Guest Post: Has Pandemic Living Caused You Stress or True Distress?

When I turned forty, I tumbled slowly into a deep hole. While caring for a six-month-old infant, two older children, and starting a new job in a new city, I was expectedly busy, some days nearly frantic.  I had always been full of energy and drive, able to handle anything that either my NICU practice or my children hurled at me. We transferred to a new city and new jobs four months after my third child was born. Then I turned forty and everything changed.

Despite taking night call in the hospital twice a week, and pumping at work, I continued to enjoy nursing my last baby. She had been easy from the start, and I planned to cling onto nursing (and oxytocin) for as long as possible. At first, I noticed my sleep pattern changing, but assigned it to my workload, the stress of moving, and fatigue. I could not go to sleep, and when I did fall asleep, I awoke at 4:00 or 5:00am each day, ruminating over all my worries (call schedules, a new school, new teachers for the kids, a brand-new nanny). Despite running in overdrive, I rarely felt hungry, began to eat less, and lost some weight.

 

When I became grouchy and short tempered with the kids, I attributed it to stress and my workload. There was always so much to do, both at home and at work. However, sometimes I erupted in anger at my children for no good reason. They were adjusting to big changes in their little lives, too. I observed myself continually furious at my husband and resented his enjoyment of his new job (when I was not). Yet, because I continued to work full-time and take night call in the hospital, the fatigue I felt was extraordinary. Some days it felt like the typical “post-call” funk, and other times it felt much worse. I literally forced myself to drive into work for my night shifts.

 

Then one morning while in the NICU attending to sick babies, I noticed that I was unable to make the most straightforward of clinical decisions. Should we treat the patent ductus arteriosus with indomethacin or move straight to surgical ligation? My thinking had slowed until my brain felt foggy. This was noticeably different, since my pattern of practice had always been decisive, even borderline impulsive. I began to have terrible throbbing headaches, and my poor husband complained about my lack of interest in sex. I was so busy with work and the stresses of my new life, not to mention goings on with the children, that I had not noticed my lack of interest in intimacy.

 

For two months, my anger, irritability, and general unhappiness progressed until one day at lunch while whining about my situation to a colleague, also a critical care physician, she opined that I was depressed, and recommended I see a psychiatrist friend of hers. Fortunately, this physician worked me into his schedule quickly, put me on an effective medication, and over the next six months, I gradually recovered. Thank goodness I never felt hopeless or suicidal, as some women do.

 

As a neonatologist I knew plenty about postpartum depression but never considered that diagnosis for myself. It is amazing to me now that I was unable to identify what was happening. My symptoms of depression were both classic and comprehensive: fatigue, poor sleep, foggy thinking, inability to focus or concentrate, headaches, lack of interest in food, weight loss, irritability, inappropriate anger, and lack of interest in sex. I quite simply assumed that I was transitioning poorly to my new job and ruled out postpartum depression since my baby was already six months old when my mood changed.

 

During this period, my feelings of guilt and self-doubt were inexorable. I felt like the worst mother and wife ever. It is only because I saw a good psychiatrist, and because medication and psychotherapy worked for me, that I recovered. These last fourteen months - this stressful pandemic living - have been difficult for many working mothers. Our jobs and our home lives have changed dramatically.

 

If my story resonates with you, and you recognize any of these feelings or symptoms, please talk to someone – a counselor, a therapist, a social worker, a pastor. Feeling this way is not normal despite how much we may convince ourselves otherwise. These symptoms indicate a severely depressed mood, which may occur anytime within the first year after giving birth. Or you may have a major depression unrelated to childbirth.

 

You are not a bad mother if you develop depression. Mental illness is a genuine biological illness, like diabetes, or asthma. Moreover, depression is treatable. With medication and psychotherapy, you can feel better. I am living proof of that.

 

Susan Landers, MD

https://susanlandersmd.com

Her new book, “So Many Babies” can be found here. 

Lack of Headspace: Mind Mapping

 Recently, a blogger/influencer I follow on Instagram introduced me to the concept of a mind map. Basically like a giant plan of what is going on in my life, what is taking up my headspace, what I am thinking about, worrying about, need to accomplish, hope to accomplish. 

Basic Idea linked here

I have just been so mentally exhausted lately. My mind has so many "things" going:" passion projects, work projects, home projects, relationship projects, mom projects. In addition to the mental load of end of school year/ camp/ summer/ moving/ COVID testing/ travel etc that takes place on a daily basis. I was told in the beginning of medical school that training is like a treadmill. You just have to keep going. Well, now it's going just a little too fast for comfort. 

