Financial Literacy Is Self Care

What exactly constitutes self care? It's different for everyone, but one thing's for certain: it's not just pedicures and massages. It's much more foundational than that.

Self care is...

• Recognizing that you must know yourself and pay attention to yourself before serving others - at work and at home. It's being attentive to YOUR particular physical, mental and emotional needs.
• Maintaining your health by keeping up appointments with a doctor, dentist or other wellness practitioner.
• Ensuring your ability to tackle challenges each day by gaining energy through nutritious food, exercise, and adequate sleep.
• Preventing defaults on your emotional bank account. And one type of withdrawal that could easily lead to a default is having problems with your real bank account.

Self-care frees you up to focus on what's most important to you

About a year and a half ago, I published this post about financial wellness. Well, I'm back on the soapbox after being motivated by a great group of financially-minded physicians in the social media sphere. We all descended on the FinCon Money and Media Expo last month, and it was an awesome display of what community can do.

I don't consider myself a financial blogger; my focus is wellness with an emphasis on how we should better know and take care of ourselves as busy women physicians. Money is a huge source of stress for many of us. Just like gaining self-knowledge, gaining financial knowledge will improve your self-care and in turn your overall health and happiness.

Figuring out how to do this in a time-efficient and effective manner is the crux. There's a TON of information out there, and it can be confusing. Here are some resources that I've found useful for learning more about finance, especially at pertains to women physicians, from some awesome ladies that I met at FinCon:

• BC Krygowski writes about downsizing and avoiding the dreaded lifestyle creep that seems inevitable as physicians transition from residents to attendings and grow their families. Ever felt like you're outsourcing everything in your life because you have no time, which in turn means you have to work more to afford the outsourcing? She and her husband (both doctors) transformed their lives over the years from New York McMansion owners to a more simple existence for their family - which translates to both of them working much less than they used to and traveling + writing much more (she also writes fantasy books).

• Eliza Minimal MD "retired" from medicine before she even turned 40 to pursue the things she's most passionate about: educating her children and traveling to far-off places. She's now back seeing dermatology patients in a clinic 1-2 days a week because she missed the mental challenge of medicine, but she exemplifies a life of minimal, intentional living. She recently published a very powerful post about stories we tell ourselves, that we're "haves" or "have-nots", and how they're completely up to us.

• Barbara Hamilton blogs at Tired Superheroine about financial wellness and navigating work-life balance as a female physician in a male-dominated field (interventional radiology). Check out her blog for practical tips about time management and simplifying life as much as possible with a young family and a leadership role in her practice.

• Bonnie Koo of Wealthy Mom MD spent years working at Morgan Stanley before attending medical school and training as a dermatologist. Her blog focuses specifically on money issues for women physicians - considerations for high income earners, blended families, couples with a significant earnings differential, etc. I've been interviewed for her "Real Women Physicians" series, and I've also guest posted on her blog to discuss parenting issues around money.

Bonnie happens to be offering a new course this fall called Money for Women Physicians*. It's an 8 week, live interactive course that marries financial education with mindset coaching only open to women physicians. A big bonus: completion of the course also awards 5 CME credits, which means you can use CME funds or pretax educational accounts for the tuition. Enrollment is only open this week (October 7 through October 14), so if this is of interest to you, please check it out!

I consider all of these ladies to be not only blogger colleagues but friends. They're examples of women employing financial empowerment as a means of self care. I hope you find as much inspiration in their stories as I have!





* The link for the MWP course is an affiliate link, which means that if you purchase the course through this link, I receive a fee. You are welcome to go through other means, but using this link in no way changes your purchase price or course experience.

MiM Mail: Considering medicine as a new mother in her 30's

Hi there! I've just discovered this blog, and have been binge-reading posts for the past three days!

I am a 35 year old brand new mother to a baby girl, living in Toronto, Canada. I have a successful career in Management Consulting (commerce undergrad, MBA), and while I enjoy many aspects of the work I am not personally or emotionally fulfilled by it. I began my undergrad in science, and for a variety of reasons (including a lack of confidence and discipline at the time) I decided being a doctor was not for me and I transferred programs. I've questioned this decision, off and on, for the past ~10 years. At the risk of sounding cheesy, with the arrival of my daughter I feel an overwhelming sense of responsibility to provide an example of pursuing a life and career that is meaningful and fulfilling. And so, I am considering applying to medical school at the ripe old age of 35 (I'd need to start from scratch with post-bacc and MCAT, and so I'd likely be at least 37 beginning medical school).

