KIT (Keep In Touch)

Isn't that what everyone would write at the end of the school year in their yearbook entries, peppered with inside jokes and other, long forgotten acronyms? I used to be the queen of correspondence; usually by phone if not by post (cards, letters, etc.) I did all that I could to keep my few close friends apprised of my oh-so-very exciting life. Once email came along, it was even easier to dash off an email. I have always been sort of the "counselor" in my friendships, so I enjoyed trouble-shooting and discussing things with my friends. It was an important part of who I was. Things started to shift a bit once I entered medical school. I was so focused on my microcosm, sometimes months would go by without talking to my high school and college friends before I would even realize it. A well placed phone call, or two, and all was right in the friendship world once again.

In residency, I fell off of the proverbial friendship map. In the pre-80 hour a week era, I could work up to 120 hours a week (every other night 24 hours on call). It was in residency that I developed an odd social phobia involving the phone that I have to this very day. I just stopped answering it unless it was my mother or my husband. I stopped making simple calls like for pizza or take out entirely. I think that it stemmed from the fact that I *had* to answer the pager. I didn't have to answer the phone or call anyone if I so chose. It wasn't that I didn't *want* to talk to other people. It was that I *couldn't* talk to them. I just couldn't give any more of myself away. As a result, I slowly lost touch with friends that I loved very much, but to which I couldn't be a very good friend at the time. Next came parenthood, a new job with little time off, and another baby. There was not much time for extra socializing, though I realized that I needed adult friendships badly.

As I take the steps toward a new job, closer to friends and to family, I have also begun to reach out to old friends in an attempt to reconnect and apologize for being such a crappy friend to them. A rather recent discovery that has been great for this is facebook. I have gotten back in touch with old sorority sisters and my college roommates through this networking tool, and for that I am grateful. I've arranged a few tentative visits with important friends in my life that I haven't seen in 3 years or more. I feel like I am on my way to rebuilding these relationships, due in part to a few easy clicks of a mouse. So facebook worked for me, how do you stay in touch with your close friends that don't live near you?

Doctor, you are hot!

I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:

Zardari then called her "gorgeous" and said: "Now I know why the whole of America is crazy about you."

"You are so nice," Palin said, smiling. "Thank you."

And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."

I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.

I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?

I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.

But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.

The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?

What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?

To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.

But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.

I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.

Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.

None of this is to say that I am as gorgeous as Sarah Palin.

Patient was a furry, red-haired monster in moderate distress

I was watching Sesame Street with Melly this morning. Elmo was sitting on the curb, clutching his left foot and crying out in pain.

Gordon: "Elmo, what's wrong?"

Elmo: "My feet hurt!"

Gordon uncrosses Elmo's legs as he again cries out in pain.

Me: [thinking] "Oh my god, is it an ATFL sprain? Is it plantar fasciitis?"

Gordon: "Elmo, I think I see what the problem is."

Me: [thinking] "Tibialis posterior tendonitis? Achilles rupture? Talar dome fracture??"

Gordon: "You put your shoes on the wrong feet!"

Wasn't even in my differential.

Ahh, sleep

This morning as I awoke, I rolled over and stretched a lovely long stretch. My first thoughts were “I feel gre-“ but my reverie was interrupted by the sudden realization that I HAD SLEPT ALL NIGHT LONG. I grabbed the on-call phone next to my bed and anxiously scrolled to the “missed calls” file. It was empty. And then I was left with the vaguely guilty feeling that I have far too frequently after having a good night’s sleep.

When did this start? Why do I have a problem with sleeping all night long?

My first recollection of this sensation dates back to when I was an intern almost 20 years ago. A resident I worked with was fond of heading to the on-call room as soon as possible during call nights and jumping into an open bed. His rationale was that any sleep was better than no sleep and 45 minutes of sleep at 7PM might well be the only sleep of the night. I still recall the first night of call when I decided to do the same; I headed to the on-call room and tucked into a lower bunk, optimistically setting the alarm in the room for the next morning. I woke the next morning to the sound of the alarm blaring and immediately wondered why I hadn’t gotten called. I frantically paged myself. When my pager went off, I hung up and did it again. Again, my beeper responded immediately. I found a toothbrush and freshened up as best I could, then headed down to the morning lecture. On the way, I ran across the resident who had been on call with me the night before. He grinned at me guiltily and then said, “You’ll never have another night like this. Savor it. But don’t ever talk about it.” His unspoken comments implied that sleeping during a night of call was frowned upon – even if there were no patients who needed the night intern or resident.

