Mau Man and the Chronicles of a Low Birth Weight Mama

BIRTH:

In early March, I became a mama for the second time. We have nicknamed our new little one Mau Man. Our home birth didn’t feel all magical like the pictures I see on the Internet but maybe after continued exposure to oxytocin while nursing I’ll change my story and in a few years I’ll tell you all about how magical it was (feel free to call me out on it!). It was intense and brief (he came within 3 hours but it felt like days). Similar to our natural hospital birth with our first Zo, the details are hazy and I feel traumatized. Did a human just burst forth from my body? Yup! He did. Did I feel like I would give up. Heck yeah, I felt like throwing in the towel a few times, but I didn’t. Was I scared. You bet I was! Did I feel powerful afterward? You know what, I sure did! And super tired too, just like with Zo. I feel like no matter where you deliver, birth takes over you, it takes hold of your being and you just have to submit to the intensity of the process.

LOW BIRTH WEIGHT, THE CONTEXT: Now we find ourselves with our newest little one who is healthy in every single way except he was tiny at birth. 2360 grams (or 5 pounds 3 ounces). Under the low birth weight cut off of 2500 grams. I have read countless studies of how Black women like myself, regardless of socioeconomic status, are at a higher risk of pregnancy complications, maternal and fetal mortality, preterm labor and low birth weight. At my Baby Sprinkle a few months ago, a group of my closest friends and I spent considerable time discussing this topic. Pretty morbid but we are all Black doctors, educators, and health care professionals. But somehow I thought, I would be insulated, I would be spared. I took my vitamins, exercised, meditated, saw a chiropractor twice a week. With all of the complications and losses friends and patients have had I realize that low birth weight is manageable but it still hurts. After our own loss last year, I realize that regardless of how small he was I get to hold him and touch him and smell him and snuggle him and nurse him and I will do everything in my power to get his weight up.

LOW BIRTH WEIGHT, THE COMPLICATIONS: Flash forward to Day of Life 3. His weight loss was more than what our Pediatrician and I liked and he was at risk of hypoglycemia and dehydration. He had a good latch but he just couldn’t muster up enough energy to transfer milk out of my breasts fast enough to grow. I had to start nursing and feeding him every 1.5 hours and start pumping several times a day to provide expressed milk to supplement him with. We worked with an amazing local Lactation Consultant friend first at our home and then in her office and started using a Supplemental Nursing System or SNS. This is a little tube that you attach to a syringe to feed babies at the breast or using a finger to help train them. This helps prevent nipple confusion by delaying the introduction of a bottle. Day of Life 4 was a blur with a ton of feeding and pumping. Day of Life 5 - he had begun to gain weight and his parents were exhausted. We were allowed to space him out to every 2 hour feeds. Day of Life 9 back to birth weight. Day of life 18 weight up to 6 pounds.

And this is where we find ourselves: Nurse and reposition the SNS 10 times. Pump. O finger feeds with SNS in the early evening so that I can sleep for a few hours (this is priceless! Many thanks to Lactation and our old school Pediatrician who made this a key part of our process). Smile. Cry. Have a melt down feeling guilty that I couldn’t make him fatter. Listen to a podcast. Take a lactation supplement. Play with Zo for a few minutes. Tell Zo to be gentle and not climb on me while I’m nursing. Get a pep talk from the hubby. Repeat.

I’ll keep you posted and can’t wait until I can throw this SNS out. I pray for the day he is exclusively breast fed and that breastfeeding soothes him.

My world at night: our 30mL  syringe, the SNS premature baby feeding tube, my 2 pumps - my Spectra electric pump for daytime pumping and my NatureBond silicone manual suction pump for easy night time pumping - I pop it on the alternate breast while nursing/SNS feeding. 

REFERENCES:

Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. https://www.ncbi.nlm.nih.gov/pubmed/21213184

Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It. https://www.propublica.org/article/black-women-disproportionately-suffer-complications-of-pregnancy-and-childbirth-lets-talk-about-it

Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206968/

What’s Killing America’s Black Infants? Racism is fueling a national health crisis. https://www.thenation.com/article/whats-killing-americas-black-infants/

Mommy time/ whenever I can get it

How do you fit your "mommy time" in?