I'm hoping some of you might provide some insights / POV on the following:

Has anyone here pursued a similarly non-traditional career change? If so could you share your application preparation and process? As much detail as possible would be extremely helpful, including MCAT prep and approach for gathering the necessary volunteer and shadow hours.

Has anyone here pursued this path at a similar stage (mid-late 30s + kid(s))? I could be mid-forties by the time I complete training. Am I totally insane? Are the extraordinary costs (foregone income, tuition, time) to my family too great? How awkward/uncomfortable/lonely (or not) is it to be so much older than your classmates and colleagues?

Can anyone provide more detail on the hours and schedule during medical school and residency? I know it's intense and unpredictable, but exactly *how* intense and unpredictable? I come from a career with long hours and lots of travel, so I'm trying to understand specifically how my work/life balance would change during school, residency, and practicing. My interest is in either OB/GYN or FM (at this point).

Thank you in advance to anyone that is able to help me think through this very difficult decision. This is a wonderful community and resource.

Meghan

Two kids, and being tired.

Last night at dinner, I looked at my husband and said, running my finger through my hair, "I don't know why, but I'm just so tired." He looked at me quizzically, "well, you get up at 4:30, work all day, have two kids, and are studying for two sets of board exams all evening."

It feels obvious when you say it like that, but I don't know that we give ourselves room to be tired.

Since I last sat down and reflected, we took another foster placement, and now have two kids, 11 months apart (now, 15 months and 26 months). It sounds ridiculous to say this (or write it, I suppose) but I fell victim to some hubris in planning to expand our family. I think by around age 18 months or so, I felt like we had this "having a kid"-thing figured out. Parenting one kid with two of us wasn't that hard, once we adjusted our lives to having a kid, to not doing things in the evenings with our friends without lots of pre-planning and babysitter scheduling, to daycare pickups and dropoffs and sorting through bins of hand me down clothes. I distinctly remember saying to J, on the night before they dropped off our daughter, "it can't be that much harder than having 1."

Wrong. Wrong wrong wrong. (I know all the parents of multiple kids are laughing at me right now).

Two toddlers is SO much harder than one. Someone is always pushing over someone else, taking the book the other was looking at, shoving the other out of the way to run over to the speaker and click the play button. The first few weeks, especially, felt like they would never end. (I think that's a blog post in itself, for another day, though I do so want advice and opinions on how to build resiliency in a little one).

But there's also such funny moments - the jabbering back and forth in the car, or watching them on the baby monitor after they've been put down for the night, holding onto the bars and ducking down and standing back up and laughing at each other. They find so much joy in each other - it has been such a gift, and such a way of introducing that joy to me. And we are so thankful for that.

I would love to know your tips for growing your family. We are unique in many ways, I know - transracial, adoptive, and many other adjectives. But also we are the same, and I would love to know what worked for y'all in battling the craziness that is toddlers x2.

But good grief, am I tired. One set of boards down, one to go. (Being med peds seemed like a great idea 4 years ago...)

Girls Day and Hurricane Dorian

Since my husband and son left town for a family event, I spent the entire past 2 days alone with my 7 year old daughter. It's been amazing. Thinking back, I think we have only had a handful, if that, of "alone time" opportunities since I started residency over 2 years ago. She is so fabulous. We did all the "girl" things that she loves; went shopping, Sephora, manicures, brunch, and pizza dinner. (How these are her favorite activities, I have no idea, since I am not particularly into fashion, makeup, or sparkles, and I  specifically chose a field where I can wear socially sanctioned glorified pajamas with my hair in a bun every day for work.)

We live in the southeast, where Hurricane warnings closed school the past 2 days, but the hurricane never did arrive in the way we feared. (But the devastation caused by Dorian is heart breaking, shattering, and completely devastating. There are many charity organizations already established and I encourage you to do your research and choose to help as you can. I have added some links below.)

This time with her made me realize the toll of the treadmill that our little family has been on the past almost decade of med school and residency. Between homework, dinner, bath, work, camp, sleep(?) and everything in between, I think that I lost sight of the down time, and effortless sense of "being together" necessary to strengthen relationships and get to experience my kids as they grow up as individuals. While initially I was sad that my call schedule didn't allow me to attend the family celebration, I am so thankful for this time at home. Staycation alone time is definitely something I want to do more of in the future.