The mind map helps me see it all laid out. It helps me prioritize, create and construct a to do list, allows me to cross things off that are complete, or are deemed unnecessary once written out in a bubble on a piece of paper. It helps transition the sensation of "busy" to "productive." It is definitely something I plan on using going forward, and wish I would have known about it sooner. 

Tonight, instead of crossing off a bubble, I chose to write. Reaching out is a passion, sending good vibes to this community of supportive people is my way to refocus and set the tone. What do you do to decrease or organize your mental load? 

My 12-15 year old son

 

Hi, yes, I have a two lovely children, a 17 year old daughter and a 12-15 year old son.

As a mother in medicine, emphasis here on in medicine, I was offered the COVID vaccine and jumped at the chance, way back in 2020.  Yes, it was December 2020 when it was first available to health care providers like me.  Then came the tiers and the categories.  It’s been a long wait, as various extended family members obtained their appointment slot (some more and some much less easily than others, but that’s another story for another day).  My daughter became age eligible for the vaccine and is now presumably immune, but what about my son?

My son.  How old is he?  I could only think of him as a 12-15 year old!   Not 14 but 12-15, indeed.

And what joy it was to see the many sizes and shapes of  "12-15 year olds" lined up last week to get vaccinated on the very day it became available.    

We’re getting there.  #ThisIsOurShot

Broken Glass

     That seems to be the theme of Mother's Day this year. First I called my Mom at the crack of dawn and somehow hurt myself on a piece of broken glass. Ignored it, and walked around in my right tippie toe finishing the conversation. I haven't sent anything yet, which I regretfully told her, but she assured me that my undivided attention for a half hour was way better than any gift. After I got off the phone I pulled the piece of glass out of my heel - I was bleeding on the floor at this point - and where it came from is still a mystery.

    Then my husband woke up and headed to Kroger after emptying the dishes while I reclined on the back porch reading. He brought back flowers (candles and flowers are my fave) and Jack wandered up - he's 15 now and towers over all of us - and wished me a Happy Mother's Day - things went awry from this point. The flowers my husband brought were originally placed in a too big vase and I asked Jack to help me transfer them to a smaller more appropriate vessel. 

    There are things I regret in my life. One, I once tried to stand upright after a fainting spell (blood pressure meds too much after I lost some weight) and I passed out and broke my jaw in three places. Two, I peed in the waiting room before my colonoscopy - first one - last week and they unfortunately require a negative preggo test if you are under 55 - it took a whole bag of saline and an hour and a half to pee. Three, I almost told Jack to move the vases to the sink but didn't. There was a lot going on on the counter. An entire candle spilled and broke on the floor. It took a lot to clean.

    Cecelia, now 18 and a force to be reckoned with (I'll talk more in a future blog) was spinning positive. She said broken glass ceilings is a good thing right Mom? I've got to go study now. Let's do brunch at 2:30 (something I am currently highly looking forward to). But Jack said he cannot go he just got a job at Cajun Sno he has a shift from 1-5. And he's three weeks out of turning 16 so he cannot legally drive yet she has to take him. He's a gem. Maybe at 15 not the best  on Mother's Day but love languages are different and his is wonderful if not on point for the holiday.

    I hope everyone out there is having a wonderful Mother's Day. We are breaking the glass ceiling, as C said. I couldn't wish for a better community. Stay tuned for more. Below is an image from a vacay in the Dominican Republic pre Covid. Much love, Gizabeth.

Hope in a cloud

I recently attended a virtual conference and one of the sessions centered on wellbeing during the pandemic. The session organizers had participants engage by contributing to word clouds.

In one word, describe how you felt during the pandemic? Not surprisingly, the words that grew largest were anxiety, stress, isolated, uncertainty. 

The next prompt was, In one word, what is the way that you coped? For me, hard to capture in one word but I think it was a combination of the words I saw populating the screen: family, colleagues (leaned on each other), exercise. On that last one, I've completely fallen in love with yoga over this past year and the wonders it has done for my body and mind. Especially on days when my almost-16-yo daughter joins me and we do it together. This is the best bonding. It's almost spiritual sometimes, and at others, it devolves into laughter when one of us falls or does yoga very wrong.

The last word cloud prompt was, In one word, what are you most hopeful for this coming year?