I love residency. I love what I do, love my work colleagues, and am so thankful for my attendings and program director. I could not have imagined a more supportive community. 

One thing I'm grappling with right now is keeping any sort of structure for my kids when I am at home. When I am at work, the house runs like clockwork. My husband gets them to school on time, the nanny has them fed, brushed, bathed, and in bed by 7:30. No fuss, no problem. 

But when I'm around, it's chaos. And not the controlled choreographed chaos of the ED. It's pure, unpredictable, chaos. For example, this morning, all before getting to school by 845 (very late- they start 745), my daughter "ran away" from home down the block, the kids put on a puppet show, everyone ate pancakes, and only then did we start getting ready for school. 

As an EM resident, my schedule is varied. I work a lot of later day shifts (10-10) or mid shifts (2-2) and at least 2 full weekends a month. I usually average about 1 dinner/bedtime/bathtime home a week. During that night, we try to fit in all the homework for the week, I try to hear all the stories about their friends, cuddle time, book time, story time, song time, just-be-with-mommy time. Needlessly to say, bedtime gets substantially pushed off. On the mornings when I'm home before shift, I'm usually exhausted, but, as I have not seen them for 2 or 3 nights already, we morning cuddle, make pancakes, read books, play dress up, etc. Trying to fit all this "mommy" time into the 1 hour or so between wake up and school is impossible. So we are late. Consistently. 

I know that once they are older, getting to school on time will be more important, but it's been a challenge to balance between maximizing every second I get to be home with them with sticking to a routine. Some days are better than others, but I'd love any tips! 

How do you maximize quality time when you don't have the quantity time to give? How do you balance discipline/structure with just enjoying their company?

Financial Wellness?

Do you know how social security works? Are you maximizing contributions to your retirement accounts? Have you ever heard of a 529 account, or a backdoor Roth IRA?

I combed the archives of this blog, and while there are a smattering of posts on money and costs of being in the field of medicine, I didn't see much about money management and financial planning. It's not a topic people commonly like to discuss, and yet it's so important to our overall well being. Physicians are notoriously horrible at managing money, and yet many in our profession shoulder a huge debt burden, one that can amount to hundreds of thousands of dollars by the time all the training is over. And at that point, the last thing most people want to do is continue "living like a resident", so they commence with lifestyle inflation and remedies for their delayed gratification.

                             

Last weekend I had the pleasure and opportunity to attend the first Physician Wellness and Financial Literacy Conference, aka the White Coat Investor Conference. It took place in beautiful Park City, UT with two days of CME talks, broken up by mid-day skiing time. The conference featured valuable information presented by physician experts in the areas of finance, financial independence, and burnout, along with some financial professionals (who did not have an interest in charging huge fees to physicians for their services, an issue common to many physician-targeted financial advisors). There was even a talk by one of the only female physician financial bloggers, Miss Bonnie MD, who also happens to run the very active informational goldmine Women Physicians Personal Finance Facebook group.

On day two of the conference, I represented both PracticeBalance.com and Mothers in Medicine on a panel of six bloggers for a Q&A session. Despite being the only blogger there who does not primarily blog about finance, it was a lively discussion with lots of inquisitive attendees. It left me with inspiration to blog more, and blog more about financial issues that I deal with!

Over the course of the weekend, I met so many inspiring people - especially women - who are taking control of their finances so as to not become an "underwater doctor" statistic. We often say in my household that debt = slavery, and that sense of lost control is what often leads to burnout for many professionals. While debt is for most people unavoidable on some level during medical training, we physicians have the power to manage it and at the same time plan sensibly for the future. I felt so much more empowered after attending this conference, and I highly recommend that you all check it out the next time it comes around. At the very least, take a look at the blogs (linked above) by the White Coat Investor, Physician on Fire, and Miss Bonnie MD. They are a great starting point on the path to proactively managing your money.

Adventures in Pumping

Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

Are residents worse post-pregnancy?

This is an interesting article about how peer evaluations of female residents go down after pregnancy, while evaluations of men who have children during residency do not go down.

I was wondering why this might be the case. I thought of a few possibilities:

1) resentment towards pregnant residents who took a leave and everyone had to do extra work to cover. I wonder how evaluations might be affected in other residents who took leave for other reasons. Of course, people generally think of pregnancy as “a choice“ so leaves for other medical reasons might be looked at more sympathetically.

