High School

My daughter started high school this Fall.

I'm 43, I mean 44? Hard to keep track these days. So I'm old enough to have a daughter in high school but it is so surreal. Cecelia is 14, Jack is 12, and all of a sudden the physical challenges of raising small children has transformed into the higher emotional challenges of raising conscious human beings.

I have spent the past five years cultivating relationships with Cecelia's friends mothers through book clubs and trips. Thinking I had all my ducks in a row for the tough years. All of a sudden, this Spring, she upended me by deciding to attend high school at Little Rock Central High. Up until now, she has always been in small private schools. I longed to leave my small private school for Central when I was her age, and logistics prevented me, so I supported her.

As you might know, the Little Rock Nine are history. Bill Clinton was here last month for the 60 year anniversary, along with members of that brave tribe. We didn't make it, I was out of town, but I'm still super proud of my daughter for going from a class of 60 something tops to a class of over a thousand in a place steeped in history. I've been in the building exactly once. She's braving it solo. Attacking model UN and AP physics with aplomb. Making all new friends, to my carefully planning chagrin.

Last weekend I was added to two group texts - one tackling homecoming pre-party and the other a post party sleepover. I know none of the parents. It was a giant text stream of numbers. At one point, right before breakfast on Saturday, I replied to the larger pre-party text, thinking it was the smaller sleepover text. Got confused. Stepped on toes. Newcomer face plant. I was very apologetic to the one person I actually met for five minutes, and they were very kind, but UGH. I thought I had this all under control.

That's life right? You think you have it all under control and it changes. Control is a huge illusion. Life is life is life. We like to operate and mitigate it through our own interpretation but really? If we shut those eyes it would all go on without us. So you just have to sit back and roll with the punches.

I was on call last week. Friday night after the football game I dropped my daughter off at a house to socialize. All I want to do on busy call weeks in the evening is veg in front of the TV or a book (hell non call weeks too). But I've got to meet these new friends and their parents, one of whom was having an after party until midnight at her parent's house. Emboldened by wine, I marched in at 10 while the teenagers were dancing in the driveway and hung out for over an hour. I met a woman, challenged by fertility issues, who adopted two sons from Ethiopia. I met another women who is an airport engineer who travels all over the country. I became reassured that even though this is a brand new social circle, these are good people. I volunteered to do the 11:30 carpool the next night from the dance to the sleepover.

Six glamorous excited chatty girls piled into my car the next night. When your kids are teenagers, you glean much more information about their lives by listening to them talk to their friends than direct inquiry. So I relish carpooling them around. They appeared disappointed in the turnout, despite what looked like hundreds of teenagers hanging out around the venue, then started plotting basketball homecoming. They played music I have never heard of on Spotify. They took selfies with their phones. I got caught up in the moment - the excitement of youth.

I think I'm ready for high school. I'm glad it's not me. That wasn't my favorite time of life, but I'm going to try to make sure my daughter enjoys the heck out of it.

Cecelia and Jack, pre-homecoming festivities. He is dressed up to see Kinky Boots with my husband, myself, and his friend. We all wore jeans and nice tops but he surprised us with jacket and tie. I'm hoping to convince Cecelia to let me use this on the Christmas card this year.

Waiting Waiting Waiting

Baby's official due date is 4 days away.

We are as ready as we are going to be. The hospital bag is packed. The date night(s) have been had. My last day in clinic was 4 days ago.

And I am going crazy just sitting here, waiting.

My husband is too - a few nights ago I was feeling uncomfortable/crampy, and he read to me off Google that "being uncomfortable might be a sign of early labor" - but then I took a bath and felt better and we were both disappointed.

I never understood women that were "so done" with pregnancy until I hit 38 weeks. After all, childbirth doesn't look like a whole lot of fun and I've never seen the point of trying to hurry it along. However, at 38 weeks, all of a sudden, sitting sucked, standing sucked, walking sucked, and so did laying down. My clinic patients would catch me wincing at work while waddling from room to room. One of my most complicated patients who has multiple serious concerns at each clinic visit told me I should probably go home and take it easy. Another one caught me making a face while I was auscultating his heart and told me he was afraid I was going to have the baby right then and there. No longer scheduling me in clinic was probably a good idea.

