Doctor-Moms, This Is Our Job

Finally, a cause we can all agree to take action on. We means everyone: Liberals and Conservatives, Democrats and Republicans, Christians and Jews and Muslims and Atheists and everyone in between. Follow to the end for specific, easy actions you as a physician and a mother can take to help stop this morally repugnant horror.

The issue? Around the world, we are seeing a horrific trend: children are increasingly being used as tools in political conflict. In Syria, children are used as human shields. In Afghanistan, children are recruited and used as soldiers. In Nigeria, children are recruited as suicide bombers. In Myanmar, children are tortured to send a political message.

Here in the United States, we take children as political hostages.

This is no exaggeration nor overstatement. This Saturday, our President stated that he is using  migrant children taken from their families as a political bargaining chip. Despite his repeated insistence, there is no law nor policy in place stating that migrant families should be separated at the border, only President Trump's personal mandate.

How could such a horrible thing happen here, in our democracy? In Spring 2017, Trump's Homeland Security Advisor John Kelly proposed separating all children from their parents as they sought shelter, “in order to deter more movement along this terribly dangerous network”, as reported in last week's New York Times.

More recently, Trump's senior policy advisor Stephen Miller reiterated that this is all Trump's doing: 

“It was a simple decision by the administration to have a zero tolerance policy for illegal entry, period. The message is that no one is exempt from immigration law.”
 
It is now well-documented for the world to see and judge. In using children as political hostages, our country has stooped to the same lows as terrorists and dictatorships in Syria, Afghanistan, Nigeria, Laos, and Myanmar.

Of course there is growing outrage against Trump's disgusting agenda. Many Republicans leaders are stepping forward to condemn this administration's inhumane actions, and not only moderate stalwarts like former First Lady Bush and Senator Susan Collins of Maine. Even Senator Lindsey Graham of South Carolina has gone on record, stating "President Trump could stop this policy with a phone call",  as Monday morning's New York Times reports.

While he is unlikely to take any action, we can.

We are mothers and doctors. We are uniquely positioned to comprehend the psychological damage inflicted upon children who are forcibly removed from their caregivers. The American Academy of Pediatrics has vehemently opposed this as policy since it was first mentioned by Trump's administration last Spring, based on the known grave consequences to child development. Pediatricians are speaking out. AAP president Colleen Kraft described the heartbreaking grief of a toddler she witnessed at one detention center, and explained the effects of harmful toxic stress on children.

As the AAP's formal statement on The Detention of Immigrant Children recognizes:

"In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings."

The American Psychological Association has also written a letter to the Trump administration in opposition to the policy:

"Families fleeing their homes to seek sanctuary in the United States are already under a tremendous amount of stress. Sudden and unexpected family separation, such as separating families at the border, can add to that stress, leading to emotional trauma in children. Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

Yes, it's pretty clear that ripping innocent, frightened children from their parents and locking them in chain link cages is not in accordance with internationally accepted rights of the child. So what can we do about it?

As little or as much as you want. This can be simply clicking on a link to sign a petition or donate to a vetted charity, to calling your representatives, to writing an article for a local newspaper or blog... It's up to you. Here are some suggestions (and I personally did every single one of these this lovely Monday morning before my clinic started):

SIGN: 
Petition to Donald Trump to stop separating families at the border: https://actionnetwork.org/petitions/where-are-the-children

Petition to the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/department-of-homeland-security-stop-tearing-families-apart

Petition to Secretary of the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/keep-them-together-stop-separating-children-from-their-families-at-the-u-s-border

DONATE:
KIND (Kids In Need of Defense) is a nonprofit that provides legal assistance children who would otherwise stand in court alone. 

The Florence Project is a nonprofit that provides legal assistance to political detainees, including children, in Arizona.

The Asylum Seeker Advocacy Project is a nonprofit that provides legal assistance to refugees feeling violence seeking safety here int he U.S.

RAICES is a nonprofit that provides legal assistance to detainees and refugees, including children, in Texas.

Al Otro Lado is a binational nonprofit that provides legal assistance to families who have been separated, navigating the legal systems of Mexico and the United States to bring them back together. They also help deportees who have been abandoned in Mexico with resources including medical care.

PROTEST:
Families Belong Together is organizing rallies and protests in opposition to separating families at the border. Check out their website to see what's happening next near you.

CALL:
This is actually one of the most powerful things you can do. Call your representatives using any of the below easy methods. You'll probably get an answering machine, but if you get the machine or a person, say "My name is (your name) and I am opposed to separating families at the border. I am from (your zip code) in (your state). I do not need a response.":

Find your representatives in the House and then find their office phone number, and call.

Find your representatives in the Senate  and then find their office phone number, and call.

Or just call the Capitol operator: 202-224-3121. This number will direct you to the Capitol switchboard. When you call, ask to be connected to your senator or representative. The operator will direct your call to their office.

Pending Legislation on this includes The Keep Families Together Act and The Help Separated Children Act . 