2) performance may actually decline after having a baby. I don’t know about you, but if I am awake breast-feeding two or three times per night, I’m probably not going to perform at the same level as I was when I was well rested. Also, once you have a baby, no matter how good your support system is, you’re still somewhat at the mercy of your child’s health. Even if you have someone to watch them when they are sick, you probably aren’t going to be able to work when you are actively vomiting from the G.I. bug that they gave you. (I tried.  I was sent home.) again, this is something where man should theoretically be affected as much as women, but there is probably more of a tendency for men who decide to have a baby during residency to have a spouse with a more flexible career. And also, they don’t have to breast-feed.

3) Other residents might not take you as seriously when you become a parent. They may feel your priorities are shifted, even if that’s not actually the case.

What do you think?  If you had a baby during residency, do you think it changed what the other residents thought of you? Did you change your opinion of female residents that you worked with after they had a baby?

My almost-teen

“I saw J do the reading the other day at church, and at first, I thought it was you. She is becoming a young lady,” Maureen said to me on the sidelines of a soccer game.

My daughter is 12, soon to be 13, but has recently passed me in height. She is never far from a book – goes through them like that – and can’t help but blurt out her responses and reactions to the plot twists in real time to anyone around. “Anna betrayed her!” “I can’t believe he did that! They have the twins!”

She confides in me still, and each time we are there with the door closed to her room, and I am consulted in critical matters of friendship or fashion decisions, I try to proceed gently as if I’ve been let in to a secret society and don’t want to blow my cover. She recently cried into my arms over a friendship disappointment. I felt the same mixture of calm, responsibility, and honor I feel to be let into that moment as I do when a medical student starts crying in my office in my role as a student affairs dean. Or when a patient breaks down in front of me under the weight of a diagnosis.

She started taking martial arts recently since she wanted to learn self-defense. We found a low-key place that offers all types of classes for kids and adults. She does the kids Muay Thai and immediately following is the self-defense class for ages 13 and up; they allowed her to trial it to see how she would do. She texted me before the self-defense class and wrote “I don’t think I’ll do it,” and inserted a chicken emoji. I called her immediately. There were adults and older teenagers taking the class and she felt very intimidated.

“You should do it,” I said.
“But I’m scared.”
“Just try it! I can’t pick you up until after the class anyway.”
“Okay…” she said reluctantly.

I came to pick her up ten minutes before the end of the class and sat down on the viewing benches in the waiting room. There she was, practicing with her partner, a woman in her 30s in a pink hoodie. She was there among older teens and men and women—she seemed so grown up! She was clearly comfortable, holding her own, and loving it. The group huddled in closure and then started clapping and looking at J. She practically skipped out to me at the end of the class, face aglow.

“I want to come twice a week to this from now on. I’m thinking it might be hard in the fall with my two soccer teams, but I want to figure a way to do it!” She was breathless with excitement. “Can we get the gear? I’ll need the punching gloves and shin guards.”

My almost-teen is growing up. I love that she allows me to be there for her. Mothering now is more coaching, guiding, discussing. It’s confiding and listening. It seems like just yesterday she was an exuberant 3-year old who loved Dora the Explorer and would grab my keys, throw them under the couch and say, “Swiper, no swiping!”

I’m amazed by the person – the woman- she’s becoming. She is still that exuberant child, but now with a playful sarcasm, insight, a deepened faith, and strong sense of morality. I’m navigating my new role: sensing, adjusting, responding, and still gently pushing her to keep growing.

We’re both growing, and I wonder how long I'll be a secret society member. Is it life long? Since that seems pretty amazing.

Going part-time

I have been a little MIA here since I've joined the chaos that is being an attending!

I was once told that the first year of being an attending would be the hardest. That is quite the understatement.

I was going through so many changes this past summer. I moved out of San Diego, a place that has been home for 14 years. I joined my husband in Los Angeles and after 2 years of long distance, we are finally under the same roof! Little C started her new school. It was basically a lot of change. It was all good but with any transition, it is never smooth sailing.