Just looking at these words in this image makes my heart rate and breathing slow. I can't wait to travel with my family again and explore a new country. Reconnecting. Being with people. I miss hugs. (Who said netflix?). I'm feeling hope again - a clearing, a light, better days with more joy and more of all of this.

The Hamster Wheel

 This year has been a hamster wheel. An asterisk. A toss-up.  Now that we are a year into the pandemic, many are vaccinated and starting to re-enter society; thought-pieces abound about seeing the silver lining, recognizing the many blessings that go unnoticed, appreciating family, home, the small things. I associate with all of it. 

But today, I'm writing to procrastinate. To feel useful. To send a message out there into the world of moms in medicine asking if you feel the same or for any words of wisdom. There was so much give and take this year, but I feel like the world kept taking and I have little left to give. Between spotty childcare, the disaster that is virtual learning, and trying to be a useful and productive fellow entering a job market that is abysmal, I feel like I have loose ends at every turn. Laundry undone, projects have finished, articles partly read, emails never sent. I gave myself permission to take a full 2 week spring break- no shifts, no teaching responsibilities, nothing-  the first real vacation in a while, as during residency traveling was hard, there was always more to study,  and I had saved up vacation for maternity leave. 

Maybe this is just post vacation blues, but the feeling of so many mountains to overcome is overwhelming. I plan to just chip away at all the responsibilities one thing at a time. Prioritizing work this week, home life the next. I'll take any tips you have.  

Materni-tine

It was the best of times and it was the worst of times to have a baby. 

For starters, I don’t want to be a pregnant healthcare worker in a pandemic again. No thank you.

We tried to induce Baby Girl early in November when the COVID was really hitting the fan here in the Midwest and we didn’t know if it would get worse. Didn’t matter, she didn’t budge. She ended up (as her older brother) needing a for-real induction a week after her due date. After the delivery, we struggled with a retained placenta so it seemed like the never-ending pregnancy - even though we had a baby, we still. weren’t. done.

There are definitely pros and cons to taking maternity leave during a pandemic. It has been so nice to keep my entire family at home for twelve weeks, although twelve weeks at home with a fussy baby and a three year old with minimal visitors has been trying at times. I am somewhat of a germ-a-phobe with small babies even in non-COVID times, so COVID gave us an easy out of crowded holiday family gatherings. It did get lonely. We made a grandparents-only visitation rule which worked out great until one side went south for the winter and the other actually came down with COVID so stayed away. I had to be intentional about Zooming everyone from college roommates to high school besties - and I definitely found some solidarity in their loneliness as well. It’s hard for everyone here as winter in the Midwest doesn’t really lend itself to outdoor socially distanced gatherings. My husband and I don’t feel like we’re missing out on anything by staying at home with our kids - because that’s what everyone else is doing too.

I will be ready to go back to work in the next couple weeks. I’m a little nervous about jumping back in at full speed with an extra little body to coordinate, but I’ve decided to “give myself grace” (a phrase I stole from one of my patients) and remind myself that it will be messy and it will still turn out OK. I got my second COVID vaccine which is reassuring. I did decide to vaccinate and continue breastfeeding which is consistent with AAP/ACOG/Academy of Breastfeeding Medicine guidelines. The doctor in me reviewed the evidence, weighed the risks and benefits, and made the decision to vaccinate. The mother in me called my mom immediately after my first vaccination to get reassurance I was doing the right thing. 

This is how I know I did maternity leave right: I rewarded myself with a post-COVID vaccine haircut (10+ inches gone! Hello mom cut!). My hairstylist asked what I’ve gotten done during my maternity leave and I couldn’t think of a single thing outside of snuggles and legos. And I wouldn’t have it any other way.

Kicks

The Match: It will all work out

 It's been a while. Hope you are all staying safe and sane and welcoming a new year with a sense of optimism. I know it's tough, but all we can do is hope, right?

I found this blog over 10 years ago. I was newly married, pregnant, furiously google searching "mom in medicine" and "can you be a mom and a doctor." Luckily, I stumbled upon this blog, read archives and old posts, and mustered up the confidence and gumption to take on medical school with a newborn. It was not easy. I recently celebrated my 10th wedding anniversary, and, as someone who got married right out of college, my husband and I realized that for the entirety of our dating life and marriage, I have either been studying for the MCAT, applying to medical school, in medical school, in residency, and now in a fellowship. The third wheel of responsibility and demands on my mind, emotions, sleep, and time, was not anything like we could have imagined bringing in to our relationship. But as I can see the light at the end of the tunnel, I'm amazed at how far we have come. 