SHARE: 
Whichever of these relatively small actions you take, TALK about it, SHARE on social media, PUBLICIZE the cause. This is really powerful.

WRITE: You are a doctor. You have a platform. Your voice is heard. Please consider writing a letter to your editor, even if it's a small town newspaper. Consider writing an op-ed for a news outlet. Consider posting on a political website, as Sanjiv Sriram, MD did. Consider writing a guest post for a blog. I accept guest posts at my own personal blog www.generallymedicine.com , and the editor here at Mothers in Medicine does as well. Kevin, MD is another great place for physicians to share their educated, intelligent thoughts.

Whatever you do, DO SOMETHING. The policy of using children as a political tool is morally repugnant, and we as doctor-moms know this better than anyone. Please help to stop this moral slide into evil.

We Are All Elastigirl

At my house, we are The Incredibles. The first time he saw the movie, my oldest son identified immediately with Dash, the blond little boy whose super power is to run super fast. Naturally that led to him insisting that everyone call him by that name, then that everyone call his little brother Baby Jack Jack. For the past year, he has also called my husband Mr. Incredible and me Elastigirl. (Seriously. When he started preschool last fall, we had to have several talks about how he could still be Dash at home but had to use his real name at school.) My younger son, who is 2, also calls himself Jack Jack (though thankfully he also knows and can say his real name), and now has a pretty clear pronunciation of my husband's and my Incredibles names. I'm not sure we'll ever go back to our non-super identities.

As you might know, this weekend is the premier of The Incredibles 2. The other day my nanny took the boys to McDonald's, where they each got a Happy Meal containing an Elastigirl toy. The moment I got home from work, they were clamoring to show me the toy - Elastigirl riding a motorcycle - and the way that it expanded to simulate the way she stretches to incredible lengths when fighting the bad guys.

It got me thinking about how, even beyond the fact that hers is the name I have answered to for a year or more, I actually identify with the character. 

I get that she had a super-impressive career fighting crime, but that she shifted her focus to her family in ways she never expected. (At the beginning of the first movie, she says in an interview, when asked about settling down, "I'm at the top of my game! I'm right up there with the big dogs! Girls, come on. Leave the saving of the world to the men? I don't think so.") That she still has the skills to take on villains, but somehow is able to attend to her children's needs at the same time, all while gracefully adapting to every unexpected turn of events, like flying off to rescue her husband and learning that two of her children have stowed away on the plane. I feel that long look in the mirror when she checks out her backside in her new super suit. I was skinny once, too....

https://radioronin.wordpress.com/2013/03/01/baby-body/

Elastigirl quite literally stretches everything - her arms and legs to reach things when sneaking into a compound or doing battle, her expectations when she believes her husband is having an affair but also knows he is in danger so goes after him, and her plans when they go astray as they so often do. It's no accident that, as they return home from taking down the robot monster, while Mr. Incredible and Violet (the oldest child) and Dash recount the amazing moments from their fight, Elastigirl is the one on the phone checking in with the sitter to make sure Baby Jack Jack is okay.

And when he is not, when it becomes clear that the villain Syndrome has kidnapped him and is about to get away in his jet, it is Elastigirl who creates a strategy and quite literally goes after him. "Bob," she says to Mr. Incredible, "throw me!" After grabbing her son, she stretches her body into a parachute and cradles him as she delivers him gently back to the ground.

http://www.writeups.org/elastigirl-mrs-incredible-the-incredibles-helen-parr/

I don't actually have any super powers - I imagine that life would be so much easier if I did - but I'm quite proud to be compared to Elastigirl. She represents what we working moms do: stretch ourselves in every way possible and do multiple things at once  in an attempt to care for everyone who is important to us, no matter the situation. You are all Elastigirl, too. And I'm proud to stand (and stretch!) among you.

After every winter, spring...

always comes.

Always.

But my life's progression to "spring" was blocked by an awful behemoth in my path--and I could see glimpses of this thing titled "spring", but I couldn't get there. So it has been a long, long winter, and I have been away from here for a long time. This thing, divorce, loomed in my life for a while, sat in my way, blocked my life and taunted my psyche. It was this big, ugly, hulking, ill-defined beast that sat defiantly between me, peace, happiness, future. It blocked the path between who I was and who I wanted to be...who I had the capacity to be. And avoiding it was causing me to become a person I increasingly disliked. So I introduced myself to it, squared up my shoulders, battled with it, and took it down. I ran, leaped, tripped, yelled, triumphed, paid (tears, money, frustration, adrenaline, fear) and then, officially---it was....over. The ink was dry. And truth be told, the marriage was over long before the divorce was--just as a piece of paper doesn't make you truly married, a piece of paper doesn't make you truly divorced. These pieces of paper simply symbolize what has already taken place in your heart, I believe. And they exist for the protection of property and children. That is all.

