to my hospital (University of Utah*) and my department (Anesthesiology). We are trying. In the age when burnout is rampant and physicians are frequently leaving clinical medicine, we are working to foster camaraderie and resilience. A few examples:

The women in my department recently held an ad hoc Ladies' Lunch. We do this every once in a while, approximately once a year, but we should work on making it more frequent. It's merely a casual potluck lunch held at a faculty member's house for all the female anesthesia residents and attendings, but for me it represents more. Because I work part time in such a large group, I can go weeks to months without seeing some of the other faculty. Anesthesiologists practice their specialty alone, so in order to process work-related issues we have to consciously make an effort to seek out those connections. Our blue scrubs and hats were replaced with sundresses and sandals, and the conversation turned from patients to children, schools, and summer vacation plans. Resident MDs who have yet to venture into practice ate lunch alongside veteran tenured professors. Many of us are moms, with children ranging from 8 weeks to 19 years old. I learned some useful school information from a few of my colleagues with grade school-age girls. It was also interesting to talk to a couple of the ladies who work exclusively in the pain clinic, sharing stories about work environment and frustrations with the medical system. Two babies even made appearances: one wide-eyed, active 11 month old and one brand new infant attached to her mother's breast at the buffet table!

We started an intra-department monthly wellness newsletter (managed by my colleague Dr. Jennifer DeCou), which not only includes interesting personal tidbits about faculty members but also links and info for wellness resources. In addition, Jen has spearheaded a plan for immediate support, in the forms of work relief and counseling, when any anesthesiology practitioner experiences a sentinel event or a bad outcome in the OR.

Our hospital just opened a Resiliency Center on the medical school campus. It provides a space and some resources for relaxation, but the main advantage of this addition is a dedicated space where for on site, free and confidential counseling services. I have personally utilized the services of the third party counseling group on two occasions during my employment already: once when I experienced a health scare during my residency, and again when I underwent infertility treatment. It was invaluable to me, and now it will be even easier for employees to access the benefit since it will be in such close proximity to our workplace.

The piece de resistance... our hospital recently opened a faculty lounge that feels like an airline sky club. Attending physicians from all specialties are invited to use it for eating, changing, working, conferencing, meeting, sleeping... it has all of those features. Not to mention two fully automatic coffee drink dispensers! We have never had a physicians' only lounge before, and I'm excited to socialize there more with doctors of other specialties.

Where we could do better: childcare. As physicians, our schedules are often unpredictable and out of our own control. I live in fear of the midday call from my daycare that my child is sick on a day that my husband is unavailable to extract her, or the moment I get stuck in the OR with no one to pick her up at the end of the day. Some physician friends work at places where there is on sight, low cost childcare with extended hours, which to me would be the ultimate benefit. Within the past year, my hospital has at least added a backup care resource to their benefit package, but my experience using it so far has not been seamless.

Does your hospital, clinic, or practice group offer any unique services or facilities to enhance your work experience and promote wellness? Share them here so we may all get ideas to bring back to our own places of work!



* The opinions expressed here represent my own experiences and are not those of my hospital or department.

Refining

So this is my introduction to you! I’m excited to be a regular contributor to Mothers in Medicine. I practice family medicine by day and wrangle my brood of three small children by night. My oldest just finished kindergarten and my youngest just turned one. I’m approaching my ninth year in a busy primary care practice in the Pacific Northwest. I enjoy the privilege and challenge of caring for a variety of patients, from newborns to nonagenarians. I used to practice obstetrics as well, but haven’t since having my own babies. I miss it sometimes.

After finishing residency, I studied tropical medicine in London and have worked at a rural teaching hospital in Kenya. My teacher husband and I dream of living and working abroad with our young family; maybe when the majority of them are out of diapers.

I began writing in earnest after I had my first child in 2011. I did write throughout medical training but it took the refining aspects of motherhood to get me to take my writing seriously. Nothing like even less time and an unveiling of your faults for some forced self-introspection! I’m curious if any of you have found motherhood to be similarly clarifying? I’ve studied narrative medicine and bioethics and have taught narrative medicine workshops. Particular interests include medical ethics, global health, motherhood as vocation and the intersection of religion and science. I blog regularly on these topics, among others, and I’m currently working on my first book. I still always cringe a little when I hit “publish” or “send.” I imagine it will always be hard, as a type A introvert, to put myself out there.

My third, and presumably last, baby just turned one and I finally feel like I can breathe again. It feels like a milestone, reaching this point, after having three children in five years, settling into my primary care practice, letting myself take my passion for writing seriously and expand into that vocation.