Here are links that highlight some of the ways to help those affected by Hurricane Dorian
https://www.newschannel5.com/news/heres-how-to-help-communities-affected-by-hurricane-dorian

https://impact.publicgood.com/campaign/3267a266-ee73-4daa-b7fe-778d036c5e6a

https://www.globalgiving.org/projects/hurricane-dorian-relief-fund/

Summer Vacation Comes to an End

It's my last night of my long awaited summer vacation. Ever since I had Toddler almost 2 years ago I have been looking forward to this summer. 

I'm so glad that Past Kicks was looking out for Future Kicks and took a shorter maternity leave to get out of residency a bit earlier. I only had 2.5 weeks to make up at the end of the year this way. There is something sad and lonely about most of your cohort leaving you behind and watching the junior residents step up and fill your roles before you're even gone, and although I love my residency, I was definitely there 2.5 weeks too long.

This summer was glorious. I took about 6 weeks off between jobs. My husband had minimal time off to help with our move, so I was glad I had plenty of time and helpful family members to get settled in our new home in our new smaller community. The weather has been wonderful and Toddler and I settled into a routine with daily adventures to parks, pools, beaches, and libraries. We've spent extended weekends with family and caught up with old friends. I had to remind myself after the first week (in which we went to 3 parks in one day) that this was a time to slow down and relax - after all, we live here now (and hopefully will for a very very very long time) and the parks aren't going anywhere. 

Tomorrow is the day I go back to work - this time as an attending physician in a brand new town in a brand new health system. I thought I would be more nervous, however I've kept myself so busy I haven't had time to be nervous (something I did subconsciously I'm sure). I think I will get more nervous the night before I see my first patients unsupervised without a preceptor for the very first time after the initial orientation wraps up. 

I originally was dreading the return to work, but this weekend has been a little trying between Dog barking at neighbors and Toddler trying out some extra sass, so I do think it is time to see some grown-ups again. I'm sure the initial daycare drop off will be a nightmare (for both of us), but we have gotten over nightmare drop offs before. 

I have one cute story to share from my time off: Toddler and I were out at my parents' favorite local coffee shop when  I learned that Toddler was actually well acquainted with all of the regulars from his times going with my parents. He was handing out fist bumps and babbling along knowingly to several older gentlemen he apparently knew. Toddler then decided (as Toddlers do), he wanted to go out the door and stand on the sidewalk to watch the goings-on outside. I followed. One of the older gentlemen held my coffee so I could follow. Standing outside lasted about 5 seconds before Toddler decided to go back in. The older gentlemen opened the door for me. I tried to explain that he didn't need to help, otherwise he would likely be up and down 10 more times. He slowly shook his head and smiled and looked at Toddler and said "The days are long but the years are short" - which is already exactly how I feel about Toddler, and am lucky to have had these long days to spend together and look back on for years to come. 

Kicks

Mom guilt

It's been way too long since I posted but life! No excuses really except I did get pregnant and had baby girl # 2 (little N).

But this post is about my first baby, little C.

What is it about kids starting elementary school that the divide between a stay at home mom and a working mom become even more apparent?

Little C started first grade last week and from Monday to Wednesday, she goes to the school's after school program. Last year she also went while she was in kindergarten but it was different. Kindergarten was only a half day and a lot of kids even the ones with stay at home mom went to the after school program since kindergarten was only 3 hours. Also, the teachers from the after school programs would walk the kindergarteners over to the area where the program is held on the school campus.

However, first grade is a different story. The kids are expected to grow up suddenly! I had no idea but apparently, little C was told to walk to her after school program once her class got out this Monday. I picked her up after work and she was playing happily when I got there.

When I was putting her to bed that night, she said "Mommy, don't be mad but I got lost while walking over to CEC (the name of the after school program) and I walked around 3-4 times until a teacher asked if I was lost and took me there." She also told me she was the only kid in her class that went to the after school program and that all the other moms are waiting for their kids at the gate after school. My mommy heart sank and tears of guilt just came streaming down as I imagined by 6 year old walking around in the hot sun, lost and confused while every single one of her friends are greeted by their moms. But her reaction to the situation was what killed me. I couldn't believed she thought I would be mad. Do I expect so much from her? She's only 6! And she wasn't at all disturbed by the fact that she was lost and seemed proud that she figured out a solution on how to get there.

