Reflections

The beginning of a fresh new year always seems to inspire grandiose dreams and aspirations of what we may want to do or who we want to be in the coming twelve months. I also try to take this last day of the year to reflect on all that has happened. I'm finding that my more generic "lose weight, get organized, attain perfection" resolutions are always at the forefront of the year, whilst the unexpected and mundane moments seem to occupy the latter portion of the year. This year my daughter turned four, my son turned one, I stopped breastfeeding, I found a new job, my husband quit work (for the better of the household), I delivered 120 babies, and I passed the board exam. I didn't lose much weight, I didn't stop drinking wine, and I didn't stop being snarky (go figure).

In the year 2009, I will have been graduated from high school for 16 years, graduated from college for 12 years, graduated from medical school for 8 years, married for 8 years, and a mother for 5 years, and graduated from residency for 4 years. I can't believe it. I turned around, I blinked, and the time was gone. I read once that as we get older, one year of life statistically becomes shorter. For example, at 2 years old, 1 year is half of your life, at 50, I year is 1/50 of your life. I do know that the coming year holds a big move, hopefully a sale of a house, the start of a new job (and with it a new lifestyle), kindergarten for CindyLou, and a multitude of other wonderful things that I couldn't even imagine. And it will feel like just a minute ago, but 2009 will be over, as well. My father always says that "These days *are* the good old days." I know one day I will look back at myself at 33 and laugh at how "young" I sounded. So my resolution for 2009 is to take each moment, the stressful and the relaxing, the harried and the hopeful, the highs and the lows, and remember that it is but the most fleeting moment in time, and from that, may I, may we all, find peace in truly living each moment in the coming new year. Happy New Year, Mothers in Medicine!

Resolved:

We're coming up to the new year, traditionally a time for resolutions to be made - in jest (I resolve to never drink so much spiked eggnog ever again) or in a real effort to better ourselves (I will keep up with all of my paperwork in the office every day). What are some of the resolutions you've made in the past, or are planning to make now?

To get started, my resolutions are the same ol' boring resolutions I make every year: 1) get the home office cleaned out and usable! 2) be a better [enter one, pending day and mood: wife, mother, doctor, friend...]. 3) Exercise regularly.

NOTE: If you're worried about being held to your resolution ('cause I'm going to follow up in August!), leave a comment anonymously...

A

image credit: www.buycostumes.com

Moms: Adopt a resident today!

Quick public service announcement:

The wintertime, especially around the holidays, is a really depressing time for residents. Especially interns. There's nothing like being on call during the holidays, driving to work while it's still dark and knowing you'll be up all night and won't be going home till the next day. That you'll be away from your family, your spouse, your child on a holiday that's all about togetherness. It's a time when a lot of sleep-deprived interns are pushed to their breaking point.

So if you're someone who works in a hospital as a doctor, nurse, or professional patient, do something nice for one of those depressed residents stuck in the hospital through the holidays. A few kind words, a cookie, a much-needed hug, etc... it's all good!

Getting in the sterile field

This is an old story, very unexpectedly resurrected by a near-stranger. A few years ago, as an oncology fellow, I was on an outpatient "float" rotation over the Christmas holiday week. What I thought this meant was short hours, no call, and no eternal rounding on the inpatient service. Hooray! What it actually meant was that all of the attendings were on vacation, so I was double-booked or triple-booked with procedures on their patients to be done--tapping malignant effusions from this space and that one and instilling chemotherapy in some of them--and that I wouldn't eat lunch or usually even get to the bathroom during my workday for the entire week.

One of the patients I met that week was a woman I'll call Sara, a nonsmoker in her 40s with lung cancer and carcinomatous meningitis. She was getting intrathecal chemotherapy instilled into the Ommaya reservoir in her brain three times a week...and this week, while her attending was skiing in Colorado, it was my turn to do it.

As you can imagine, putting chemo into someone's brain is a tad unnerving. The sterile field is no joke. Enough said.