I recall the same sensation the first night both kids slept through the night. My initial drowsiness upon wakening abruptly vanished with the realization that I hadn’t heard the baby cry. Stumbling into the nursery expecting the worst, my fears resolved upon the sight of Eldest earnestly holding a conversation with his stuffed bear; a few years later, it was Youngest’s voice singing aloud which soothed my concern after a similar night.

But I still don’t know why I feel guilty after getting a good night’s sleep. Is it because I spend so much of my time fighting fatigue that I don’t know what to do when the feeling is gone? Have I grown so accustomed to chronic sleepiness from interrupted nights that what should be normal for my brain and body is now considered the aberrant?

Even now, after having been awake for several hours, I feel “off”. Is it extra energy, lack of fatigue, hypercapnia from sleeping with my head under the pillow for an additional ninety minutes?

So MWAS, here's a really long answer to your question of the other day: 7 hours to function, 8+ to feel good (but then I feel bad). Does anyone else have this guilt after sleeping well?

A

Regular Mom

Son is asleep on the couch next to me...couldn't make it through the presidential candidate debate. I know I should move him to bed, but I love the warmth of his feet pressed against my leg.

Last night, he woke up with growing pains. My mom is staying over to help me while Husband is frolicking in Europe attending an important business meeting. She slept next to him in his bed and tried to help him. His screaming "Mama! Mama!" woke me.

I gave him some ibuprofen, then put him in my bed and tried my best to comfort him. I rubbed his legs and sang songs. Twenty minutes later, he was asleep.

I had growing pains, and I know that's what Son was experiencing, but the doctor in me went wild thinking of more unlikely, and scary, causes of leg pain. Osteosarcoma. Rheumatoid arthritis. Leukemia.

I realized, after an hour of stewing, that I would have those fears even if I weren't a physician. It's a maternal impulse to fear the worst. I'm just a regular mom.

Tugged

"Can you write an order for that?"

"How long will the epidural take to put in?"

"Mommy! There's a bug in my shoe!"

"What's for dinner, honey?"

"Attention all personnel, Code Blue, CCU..."

I am a tugged person. That can be stressful.

Last week while I was brushing my daughter's hair I started thinking of generations of women who have been brushing their daughters' hair for hundreds of years before me. The brush almost tugs her closer to me with each stroke - a wistful rhythm. It's an act that seems to expresses this tender, almost plaintive thought: stop a moment, my lovely girl; don't grow up too fast; enjoy this time to yourself, this untroubled time without complications or worries or major responsibilities, this fledgling time to be you and be entirely lovable and free.

I talked to her of our good fortune: we are women in a society in which we are free to choose to be wives or not, mothers or not, with opportunities to educate ourselves, vote for our leaders, work at professions of our own choosing.

Yet centuries of disregard for women don't fade all that fast. Just days ago I had to draw a thoughtless nurse aside for speaking to me in front of a patient in a way I truly believe she wouldn't have with a male physician.

Then I had to let it go, fast. I had a patient who was afraid to the point of tears. With her I was gentle, I hope, and reassuring. She nodded as I described things, showed relief when I explained things, clung to my hand when I rested it on her arm.

I was pulled away again for some other unpleasant business, and I had to put the harder face on, the one that has to take charge and get things done right. Then back to the patient, and more reassuring murmurings, more of what I hoped were kind words that built trust, and soothing moments.

Then the procedure began, and again, there was a need for firmness - my more business-like side, as I tried to convey important directives and elicit competent, efficient work from the team I was working with.

Then it was time: the patient awoke, surprised it was all over, refreshed. Again a hand on the shoulder. Everything's all right. You're just waking up. Procedure's all done. You did great. Tears of relief. A smile. A squeeze of my hand.