Fortunately, all that stuff mentioned above went pretty smooth. Kids are so resilient. Little C had a best friend by week 2 and by the second month, she was completely adjusted. It is definitely nice seeing my husband's face in person and not via FaceTime! But it turned out, the hardest transition was my new role as an attending.

I joined a private group. I remember posting on this website about what to ask in a job interview. To sum it up, I was way too excited that I was actually getting a job that I forgot majority of the advice given to me and signed a contract without really knowing what I was getting myself into. I had a sense of what the group would be like but I went along with their assumption that as my first year out of training that I would want to jump right in, make a lot of money and be on the full-time schedule, which included a lot of weekend call and evening shifts.

Initially, it didn't seem horrible compared to residency and fellowship. But my biggest dilemma now was how do I juggle being an attending and a mom without my own mom? My mom has been more than a grandma the past 4.5 years since little C was born. She was her primary caregiver for 2.5 years and the following 2 years of my long distance with my husband, she was available for every single sick day, call, evening shifts and weekend obligations. But I wanted to hold true to my promise that she would be a grandma once I became an attending. I think I really burnt her out the past almost 5 years and I think it was starting to put a dent in our relationship so this was new territory for me.

I found an incredible nanny to help with picks ups and drop offs but I was often very frustrated as to why I was working this hard and still not getting the work life balance that I thought I would ultimately have once I became an attending. I grew very unhappy, bottled it all up inside and did something I never thought I would do.

I quit.

But the most surprising twist of all was that my resignation wasn't taken and instead I was asked what would be my ideal schedule. I was shocked. I didn't expect such encouragement and flexibility. It took some convincing because I didn't think I deserved this kind of special treatment being so fresh out of training but it turns out, there were many people in the group who had different contracts that accommodated their lifestyles.

I thought I would let the group down if I didn't work the regular full-time schedule. I thought I was selfish asking to be taken out of the call pool and to only work from the hours of 8-5. But trying to quit ended up being the best decision ever. I got my dream schedule. I finally have time to work out for the first time in 5 years. I have the luxury of dropping off and picking up little C from school on Tuesdays and Thursdays. And the idea of second child is exciting now, rather than terrifying!

I feel like I can finally breathe now after 6 years of holding my breath and just trying to survive during residency and fellowship. I finally did it. I got my work-life balance. It's never perfect but I can work with this. So my take away lesson from all of this is don't be scared to ask for what you want, preferably without having to go through an almost resignation like myself!

The MiM Book is out!

Available through Springer, Amazon, and Google Play

We are thrilled to announce that our MiM book "Mothers in Medicine: Career, Practice and Life Lessons Learned" is out! Written in the same conversational style of the blog, our authors address issues such as having children during training, practice considerations for the mother in medicine, negotiation skills, work-life integration, and challenges including divorce, financial hardship, and infertility, and more. We capture some of the wisdom "gold" mined from the blog over the past 9 years. We hope this can serve as a valuable guide for women at all stages of their career: from the premedical student wondering if she should go to medical school, to the practicing physician looking for support in balancing their multiple roles.

Chapter authors include MiM contributors T, Cutter, Genmedmom, Fizzy, Jay, m, Gizabeth, PracticeBalance, Emeducatormom, and Beckster. We also were fortunate to have authors with expertise in their areas write other chapters (e.g. an amazing student affairs dean writing with one of her former students, a thoughtful internist who chose to leave her job, private practice partners who learned to negotiate the hard way). Physician writer mom Danielle Ofri writes a lovely Foreword.

Sprinkled throughout the chapters, we feature blog excerpts and comments - some of you faithful readers and commenters might find your comment included! You all helped make this book a reality. Thanks, as always, for being part of our community.

Happy reading!

*Springer, our publisher, has offered a 30% discount through a discount flyer that you can access through the tab "The Book" above. (They don't do discount codes apparently.) The discount is good through June 1, 2018. 

What is wrong with you??

Lately, I've been cutting back my hours at work for it to be more in line with the part-time job I originally signed up for.  This resulted in an interesting conversation.

Coworker: "Can I ask you a question?"

Me: "Okay...."

Coworker: "I don't want you to be offended."

Me: "Oh my God.  Just tell me the question."

Coworker: "Why would you want to work part-time?"