The rest of the last three weeks have been filled with research elective time. I thank my lucky stars my program director has had enough pregnant residents to know that research would be a great use of my time leading up to baby. I have probably been driving my research mentor crazy - I have nothing else to do to distract myself from the waiting and the constant discomfort, so I've been working ridiculously hard on my research project and I have a tendency to send her these long detailed emails only a day after we've met and hashed out the details on the last one.  I also find myself spending a lot of time on Google reading terrible parenting/pregnancy advice on blogposts (obviously not this blog!) and also relevant medical literature on PubMed to my situation (Fun facts: 30% of women will try some kind of non-pharmacological measure to try and start labor. And there is good evidence behind "membrane stripping" with a number needed to treat of 8 to prevent a formal induction!).

I haven't had this many nights/weekends off in a row since before med school clerkships. We've stopped making any sort of plans on the weekends. Last weekend I couldn't handle the not busy-ness any more and spent a day making 10 of those freezer meals for when we don't feel like cooking (never done that before).

I know I will want to cherish these moments of quiet, of resting, of the calm before the storm, but I still find myself silently pleading with baby to hurry up and meet us soon.

No big surprise, but…I’m still tired

I’m currently mid staycation with my daughter, and I disobeyed my own advice.  I overplanned.  As a result I set myself up for constant disappointment because, I AM TIRED.  I’m now re-grouping and re-thinking.  Just getting done what I can, hanging out with my girl and enjoying her warm little hugs - realizing it doesn’t matter if we make it to every museum and live kids music performance and puppet show imaginable.  She just wants to hang out and read Rainbow Fairy books.  I have the same bleary eyed overwhelmed tiredness of residency staycations, and it’s a little bit of a revelation.

Attending life is full of new challenges.  I have called patients and set up appointments and reviewed pathology this entire break.  I can’t emotionally separate from what is going on.  There are many good changes - I do have increased control over my schedule, autonomy, and there is a more personal sense of fulfillment.  But, I am still so tired.  I feel constantly behind at home and at work - there is always more to do.  Part of the reason we’re having a staycation is just I didn’t have the energy or time to plan a proper vacation.

So, I’m writing this post as proof that from this moment on I will close my laptop and try to unplug.  And in a few days I will be back, hopefully energized just a bit so that I can keep moving.

Mindfulness or multi-tasking as a mother in medicine

And then she said, “Wait what?”   

As a mother in medicine, are you engaging in mindfulness, or are you a multi-tasker?  Perhaps that’s too simplistic of a question, as it’s not necessarily an either/or.  The complexity may rest in which of these two are you striving for? 

My challenge is I find I’m striving for both.  I want to be more mindful and present with the people I’m with, but with things I want to multi-task.  When I’m with my family, I should be with my family.  When I’m with my students I should be with my students.  When I’m with my patients I should be with my patients.  When I'm in a meeting, I should be with the meeting members... that last one is a hard one!  What if you find yourself with people and it’s not worth your while?  When it’s not engaging.  When you have sooooooo many competing priorities and demands.  Do you exit (physically or mentally)?  Do you meditate or do you multitask or do you make your way out the door?

And, what about when the people aren’t fully present with you?  I’ll wait… And I’ll aim to make being there, being here, worthwhile. 

Maybe the key is to be mindful and fully present with people, and to multi-task effectively with things. But that may also mean you have to be around the "right" people and do the "right" things... the people and things that give your life meaning!

I guess it’s kind of a topic or conundrum for us, the busiest people.  And on that, do we agree that the busiest are the mothers in medicine?

You're a part time mom

What was the worst thing anyone has ever said to you?

I found the answer to that today. It was an eventful weekend. It's been about 2 months since I've started my new job as a first time attending (more on this on another post!) but since then, it's been non-stop with the move from San Diego to Los Angeles, getting little C adjusted to her new school, starting a new job, studying for boards (which is next month!) and furnishing a new house! I have to say we got pretty lucky and everything is going fine with of course a few bumps in the road but that's expected.

My in laws, including my mother in law, father in law and two aunts came to visit for the weekend. It was a stressful but happy weekend! Moving on to the topic of this post, my brother in law (big C's brother) and his wife and I don't get along. The primary reason being that he doesn't like the fact that I'm a physician and how often I talk about it, which with him, is mainly limited to group emails and text messages amongst my husband's side of the family.