Thinking back to January 4 years ago, I remember the fear with which I submitted my match list. I knew the programs near my hometown were notoriously competitive, especially in my chosen field. Being 8 months pregnant with my 2nd during Step 1 did me no favors and I had an unlikely chance to match at my medical school's program or the other local programs. So we looked around America. We kept an open mind. And I submitted a list that was part hopeful, part practical, and part prayer. 

I didn't invite my parents or anyone aside from my husband to match day. I was dreading it, honestly. I didn't want to move away, I didn't know how I could possible do residency without that supportive backbone my parents gave me throughout medical school. I knew that I would most likely end up on the other side of the country, near my husband's 1 relative, and without the support of my family and parents and friends and everything I knew. 

When I matched at a smaller program 3000 miles away from home, at first I cried. It was confusing. I loved the program and knew in my heart it was the best fit for me. It was family friendly, supportive, great staff, respectful of the lives and time of its residents, and an unbelievably rigorous place to train. But in the beginning, those feelings were hard to reconcile. I hated the match process, doubted medicine, and questioned what the purpose of the whole thing was. It was hard. But now, looking back, I am so so glad I did it. 

My mentors in medical school and various blogs tell residents to "trust the process." Trust that "the match works itself out." For some, it doesn't. But for me, those words rang true. We created a community in our new city, explored a different climate and culture, and really had a wonderful adventure. I am now doing fellowship in the midwest, slowly inching closer back to my home in the West Coast. But I am fortified in my relationship, as a parent, and have learned to lean on community and friends, not just family. My kids are resilient and adaptable. The feeling of "us" in a little bubble- amplified by the pandemic- has only made my relationship with my husband stronger. Had I quit or compromised my goals during match, I don't think I would be as fulfilled, happy, and motivated as I am now. 

Good luck to all the applicants submitting their rank lists. Stay open minded. I'm sending good vibes that it works out. 

Crunch Time

Sitting in my rocking chair taking a few deep breaths.

We hadn’t shared it on the blog yet but we are expecting Baby #2 any day now. I can tell you that the pandemic is about 8.5 months along because I took the pregnancy test the week we started shutting things down. I had some funny experiences I had forgotten to share - for example, I found out buying a pregnancy test when you’re the small town doctor is a little more difficult than anticipated, and due to a miscommunication between the pharmacist and me, somehow I accidentally bought 6 pregnancy tests.

We have 2 weeks (give or take) until Baby Girl arrives and of course it’s been the worst of the pandemic that the Midwest has seen. I luckily have gotten approval to work remotely doing video visits and phone visits at home alongside my husband who was working from home even prepandemic. However, I still feel every day I remain pregnant is a day we are trying not to bring COVID into our house. We are just ticking down the days. We removed our 3 year old from day care for the next two weeks and convinced my retired parents to watch him at their house out of town, but the members of our already very small family circle are also reporting positive contacts one by one. It feels suffocating. I spend my mornings as a primary care provider cringing at the notifications of positive test results in my elderly and institutionalized patients. I spend meetings hearing about surge planning and watching steadily rising graphs specific to the region where I live. I talk via phone/video to my patients who are either having significantly worsened anxiety - or don’t realize that the term “quarantine” means “don’t leave your house”. I do everything I can to make sure we have minimal in-person interaction in all we do - and then I turn on the TV and the high school football team is still playing their rival team. I scratch my head and I just can’t reconcile the world I live in and the world other people seem to live in. 

I am ready for Baby Girl to get here, but not in the way I was hoping. I wanted to be eagerly awaiting her arrival, not feeling like I have to rush her along so we can barricade ourselves in our house during maternity leave. I wanted to spend time with our 3 year old and enjoy his last moments of being our only child, not ship him off to Grandpa and Grandma’s so I can finish working. We’re doing okay, and we are lucky in so many ways. We’ll continue to take it here one day at a time, and I’ll try to take advantage of this quieter time as much as I can while it lasts.

Kicks

What Exactly Is Coaching?

This being a blog made of women physicians, I thought it would be prudent to write a post about Coaching. If you haven't noticed on the socials, coaching - a fixture in the corporate leadership world for some time - is really taking off in the physician and professional wellness space. There are coaches for every sort of physician wellness niche issue you might be facing: burnout, getting unstuck, work-life balance, negotiations, finances, parenting, weight loss, etc. And with some exceptions, these coaches are predominantly women. During the takeoff of the pandemic, coaching programs around the problems of PPE stress, furloughs, homeschooling, and quarantine were everywhere. 