Hard. Soft. Hard. Soft. So it goes all day, every day. Compassion in the interstices, between moments where I have to take a stand, or take charge of something, or direct someone, or all the above.

Tugged.

We're tugged in so many directions. I think of trees pulled about by storm winds or rain. How can I teach my daughter to stand firm in this whirlwind world, to bend but not to break, to be firmly rooted but pliant, and most important of all, to use her health and her gifts to bear good fruit? I want her to be happy and safe. I want her to stay energetic and free. I want her to feel satisfied with her work but not to get too physically and emotionally exhausted. All day at work as I travel from patient to patient, task to task, she is in my thoughts, like a song in the background of everything I do and try to be.

What can I teach her about how to cope with wave after wave of demands on her attention, her time, her energy?

It comes to me: I will have to teach her, by example if not by word, to reach for stillness, again and again. When I return to it, sometimes it's for just a millisecond. A pause before inserting an I.V. A putting aside of annoyance at a fellow-doctor's lack of consideration or a nurse's thoughtlessness, in order to lay a hand on a patient and hold still for a second. I hold still. My daughter and me brushing hair during a weekend retreat: another moment of stillness. It's a rhythm, a habit, but one that takes practice, one easily forgotten.

I flutter around, busy, sometimes frenetic. But I have to go back to that stillness, even draw other people into it if I can, or I absolutely cannot cope with all the tugging.

Stillness. Young people so often underestimate the value of that, the gift of that. Everything now has to be high-stim, instant gratification, always on-the-move. My kids are no different. They are sucked in along with all their friends, into the maelstrom of entertainment and activity that their generation craves. But there is something in mindful stillness that none of those delights can match.

Somehow I will have to teach my children this if I can, and hope that it's of use to them as they grow (too fast!) and discover (wonderfully!) who they are.

[Cross-posted in slightly different form here.]

Seriously, I wanna know...

Jay Leno needs five. Albert Einstein needed ten. Leonardo da Vinci took his in 15 minute intervals. Hours of sleep, that is. How many hours do you need to feel human? Do you catnap?

Role Modeling

As parents, we are the shining (and often, not-so-shining) example of who and how to be for our children. Our food preferences, our political preferences, our jobs, and our recreational preferences shape the way that our children see the world. If we are doing our job, then our children grow up with the ability to decide whether or not they share our preferences. Who we are affects who they will be...good, bad, or in between. Despite the fact that in the last 20 years the medical profession is regarded more often with fear and mistrust than with respect and value, I still find myself in the role of role model and mentor for my patients, as well.

Lately, I've been thinking a lot about how one area in my life is absolutely out of control, and how it affects both my patients and my children. That issue is lifestyle, and more specifically, my weight. When I started medical school, I took care of myself. I ate well, exercised, and got plenty of sleep. Not coincidentally, I was also a healthy weight. In the 11 intervening years between the start of medical school and now, this has all fallen by the wayside. I eat a terrible diet, often rewarding myself with food, rarely exercise, and sleep is inconsistently 6 hours a night, at best. I look at myself now, 14 months after my second child was born, and I know that I no longer have any excuses. I am obese with a BMI of 36. I didn't "just have a baby." It was over a year ago!

Day in and day out, I give weight loss, diet, and exercise advice to patients. Prior to medical school I was also a weight loss counselor. I *know* what to do. How can I expect them to listen to my advice, as a role model, when it is obvious I do not practice what I preach? Worse yet, how do I model a healthy lifestyle for my 4 year old daughter? I can't keep fixing her fruits, veggies, and healthy dinners while I eat a pound of pasta night after night. I can't encourage her to keep active and fit when I come home at night, exhausted, and plant myself on the couch. Soon enough, the questions will start.

In my quest for a better work lifestyle, I am also embarking on a personal lifestyle change. Mr. Whoo and I are taking the kids for walks before or after dinner. This week I have started a weight loss regimen that requires me to track what I put in my mouth. I've started over and over again in the last 3-4 years down this road. I need this time to be the last. I'm doing it for myself, for my family, and also for my patients. It is time to realize that *my* health is important, too. I want to be able to tell my overweight/overworked/overstressed patients "I did this, this is how I did it, and you can do it, too!"