Sara was a delightful young woman but very scared of needles. Sara's husband was an extraordinarily hairy, extraordinarily affectionate guy. Though I had never met them before, it was obvious they were MADLY in love. They had been married for 7 years, as they told me in a giddy voice at some point, but they looked like honeymooners--nuzzling noses, rubbing each other's shoulders. It bordered on inappropriate for a clinic waiting area, but I figured: hey, she's got metastatic cancer; they can do whatever they want. I certainly wasn't going to say anything about all the physicality....

except that it was almost impossible to administer her intrathecal chemotherapy. Over and over, I would sit her up and prep and drape her upper half. At the moment of truth, dose measured, name and history number of the sticker double-checked against her hospital bracelet, syringe full of chemotherapy approaching, his big hairy hands would grip her cheeks through the drape, and he would plant a big kiss on her forehead and say, "It's just one more small needle, hon, and it'll be over in a few seconds" or "I love you so much. You are the strongest woman I know." On more than one occasion, he actually lifted the drape with those big furry hands and said, "Baby, how do you manage to look so beautiful without a single hair on your head?" He looked lovestruck every single time I saw him, as though he would die if she had to be draped and therefore out of his sight for another minute. Over and over, I explained that this was the brain we were dealing with. Over and over, I explained the sterile field and how you really couldn't get in it, seriously. Over and over, he couldn't resist--or, more precisely, couldn't resist her. Every single time I saw her that week--three visits in all--it took at least 3 tries to seal the deal and instill the chemotherapy into her brain. Though I will admit that it drove me crazy at the time, particularly on the busiest days, I always walked away from those visits kind of smiling to myself.

I learned 2 or 3 weeks later from Sara's attending that she had passed away. She was sitting on the toilet one morning and just fell over dead. Her husband was so grief-stricken by the realization that she was gone that he just held her on the bathroom floor until she was cold and it was dark outside, and then called 911. By the time the ambulance came, she was clearly long-deceased, and they did nothing more than give her (and him...in the back, lying on the stretcher with her) a ride to the hospital. Apparently it violated their policies, but apparently they couldn't say no to him. Huh.

Though I didn't know either Sara or her husband well, I was absolutely overwhelmed by their love. I have cared for a lot of cancer patients and their families at the end of life and witnessed love under the magnifying glass of impending death more times than I can remember. But Sara and her husband were different somehow. Their love was truly unconditional, timeless...raw and unstoppable.

I'm not sure why, since I really didn't know him, but I decided to write him a quick condolence card. It was a completely nondescript card from a box of generic condolence cards--a sad reality of life as a medical oncologist that we buy the bulk condolence cards in packs of 10 or 25 the way others buy their generic thank you cards--but it's the thought that counts, right? As I wrote and reflected on why I had been driven to write to this near-stranger, the words just kept coming. It ended up having 2 or 3 extra pages (all on basic white paper from a Staples 500 pack) added, folded up inside the card. Unleashed, the letter morphed out of my control--as I recall, there was talk of great loves and young life inexplicably cut short and spirituality. I never got any reply. I hadn't really expected to, but I nonetheless wondered if I had overwhelmed him (did he even remember who I was?). Eventually I let it go and kind of forgot about the letter and Sara and him in the deluge of loss we face in oncology.

Years passed. On a random busy December day, I was in clinic and one of the front office staff came to get me, saying I had a visitor. It was Sara's husband. I didn't recognize him at all at first. He had cut his previously longish hair very short and shaved off his full mustache and beard since I last saw him. He looked tired and old for his apparently middle-aged age. As I approached him, I searched his face for clues of who he might be, not wanting to deal with the awkwardness of confessing I had no idea who he was. Then he stuck out his hand--the hairiest hand I have ever felt--and it all came rushing back. "You're Sara's husband. How are you doing? I hope you're not here as a patient..." (it is a Cancer Center after all).