My life has been disrupted many times in the past year with unexpected challenges and writing and community have pulled me through. I think much in medicine and in motherhood is refining: the pressures of medical school and residency, the intensity of caring for babies and children who need so much.

I’m excited to join you all in this journey; to learn from your wisdom and laugh alongside you. If medicine and motherhood have taught me one thing, it’s that we all need each other desperately - for kindness, for encouragement, for understanding. These are the things to cling to and to provide for each other in this world. Thanks so much for having me.

Time To Move On

Hi, I’m new here.  And very honored to be here, at that.  I’m a pathologist, in private practice for > 5 years (settling in to the flatter portion at the top of the exponential career curve of knowledge/abject terror), but < 10 years (I suspect, the point on that curve at which cynicism overrides all other basal functions and drives one towards a retirement countdown sticker chart).

I’m in my second post-training big-girl-pants job, and I’ve been here for a little over 8 years.  I briefly tangled with a super-crap job, lasting only six months right out of training, working for a very bad man rocking various personality disorders.....but that will be another story for another day.  This current job is where I became an adult.  And this job is where I damn near had my love for pathology drained of my brain completely.  But it’s time to move on, and I’m doing just that.

Over a period of years, I had somehow found myself struggling to get through the work day, doing twice as much work as is safe to do, getting paid a quarter of the money being made off of my back.  I had become everything to everyone in my office and to the clinicians in the hospital, and nothing to myself professionally. I hated every minute of it.  And my marriage was suffering for the long hours, which I finally figured out after hearing myself in every conversation trying to justify my absences. It just didn't sound authentic to me. Working 60+ hours a week as a pathologist is not particularly normal. But it took a while for me to figure this out -- Stockholm syndrome is real, ya'll. And then, nearly exactly two years ago I had a gorgeous baby girl, induced at 36+1 weeks for oligohydramnios, weighing in at a whopping 4 lbs 15 oz.  And my placenta was just as small as that tiny girl, 5th percentile.  Everything was "fine" until it wasn't.  I've since learned that many of the births to female docs in similar situations to myself are premature for various reasons, commonly for oligo……………can’t help but think there is a link there. 

I’ve worked with some wonderful people over the years while doing this job.  Most of the ones who have stayed for longer than a year are the type that persevere long past the expiration date, and they just keep on going.  Each seems to have his or her own reason for doing so:  'finish what you start', 'I cannot be defeated', 'everyone will like me eventually', 'it’s not really that bad', 'I deserve this pain', 'it is too hard to change'.  What is my reason?  I’ve already made too many mistakes.  This can’t be another one.  I can make this work.  My family is depending on me.

Life is too short to stay in a job that is soul-crushing.  No job is perfect certainly, but no job should harm your psychic core or fizzle your spark.  If you don’t recognize the person that you were, that idealistic nerdling resident, marveling at those exquisite enterocytes mingling with those gorgeous goblet cells, and you can’t find her deep down in there somewhere………..it’s time to make a change. And preferably before that gal has packed up her shit and moved to the outer recesses of the universe, never to be seen or heard from again.  Mistakes will always be made, some big and some small, but they can always be corrected.  Be the change, as they say (whoever they may be).  You always have the power to make things better.  I have become a path beast during my time here, and now I’m doing my best not to become a pathological beast.  Put yourself into the situation that you want to be in, whatever that may be.  It could take awhile, sometimes may even take eight years and some major life changes.  Remove yourself from the people and entities who take everything from you and give nothing back in return.  I’m doing just that in short order.  Even though it’s a move to a more backward state than the one in which I currently reside, but that’s yet another story for another day………

Take care of yourself first, the rest will follow.

Progress and peace to my fellow burnout warriors :0)
TheUnluckyPath

The Year in a Word Cloud

Control Issues

Hello everyone! I am going by Kicks, and I am 4 days away from finishing up my intern year in family medicine residency! We're currently pregnant with our first and can't wait to absorb all of this community's wisdom and advice. :)

Today was a rough day.

It started out okay. I'm on inpatient wards now, and I knew most of my patients going into the day. I had a very reasonable goal of being done by 3 to make my 3:45 OB appt with plenty of time to spare.