How are you being a positive role model in your patients' and families' lives?

If I can do it, why can't you?

Every year in my residency program, we are given what is basically a "practice board exam". It is hyped up as being extremely important--something that the program uses to judge its residents and something that fellowships might ask to see. We were told that if we did well, it would make our program look good compared to others, so "make sure you do good". Eep, pressure!

During my first year of residency, I was going to be 39 weeks pregnant when this three-hour exam was scheduled. Considering the importance attributed to this exam, I asked the female program director if I could either be exempt from the exam or take it under circumstances more comfortable for a woman who was nine months pregnant, since three hours straight in a tiny desk with a hard wooden chair did not sound tempting.

Before I conclude this little anecdote, I want to say that I bet I know what some of you are thinking. You're thinking, "What's the big deal? I took my REAL board exam while nine months pregnant, also while breastfeeding a one year old, and pumping during my 15 minute breaks. Also, I had eclampsia at the time and was actively seizing. And I didn't complain."

Admit it, that's what some of you are thinking.

Which isn't so far off from the response I got from my program director, who was the mother of three small children. She told me (via email), "We'll see. I was still answering pages when I was in active labor."

I'm not as strong as all that. When the epidural went in, my pager went OFF.

Still, this incident made me aware of the fact that while other physician mothers ought to be our greatest advocates, sometimes they are our worst enemies. There's a general thought from some female physicians: "If I did it, then why can't you??" I think we've all had encounters with physicians mamas who showed a surprising lack of understanding, sometimes even worse than the men.

I'm guilty of it too. When other women with kids take off a day because their child is sick, I automatically think, "Well, I came to work when my daughter was vomiting." Or when another resident started her maternity leave a whopping month prior to her due date, I couldn't understand why she was unable to work till the very last day, like I did.

And I hate myself for thinking that way. Female physicians should support each other and work together to foster understanding and acceptance of things like maternity leave or having non-insane hours that allow us to spend time with our kids. Everyone is different and just because we were able to work until the last day of our pregnancy or pop back to work three weeks after delivery or have a nanny that never calls in sick, that doesn't mean we shouldn't stand up for other women who might not be exactly like us.

(In case you were wondering, I was granted extra time for that exam.)

Topic Day: It's About Time

Welcome to our second Topic Day at Mothers in Medicine. Throughout the day, we'll be featuring posts about Time Management. How to juggle motherhood and a demanding profession? Here we share our tips, secret weapons, philosophies, and choices.

Scroll down to find the posts...

Time is sanity

For me, time management equates to stress management. When I'm less stressed, it seems that I'm better able to manage my time. To that end, these are the tricks that work for me on a regular basis. I wish I could say that I always use them, but I don't. Perhaps that's why I've been able to recognize just how well they work - because I have so many times when I haven't used them to compare!

1. Exercise. This is the best way that I've found to bust stress and keep me going. When I exercise regularly, it seems that I'm able to be more efficient in almost everything I do.
2. Write it down, write it down. Make a list, check it twice. I write down everything, from things I want to get done to gift ideas for the kids.
3. Everything has a home. This is the best way I've found to keep track of items.
4. Make use of duplicates. How many pairs of reading glasses does one busy doctor need? um...at last count, six. I have them in the car, in my office, in my bag, and 3 pairs at home (bedroom, kitchen and family room). Yes, each pair has its own home in all of those locations; the upside is that I never spend time looking for glasses. I do the same thing for scissors and office supplies (kitchen, bedroom, office).
5. Hug my kids or husband. No matter how busy I get, a hug always regenerates me in a way nothing else seems able to.

Even though time isn't my friend on too many occasions, using these tricks makes me feel like I have at least a little control over my life - and that's always a good thing.
A

Guest Post: Recipes On The Run

I try to cook healthy, fresh meals at home whenever possible. I have found that having my recipes available wherever, whenever helps me get this done more often and more efficiently.

For those who have an iPhone or are considering one, it’s been a huge help with this. I have an application called “Folders” that allows me to keep my recipes, organized neatly, at my fingertips at all times. I typed in each recipe as a word doc and uploaded them onto the app. I created folders for main dishes, crock pot dishes, side dishes, soups, etc.