I used to think coaching was for CEOs or entrepreneurs. High-powered execs who use The Secret and go to Tony Robbins events. Yet now, in our current landscape as women physicians, there's never been a better time to get some coaching.

My experience

When I was in the throes of burnout and self-care failure years ago, I had a coach. He was the spouse of my residency mentor, a person versed in executive problem solving with a thriving business and book on the subject. My sessions with him were so incredibly insightful; he helped me embark on the self-knowledge journey that I started during my sick leave... which ultimately lead me to starting PracticeBalance!

Yes I have a supportive family. I have a great relationship with my husband, and we openly communicate about everything in our lives. I've also seen a therapist during particularly dark times. But until I had a coach, I never realized just how powerful it can be to have an objective person listen to you, whose sole job is to listen without judgement, and help you analyze your thoughts.

It's like, all of a sudden, you gain CLARITY: on directions, on decisions, on values. Yet YOU are the one who solves your own problems... with some gentle help. I've had other coaches since, and I have one now.

The Power of Clarity

Is coaching effective?

Aside from the fact that it's very popular to have a coach right now, it's also effective. A 2019 study in JAMA found that primary care physicians randomized to a 6 month professional coaching program reported lower rates of emotional exhaustion of overall burnout. A 2020 study in the Journal of Occupational Health Psychology of a six-session coaching intervention found the same. And these studies are now extending to medical students and residents.

Coaching can take place in different settings: group, one-on-one, in person or virtual. Sometimes sessions involve themes, lessons, or mini lectures, and other times it is completely client-led. Sessions can last anywhere from 45-90 minutes, and as the coachee, you should expect to be put "on the spot". Coaching is about YOU. And expect to have homework between sessions. Also, the most effective coaching will involve follow-up, as you see demonstrated in the above cited studies. One-off sessions aren't completely useless, but part of the coaching experience is the accountability to take what you've learned/realized and apply it to your life... then report back to your coach.

Coaching vs. other things

How is coaching different from therapy, or even mentoring? Coaching takes a collaborative approach that is often future-focused and/or goal-focused, with the intent of changing behavior or thought patterns. Therapy tends to focus on past traumas and other experiences as root causes of behavior or thought patterns. Whereas coaches ask focused questions to help clients gain better self-awareness so as to institute their own changes, mentors offer advice and more concrete guidance.

What kinds of things can you expect to discuss in a coaching session? That depends on your coach, and why you sought out the coaching in the first place. (Full disclosure: coaching is a service I offer through PracticeBalance.) While I personally love to guide physicians on journeys of self-knowledge and self-care, my approach has been to individualize coaching based on what each client needs: more frequent sessions vs. less frequent sessions, higher structure vs. gently guided conversations. But some exercises I always suggest are mindfulness techniques and self-knowledge assessments; which ones depend on the individual client's interests and lifestyle.

How do you know if a coach is qualified? Unlike the practice of medicine, the field of coaching does not currently have an over-arching, governing body of certification. A "certified" coach is not necessarly better than a non-certified one; it really depends on the coach's experience - both with clients and within themselves. Kind of like a senior resident or a newly-minted attending vs. the senior physician with tremendous academic accolades, recent life experience can trump a pedigree when it comes to the quality of care you receive. In my opinion, in addition to basic listening and questioning skills, a good coach for you is someone who's experienced the pain points you're going through and has successfully moved past them.

Have you ever had a coach - even a traditional coach for athletic performance? What was it like, and what did you learn? Share your thoughts below in the comments.

(A version of this post first appeared on the blog PracticeBalance)

When is it over, mommy?

 I hate this whole thing so so much. I was congratulating myself on the "so far so good" few weeks we had been enjoying. Our kids didn't mind the masks and new school regulations that much, and were mostly excited about being a part of society again. We had settled into a little routine. Life began humming along back to some sort of predictable rhythm. 

Until it unraveled. As kids do, one of my kids caught a little head cold. Congestion, runny nose. No fever, no cough, nothing that in any other version of reality would make anyone blink an eye, much less miss school and go to a doctor for. But, in Corona-land, this little head cold was an all alarms fire. Visits to Urgent Care, begging for a test, Zoom school, quarantine. At one point, my child broke down. "I hate this. When is this going to be over? Why is it still going on? Why can't the world just fix it?" 