The initial months after my ex-wife moved out were a blur of pure relief, loneliness, freedom, calm, financial stress, happiness, and much needed solitude. I never looked back. I never doubted my decision to leave, not one time. I knew I'd done the right thing, as hard as it was to enact. As time passed, I dated a few women, but no one in particular really struck my fancy. I never found anyone who I thought was really special. Nice, kind, smart, attractive? Sure. But that wasn't enough to keep my interest in anyone in particular, and after a while the dating world was....tiresome. I had no real connection with anyone, no real chemistry. The thrill of being single, being free, being wanted, flirting was...getting dull. There I was wandering aimlessly around a romantic virtual world, without any real destination in mind. So I'd delete the app for a bit, roll my eyes, and drink/hang with friends. Onward....maybe someday I'd find someone again, but I sure wasn't in ANY rush--the very last thing I wanted was A Real Girlfriend. I didn't want to be anyone's person--I didn't want the obligations, the expectations, none of that. I wasn't sure I could do that again. Been there, done that, and in some ways----I'd failed miserably. It had been such a tall order before and I'd not measured up....right?

While I dated casually, I also worked to heal myself from the damage that our marriage had caused.  I was in therapy, and I fought to delete the list of ways that my ex-wife had said I'd failed her, failed our marriage, failed our children--all by initiating the divorce, which was the only way to a better life that I knew (after thousands of dollars in marital therapy and two separations). I realized that I had recreated my self-image according to her feedback, not my self-knowledge (or the knowledge of others who really know me)--and I was angry and disappointed in myself for having done so. I had actually believed all of the things she'd told me about me--things she'd said over the years out of anger/need/frustration/hurt, time and time again, as I repeatedly failed to meet myriad unspoken and seemingly mysterious and randomly presented expectations and needs.

I didn't know what was true anymore, and it was terrifying. Was I Person A or Person B? I fought to redefine (rediscover, really) myself for myself, to believe my voice about myself instead of her voice/story about me--and it was impossibly hard at times, and I did not always succeed. Some days were interminably long and painful,  and I worked to feel valuable, attractive, intelligent, worthy of anything--love, respect.  I worked to make eye contact with another human, some days. I worked to summon the energy to go to work, to engage with my patients beyond lab data and physical exam findings. My therapist was my reality check, when I wasn't sure which way was up some days, when I wasn't sure who I was anymore.  She was my mirror through all of this--she showed me the little tiny bit of myself that was still there, that was unchanged, the essence of ME, that was going to be ok--that had always been ok and that always would be--no matter what. Her unwavering belief that I would be ok was steadfast and solid; some days I counted on her belief in me far more than I ever believed in my own ability to be ok. I had to take her word for it. And I did. And some days, it saved me.

Fast forward a few months. The dust had firmly settled. I could see the good in life again. I realized that I am an ok person. I was in a new routine with life, work schedule, kids. I was single. Spring was ...here.. I think? I felt pretty good in my body, my mind, my heart. I'd dated a bit, and it'd been fun. I I was happy, and not seeing my therapist as much. The worst of things was over...life was looking good again. So I opened a dating app, while I was standing in the middle of my kitchen--and I don't know what made me do it, I just... opened it. And there was one of the most handsomely gorgeous women that I'd ever laid my eyes on--my inner dialogue was "Oh my goodness....!", I had a run of a-fib, and I sent her a message. And I wasn't so sure I'd hear back...I mean, she was so damn cute and...I'm just..me. But something about her simply took my breath away. Something.

Well, I heard back. And back. And back some more. And now we're heading into our sixth month of dating and I love her in a way that I didn't think my heart was capable of loving. Nor did I think my heard was capable of receiving such love. I have loved before, and she has loved before--we've been on the planet too long to not have, and the loves we have had have helped craft us into the humans we are today--and for that I am thankful for us both. But I've never loved like this before. It's different; it's more complicated. It's more complete. And I didn't know that this kind of love, this kind of seemingly unconditional love and non-transactional love--the kind of love where someone loves you simply for who you are--not what you do for them, the money you make, what you say or what you look like or what you provide now or could provide or anything else---could ever be a part of my life-I assumed it would forever be beyond my reach, that it wouldn't happen in my lifetime. Thankfully, I was wrong. "BB" suddenly landed in my orbit and I knew that spring had definitely arrived.

To be continued...

ZebraARNP

Hello from Ticketyboo

I am so excited to be a new contributor to this awesome blog for momma docs. 

I’m a Canadian internal medicine resident in the early years of training. My spouse is also a resident, and we became parents to our wonderful baby boy earlier this year.

Thanks to Canada’s parental leave policy, my spouse and I were each able to take approx. 6 months of leave to spend with our little one (really lucky, I know). I took the first 6 months, because of childbirth and breastfeeding and all that jazz, while my spouse is taking the last 6 months. The shared leave is supposed to help coordinate our residency completion dates, and make some of my upcoming hectic rotations more manageable. Pre-baby, I also felt strongly about sharing the “primary parent” role with my spouse. Now, I see taking care of our baby more as a treat rather than as a responsibility to share (that’s what bonding will do to you I guess!), so I’m doubting my initial reasoning. It’ll be interesting to see how we feel once our year is up. 