I drowned myself in mom guilt this whole week over this situation but today (my day off) as I was walking her to school I asked her if she would prefer if I could do this every day and not have to go to CEC.

She said, "NO MOMMY! I have the best mommy in the whole wide world and I tell everyone that my mommy is busy helping other people and my daddy is busy helping other people and thats why I need to go to CEC. I want to be just like you mommy--a mommy and a doctor."

She killed me again. How are you only 6, my little C? Your insight and understanding is something I don't deserve.

I am so blessed to be your mom, kid.

She continues to do this every single day. I always thought there would be so many things to teach my kids but turns out they teach me something new every day.

So mom guilt, it never ends but every once in awhile, your kids remind you that you're doing a great job and everything is okay.

True confessions

Last summer, during the final weeks of a high-risk pregnancy, I was on bedrest. It wasn’t your run of the mill work-from-home bedrest, or even the stay-in-bed-at-home-and-go-downstairs-once-a-day bedrest. It was closely monitored bedrest, in the hospital, for an entire month. It was the kind of bedrest where I couldn’t venture out of the antepartum unit without the company of another adult, lest I suddenly decompensate in the elevator. The kind of bedrest where I had to shower and wash my hair one-handed, to protect the IV that was required to stay in my arm at all times, just in case. That kind of bedrest.

It was awful. I worried about the outcome of my pregnancy, of my baby, of my own health. I had to take an unanticipated extra month off from work. I was bored out of my mind. Every time a well-meaning relative or friend would call and ask, “so what did you do today?” I wanted to throw my phone across the room. But worst of all, I painfully, painfully missed my children. Sure, they came to visit. My amazing husband loaded the kids into the minivan and brought them to the hospital a few times a week. But the visits were pressured, and weird, and always shorter than planned.

I missed end-of-the-year celebrations and the first day of camp. I even missed my son’s third birthday party. But it was the in-between time that I missed the most: a funny comment at dinner that caused bursts of laughter, an unexpected helping hand with a bag of groceries, a hug that seemed to come out of nowhere. Helping my daughter pick out her clothes, kissing a boo-boo, sharing a mango.  My husband texted me a picture of my son post-bath and I cried; I had forgotten what he looked like with his hair wet.  It was, hands down, one of the most challenging times of my life.

And yet. Sometimes, deep down, I long for the quiet alone time in the hospital, when I had no responsibilities other than trying to keep myself healthy and sane. Now, when I am being pulled by call schedules and challenging patients and medical students and academic responsibilities, and being tugged by my children who just pooped and forgot their homework and are crawling in the blueberries that they earlier threw on the floor and he took my crayon! and she’s singing the song wrong! and we’re huuuuungry can we have a snaaaaack even though they just.ate.dinner. and they’re fighting and they’re whining and the house is a mess and the resident just texted me … sometimes, deep down, I wish I could find a portal, slip inside, and crawl back into that warm cocoon of the antepartum wing, where people were paid to fluff my pillow and clean my floor and bring me ice water, and to care how I was feeling. Where they would sing to my unborn baby while trying to find her on the monitor and we would chat about the weather and I was bored out of my mind doing crossword puzzles while The Office was on in the background. I am a year out from that experience, and beyond grateful that despite a high-risk pregnancy and complicated preterm delivery, both I and my baby girl are doing well. I am so thankful for my full and beautiful family, for my rewarding career. But sometimes, just sometimes, late at night when my kids are finally sleeping and my husband is softly snoring beside me, when I lie awake thinking of all the things that need to be planned and done at work and at home, I yearn for a bit of calm and quiet. Just for a moment…

Sweating the small stuff

It's been forever since I've posted so I figured I would dive back in!

I've been noticing lately that I'm been getting myself extremely worked up over minor issues that ought to be minor annoyances.  I think it's because my overall stress levels have been high and I've been juggling too many balls, so I let little things get to me.

For example, at my kids' camp, there are two entrances.  One of them is right next to where I live and opens right into the camp area.  The other is all the way around the block and involves walking through the entire building to get to the camp.  Guess which door they keep locked.