He proceeded to ramble, standing right there in the lobby, how much he had loved Sara, how much he treasured that letter, how much it had quieted his mind that a stranger could see how much he loved Sara, reasoning that if a stranger could be so moved by his love for her, then surely Sara must have known how much he loved her, and how that was all he could ever ask for on earth. Then he said, "We always had a bunch of photographs and knick-knacks on our hearth. After Sara died, I cleared them all off. The only thing up there now is the urn with her ashes...and your letter. Anyway, I just came to tell you that." Then he turned and walked right out the front door.

I was too dumbfounded to say anything or walk after him, but in mind, I said to him: You just got in the sterile field all over again.

5 Ways I know I am Not My Mother at Christmas

1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pillsbury, Duncan Hines, or my own.

2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.

3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.

4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)

5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.

A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!

Crossposted on momwithastethoscope.wordpress.com

Getting into the spirit, part 2

So much for my plans to volunteer in a homeless shelter this year. No one answered my voice mail messages. I don't blame them. I'm sure they are flooded with this once-yearly outpouring of help, despite really needing the help during other times of the year. It probably can get a bit annoying and old.
But, reading the comments to my post where people shared the ways they give and show their children to give during the holidays was inspiring. I loved how Nurse Heidi holds a charity drive in her garage, how Laura and her mother bought gifts for kids on an Angel tree every year growing up, how Tempeh's extended family spreads kindness with every gift they exchange.

Saturday, we took my daughter to the mall (note: madhouse, avoid if possible) for the sole purpose of picking out a gift for a girl who wouldn't otherwise be getting toys this year. I loved watching her critically evaluating the toy aisles looking for a good gift. I have this! She would like this! She finally decided on a Little Mermaid doll, since Ariel is her favorite character. Note, she does not have one herself.

We went to the fire station yesterday and she dropped off the doll in the big box in the lobby.

As I walked back to the car, holding my daughter's hand, I felt such a connection to her. Such a tenderness. Such rich love. It was such a small act, this donating of a doll, but it felt like much more. It was, indeed, a beginning. A seed, I hope.

***

Happy Holidays, Mothers in Medicine.

The gloves are off

In recent weeks, just about every day my four and a half year old goes through a routine, asking me if I wore gloves at work that day. I think quickly back to my day. Was I sitting at my computer or in meetings or teaching sessions that day, or was I seeing patients? Even with patients, gloves aren't always required; after all it is outpatient pediatrics. Inevitably, though, when I tell my daughter, "Ah yes honey, I did wear some gloves today," she requires a reason. So I tell her I touched a patient's rash. She then informs me, or at least seeks verification that if I were to touch any hypothetical rash she might ever have, I wouldn't need to wear gloves... because I'm her doctor mommy, right? A little assurance that I am a doctor but always her mommy.

Good doctor qualities can be liabilities in family life

"These are attributes of physicians that serve them well professionally," said the presenter,* flashing a list onto the giant screen:

• control
• perfectionism
• competitiveness
• dedication
• perennial caretaker
• emotional remoteness

The family medicine conference attendees nodded and murmured in recognition, and he continued, "And these are the attributes of physicians that are liabilities in family life." He flipped to the next power-point slide:

• control
• perfectionism
• competitiveness
• dedication
• perennial caretaker
• emotional remoteness **

As the audience burst into appreciative, rueful laughter, I was struck by how neatly my domestic difficulties had just been explained.

I've often noticed that the very qualities that enable me to do a good job at the clinic frustrate my efforts at caring for my family and our home.

My days at work are organized exactly as I like them, from the length of patients' appointments to their medication lists to the position of the stapler on my desk. I interview patients, I examine them and I write prescriptions, requisitions and orders. I don't determine what walks in the door, but I manage every aspect of the problem once it's presented to me.