My time of full-time snuggling with bébé is almost up and I’m soon returning to residency. Even though I know I’ve been very fortunate to have MONTHs of time with our little one, I’ll nonetheless miss him tons while I’m away doing the resident thing. 

In the next year, I’m hoping to share my experiences as a resident and mama, attempting to balance it all (or realistically, just survive it!).

Sincerely,

Ticketyboo

P.S. My pseudonym is an infrequently used Canuck expression that means “going fine” (e.g. “everything is tickety-boo”), which is how I hope life will be going in the coming months/years. Also, I think “tickety-boo” has a nice ring to it, although it does sound like something you might name a teddy bear...that’s not bad though, right?  

Morning Routines: Is There Such A Thing As A Mother In Medicine?

Years ago, I wrote this blog post about morning routines and how much I adored my "slow" non-workday mornings. I was in the midst of a 3-year IVF journey, but I wasn't pregnant yet. A friend of mine, who at the time had a small baby, laughingly said in response, "That sounds blissful, but wait until you have kids!"

So what's my routine like now? It's still a bimodal scenario: as a part-time anesthesiologist, the morning "routine" varies dramatically depending on whether or not I'm headed to the hospital. On a morning when I don't have to work, the old way I described of waking up to the natural dawn of the sun is a thing of the past. In contrast, many of my mornings start with my two year old daughter either crying or yelling, "Mommy!" I stumble into her room, change her diaper and make her bed/assess for any damage that might have occurred in the nighttime. I may or may not have been in there multiple times during the night prior to the actual wake up. We head out to the kitchen and immediately take our vitamins (me and her), drink a large glass of milk (her) and make a large cup of coffee (me). I tap dance around my husband in the kitchen, which despite being adequately sized, feels like we are bumping into each other constantly. Here's where the "slow" part comes in: we have a little time to chill, play, hug, talk, etc. Eventually we make a breakfast, usually eggs +/- bacon. Once the sun comes over the mountains, we take the dog for a walk to the park.

Those last steps are especially important to me, since I definitely don't make food on my workdays. In fact, on those days I have no idea what my daughter actually eats for breakfast. One thing that has really helped to smooth over my (sometimes rough, always rushed) workday mornings with a baby and a husband with his own agenda has been to hire what I call our Morning Nanny-Taxi. This person comes to our house at 6 AM, plays and takes care of our daughter, gets her ready for the day, and then drops her off at her daycare/preschool at 8 AM (she only goes on my workdays and a smattering of random other days). I've found that this is well worth the market price for 2 hours of service by a driving babysitter. Amazingly, there are people who will do this! Many of the people I've interviewed for this position have another job that is either part time or has a later start time. The few wonderful women we've hired so far were found through websites such as Sitter City and Care.com. (Note: I am in no way affiliated with these sites but have used them successfully to get good babysitters. I would also offer the opinion that Sitter City's pool of applicants seem more suited to random and part-time work as opposed to Care, which tends to have more applicants for regular or full-time nanny work.) While our household is very often awake prior to 6 AM, I don't have to leave for work on my workdays until 6:30. This little half-hour buffer gives me a small chunk of uninterrupted time to get ready, which I now relish just as much as my old pre-baby slow mornings.

You can find mommy blogs and parenting books everywhere that stress the importance of a consistent, daily routine in children's lives. Important for what? My daughter seems to be doing fine despite our undulating schedule. With complicated call schedules and specialties that rely on shift-type work structures, I'm sure I'm not the only mother failing at the routine game. And what about double-doc families? More than one child? Large age ranges? The complexity multiplies...

How do you deal with mornings?

Intern Year Recap

Intern Year Recap

As my kids end school and I start power- reading to get ready to be a 2nd year resident, I want to take a chance to recap this crazy roller coaster/ transformative/ at times impossible/ at time inspirational year.

Top 10 ways to rock intern year.

1. Make friends with your co interns. Your nurses. Your seniors. Basically, anyone in the hospital. It is the place where you will spend the bulk of your time, so having people you look forward to seeing, talking to, working with, will make the tedious hours go by shorter, the hard times a bit easier, and the terrible days a little less terrible. You may even have fun.

2. If you ever are doubting your abilities, teach something, anything, to a medical student. You will be amazed at how much you actually do know. You will help them learn something. And you will feel like a better, kinder, and more capable person for it. Teaching also helps solidify information, so if there is something you struggled to know the day before, teach it to a medical student today. Believe me, it is a huge ego boost and a way to help out someone who will one day be your colleague.

3. DO NOT LIE. If you didn't order a test, or do a complete exam, or replete lytes, or order an antibiotic, DO NOT LIE. Just be honest. Admit mistakes, and work to correct them.

4. Invest in really comfortable shoes. I wore worn out tennis shoes for 6 months and my feet ached. every. single. day. When I finally bought a better pair of supportive, soft, arch-supporting shoes, I felt 100 times better at the end of a shift.