Now, with my folders of recipes on my phone, I can decide what to make before I leave the office. I can then stop by the grocery store on my way home and get the ingredients, since I have them all listed in the recipe. When I get home, I make dinner using the recipe on the phone. I know when the dish is done by using my iPhone as a kitchen timer!

I can even find out what the half-price specials are at the grocery store while I’m at the office deciding on a recipe for that night. I pull up the store website on my iPhone, and if ground beef is half price, I’ll pick a dish that uses it.

The iPhone may be a bit pricey, but for everything it’s helping me do (including acting as my pager), it’s been worth every penny.


gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.

Under pressure

As a resident, it's important for me to put aside time for studying while I'm home, so that when I graduate I'm not just a huge malpractice suit waiting to happen. Having a baby has in some ways made that more challenging, but in other ways has actually helped me (believe it or not).

My typical evening prior to having a baby:

6PM: Arrive home

6:30PM: Leisurely dinner

7:30PM: Watch television, think about studying.

8:30PM: Surf the web, usually while watching television

9:30PM: Consider studying again.

10PM: Bedtime snack

10:30PM: Consider studying again, but figure I'm too tired to absorb anything. I'll study tomorrow.

11:30PM: Bedtime

My typical evening now:

6PM: Arrive home

6-9PM: Baby care

9PM: Get out book and furiously study, write presentations, whatever

10PM: Collapse into bed, totally exhausted

The difference? When you have a kid, you know free time is scarce, so you take your studying when you can get it. You can't afford to postpone work till tomorrow, because god knows what will come up tomorrow.

As a result of all the studying I've been doing lately, I've become one of the most knowledgeable senior residents (in my very modest opinion). Sometimes I forget how it used to be and I wonder why the residents without kids seem to never have time to read like I do. I mean, what do they DO all night?

Choices

I chose a job where I had control of my schedule.

I chose to have Mondays off.

I chose to work out of 1 hospital only (God bless you crazy OB ’s that work out of multiple hospitals and have people in labor all over town)

I chose a good man.

I chose a low maintenance haircut.

I also try to start most days with a run and some time in prayer.

I finish my charting before I leave the office, but I keep a small stack of paperwork that can be procrastinated. I keep my journals in this stack. Then, I go through them when I’m stuck at the hospital waiting for someone to deliver (My office is down the hall from L&D).

I’m a optimist. I don’t let myself wallow in self pity when I have to work late or don’t get any sleep. I try to focus on what an honor it is that people let me into their lives so intimately. To deliver a baby… even at 3 am …… is still the most amazing experience in the world.

I also drink a massive amount of coffee.

Commute time is not more fun than time with the kids

Like the dog year to people year conversion factor (what is it 7 to 1? I'm no vet...), there is something funky about the commute time to kid time equation. Even though I can listen to my favorite radio hosts who catch me up on local, regional, and world events, even though I can unwind after a rough day seeing pregnant teens who didn't know they're pregnant, and even though I can make cell phone calls (hands free) to friends I don't get to see that often anymore, I will unequivocally say that time spent commuting is not more fun than time spent with my kids. A simple fact. The commute is a time-sink. And commuting in traffic is negative time. At least if I were in the car with my kids for the bulk of those travel minutes, then it wouldn't be too bad, as we talk, listen to music (on my rockin' cassette player), discuss what we see on the side of the road, and make stops at farmer's markets (always a winner) and gas stations (fun because Mommy washes both rear passengers' windshields a few times) . But commuting without either rear passenger is painful indeed. I recently obtained a navigational GPS that I thought would help me Get Places Sooner, but I find it actually gives me more choices that I can now fret about... will it be faster or slower to turn onto this side road, and why does it say "no outlet?"



One good option which serves to add precious moments to the standard 24 hour day, when I can swing it, is to skip out of work early on administrative days or light clinical afternoons, avoid traffic altogether, and surprise my children with an early pick up. And, on a typical trafficky commute, what makes up for those negative minutes are the positively huge smiles, cheers, and hugs when we all meet up again at the end of the day. And I don't dare let thoughts of tomorrow morning's commute intrude on our fun-filled evening.