He wasn't trying to snark my decision, but was actually genuinely baffled.  Why would I want to work 60% time and earn 60% of the money everyone else does?  Many other people go in the opposite direction: picking up per diem work wherever they can get it.  I know one guy who does per diem work both days of every weekend after working all week.

It was easier to justify to others working part-time when I had babies, although in some ways, I'd rather be part-time now.  My kids are SO much more interesting now.  And while daycare always ended at 6:30, school ends at 3, and I actually have a chance to be there when they come home from school.  I can help them with homework instead of entrusting it to the afterschool program.  I can go to girl scouts.  I can actually be an involved parent.

And the other factor is we don't live large.  I don't like to travel. I don't like to go to expensive restaurants or shows. I'm wearing the same winter coat I had in college.  We have all the same furniture we bought a decade ago at a discount furniture shop.  And we live this way not because we're depriving ourselves, but because I simply don't long for anything different.  If I won the lottery, I don't know if my home would look that different.  But I would work part-time.  That's all I really want.

So if I can, why wouldn't I live like I won the lottery?  Why make a bunch of money I have no interest in spending just for the sake of making money?  We make plenty of money for the life that we live.

And going back to that conversation with my coworker, that was my answer:

"Why do you want to work so much?"

Tales from intern year

I am now several months into intern year. The first few weeks... months... of intern year almost seemed like a daze. Wake up. Work. Eat, sometimes. Sleep, maybe. Rinse and repeat. It was only a few short months ago, which almost seems like a lifetime ago, that I was looking back at the trek through med school and wondering what loomed ahead in intern year.

Several weeks after that, I was sitting in an orientation for newly minted residents, listening through a whirlwind of talks about figuring out the EMR system, deciphering HR benefits, wellness talk by the program director, who predicted our intern year trajectory would go thusly: "first 2 months being scared s#@*less, next 2 months starting to feel little more comfortable, and the next 2 months, which puts us squarely in the middle of the long dark nights of winter, being depressed, the gloom of which will start to lift off with more daylight hours".

The beginning of intern year felt so jarring, to one day suddenly have people refer to me as "Dr. Lastname" instead of "Firstname" or "yo medstudent". Not exactly an unexpected outcome, I got plenty advance notice that was coming after 4 years of medical school. But I was so used to being either ignored by nurses or being treated as a nuisance, that when they suddenly started asking or paging me about whether to give insulin to this patient or Ativan to that patient, yeah, my thoughts at the time are illustrated above.

I remember agonizing endlessly over the smallest of decisions in the beginning. "Doctor, this patient is asking for Tylenol". "Let me call you back in 10 minutes after I do a thorough chart review to make sure I don't harm this patient with Tylenol with some contraindication that I haven't thought of as yet". I distinctly recall the jubilant moment of the first day of intern year when my co-intern and I high-fived each other after our biggest accomplishment for the day, figuring out where the restrooms were!

As months rolled on, just by the virtue of doing the same thing over and over, I started to feel more comfortable. Though I have soooo much more to learn and improve upon, reduction of that initial cognitive burden (figuring out the EMR, where the restrooms are etc.) has helped with efficiency. Some things have started to become second nature, with enough jolts to snap me out if I become to reliant on heuristic thinking.

There was something to what our program director said in the beginning of the year. We mostly followed his predicted trajectory, cluelessness --> tenuous comfort --> gloom. Which now brings me to the deep dark cold months of winter, which coincides beautifully with the peak of influenza season, everyone getting sick, chaos of finding coverage, and on a personal front, uncertainties of kindergarten/pre-K lotteries. Perhaps his predicted trajectory will continue, and when things settle down, and there are more daylight hours, gloom will lift?

Doctors Make the Worst Patients (Part 2)

You can take the girl out of the mania, but you can't take the mania out of the girl.

That doesn't even make sense, I know, but most of December not long after I was diagnosed with hypertension was senseless. When I went for a follow up two weeks later the nurse asked if I forgot to take my medicine. "Are you on Adderall?" she asked. Heck no. This beta blocker is just about the only prescription drug I've taken in my life besides rare antibiotics. "Well take a deep breath. Maybe I can get some better numbers. You know you've gained three pounds." This, a pet peeve of mine. I hate when I tell them I don't want to know my weight due to my OCD tendencies with numbers and they make comments about it. I reminded her we are in the middle of the holiday, everyone gains weight. She smiled, shrugged, repeated the study. Still sky high. So my doctor started me on a second drug, told me to take my pressure once a day to make sure the numbers were going down, and come back in two weeks.