5. Check in with yourself. At some point, I realized that I (a little curvy to begin with) had gained 10 pounds during my first 6 months of residency. Check in. Run, Exercise, Eat right. Come up with a plan. Bring lunch instead of ordering in or buying cafeteria food. Skip the muffin at the free breakfast. The past month I have been committing to 2BMindset (on the Beachbody website) and I lost those 10 pounds. It was a lot of effort and commitment, but I feel better, healthier, and am inspired to keep on a weight loss track to lose the rest of the "curvy" that still has me 20 pounds over my pre-baby weight.

6. Find something you love and make time for it. I love cooking. I stalk instagram food bloggers, hoard too many cookbooks, and screenshot recipes compulsively. Cooking gives me a creative outlet and also lets me feed myself and my family in a healthy, affordable way. Having an outlet outside of the hospital is essential for your wellbeing.

7. Drink water. Being dehydrated is awful.

8. Remember your "Real life" friends. There was  period of time where I had not spoken to my best friends (non medical, live in a different state) in over 2 months. I missed the birth of their babies, kids' birthday parties, their birthdays. I felt terrible and lonely. I just wanted to go home and give up. Luckily, face time and whatsapp goes a long way and I was able to realize why I felt so lonely and make an effort to reach out. Don't forget those who loved you and supported you along the way.

9. If you have a significant other/partner remember them. Try not to come home so utterly depleted that you have "no nice left to give." Your relationship deserves it.

10. Make every day a learning day. and try to end every day with positive thinking.  When you get home, think about 1 thing you learned. Think about 1 thing that made you happy. Think about 1 think you are excited to do tomorrow. (Bonus: think of 1 thing you did to make someone ELSE happy.) Thinking positively and productively will help you sleep better and be happier overall.


* Bonus- remember that your kids will think you are the coolest person ever no matter what. Love them unconditionally, the way they love you. If you only have energy to cuddle in bed, then do that. They don't care if laundry isn't done. One thing I learned this year is that my kids are freakin awesome. Resilient. SO. Much. Fun. Way more social than I am. Adaptable. And as much as I feel like I am never home, they have taught me to appreciate the time that I am.

Off to Year 2!

Reasons to Wear Lipstick.

It's a peculiar thing being a single mom, 30, and a first year medical student. At the med school parties, I'm 8 years older than everyone. In the hospital, I'm 8 years behind on my training than physicians my own age. At my kid's daycare, I am that parent that hasn't a clue it was my turn to pay for pizza Friday, or it's the teachers birthday. The other non-traditional parents in my class live with supportive spouses, so it is hard to fully relate to anyone. I like the uniqueness of my life, and on multiple occasions do classmates and strangers tell me how inspiring I am. But, I also admit it is quite lonely.  I moved into a new apartment with my 2 and 3 year-old last year. It was the first time I had to live alone with two toddlers. My life was study, change diapers, study, take the kids to beach, study, clean, study, yell at toddlers to stop drawling on the walls, study... It was a crazy adjustment, but I rocked it, mostly, after I found a good balance between those two heavy identities of mum and med student. (Finding that balance took a lot of tears, complete break downs, sleepless nights, fits of being woken by crying toddlers at 4am before a final, lots of use of a babysitter etc. etc). After three months of nothing but late night study sessions in the library, alternating with being Mom, I wanted an escape. Something fun. Something easy. Something to take my mind off of my chaotic life and make me feel like a normal human again. So I got on Tinder. Yes, that awful addicting dating app/hook up site for people like me who are incapable of meeting someone the old fashion way through mutual friends or some serendipitous moment in a coffee shop. The swiping happened, the chatting started, and the harmless fun of it was a light and easy way to wind down at the end of the night. Like how normal people watch TV, I ask completely random attractive men about their lives. I finally got ballsy enough to meet these completely random attractive men in real life. Of course only on weekends after tests when I didn't have to study as much. My basic day to day attire was messy bun and yoga pants, so it was so nice to wear real clothes again! I went Salsa dancing on the beach with a CT surgeon, played board games at a bar with a teacher, picnicked by the water with wine and a book with an IT guy, watched a play with a lawyer, drank more wine and watched the sunset with a pediatrician. It had been 5 years since I dated, and the timing of course is terrible as being a mom and med student makes an impossible girlfriend. But the experience, fun, and connections are just what I need to take me out of my diaper/molecular biology bubble.

Turns out some of my classmates are also on Tinder, so now study breaks consist of swiping and comparing baes (yes I started saying bae, I hang out with 22 year olds). Definitely no Mr. Right in the near future, but I will update y'all if anything crazy happens. Not crazy like the time my date showed up hammered after 5 shots of Whiskey. Just hoping for more wine, sunsets, good conversations, and a reason to wear lipstick.

What are y'alls reasons to wear lipstick?

Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.

Health

This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?

On Well-being

Physician burnout and mental health have been on my mind lately. Considering the many articles I’ve read recently on these topics, I’m sure it’s been on your mind too. I’m part of an initiative at my organization to address physician burnout and improve wellness among staff, both at the individual and systemic levels. I find this recent article on Kevin MD an interesting idea. Given all the metrics we tailor our system to based on patient care, safety and satisfaction, it’s an innovative twist to ask that our wellness, or lack thereof, be a goal marker as well.