I approached the director of the camp to ask if she could keep the other door unlocked just during the 15 minute drop off and pick up window.  She told me she couldn't because she could only keep the front entrance secure, and security was her biggest priority.  I had to accept this because I care about security too, obviously.

Until the next day when I went to pick up my kids early, found the front unlocked and totally unguarded, which is apparently how it is all the time.  When I pointed this out, she gave me this big smile and said something about the custodial entrance being there.  So.

Now I don't expect armed guards at the front entrance to the building, but if she's using security as a reason for keeping the more convenient entrance locked, it seems a bit hypocritical.  It pissed me off to no end.  So much so that I had trouble sleeping that night.

It bothers me how bothered I was by it.  Yes, it sucks to have to walk around the entire building when it's 90 degrees out.  But in the scheme of things, it's a minor annoyance.

So why do I let these things bother me so much?

Residency Roast

Another academic year comes to a close this weekend. Tomorrow a fresh fleet of interns across the country will be starting their first days nervous and tremulous to be finally let loose on the wards. Although most of my classmates have walked out of the clinic for the last time, I and a number of my classmates have “mom time” to make up for maternity leave (which feels a little like a punishment for having a baby during residency, despite only taking a 5 week maternity leave....but I digress) so I’ll be around a few more weeks.

Our residency celebrates the end of each year with a large banquet to celebrate the new arrivals and to honor the graduating residents with awards, nice words, and roasts. The outgoing residents get roasted by the program director first, followed by another roast by the incoming chief residents. The outgoing chiefs roast the faculty, and everyone has a good laugh along with some good food and drinks.

As a graduate, I was able to bring a whole table full of family to the banquet this year. During cocktail hour I was able to show off Toddler as we mingled with my friends and coworkers and faculty and guests. I was honored to be able to receive an award as well as present a teaching award and was glad those close to me were able to make it. 

I awaited the roasts with some trepidation. I felt I had a lot of potential - I’m a messy eater, a loud talker, a clumsy walker. My PD went first. When it was my turn, he poked fun at my small town (as he is originally from a neighboring small town to my own), my instant apologies whenever something even mildly inappropriate escaped my filter, and my overall “church lady” nature (I used to play church piano and work at a Catholic hospital so it was fitting). He did mention how pragmatic I was, to the point I would send my child away when I was on weeks of night float to my small town (my mom and sister cheered at this point seeing as that was who Toddler spent the most time with on those nights). 

I instantly had a bit of a flashback and felt a familiar feeling in the pit of my stomach. I hated those weeks so much. I remember the first week of night float I had as a parent. I stressed Husband out so much trying to get us to cross paths for those 15 minutes before he had to leave for work and I was coming home and vice versa and losing sleep trying to spend minutes with my Baby. It was awful. It was nerve wracking and left me in tears. The next week I sent Baby to my parents. It was such a good logical solution. My Baby would get to spend time with his grandparents who lived out of town, and they coordinated things so my in-laws could see Baby too. My husband was less stressed trying to hurry home as fast as possible to I could see Baby for five minutes before heading to work. And I got to sleep. It worked so well we did it for pretty much every week I had of night float. 

Logic didn’t stop the deep pit I would feel in my stomach as I handed off Baby each of those weeks. It felt like an essential part of me was getting ripped from my gut every time. I would do those hand offs and head off to the hospital to spend overnights alone isolated in my call room or being crushed by the pager. It was absolutely awful. 

And even in the banquet hall, surrounded by those I love most and my co residents and members of my residency who I will miss dearly, surrounded by all the warm fuzzies from sharing memories and laughter together, I felt a remnant of that aching pain in the pit of my stomach. As I looked around the room and thought about all that I would miss about my program, I knew what I would be the happiest to leave behind.

I snuck into Toddler’s room that night when he was fast asleep. I watched him sleep with his face shoved against his crib mattress and his diapered butt up in the air. I thought about how grateful I am for my upcoming attending  job - outpatient with low volume OB call - and thought about all the weekends and nights we would be able to spend together from here on out. I am so happy for the bonds he has formed with his grandparents and extended families from those weeks away, but am even happier that those weeks have finally come to an end.

With love,

Kicks 

Sneezing, coughing, itchy eyes! Oh my!