I enjoyed my AM visits with my patients, however I was late to group table rounds due to a few chatty cathys - one who had plenty of demands before going home tomorrow and one long conversation regarding an abusive situation. Rounds went until 1, however I knew I would still have time to do notes and do my last minute tasks before 3. And, being pregnant, obviously deserved a quick lunch break for nachos in the cafeteria. I have been trying to be a good role model for well being for the medical students on the service, and try to make an example of making time for lunch (although sometimes when they're not there, I try to sneak by with a Naked juice and cottage cheese break occasionally. Baby-to-Be loves the Naked juices).

After lunch, one of the medical students went with me to discuss MRI findings with one of our patients. We both were stuck in front of our loading EMR for awhile, and I made it a point to tell her that sometimes watching the EMR loading bar and being stuck in one place not being productive for a few minutes was a reminder for me to take a deep breath and remind myself I am not always in control. (Again, when I don't have a witness I've also been known to lightly slap the computer monitor). The MRI showed a likely tumor, so the discussion took awhile. I also had to stop downstairs and discuss the abusive situation from above with one of our social workers.

So clearly I am already running late. However, I hammered through my notes and was able to escape by 3:30 - so if all went well I would make it exactly on time to my 3:45 appointment 15 minutes away. Very doable.

I was not even one block away from the hospital when I got stuck. I have no idea why this van was stopped in the middle of the road, but it was surrounded by other cars who couldn't get around it. I waited at my light a few rounds before realizing this van wasn't moving one inch. I tried to go around the block - along with the rest of the world. Some random construction also popped up. Within half an hour, I had not made it 4 blocks away from the hospital.

I called the OB office in almost tears from my frustration. I felt terrible - the other intern was covering for me leaving early and I couldn't even make it to my stupid appointment. The scheduler on the line sounded slightly alarmed at how upset I was, and reassured me it would be okay and I could always call back in the morning to reschedule.

I felt awful. I don't think I have ever missed a doctor's appointment before. Where did I go wrong? Should I have taken a shorter nacho break to leave earlier? Should I have tried to write a note or two while the other residents presented during table rounds? Should I have delegated more of my afternoon tasks? The guilt piled on when I realized this was still pre-baby life. I had a mental image of Baby-to-Be sitting alone outside of the deserted daycare waiting for me, the long lost parent not yet able to make it home from work. And it got worse when I got home - and saw the laundry, dinner needing to be cooked, messy table and counter tops, Dog in sore need of a walk, and again realized - this is pre-baby life during residency and I am already exhausted. I cried into Husband's hug, and he promptly suggested leftovers for dinner and a nap for me.

I can say now I am a more functional person tonight s/p nap. And the dog did get a walk, but everything else is still dirty and that's okay. And it's okay to miss an appointment here or there - because one has to assume one can travel 3 blocks in a 30 minute time span on a usual day. Crap happens, and - as I was hypocritically telling the medical student just hours earlier - I am going to try and take more of those forced unproductive moments (like sitting in traffic) to take a deep breath, and carry on.

4 days left of intern year, guys. Just 4 more days.

Moving with Boxes: The Milk Update

My Monkey (3) wants to go home. One night this week, he started crying, sobbing, about milk. He is a bit speech delayed, so it is hard to understand him sometimes, but while we can usually figure it out; this time, we had no clue.

Monkey(5 AM): "Milk with cow! More milk!"

Me: You want another bottle?

Monkey: NO!! Milk with cow!

Me: What?

Monkey: Cow! Milk with the cow!

After 20 minutes of taking everything out of the fridge, his suitcase, and the pantry, I finally realized he was talking about the brand of milk we used to buy. The milk I bought had the wrong logo and all he wanted was a different brand of milk. So, the next day, we went to super specialty fancy store to get the milk he wanted. (Because here, in NEW CITY, they don't stock it in the general local grocery store).

Like the milk, we are slowly figuring things out. We are still in mattresses on the floor, because our truck is somewhere in the middle of America. The old washer that came with the house made rust stains on all our clothing. We ate 5 days of pizza/hot dogs and fast food takeout. But it's been a LOT more fun and a better adventure that I was anticipating.

I know my post last week was super intense. With the whirlwind of the first week in a new home and new city behind me, I can happily say this one will be a lot lighter!

The past week, our life has been a series of lists. To do lists, errands, stuff we need for the house, day camp supplies, etc.

So, here is my update list:

1)  Your village can be online. The minute we got on the plane, my sister, brother-in-law, and other siblings got together virtually to order a whole box of essentials on Amazon Prime Now to be delivered to our new home. That first night, after straggling off of the airplane/Uber journey with 2 very very overactive children and 1 anxious dog, I felt such a surge of relief, joy, and gratitude when I noticed the familiar Amazon logo. We already had a stock of tissues, toilet paper, dog food, dog bowls, Cheerios, hand soap, and Cheerios waiting at our doorstep. It was as if my entire family was there, hugging us, welcoming us and cheering us on. 