If you guys remember my story, I did not live with little C for the first 2.5 years of her life as she stayed with my parents in Irvine, an hour away form San Diego. Afterwards, I was a single mom with little C for 2 years while I did long distance with big C. During those times, we didn't have much time to visit his side of the family in northern California. I look back at these emails and I do realize I talk a lot about what I do, career wise, but often times, it was out of guilt and my way of explaining as to why I was so sorry that they aren't able to see their granddaughter that often.

Moving on, my brother in law and I had an argument today about the fact that he cancelled plans on us this weekend and he didn't offer an explanation. (Reason being--he just didn't feel the need to tell me.) But regardless, in this argument, he said that I needed to know my audience. The fact that his wife (stay at home mom) is at home with his daughter all the time with no help makes me inadequate to talk about my struggles as a working resident mom when I had help from my own mom. He said I was a "part time mother" for 2.5 years and that his wife is a "super mom" because she doesn't ever use a nanny or house cleaner. Wow. Those words really got to me. It took awhile to process. Little C is already almost 5. She's been with me over 2 years now. I an her favorite person. She is 100% sure that I am her mama so why did I feel like I couldn't breathe?

I did my best to hold it all in during the conversation but when it was done and over, I couldn't' even process it. I had to excuse myself and go the bathroom. I locked myself in a stall and I was brought back to my first week of residency after maternity leave. My boobs ached. I was still pumping and bringing milk back to C at the time. I was experiencing all the symptoms of post-partum depression but didn't even realize it. People asked how little C was doing and I could barely hold in the tears as the insurmountable guilt of leaving her with mom came back to me with every mention of her name. The mom guilt was so strong and with just that statement--it came all back to me.

It made me question am I bad mom? Is C going to be okay? Am I selfish for wanting a career and motherhood? I turned into that insecure first year radiology resident in the bathroom at the VA hospital with tears streaming down my face only to bite my tongue so hard as if the physical pain could take the emotional pain so I can back to fluoroscopy suite to do the next upper GI study that was on the schedule.

But I am not that little girl. I am not a part time mom. It takes a village to raise a child. Even as an attending, I have a wonderful village that includes a nanny who helps me with morning drop offs, a house cleaner, a dog walker, a grandmother who is willing to help out whenever she's needed and a wonderful husband, who despite his own busy work schedule, will watch little C in a heartbeat if he is free.

I will not apologize for my village. They make me the mom and physician I am today. I will not apologize for being a doctor. I will not apologize for being an example of what a woman can accomplish to my daughter. And most importantly, I will not let your words doubt my ability as a mom ever again.

I am more than a part time mother. I am her mother. And the only opinion that should matter is hers. And tonight before bed, I asked little C, do you wish mommy could stay home with you? She said, "no mama, I go to school because I'm a kid and you go to work to help sick people because you're a doctor."

Don't let people like him bring you down. As Taylor Swift will say, haters going to hate hate hate but I'm just going to shake, shake, shake, shake, shake I shake it off, I shake it off...

Mothers in Medicine: THE BOOK

I am thrilled to announce that we've been quietly working on a book that assembles the best advice, wisdom, stories, and insight shared on these pages since the blog started back in 2008. This is the heart-to-heart, girlfriend-style kind of advice and reflections that I would have loved to have when I was just starting out as a woman in medicine, with many questions about the best time to start a family, making it "work" in terms of work-life integration in my specialty, practice considerations as a mother in medicine, and even negotiation advice for landing that job and asking for what I need to be the most successful in my role.

The chapters are organized by theme and cover all of the above questions, as well as separate chapters on having children during medical school or residency, navigating life challenges such as divorce, infertility and financial hardships, the mother in medicine's village of support, and even sharing the humor of being a mother in medicine. Many of the authors are voices readers of this blog know well (T, Cutter, Fizzy, Genmedmom, Jay, m, Gizabeth, Emeducatormom, PracticeBalance, Beckster) as well as special guests who bring unique experiences to lend to their chapters. We're honored to have a foreword written by the accomplished writer, Danielle Ofri. The final chapter is a compilation of our most frequently asked questions from readers posed on the blog, with a summary of answers from our community.