It’s that time of year. In my practice, I am seeing more children and adults with sneezing, puffy eyes, itchy eyes, forehead headaches, you name it. Look outside and the reason is clear, our region is plagued by significant amounts of tree and plant pollen and flowers and trees are blooming. The pollen blankets our sidewalks, cars, and homes with fine, green powder that causes a range of allergic symptoms.

My son and I have horrible seasonal allergies. I get runny eyes and sinus headaches (the pressure above my eyes, across my forehead, and next to my nose) and he gets puffy and itchy eyes, sneezing, coughing, and asthma flares.

Here are the basics that we use to keep things under control:

-       Avoid indoor allergens by vacuuming and dusting regularly.

-       Avoid strong smells indoors such as bleach and air freshener plug-ins and instead try fragrance-free cleaners and a few drops of essential oils mixed with water. 

-       Let kids play outside as much as possible but pay attention to the Air Quality Index on the news. After playing outside, have kids wash their hands and face to rinse off the pollen.

-       Rinse your sinuses with saline (special salt) water to get rid of all of the pollen. You can buy a sinus rinse bottle or neti-pot for less than $15. When you are having a lot of symptoms use it two times a day, once in the morning and once at night. When things are going well, just use it once a day at night before bed. Sometimes my patients do not even need other medicines when they rinse their sinuses out regularly.

-       If needed, talk to your doctor about fluticasone nose spray or antihistamines that don’t cause sleepiness such as cetirizine (Zyrtex) or loratadine (Claritin).

-       Avoid using antihistamines that cause sleepiness such as diphenhydramine (Benadryl) too often unless prescribed by a doctor.

With these few tips, I hope that you can avoid sneezing, coughing, and itchy eyes.

For more information, check out a short article: https://kidshealth.org/en/parents/seasonal-allergies.html

Originally posted at: https://www.healthyhomepediatrics.com/blog

News Cycle Fatigue

I recently took a week hiatus from the news. I was on a week of overnights, and the work- sleep- give kids dinner- back to work cycle didn't leave much time for CNN, Instagram, Facebook, the Times app, or other sources of the often depressing news cycle. And I was so much happier. I felt more present, more clear minded.

Do we have an obligation to be immersed in the greater world around us? In the presidential turmoil, the awful treatment of individuals in desperate situations, the lack of autonomy for an entire gender, the horror stories of workplace violence and very public child abuse? I used to think it was a social responsibility to stay informed and maintain that knowledge; but after the inadvertent hiatus, I realized that the lack of external negativity and stress made me a more complete, positive, and happier person.

So now I feel conflicted. I want to discuss the events of the world with my children, husband, colleagues. But there is a simplicity of staying within my own little bubble that is increasingly appealing. How do you grapple with the two?

The kinder choice: Antibiotics editon

Believe me, I know how to put a kid in a headlock. When my oldest was 3, a positive rapid strep test sent me to the pharmacy to pick up amoxicillin. This was going to be easy, I thought. It tastes decent, the volume is small enough, and it’s only twice a day. My daughter was a precocious sort, easily engaged and reasoned with. But twice a day, for ten days, we would have a conversation that went something like this:

Me: It’s time for your medicine. We can do this the easy way or the hard way. The easy way is you take your medicine and then get a spoonful of ice cream. The hard way is we put you in a headlock and force it down.

Her: Hard way.

Me: Are you sure? You didn’t really like the hard way last time.

Her: I’m sure. Hard way.

So, twice a day for ten days, my husband and/or I would put my daughter in a headlock and force the syringe of pink bubble gum-flavored antibiotic into her mouth. We would hold and she would squirm and cry and scream, and somewhere after 2 cc’s or so she would yell – Stop! I’m ready for the easy way! And then she would calmly drink the rest and have a spoonful of ice cream. We did this 20 times.

Fast-forward 6 years.  My son is 3 and now he has strep. But he’s … different. He doesn’t understand the easy/hard conversation the way his sister did. His tantrums are louder, and longer. He does not recover from them as easily, and they can ruin his entire day. My son is not officially on “the spectrum”; there’s no label to why is he how he is. We are still in the process of figuring out how his (different) (amazing) (beautiful) brain works. The journey is both frustrating and heartwarming, and there is so much unknown. But one thing is clear: the headlock isn’t working.