Then, (this child has a bit of anxiety) "do I have to stay in my room? Can you hug me? Can I hug the baby? I don't want a test! I hate Zoom School! It's just a cold! What if it happens again? Don't tell anyone- what if someone else gets sick? What if someone dies?..... 

As a doctor, my kids look to me to fix most ailments- scrapes, splinters, even stitched up chins and stapled scalps. But this is something so beyond any of us. The mental health aspect is as-yet not understood, but judging from my little microcosm of family, friends, and acquaintances, the impact on every aspect of mental health will have far reaching consequences. Words like social distancing, quarantine, and the realities of masks, "shadow tag", zoom school, virtual learning, and a pervasive fear of "others" will take years to recover from. My 7 month old baby has had interactions with a total of 2 adults aside from myself and my husband. We are now teaching an entire generation to on one hand love and respect others by keeping them safe, but on the other hand, never to share, not to recognize a smile, and to essentially exclude anyone not welcomed in to a pre-determined "bubble." It's insane. 

As an essential health care worker, I am "lucky" as I get to go to work and my schedule has not been too disrupted. I have a job, we have a home to quarantine in, and we feel safe in our environment. But we are all living on a tightrope, and our sense of "normal" has cracks and tears when examined up close. Sending vibes of peace, love, safety, health, and calmness out into the world. We all need it. 

Guest Post: Frenemies

This isn’t the way I had wanted it to be. When I met and married my husband I had envisioned a relationship with my mother in law that would be better than those of other mothers and daughters in law. We would not become frenemies. My husband would not become the pawn or middle man in our petty disagreements. I would be patient and respectful, and eventually develop a love for the woman that bore and raised the man I loved. Most importantly, I would not become my mother, who I felt harboured a lot of resentment towards my grandmother over things that seemed trivial.

It is clear to me now that how we are and how we come across is as much of a reflection of who we are with as who we are ourselves internally. My best intentions have slowly over the course of the decade chipped away leaving me chronically agitated at the woman who I had hoped to understand and befriend.

 

She has always been a hypochondriac. Something is twitching. Is it a sign of something dangerous? Her face aches with tomatoes. She must be allergic to vitamin C, in fact she is sure of it. She can feel her blood pressure go up, so she will check it every 5 minutes until eventually it does. Her blood pressure is too low, she feels sick. She has this pain, but doesnt want to take tablets. Who knows what the side effects will do to her? We have been there for countless trips to the emergency room via ambulance, only to be sent home soon after as all is fine. I humoured all this, not only because of my commitment to the relationship, but being in the medical profession I was kind of used to dealing with strange and unreasonable people. I had developed a patience with them at work and this transcended easily over to my relationship with my mother in law. So we were doing fairly well, until the children came.

 

With the children came a loss of boundaries. I remember the extreme pain of trying to hobble over into the bedroom with the baby in one hand and breast pump in the other, barely clothed (what was the point?) and the episiotomy and high vaginal tear still very much fresh. My mother and father in law had decided to come by unannounced and were at the front door of our small apartment. Of course they wanted to see the little munchkin. Had he gained any weight? Was I breastfeeding? Were my breasts making enough? It was very important he was breastfed. My husband was breastfed until he was two, my father in law touted proudly. I excused myself, scrambling to hide the formula and baby bottles drying near the sink. Why was he crying now? Had he been changed? Maybe he was hungry. Had I fed him? At this point my mother in law would take it upon herself to soothe the crying baby. My rocking wasn’t good enough. I was failing at mothering already. She had more experience with rocking babies. She would be able to fix it, of course.

 

This only got worse over time. At outings I was instructed to give my son some more chicken, more bread perhaps, the orders from across the table never stopped. He never seemed to have enough food to her satisfaction. She never trusted me to know how much my child should be eating. Of course he didn’t sleep through the night, he was cold and he needed more layers on! (she’d never heard of SIDS). When I went back to work the pity she expressed for my son when he started daycare would make you believe I was sending him to an orphanage to be raised by drug lords. It wasn’t only parenting that my mother in law second guessed me. Here I was managing a delivery suite by day, and then having to convince my mother in law that I have enough medical knowledge to know this rash my son has is not worrying. He does not need to see a doctor as I, his mother and a doctor myself, am not worried. All of this preyed on my insecurities as a new mother. I was a doctor first, and I loved it. My time and attention was divided. This could not work any other way. Would it be enough for my son? It would have to be. Perhaps her words and actions were not as bad as the feelings of incompetence and loss of autonomy they elicited in me.