My life at home is an unpredictable, distracted mess. Much as I'd like to slot in a toddler bum wipe at 10:15 and keep the school backpacks stowed in the hallway closet, urgent requests and displaced things greet me at every turn. I may be the one guiding the day in a general sense, but the thousand details are determined by three messy, spontaneous children.

The satisfaction of measuring performance by objective standards at work cannot be achieved in the same way at home. I can pick up the faintest of heart murmurs, I can suture a laceration beautifully, I run my clinics on time, but how do you grade yourself on raising a daughter well?

At the clinic, I take on challenging work, complete it, and turn to the next diagnostic puzzle. But at home, I repeat menial tasks thousands of times, while others undo them.

Like most physicians, I thrive on competition. It's always motivated me, and winning is powerful affirmation. But motherhood is a different beast from the MCAT, pharmacology prizes and residency applications. No one's going to come out on top, and comparing yourself to other mothers is futile and dangerous ground. The competitive mother after gold stars is the one no one wants to be around.

The only item on the list to which I can't relate is emotional remoteness at home. My problem is the opposite. Because I am so emotionally controlled at work - probably because I hear the very moving stories of refugees every day - I tend to let any restraint slip away when I walk in the front door in the evening. I can be extremely irritable, though no one at work would ever believe it. Once, when I was being particularly foul, Pete gently suggested, "I think you should try to treat us like you would your patients."

I want to be a great doctor, and even more, a great mother. But if the qualities of one can be the undoing of the other, no wonder it feels such a struggle some days.

*Dr. Paul Farnan, St. Paul's Hospital CME, November 2008

**Ellis and Inbody, 1988

Good Grief!

One of the best things about having my son has been getting to relive my own childhood. What better time to do that than Christmas! The cookies! The stockings! The lights! As he’s gotten older we’ve started to watch the classic Christmas cartoons I loved as a child.

He has always loved Dr. Seuss, so last year we got him “The Grinch that stole Christmas” book. We read it for a couple of weeks, then we all sat down and watched the cartoon (not the Jim Carey version, the original). It was such a hoot. He loved it and it was as good as I remembered. We all had it memorized by the end of the season. Even though we packed it up with the Christmas decorations, throughout the year when anyone in our family said “I have an idea” my son would pipe up and ask, “Is it a wonderful, awful idea?”

This year I got him the “Charlie Brown Christmas” book and we had been waiting patiently for the special to come on TV.

But….. it was a little different than I remembered.

First of all, the whole premise of the show is a child who is battling depression. Not necessarily the feel good plot of the year. Seriously, any child psychiatrists out there want to give me a differential diagnosis on Charlie Brown?

Then there are the other kids who are just plain mean. Calling him “stupid” and “idiot” all over the place. My son’s eyes got huge. These words that aren’t allowed in our house.
Add to that, the complete lack of adult supervision. Where are the adults? Why can’t they talk?

The plot is a quite lacking in general. Although I did feel some nostalgic warm fuzzies when Linus recited from Luke Chapter 2 and they sang “Hark the Herald Angels” sing at the end.

At least Lucy has some good business sense for her practice. She collects her 5 cent co-pay upfront. I’m worried she might be violating HIPPA, though since she doesn’t seem to have any walls around her booth.

after hours

Have you set a "no work at home" rule for yourself? For me, I'm fine with doing a little bit of work after the kids go to bed. I rush home at the close of my workday to spend the most possible quality time with them in those late afternoon/early evening hours, and then I catch up on some work. Could be my office email or other pediatric-related reading, reviewing, and planning, preparing or refining educational sessions, reading applicants' files, submitting trainees evals, and so on. After my kids finally enter REM stage (which, in our family, is somewhat later than the average 2 and 4 year old go to bed). After dinner and books and music and bath and teeth and more books. They are finally asleep. But there is still time for some other activities before morn, what do you do after the kids are finally asleep?