Sure enough the numbers came down, but I was in despair. Two prescription drugs? Hypertension doesn't even run in my family. I bumped into my cardiologist friend in the cafeteria on call New Year's Eve weekend, and shared my story. He told me to get on a low salt diet, specifically the DASH diet. I promised and walked over to get my normal lunch - a cup of soup, which to my alarm had almost as much sodium as a normal person needs in one day. I withdrew from the soup stand in fear and grabbed some fresh veggies from the salad bar.

Now I've been on a lot of diets in my life for various reasons - gluten free to calm down IBD, watching calories, etc., but I learned over the next few days avoiding salt is like avoiding the AIR WE BREATHE. It's in everything. Last year I was so proud of myself for buying unsalted butter but I needed to get a little more serious this time. Soup was out the window. Soy sauce, even the low salt OMG. Salad dressings. All preserved and canned foods. Most things pickled. The yummy salami and pringles and cheese that my impossibly and aggravatingly fit husband brings to the couch to watch TV after a full dinner every night; somehow he can do this whether he's riding his bike or sitting on the couch for two months and gains not an ounce of fat. My body is not so forgiving. It has to go.

I made a quick trip to the supermarket and bought every superfood to lower blood pressure I could find on Google on New Years Eve. Ordered ground flax seed off of Amazon.  Have you ever eaten naked beet chips? If you do, when you go to get that little bit out of your tooth don't worry, as I did, that your mouth is bleeding. And I guarantee one naked beet chip will be enough for the rest of your life. I drastically cut my food intake. I went back to the doctor for my yearly wellness visit a few days later, ugh. I've visited the doctor more in the past month than I have in years. The nurse, again with the weight thing. "You've lost 12 lbs since you were last here." I was startled. I certainly did feel less bloated. I guess I was so salt overloaded I was carrying at dozen lbs. of excess water weight that took only 10 days to shed. In retrospect I did spend much of the first two days in the bathroom. Current in office blood pressure: 100/70. Whew. The doctor was so impressed he advised cutting back the water pill in half.

Well, that didn't work. The numbers crept up. And thanks to the nurse telling me my weight, I was manically stepping on the scale every morning. The cardiologist informed me that some people have a low tipping point, and mine is obviously one of those - losing a few pounds could help a lot. When four days later my weight hadn't changed despite severe food restrictions and my blood pressure was so sky high it scared me into taking the second half of that pill I had an uncharacteristic ugly cry meltdown in the shower, laced with intermittent screams of rage at lack of control. The very same me that read The Untethered Soul two months back and decided my soul had transcended any Earthly need for control. I took a deep breath. I am the same person that looked at myself in the mirror admiringly a month ago without knowing the numbers. No more numbers. And what was that diet the cardiologist recommended again? I googled and found there was a book! On the DASH diet. Whew. I can do anything with a book. I ordered it on Amazon and learned it is ranked #1 Best Diet Overall by US News and World Report. It was developed as a heart healthy diet and turned into a sensation. And better yet there was a new one published advertising eternal youth as well! Well, younger you anyway.

It arrived Sunday and I skimmed it over an hour. Got the gist. To my relief I can actually add food to my  current restricted diet, a lot of it, if I just eat the right things. And it's really easy, except the suggested recipe part that almost gave me a nervous breakdown. And the part where it gives examples that seem to require I quit my job and tie myself to the kitchen to create such a varied diet. Luckily I can largely achieve the basic formula with food at my grocery store and in the hospital cafeteria. Maybe try a recipe every few months if I get a day off. And it encourages daily red wine! Perhaps not as much as I'd like but definitely a plus. I'm just waiting on my food scale from Amazon to learn what four ounces of fruits and veggies are, guestimating in the meantime. Reminding myself that this doesn't have to happen overnight. Hopefully if I keep it up a few months I can get off of the meds. I'm 44 years young, I've got a lot of days left in this meat suit. I've got to keep it going - there's much more to do.