Ultimately, our well-being affects how well we care for our patients and even their outcomes. The cynical part of me thinks the only way we can really get our healthcare system to change and address the epidemic of physician burnout is to tie those levels to dollar signs. There is a strong argument for the financial benefits of physician wellness and many organizations seem to be acknowledging that reality and investing more in this issue.

As mothers and physicians we’re used to putting others’ needs before our own. But I’ve realized over the years that I’m a better caregiver - to my children and to my patients - when I’m practicing good self-care. In the world of healthcare though, systems need to be in place to support that ability.

What are your thoughts? What has been successful or not so successful at your organization? Has your workplace found ways to encourage not only personal resilience but also support an organizational culture of wellness?

Here's to 10! Book Giveaway and Call for Contributors

It's hard to believe, but this month marks Mother in Medicine's 10th birthday.

Here's 10 reasons to celebrate with us:

1) Over 1500 published posts with the top all-time pageviews going to

• Day in the Life of a Neurosurgeon - SERIOUSLY? -by GCS15
• Why you absolutely need to have a baby during residency  - by Fizzy
• 10 Guidelines for Work-Life Balance - by FreshMD
• A day in the life of a part-time medical oncologist - by Tempeh

2) 1000 comments (Yes exactly. Right now.)

3) Fabulous, fearless contributors over the years, some with us from the very beginning (See Call for Contributors below)

4) One Mothers in Medicine book! (See Giveaway below)

5) 148 Heartfelt guest posts

6) MiM Mail

7) 5.2 million pageviews and counting

8) Global audience with top countries: US, Canada, Germany, Australia, UK, Ukraine, Russia, China, France, India (in that order)

9) Topic weeks (remember Childcare? How medicine changed me? Thankful? And many more)

10) Fabulous readers (you!)


It's been a great 10 years! We are honoring the occasion with a Mothers in Medicine Book Giveaway. To enter, just send an email to mothersinmedicine@gmail.com with the subject line: MiM Book and we'll select 10 random readers to receive a copy of the book. Deadline to enter is Monday, June 4.

Annual Call for Contributors
Come write with us for a year! Each year, we open up a call for new writers to join as blog contributors. It's a chance to write, reflect and help the MiM community by sharing your stories. If interested, send an email to mothersinmedicine@gmail.com with the subject line: Call for Contributors and tell us a little about yourself and why you would like to contribute. Deadline is Monday, June 4.

Thanks for reading, commenting, writing, sharing. Here's to 10!

Pink eye

Sick days are hard.

I'm on a tough couple of rotations coming up - I have 2 weeks of 24 hour shifts of my own, a week of nights, and another 2 weeks of 24 hour shifts I picked up for another resident's maternity leave, not to mention some 12 hour shifts in between all that. Future Kicks is going to be happy - less 24 hour shifts for next year - but presently I'm looking at the upcoming calendar and thinking....blegh.

We've been pretty lucky when it comes to Baby's health though. We've walked through the day care door for the past 4 months despite the warning signs of RSV, pneumonia, and strep and come out with multiple runny noses but nothing else. 

Yesterday he was a bit crabby but hadn't slept much and was. not. having. the peas we were trying to introduce. I thought he had a booger in his eye, but didn't think much of it as he pretty much has boogers everywhere all the time. However, this morning one of his eyes was matted shut and it took multiple wipes to get the goo off. Was it pink? I thought so, but the lighting in our house isn't great so I couldn't be sure. I just kept staring at him for a few minutes trying to decide. It definitely wasn't clear cut pinkeye but I wasn't sure. 

I took a minute to evaluate the week's schedule. It was about 6:15. I had a meeting at 7:30 with my PD, I was the walk in clinic resident this AM, and I had block ed this afternoon. Nothing that couldn't be rescheduled or easy to fill. Tomorrow and the next day were 12 hour shifts at the hospital that could be much harder to fill and impossible to leave mid-shift. I knew I had two options and I had to make the choice quick.

1) Take him to daycare and roll the dice that it wouldn't get more pink. 

2) Call in sick today even though it was a soft call on pink eye with the hope of nipping it in the bud today and having a doctor's note to return to daycare tomorrow

I opted for #2 because it's much more difficult to leave mid-clinic shift than to not go in at all. Took him in right away this AM. Of course under the bright lights of the office, those eyes looked clean and white. The FP there recommended I stay home with him today and gave me a note saying safe to go back to daycare tomorrow. 

Now I'm home. I feel really guilty about calling into work, but trying not to. The meeting will be easy to reschedule, it's generally easy to fill walk in clinic, and the only one who loses if I miss out on block education is me. I still think I made the right choice and I am going to finish out the day at home (doctor's orders as above :)) 

I'm reflecting today on how utterly hopeless it is to try and schedule a sick day. 