I text my pediatrician and ask if she will administer intramuscular bicillin. She agrees, but doesn’t have it in the office. I call around and find a compounding pharmacy 45 minutes away that has it in stock. She calls in the prescription, my husband drives out with all the kids to pick it up (I am in the hospital on service of course), and then drives back to the pediatrician, who gives my son the shot. He cries a little, and we’re done.

As a pediatric hospitalist, I spend a lot of time teaching residents about prescribing antibiotics. We talk about cultures and sensitivities, about side effect profiles. We talk about mg/kg, a lot. The residents all know that liquid clindamycin tastes gross and that augmentin ES causes less diarrhea than the original. But one thing many of them still don’t understand is why any parent in their right mind would subject their poor innocent child to an injection (a shot!) when the same medication can be given orally. What I try to teach them, to illustrate to them, is that sometimes it’s actually the kinder choice.

It’s not the right call for every kid every time. For my son, I am confident that we made the right choice, the kinder choice. But every child is different. I encourage my residents to think creatively about their patients, to use the biopsychosocial model to help guide their management decisions, to be flexible in their thought processes and to always, always show compassion.

The great thing about kids, though, is that they grow. My daughter who had strep when she was 3? Well, she’s 9 now, and she just had strep again along with her little brother. And she squirted her own amoxicillin into her mouth every time, no ice cream required.

My ideal medical practice - I opened up shop!

House call doctor tools of the trade. I have since gotten another rolling bag.

Over the last few years I have slowly been inching toward establishing my own practice. And this January, I did it, I incorporated my practice, Healthy Home Pediatrics! It is a house call based concierge, or direct primary care, practice serving Washington, DC and the surrounding Maryland and Virginia areas.

In my first blog post as a new business owner, I wrote:

It feels so good to work hard for my own vision. For the last 5 years I have worked extremely hard for visions that were established by hospital administrators or the organizations that I worked for. Too often, these visions fell short of what I knew my colleagues and I were truly capable of and far short of what patients really wanted and needed.

During times like this, when I am venturing into the unknown, I often go back to one of my all time favorite books, The Alchemist, by Paulo Coelho. I have read this book countless times. In it, Coelho shares the story of a young shepherd boy who leaves home and goes in search of his dreams. Along the way he is tested and experiences both profound joy and deep disappointments. One of my favorite sections of the book shares a conversation with the boy, his heart, and the alchemist:

“People are afraid to pursue their most important dreams, because they feel that they don’t deserve them, or that they’ll be unable to achieve them. We, their hearts, become fearful just thinking of loved ones who go away forever, or of moments that could have been good but weren’t, or of treasures that might have been found but were forever hidden in the sands. Because, when these things happen, we suffer terribly.”

“My heart is afraid that it will have to suffer,” the boy told the alchemist one night as they looked up at the moonless sky.

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams, because every second of the search is a second’s encounter with God and with eternity.”

“Every second of the search is an encounter with God,” the boy told his heart. “When I have been truly searching for my treasure, every day has been luminous, because I’ve known that every hour was a part of the dream that I would find it. When I have been truly searching for my treasure, I’ve discovered things along the way that I never would have seen had I not had the courage to try things that seemed impossible for a shepherd to achieve.”

This is my dream. To practice medicine in the way that feels good to my heart, in a way that I know will help families and my community. To be unhindered by traditional systems such as hospital systems and clinic administrators. To collaborate directly with my patients and their families. To build sustainable relationships with families that help prevent disease and suffering. To be there for my patients when they need me.

Many thanks to KC and others for encouraging me and supporting me. A gentle nudge from her is what prompted this post. Even though it is scary, sharing such a personal detailed account on MiM, I want to share this new phase of my life because I have already received countless messages from colleagues, friends and family saying how much my business has inspired them to pursue their own dreams. I want to take you all on this new path with me. Let me know if there are particular topics about entrepreneurship and balancing work and life that you would like me to write about.

Thanks Mothers in Medicine for inspiring me!

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What my toddler is teaching me about growth

In the last couple of weeks, my son has been learning to identify colors. Mama and Dada are bursting with pride that he's so verbal and learning new things so quickly (he's not quite two years old). For the first few days, he would try to identify a color and be right maybe ten percent of the time. When we'd gently correct him, his little brow would furrow for a fraction of a second, and then he'd try again. He's been persistent, and now a few weeks in, he names the colors of the flowers and the cars that we see walking around our neighborhood. And he's so excited when he gets it - just bursting with pride that he's learned something new.