To OB or not to OB...that is the question

Career advice wanted

I’m having a mid-residency crisis. I’m halfway into my three year family medicine residency, which means in a year and half there will be much more independence but also much less of a safety net below me.   I want to practice in primary care - so I know that it won’t be hard to find a job, however will be much more difficult to find the right one. I’d like to continue doing underserved medicine of some variety - but not sure if that means staying in the city as I am now or moving to a rural area, possibly closer to family now that Baby is here. I’m currently ruminating on whether I’d like to continue practicing OB or not.

It was a surprise to me how much I liked practicing OB as a resident. I liked it as a med student enough (although I will forever hate ORs - I’m too clumsy with too little body spatial awareness) but doing deliveries of my own clinic patients has been so rewarding and energizing. When I find that precious time to devote to independent learning, I find myself reading OB literature (and staying awake through it) more than any other kind.

Today was the first call for a delivery I’ve had since our own Baby was born. As timing goes, it was perfect for me. I was called at 6 am, ran to the hospital, and was back after a beautiful delivery by 9 am. It was great for me - but maybe not so much for Husband. When I left at 6, Baby was just starting to wake up and Husband had stayed up late working the night before, was already awake and was very much looking forward to a morning nap. He didn’t say anything negative, but his expression was less than pleased.

...and this is a best case scenario when I got called in. Our residents are continuously on call for our own patients with lots of back up as with residency schedule we may be working nights or a hospital shift elsewhere that we may not be able to leave. My husband didn’t realize it was a possibility that I would be going in today, but the reality is it’s pretty much always a possibility as I’m usually within 2 weeks of a patient’s due date and babies don’t always come on schedule. And I think as an attending, I’ll likely be much more responsible for my own patients’ deliveries - although having adequate back up is something I am definitely evaluating as part of my future job.

So my question is... can we do this? Or more accurately, will it be worth the effort to do this? We don’t have family close. We don’t really have an emergency contact nearby who can watch Baby if plans change quick. I think I can handle the lack of sleep and unpredictable hours, but is it fair to ask my family to do the same? What about when we want to leave town and spend time with our family? Husband and I have had several conversations and will continue to do so over the next 6 months as my patients continue to deliver and we’ll see how it goes.

 I just really wanted the advice of some moms who have been practicing outside of residency for awhile. Spoiler alert: this likely won’t be my last post asking for career advice. Are you doing what you want in your careers despite a somewhat demanding call schedule? Or did you find that giving up a bit of call was worth it for a little more overall family stability?

The Little Echo

Almost a year ago, I was worried about her lack of verbal expression. Now, she talks constantly. She knows so many words, it’s amazing. But I'm starting to realize that having a highly verbal child exposes your own verbal ticks.

She adorably engages in imaginary play with lots of critters and stuffed animals. When they “take naps”, she shhhhhs them really loudly and pats them quite vigorously. Hopefully that’s not how she sees my pats and shhhhs. She scolds the dog in the same booming tone and inflection as my husband. She rattles off “thereyago” all the time. Apparently I say this a lot. Along with some choice swear words, particularly the ones that start with S and F, when I drop things or mess up in some way. Bad mama.

But most concerning is actually her use of “sorry”. I’d rather have her throwing around an occasional swear word than apologizing for everything she does. I didn’t realize it, but I do this too. It’s such an easy word to say, yet the meaning is both diluted and potentially detrimental when used to frequently. Saying sorry is apparently epidemic among women. There have been so many pieces written about this in the past few years, but I found this one most entertaining (replete with GIFs). Sasha at Brave Enough gave examples of how sorry is frequently used by women in the OR. After reading this, I'm going to think about what I say the next time there is an anesthesia delay during surgery.

What about you? What do you say that your child echoes back to you, and has it prompted you to change the way you talk?

Chocolate Sprinkle Sandwhiches

I cannot believe it has been so many months since a post. A quick update...

1) Biking to work is so unbelievable. When we moved across the country, one promise I made myself was that if I had to fly 3000 miles to train in my dream specialty, there was no way I was going to sit in traffic every day. So we found a house that is a good bike-able distance from the hospital. I have composed so many posts in the many early morning and late (and odd, 2 AM post shift) rides home, but none have translated into an actual post. I'll catch up.