SLEEP: Do you go right to sleep? Are they actually sleeping right beside you?
FOOD: Perhaps you're eating your own dinner. Or is this the time to make their lunches for tomorrow? Or make your own lunch (or your partner's lunch) for tomorrow?
READ: Is it time to curl up with a magazine (The New Yorker? People? Time?), or read the web in its entirety, your academic journals, some fiction?
WRITE: catch up on emails, your blog, your list-making
CONVERSE: have at least one meaningful, or at least uninterrupted, conversation with your spouse/partner.
LAUNDRY: and all those other housekeeping chores, anyone shopping online?
EXERCISE: see next
SEX: in your dreams or in reality

What did I miss, is there anything else? Oh yes, some people probably go out. Is there life after the kids go to sleep (suddenly I feel like I am writing this in Carrie Bradshaw style, do forgive me, MIM pals)?

Slacker.

"You're a slacker, McFly!" is exactly what I hear in my head when I look at the blank screen of a new blog post template. Yes, I have been a slacker (sorry, KC, gentle nudge acknowledged!) I do have a good excuse, though. I was only studying for one of the scariest exams of my life to date (and that's a pretty big deal for a physician!) I recently took my oral board examination for board certification. It was like no other test that I ever had. I would not care to experience it again, though I fear I may. There is something really humbling in studying like a college student cramming for a final exam when you are in your mid-30s. I am not going to lie, I felt a little bitter and resentful about it. I mean, I do this work every day. I feel fairly competent, and, if I don't have all the answers, I do know where to look for them. I also have colleagues to which I can refer, so I really resent that I am not deemed a "good enough" physician until I go through the hazing ritual.

Truly, as I looked around the room the day of the exam, I felt as if I were in the inner sanctum of a (not so) secret society. The testing center was the house of the brotherhood. The examiners were the brothers/sisters, and I was the lowly pledge, so desperate to be on the other side of that imaginary line between junior fellow and fellow. It was all rather unsettling. I have been beating myself up since the test has concluded, and I'll have to wait a little longer until I discover whether I am "in" or whether I am "out." My family has been grounding me since my return home. To them, I *am* their inner circle, and, whether or not the brotherhood deems me worthy, I know that I can count on their radiant smiles and open arms to welcome me into our own little cozy inner sanctum. It puts everything in perspective, of which I am in great need. So, no more slacking, at home, work, or the blogosphere. The test is over, and life moves on.

The Late Dr. Fizzy

Some of the residents in my program have been accused of being persistently late for the morning lectures. I'm not one of the major offenders, but I'm not the most prompt person in the world either. I'm not very late, but maybe five minutes late every now and then. Maybe once a month. Maybe a little more.

The argument is that if you're five minutes late a lot, how come you can't just leave five minutes earlier in the morning?? Good point.

I can't really use the baby excuse because other residents in the program have kids, so I mostly say something along the lines of "I'm a senior resident and I'm pretty much checked out." I'm embarrassed to admit the real truth, which is that it often is Melly that makes me late.

I have good intentions: I'm usually dressed and ready to go with plenty of time to get to work. But then sometimes as I'm walking out the door, I hear her crying... and I think to myself how rare it is that I get to see her in the morning. I almost never get to be the one to rescue her from her crib and give her a bottle while holding her. That's so much more important to me than any lecture could possibly be. I don't think my priorities are screwed up.

And of course, if I hear her cry "Mama!" there is no chance of me getting out the door on time. I'm not made of stone.

It's especially hard for me because there has never been a time in Melly's entire little life that I have NOT been a resident. Except for my 6 weeks of maternity leave, I've never gotten to have an extended period of time when I could wake up with her every morning and spend the day with her. Or even part of the day.

Those extra five minutes in the morning are all I've got and I just can't make myself walk out the door. It's well worth getting yelled at.

Pictures….Not!