I also feel somewhat stupid for bringing him in to clinic. After all, I am a family doctor who diagnoses pink eye in kids all the time. As soon as I brought him in, I knew that his eyes would be clean. I remember looking at him on the table early this morning thinking "I am a mother-effing doctor. How am I not able to tell if it's pink eye or not?". I've read about the fallacies of trying to diagnose your own kid and the scary stories of doctor parents never bringing their kids in, so I'm probably overcompensating the other way. 

How do you guys feel about bringing your kiddos into the doctor? Do you think you do it too much or not enough?

In the end - I'm going to enjoy our day off together, put the guilt aside, and rejoice that it's not pinkeye (yet). 

Supporting parent learners in medicine

I recently put together a panel for the AAMC Continuum Connections conference (a joint meeting of student affairs, GME, medical students, and residents) on Supporting Parent Learners Throughout the Continuum. The goal was to discuss the unique needs of our parent learners, identify gaps in support, and share best practices. We had a fantastic panel including a medical student dad, an OB/GYN fellow mom, a student affairs dean, and a former PD/central GME leader.

The 1 hour 15 minute session was clearly not enough time. We could have filled 2 days with the discussion. I loved that so many people had chosen to come and think about these issues and the panelists' personal experience and perspectives were insightful. 

Some key areas that were brought up:

• communities of support for parent learners to connect with each other
• childcare
• stigma/bias
• parental leave
• breastfeeding (particularly with regards to culture/time and certain rotations)
• parental leave

One institution holds spots in a local daycare for incoming PGY-1s since the process can take so long and there can be too little time to secure ones after Match Day. Love this idea. One school holds a welcoming event for medical student parents and their families to get to know each other right from orientation.

And I shared the upcoming event at my house: babysitting for medical student parents so they could have a nice night out together --Parents' Night Out. It was so difficult for my husband and me to share any alone time without a baby on our lap, and it's expensive to hire babysitters, so I wanted to give our student parents some wellness. 

We had it this past weekend and it was a ton of fun. Students dropped off their kids at our house and I had a small crew of student volunteers who wanted to help. There were five kids total, ages 3 months to 3 years old. We adults outnumbered them -which turned out to be a very helpful ratio to trade-off and allow helpers to eat and take a break. I loved loved loved seeing our medical student parents and their kids. When one couple came to drop-off wearing nice going out clothes and mentioned it was their first date since the baby was born, I think my heart grew two sizes. I also enjoyed getting to know the students who volunteered their time to help on a Saturday night.

At the AAMC panel, the former PD/central GME speaker said to the audience: to the younger generations, I'm sorry my generation could not figure it out (in terms of parental leave). It's still an issue after all of these years. But, what I would add to that is that we have certainly made progress. More of us are thinking about how to support our parent learners better, as well as all of our learners. Just having a dedicated session to that during a conference is a start.

Who blinked first?

It was a random Wednesday that I was off from work. I was thinking of the possibilities. Oh the possibilities! I could do my ever piling load of laundry. Replenish the empty fridge. Or forget all that, and keep my toddler child from daycare and spend time doing something fun with him. Since starting intern year, it feels like our time together has became ever so scarce. Today I would make up for all that missed time. We could go to the playground, do story time in the library, visit the local children's museum. Endless possibilities!

First things first, we'd eat some good healthy breakfast to get the day started right. Today I was in no rush. Instead of his usual sugary cereal breakfast, I was going to make eggs and toast. Now anyone who knows my toddler child knows food is a big struggle with him. He reacted to eggs and toast like I had handed him a plate of dog-doo. He put on a whole production. Defiant "I don't wanna". Pushing the plate away. Putting a bite in his mouth followed by gagging sounds. Finally, eating his food in infinitesimally small bites that he would take an absurdly large amount of time to swallow each bite. I was already questioning my decision to keep him home from daycare. I was now fantasizing the alternative of doing laundry in peace.

Finally after an hour or so of lingering, pleading, arguing over the table, I just had it! Out came the threat, "Child, you don't like the food here, I'll take you to school where you seem to have no problem eating the food. Forget about the museum or playground".
"Noooo"
"So you want to finish your food?"
"No"
"So which one do you want, go to school or go to playground"
"Playground"
"Then you have to eat your breakfast"
"No"
"So school then?"
"No"

Round and round in circles we went. And of course there were lots of tears involved!

"Alright then, let me break this down for you. You can go to school. Or you can finish your breakfast and we can go to the playground." Lots more tears. Then he said something shocking! "I want to go to school." I was not expecting this at all. Really!! He wanted to not eat that food so bad, that he would forgo museum and playground, something he normally loves to do! Well, I may have been bluffing a little, we were both in our PJs, not daycare ready. But it was too late to turn back now. I got dressed, got him dressed. All throughout in a shock, asking him several times, "so you want to go to school, not to playground?". Each time, "yes". Alright dear child, as you wish! 'This was incredulous', I kept thinking all the way on our tense walk to the car. Just as I was strapping him into his car seat, he said in a low voice, "I want to eat the breakfast".
In my mind, I thought, "Are you for real??? After all this, after I got dressed, got you dressed, after all those tears and drama, now you want to eat breakfast!!!"
Deep breath.
Aloud I said, "Have you decided for sure?"
"Yes", he said.