2) Time is a great healer. A great equalizer. A great decompressor. When we first moved, everything was so raw, so scary. It stayed that way for a while. That fear, uncertainty, difficulty, and stress was only compounded by having our moving truck arrive a month late, evacuating for a hurricane, and realizing that being a resident is really intimidatingly scary stuff. Also, my son HATED school. And my husband realized finding a job was not as easy as it seemed in a new city with no contacts or networks. But all that is over now.

Which brings me to now...

Some days I feel like super mom. I have prepped meal plan organized food in the fridge, menus written on the kitchen chalkboard, cut up fruits and vegetables to snack on. My kids have their backpacks and lunches packed by the door, clothing laid out on their beds. I'm rocking this mom/resident thing. But then there are days like tonight. I was coming off a really hard stretch of super intense 5 nights in a row. Working over Xmas in a vacation spot is like Target on Black Friday in the ED. So. Many. Patients. So. Many. Drunk. People. So. Many. Lacerations/Holiday Hearts/I left my meds in another state. Just. So. Many. So when I had a "switch day" from nights to days, I slept. Then I made a cake. Then I went out for a manicure. I had no energy for the market, meal prep, lunch making, and homework organizing, so we took a night off. But today, I had an early morning shift, that stretched from "I'll be home by dinner" to "I'll be home after a central line/LP/all my notes." Our wonderfully flexible nanny texted me at 5 pm asking dinner plans. At 5:30, I got a picture of my kids eating their favorite go to snack-for-dinner: Chocolate hazelnut butter sandwiches with rainbow sprinkles, on whole wheat bread. At least it's whole wheat? And the "healthy" brand chocolate butter instead of Nutella?

One thing I am learning as a resident/mom without my family around is that I can't do it all, and I can't pretend to do it all. I have learned to be okay not looking put together all the time (ie: show up to the holiday show post overnight in scrubs), be okay that my kids eat the provided lunch plan instead of a cute bento box, and be okay that I have yet to attend a single PTA function and don't really feel guilty at all.

Hope to post more often,
Boxes

'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy

I've always been slightly more than casually OCD.  Not the flip-the-light-switch-seven-times-then-tap-dance-thru-three-choruses-of-I-Could've-Danced-All-Night-before-leaving-the-house kind, but more like the picks-stray-hairs-from-my-pillow-before-laying-down-and-always-on-the-lookout-for-dead-bodies kind.  I can't explain away the hair thing, but you try working for the body pickup service contracted to the medical examiner's office of a major metropolitan city for a year and *not* look for corpses on the side of every road and behind every hydrangea.  They're there, people.

Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery.  "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top".  But let me tell you, shit got real when Punky arrived four weeks early.  I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind.  I had no idea that this was even a thing.  You learn some (but not near enough) about post-partum depression in med school.  But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period.  It was absolutely heinous.  I've never been so terrified in my whole life.  I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze.  And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene.  I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four).  I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in.  I visualized her tiny electrocuted body lying next to a wall outlet, no joke.  My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find.  Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time.  And a little bit of me mourned her faux death, so many times a day.

But that actually wasn't the worst of it.  The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it.  It was me hurting her in all of those ways every time.  In the bath tub.  In the kitchen.  In her nursery.  It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind.  The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having.  I was beyond terrified.  I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her.  A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior.  It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple.  They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen.  And he was the one doing it.  On one hand, he just *knew* that he had no desire to harm his wife in the least.  But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?

Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self.  These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)

So, I went back and listened to the episode again, and I felt an immediate sense of relief.  I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard.  However, at least I had some hope that perhaps I could fix this somehow.  So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment.  And, I did.  And doing so was the first step in my journey toward recovery from my post-partum Harm OCD.  And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.

And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues.  Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening.  Gives me the sense of control that I need to feel comfortable and safe.  And then I can go about my quirky day.

Watching a toddler eat peanut butter off the floor of an airport.  Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim.  Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy.  It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light.  And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience.  It was a super gross experience, but she thoroughly enjoyed it nonetheless.  And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house.  There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good.  And the older I get, the better of a handle that I have on my weird brain.  It's actually pretty interesting in here most of the time.........  :0)