I have a lot to learn from my son. He is curious and eager to learn, and he doesn't give up when he struggles. He's not embarrassed to admit that he doesn't know something, and why should he be? It's all new to him, and he's learning so much! He's having fun, even when he doesn't know the answer.

In just 7 short weeks, I'll be a brand new intern, and I will struggle. I will be wrong often. I will try my best and still fall short. Obviously, the stakes are drastically different for me than they are for him. But if I can approach the next phase of my training with half of my son's enthusiasm, joy and persistence in learning, I think I'll be ok. 

The critical first decade

I was at a conference a few weeks ago for rising chief residents. Hilariously, my husband (who had a few days off from work) decided to take advantage of the free hotel room and come with me, bringing out 20 month old. They had a lot of fun during the day, until he got a febrile URI and became a clingy mess. (Of course, then I felt guilty being wined and dined with the program leadership while he sat in the hotel room with a sick kid, but what else is new in Mom-land?)

But this isn't about that.

During the first day, the keynote speaker gave an address about carving a career path for yourself in academia -- life "after" chief year. He talked about the historic ideal of the "triple threat," where you succeed in teaching, research, and clinical time, essentially having a contract that allows you to spend 1/3 of your time in each area, adding up to a full time job. He reminded us, not so gently, that no one ever succeeds at all of these things, not as effectively as they could if they focused on one or two areas, and encouraged us to pick one or two when envisioning our future career.

And then he described the trajectory of a career in academic medicine: "The first decade is focused on establishing yourself, making a name for you and the research or clinical area you want to be known for. The second decade is to deepen that commitment to "your thing" -- publishing extensively, traveling, teaching, and speaking. By the third decade, you're known -- being asked to contribute chapters to books, leading courses with medical students, innovating as a clinic director. The fourth decade is a time to relax, to live in the space you've carved for yourself - and if you're lucky enough to have a 5th decade, you're an emeritus, enjoying the learning and not doing very much."

And as I sat in the audience, surrounded by future chief residents, I thought about how ~50% of us are women, and women who, most likely, will only be fertile during that first decade of our careers. What does that mean for the "most critical" decade of our work, to also recognize the very real demands that daycare and illness and doctor's appointments and soccer and pickups and dropoffs have?

Years ago, I once told a mentor that I thought that, realistically, this 10 years of my career would likely be my least productive, by publishing standards. I have a small child, I was planning on having multiple others. He was totally blown away, immediately shook his head, said there's no way that would be true, that he knew me and my work ethic, that lots of women "succeed despite kids." I left that meeting embarrassed, thinking that perhaps I shouldn't admit what I knew to be true - my partner works, too, and our lives have to adjust to the very real presence of our child.

This lecture was fresh on my mind when we returned from the conference and my husband went back to work. They've had some staffing turnover among the employees, and a new boss has been hired. Two leaders who currently work part-time (for various family reasons) were instructed that they would be welcome to sign a contract for next year in their current positions, but would not be able to work part-time - leadership requires a full time commitment. If they wanted part-time they could do a similar role, but without "a seat at the leadership table." This discussion among the staff at his job has been burning my brain ever since he told me - that two of the women (and, not-coincidentally, the only two mothers) on their leadership team were told that their commitment wasn't enough, that their desire to work part-time wasn't enough, that the hours they put in at night after their kids go to bed, and on the weekends, and in-between the other parts of their lives wasn't enough. I was in tears as he explained it to me, and I don't even know this women well - they work in another department.

I remember this keynote speaker, and I imagine the first decade of these women's careers. I suppose they didn't establish themselves, their credibility, their niche as clearly or as well as their male colleagues - that when it comes down to it, their skills are dispensable. The New York Times had a great article about this very topic yesterday - in short, that in heterosexual couples with children, employed mothers get the short end of the proverbial stick - faced with the demands of parenting and the ever-increasing demands of the work force, they end up forced to cut somewhere. For these women at my husband's workplace (and, realistically, for future me) - they cut back a bit at work. But working 25% less doesn't mean making 25% less, or being valued 25% less -- it means making 200% less, being valued 200% less.

I'd love to know reflections on your first decade at work, post-residency and fellowship and training. How did you carve out a niche for yourself? Or is that overrated in the first place? And what does it look like to parent when work is "greedy"?