We walked back to the apartment in silence. He finished his breakfast without another complaint or tear. I'm happy to report, we had a great rest of the day in the playground and museum, of course peppered with occasional meltdowns here and there, but nothing quite so epic.

I was amazed and strangely proud of my offspring's skepticism. For not just taking my word, but for calling out my bluff with his own bluff. Keeps growing up so fast, keeps me on my toes. Teaching me that,
1. I must be fully prepared to carry out any threats I issue or rewards I promise, and,
2. Conversely, I can not make threats or promise rewards I can not execute

(Credit: Images from the hilarious Hyperbole and a Half, which can now be generated into endlessly entertaining memes)

Being The One

As a pediatrician, I got the chance to preview parenthood in more detail than many people likely do. The five-year-old little boy who clutched his mom during bedside rounds my intern year stands out even now: he buried his head in her chest as soon as we entered the room. She whispered, "Does something hurt or are you scared?" He managed to whisper that it was the latter and she held him tight, soothing and reassuring him while she listened to the plan for the day.

I carried that rosy picture along with many others as a boon of future parenthood. The chance to cuddle, to protect, to take complete care of my own little person someday - and, yes, in all honesty, the chance to be so important, to be the one. The one a child immediately turns to, relies on, needs.

Since that encounter, I have had two sons, and it thrills me to know end to be, along with my husband, their person. Nothing compares to the sound of little boy feet running toward the door with the greeting of a wide smile, a "Mama!," and eventually, "Mommy's home!" To the high-pitched voice calling your name in the middle of the night because of a scary dream or a need for water or just some extra cuddles. When in shyness they hide behind me, hugging my legs, my heart bursts with joy and wonder at the chance to be part of this classic, perhaps cliched but no less endearing, image of a child clutching his mother for comfort.

A few months ago, I saw a teenage boy in my office for consultation. I'm training in pediatric hematology/oncology, so trips to my clinic can be nerve-wracking for patients and families. This young man's sheer terror at what he feared were symptoms of cancer (happily, they were not) was visible, audible, nearly palpable. When I sent him to have blood drawn and imaging done, I heard him say to his mother, who had accompanied him, "I need to call [insert girl's name here]."

His reaction startled me. I could appreciate the anxiety, but the realization that, even with his mother beside him, his instinct was to turn to someone different - presumably his girlfriend - took me by surprise. Once I reminded myself that it was, in fact, developmentally appropriate for an adolescent to be developing relationships and establishing independence from his family, I was left with sadness. Someday, far sooner than I hope, my boys will turn to someone else as their person. Someone other than me will be the one.

I sit with that sadness even now. With each milestone, it mixes in with the joy and pride. And as my children grow and I grow, my work continues to provide examples of the realities and possibilities of parenthood. So when I encountered another adolescent who, facing a challenge, had little support and no peers, romantic or platonic, to whom to turn, my apprehension and sorrow began to abate. I want my children to grow and develop, to have healthy relationships and support, even if they must eventually come from someone other than me. 

For the time being, though, I'm fortunate to have my days peppered with eager footsteps, warm hugs, and sticky kisses. And when I dropped my older son off at school yesterday, after we had said our goodbyes, he ran back for one more hug. I savor every single one.

Open or closed? How do you deal with emotions?

My whole life is organized into boxes. (ie, my blog name). I like to compartmentalize, keep work and home life separate, keep public me and private me separate, emotional me and getting-through-the-day me separate. Usually, this works. I can be the happy, relaxed, fun loving mom I want to be to my kids, efficient and professional at work, and contemplative when I'm by myself on a run or on my own. But recently,  I have not been able to figure out who I want to be or who I am when I'm with my husband. The problem, I think, is that I want to be all of me for the one I love and built a life with, but I'm having a hard time putting it all together in a cohesive, not unpredictable, way.

A lot of what we as physicians see daily gives us perspective, and makes us confront our own mortality. It's heavy stuff, if you let yourself think about too much. So I try to leave work at work, keep the danger stories or cool saves to share with my family, and  compartmentalize. With the kids, it is easy. But it is sometimes hard to explain to my partner the intensity of what I do and see daily. I want to share, but sometimes I can't begin to explain or unpack my feelings. I have never been an emotionally open person and keeping things inside and putting on a happy face is how I have been able to overcome a number of difficult periods in my life. It has worked for me before, but now it is creating an emotional void between me and my partner that I don't want to get any deeper. As I write this, I realize more that the problem is that since I can't try to explain, I don't. I simply shut it down. And then, eventually, pandora's box opens and all spills out.

For those of you with non physician partners or partners whose days look very different than yours, how do you balance? Any resources that you have read, or used, to help me feel more comfortable expressing myself and verbalizing my thoughts?