 

With the second baby came more of the same, but I was better equipped. No she isn’t breastfed, it just didn’t work for us. But I am happy to report she is fed, Sorry, I can’t let you in. I just got out of the shower and am not yet clothed. I will not be opening the front door naked. If you had called before coming I would have told you. They have had enough to eat, thank you. In my assertive and often uncomfortably direct responses to her behavior, I have resigned myself to a relationship with my mother in law that is nothing short of frenemies.

En322  is a OBGYN in London who has been a silent follower of MiM for years. She has two children who are 8 and 2.  

Speaking Up

It’s a strange time to be living in rural America. I suppose it is a strange time to be living anywhere in America, or anywhere in the world for that matter. This is not new territory for my husband or I as we both grew up in small towns and the country side, but we did spend the last few years in metro areas and suburbs before committing to our hopefully forever home here. 

There’s a strange disconnect from what happens in the large metro areas only about an hour away to what is happening here. A large portion of my patients think wearing masks are unnecessary and the whole coronavirus is blown out of portion. I am somewhat removed from the direct horrors of the virus myself, as I am currently working outpatient care in a “clean clinic” which means you have to undergo intense screening to make sure no cough, cold, or loss of smell sneaks through the cracks (which also means I have some frustrated COPD patients I haven’t seen for months). However, an hour away my best friend from medical school is working part time in a COVID clinic seeing 30+ patients a day and part time in the hospital and telling me the stories of the young healthy patients who came down with vicious complications. 

I also have plenty of Facebook contacts from various circles posting fake news and theories about mask dangers from hypoxia - at what point do I step in? At what point do I stand on my medical training and credibility and post that “this is not right” while awaiting the wrath of anyone who dares to post back?

I was raised to not argue from when I was young. I was taught it often doesn’t get you anywhere other than trouble. I have always leaned away from engaging in controversy. I want those around me to feel comfortable in my presence. And I have always been much too cognizant of what others think of me.

However, during my last year of residency I learned a lot about the power of advocacy through social media from some of my favorite mentors and the power of a Tweet- especially a Tweet by a physician. I reactivated my Twitter account when I strongly disagreed with plans to shut down an area hospital that directly served some of the most underserved in the area and probably annoyed my entire handful of followers with my onslaught of Tweets that followed. 

On one hand, I’m not brave enough - or maybe I simply don’t have the energy to fight off Facebook warriors. On the other, I don’t know how much misinformation I can continue to ignore - especially when I happen to have an advanced degree in the field being discussed. 

 So I have to ask - how have you all been handling your social media? Especially friends and family? 

Mindful Parenting and a Toenail Drama

It started back in May. She dropped her stainless steel sippy, and the bottom rim landed right in the middle of her big toenail. For hours, she was beside herself. All we could do was kiss and hug her and say, “Yep… it sucks to drop something on your toe.”

It was the first, but it won’t be the last. A week or two later, there was a good-sized, eggplant-colored bruise right under the nail. Welcome to the Black Toe Club. She didn’t seem to care too much about the discoloration, and we went on with life as normal.

Fast forward to a week ago, when I noticed that the nail was starting to unroof itself. It became so… flappy... that it started to catch on things, which resulted in fits of pain and crying. Being the Doctor Mom that I am, I devised a treatment plan involving an epsom salt bath followed by lidocaine ointment and a sharp pair of scissors. But after the bath, she had a freakout.

She WOULD NOT let me cut it. Would not let me even touch it. We fell into a cycle of hugging and talking and attempting, followed by pullback and more crying.

Her: “I’M SCAAAAAARRRRED!”

Me: “This is the best way to deal with this. Otherwise it’s just going to keep catching on things and eventually rip off, which will be even more painful. Trust me! I’m a doctor! You just took a bath! It’s soft right now! Let me cut it!”

Her: [uncontrollable sobs]

This went on and on, extending past bedtime. And repeated for 3 days. The toenail would catch on something, even bleed. It separated further from the nail bed until it was sticking straight up in the air. I got so frustrated… if you’re a physician, you’re likely familiar with the experience of family members not taking your medical advice. All those past memories welled up, compounded by a screaming, inconsolable child.

One night I threatened to rip it off after she went to sleep. One morning I told her we weren’t going anywhere until it was dealt with. We devised different plans, all foiled by her going into a crying fit… and when one involved her dad helping to hold her down, he looked at me with his peircing eyes and said straight up, “What are you doing?”