2) Make new friends but keep the old. My mom's old childhood friend, who I knew well as a child, but have had little interaction with in the past >20 years, lives in our new city. My mom reached out to her and as she is such a gracious woman, she has been like a second grandma to us the past week- bringing us dinner, allowing us to swim in her pool, and giving me lists of handymen, gardening advice, and other helpful pro-tips about our new town. I miss my mom so intensely, but having someone here is making that void a little less raw.

3) Be open-minded. My husband has a sister in our new city (the one saving grace for my husband). With medical school obligations for most of my marriage, I have not had a chance to really form a super close friendship with her (we see her maybe 1x/year). She has her own family and obligations, and I was tentative about asking too much of her. But she brought us dinner our first night, and has been SO above and beyond helpful, kind, welcoming, and supportive. I am looking forward to getting closer to her and actually forming a proper relationship.

So, even though all 4 of us have all been sharing 2 towels for a week because our truck is MIA and I refuse to buy stuff we already own, I think we can call week 1 a success! Orientation starts tomorrow, so hoping the good times continue!

- Boxes

Hostage

Tonight there will be no ransom paid, despite the long list of demands:

wash the dishes
clean the kitchen
wipe down the highchair
finish charting
return emails
analyze research results
research preschools
order Spiderman pj's
check yoga schedule - missed it tonight, maybe tomorrow
pay bills
fold laundry
feel guilty for not doing more


Tonight, the hostage will be released after being locked away too long. Into open arms it will stumble, what was once so comforting feeling foreign, unsure how to proceed. It is time to disregard the ransom, knowing such a sum will never truly be paid: best just to let it go, start anew.

Tonight there will be no ransom. Only the freeing of that long-awaited, so often yearned for, prisoner:

Sleep.

Moving with Boxes

Hi! I am so excited to join this community. I have been following since applying to medical school 6 years ago and now, med school and 2 kids later, am honored to be able to share with this community more regularly.

I am usually an upbeat, sunny side up, West Coast girl. But I would like to introduce myself with a post that bares my soul and reflects a more raw version of myself. Below is what I wrote 3 days ago, the night before getting on a plane with my husband, kids, and dog, to fly across the country to start EM residency. With the chaos of moving I didn't have a chance to share until today. I'll hopefully post a more positive update later next week!

I'm flooded. And overhwlemed. and the dam that has been holding my emotions at bay has broken and every thought, fear, feelings of guilt, absolute fear, and sense of desperation keeps washing over me, unrelenting, like a wave, as I fight the current in the tumult of emotions  that keeps pounding relentlessly. 

let me backtrack. 

when I fell in love with emergency medicine the beginning of 3rd year, I knew that was the only field of medicine for me. the pace, the variety, the sense of camarederie, the fast paced atmosphere. I was hooked. I also knew that getting a residency position in my home town would be a stretch. my step 1 scores were okay, but test day was blunted by braxton hicks contractions and running to the bathroom with my 8.5 month waddling belly and I underperformed all my practice tests by about 10 points. so when eras and interviews started, i knew that moving away from my hometown was a real possibility, if not probability. 

on match day, i told me parents and grandparents and aunts and siblings  (who all live within a 5 mile radius of me and the med school) not to come. i knew i would not get in to the top 10 rated programs in my hometown. i was right, and opening that envelope ensured that my husband, 2 kids, and i would be traveling for an adventure across the county for at least the next 3 years. 

i went into GO mode. i found a house, registered the kids for school, hired a moving company, organized a goodbye party. but we leave tomorrow. and i am now terrified. 

i had my daughter, Chicken, a few months before starting med school and my son, Monkey, after Step 1. My kids go to my parents every day after school and most weekends when i need to study. They play at my grandparents' house on Sundays. My aunts and siblings have driven more carpools and orgsnized playdates and provided last minute babysitting more times than i can count. and now i am leaving the village that helped my little family thrive in med school and we are leaving so so far away where we have none of that.

i am just so scared. so scared that my kids will feel lost and alone. so scared that they wont be able to continue strengthening the amazing relationships they have with their grandparents and great grandparents. so scared that i will ruin or permanently derail my husbands career. so scared that it is all my fault because chose too competitive of a residency and wasnt good enough to get in at home. 

i love my program. i am going to love residency. im just so scared of what i am going to mess up in the process. 

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.