A fellow Peds resident took his dream job on the North Shore of Oahu. In our former lives, we enjoyed windsurfing together the sounds of the East Coast. He dreamed of bigger waves, and he found them. He sends me pictures from time to time of his beautiful and expanding family. His last set was taken along the shoreline of Hawaii. I want pictures like that, I thought. Serene. Idyllic. Outdoors.

Then I saw KC’s pictures of her family. Sweet pictures to be regarded for years to come. Happy baby pictures. Sibling enchantment (however brief). Glowing parents. I want pictures like that!

So I’m on a quest for some visual memento of my seven and eleven year olds. How else can I freeze them in time? I want to capture Harry’s tossed salad blond hair, and Will’s prepubertal glow. Not only would pictures satisfy my mommy-lust for holding back the sands of time, I could use them as Christmas gifts for family and Husband.

One of my office staff showed me her Christmas pictures. They were urban and modern, and I loved them. Her website showed pictures of playful kids in old chairs outside. This photographer, like KC’s, had the gift of not only catching the image of the subjects but their spirit as well. Sign me up!

So we were all set Tuesday afternoon to meet this photographer after school. The rendezvous point was a field of wheat on the other side of town. Prior to this meeting, I had run all over town looking for the right wardrobe. I had settled on solid color sweaters and t-shirts, and had tried hard to pick items that the boys would wear anyways.

Will, Harry, and I piled into the car for the 20 minute drive to this field – my rough directions in hand. We dodged traffic lights. The boys muttered about interrupted play time, but understood that surprising Daddy was part of the adventure. I chatted them up about how much fun this would be – trying hard to keep the atmosphere light. We found the field on the side of a road, and pulled over to park and wait. We were a couple minutes late. No problem – we had 30 minutes of daylight left.

My first clue to impending failure should have been that the wheat was actually weeds – a disaster for my allergic seven year old. The second clue was waiting for 20 minutes with two antsy boys in the car. I’m not sure I would have wanted the pictures of that afternoon. Surly Will. Pouting Henry. To be honest, I was pouting like a toddler, too. The photographer left us in the field. No show. Nadda. Disappointment is an understatement because then I had to explain to Husband why the boys were so moody when we returned home. Surprise revealed. Ta dah!

Maybe a trip to Hawaii for pictures is not such a bad idea after all. Hmm….

Getting into the spirit

My daughter is finally old enough to understand the concept of Santa. At 3 1/2, she can grasp the concept that a jolly bearded man in a red suit might bring her presents IF she is good all year. I have just started to capitalize on this fine new tool of behavior blackmail. At the dinner table during a whine fest. During a sleep-deprivation inspired meltdown on the kitchen floor. You better watch out...

The potential is huge.

But, I've been recently having second thoughts about this Santa-biz. I don't want Christmas to be all about getting. Sometimes, the way she acts, I think: wow, you have no idea how lucky you are. Sometimes, she is a complete brat. How to make her understand how blessed she is? To appreciate the joy of giving gifts (in all senses of the word) to others? Can they get that at this age?

And then I think of my friend Jen and her daughter M and know that they can. Jen runs a homeless shelter in the Bay Area and M, very close to my daughter's age, helps out at the shelter from time to time. Hearing about M at the shelter is inspiring. Her daughter is sensitive, loving, empathic, and so utterly giving it takes my breath away. I want that.

It may be cliche to volunteer at a homeless shelter during the holidays but what better time to start a family tradition of giving? I want my daughter to really understand that people out there don't have homes, don't have food, and sometimes, the only difference between us and them is luck. I want her to know this intimately, more than the times she asked me why I rolled down the window at the stop light to give money to the man standing at the island. (Why doesn't that man have a house?)

So I'm looking for local shelters where our whole family can go and help. The experience probably won't overshadow the receiving of Christmas presents for my daughter this year, but I'm hoping it will be a seed of awareness, of goodness, that grows.

Seriously, I wanna know...

Do you have a favorite memory of gift-giving? What has been your favorite gift to receive? Any favorite gift-giving tips for the holiday season?