[long pause]

Um…. What WAS I doing?

I was trying to control the situation. I was worried for her, anticipating the great pain she might experience if the toenail ripped completely off on its own. So instead of letting things take their course, I tried to solve the problem for her. Like lots of well-meaning parents these days, I was coddling.

I was acting on my own aversion to the appearance of her toe (as a self-confessed Picker, if it were my toe I would have cut that flapping nail off immediately despite any pain pemature action might have caused). The sight of it bothered me more than it bothered her.

I was using logic to appeal to an illogical, 4 year old little human. Although I want to respect her as her own person, she’s not a little adult. Yet I sometimes talk to her like she is.

I was trying to control someone else’s body. Someone’s body that is not mine to control. And I was using threats (again) to try to get what I want.

These are all Respectful Parenting fails.

Before even having kids, we decided that respectful parenting was the kind of parenting we wanted to do. I read books like The Gift of Failure and The Conscious Parent. I listened to Janet Lansbury‘s podcast. But like so many things having to do with mindfulness, theory is different than practice. It’s easy to have a plan, but what matters is how you act in the moment of need. Sadly, this time it took me approaching the use of force to realize how far I had drifted off the path I meant to be on.

Defeated but brought back to reality, I admitted I was wrong. This was wrong. My emotional bank account depleted but not quite in default, I was able to salvage the day by taking responsibility.

She put on flip flops with her little nail sticking straight up, I tried not to look at it, and we went about our day. I dropped her off at the gym childcare center, assuming I would get a call about another episode when she caught her toe on the playground or something.

But do you know what happened? When I picked her up, the nail was gone! She hadn’t even noticed it fall off; it didn’t hurt a bit. After all that, leaving it be was probably the best thing to do anyways.

I’m so lucky to have her (and him); I’m always learning from them. Being a parent has been the greatest lesson in mindfulness.

(A version of this post first appeared on the blog practicebalance.com)

The summers of my childhood

As a kid, my parents rented the same beach house every year for the month of August. We would rent a U haul, and drive down our bikes, boogie boards, surfboards, roller blades, books, toys, clothing and never enough towerls, and set up shop. We were friends with the owner of the local kayak shop and had an open account at the small general store, for things like popsicles, chocolate chip cookie ingredients, and other necessary groceries. It was pure freedom. Pre-cell phones, we hardly saw a screen all summer. Our only rules were to come home for lunch and dinner, and stick together. My brothers and I made friends quickly with the other beach kids, and would bike and swim and play for hours. I'm still a beach kid at heart and can't wait until life can lead me back there again.

We just moved from our East Coast beach town where I finished residency to a big city in the midwest for Fellowship. With the pandemic and the arrival of baby #3, we chose to live in the suburbs, in the heart of a kid friendly, tree lined, park-filled community. Within 1 month my kids have made  a gaggle of friends on the block, biking, meeting up for social-distancing playdates, and doing baking soda-vinegar-food coloring experiments. We have chosen not to participate in organized summer camp for the time being, so their time is unstructured. While the first week was hard, with incessant requests to "watch" or "tablet time," the past few weeks have evolved into what mirrors a summer of my childhood. Sun-kissed, dirty, happy, and (relatively) screen free.

I was pretty nervous to uproot my little family (again) after residency to yet another temporary city for fellowship. But the past month has reassured me that it was an upward move. Career-wise, without a doubt, but for their own needs as well. Change is really scary, but now that we can see the end of the unpacking on the horizon, and we are all in our own beds again, I think it will be a positive change. When I chose to do fellowship and matched, the most common response was "what about your family? Are they coming too?" While I know that many choose to do long distance relationships for training, I am lucky my husband works from home in a flexible position. The question made me wonder about if I was forcing everyone to sacrifice for my own dreams, if I was being selfish in pursuit of my career. Hadn't they endured enough during residency? Were the kids going to be negatively impacted by moving again? Was it wrong? Should I just be grateful I did residency and we all came out in one piece?

But one thing I learned this month, is that I am so incredibly blessed to be part of one resilient, adaptable, and happy crew. My kids will be fine, and have a broader worldview because of their experiences. We are now living in a community that I think will be a better fit than the one we were already comfortable in. Hopefully, everyone will still be happy once midwest winter arrives, but for now, we will enjoy the barefoot freedom of summer.