Importantly, the book reflects the thoughtful, honest, supportive tone of this blog community that has featured over 1500 posts and over 14,000 comments since 2008. Our ultimate goal is to support women in medicine at all stages of training and hope it is a useful, contemporary resource for years to come.

So, stay tuned for more book announcements! We're hoping for a late 2017/early 2018 debut.

Thanks for reading!

Better Late than Never…

Or at least that’s what I always tell myself. But I can’t get around it: I am way overdue introducing myself to this community, although I am ecstatic to do so – I love this blog more than I can say. I have been reading it for the last 4 years (3 years of med school plus 1 for a research year), and I always look forward to the good advice, shared experiences, and welcome distraction I find here.

I am a medical student in a big urban, academic center, joining the health care field after a career in political communications. Because I came to medical school later in life, I have also started a family at the same time, which consists of a supportive, ever patient, ever loving husband and two sons, Billy Boy 1, born in 2013 and Billy Boy 2, born in 2015. It has been the definition of a labor of love, balancing school and family, but watching these boys become themselves has been the most profoundly joyful project of my life.

As many of you may know, this is the season of residency applications and I am planning – with much excitement – to apply into pediatrics. I plan/hope to eventually to go on to a fellowship in hematology/oncology. But first things first: hello out there ! I am so excited to be here – I hope I can bring some of value to this amazing conversation.

lamentations of a community pediatrician

I am tired of hot cheetos. I am tired of juice and kool-aid for toddlers. I am tired of pizza or and wings from the local takeout. I am tired of 1 month olds being given 4 ounces of formula with cereal in it to “help them sleep” and the school aged children drinking milk or chocolate milk with every school meal even though they don’t really like the taste of it. I am beginning to see more and more 200 pound 12 year olds and 80 pound 6 year olds.

It is Well Child Check season in the land of pediatric primary care. As a private practice Pediatrician in Washington, DC I don’t actually eat those foods myself or feed them to my child (though I do love pizza and wings once a month) almost every single patient I see with elevated body mass index or abnormal increased weight gain has had or currently has some part of this in their diet.

I am beginning to worry every day I am in my office about all of the premature heart disease we are going to see in 20 year olds because I now have seen close to 10 school aged children with abnormal lipid panels due solely to their poor diet, I have seen more than my share of toddlers and school aged children with developing Blounts Disease (this is a disorder kind of like deforming kiddie-arthritis where the bones in a part of one or both knees begins breaking down due to excess weight, causing deformity of the knee), I have seen countless young women with metabolic disorder and polycystic ovarian syndrome (think bad cystic acne, hirsutism, abnormal and often heavy periods). I have seen more than my share of rotting teeth due to prolonged bottle use, inadequate teeth brushing, and poor diet high in sugar-laden beverages.

Every day I say or type in my instructions to countless children and parents “no juice, soda, sweet tea, or koolaid, it’s bad for your child’s teeth and behavior” and I cannot tell you the number of children and parents who argue that juice must be good because “WIC (Women, Infants and Childrens Program) gives it to me”. Or the kids that say “I don’t even like milk, but school gives it to me at breakfast and lunch so I just drink it”. Ohhhhh WIC and schools! If only we could divest ourselves of the sugar and milk lobby and give these kids what they need - gasp, WATER! Water, the only drink that other countries, with much lower rates of childhood obesity than the United States I might add, allow in their schools. It literally takes me a several minutes in most visits to share with parents that no juice is definitely not healthy even though it has “vitamins and minerals” and that no it’s not the same as eating a piece of fruit. And no, if your child doesn’t like milk they don’t actually have to drink it and they can just drink water and get their calcium from things like yogurt or cheese. And no, chocolate or strawberry flavored milk isn’t needed because if your kid doesn’t like milk he/ she really doesn’t have to drink it. And yes, the sugar in juice and chocolate milk is just as bad in it as the sugar in soda is and nope I don’t allow my 6 year old to drink juice, soda, sweet tea, or koolaid (except at the random birthday party or when he is with my family who simply won’t listen to me) and nope my 6 year old doesn’t drink cow’s milk. Seriously, I can recite these points in my sleep because I say them every day countless times.

My heart hurts. The ICD 10 codes: abnormal weight gain, childhood obesity, pediatric BMI greater than 95%ile dot the majority of my notes. Cutting out the “juice, soda, sweet tea, and koolaid”, cutting back on the take out, increasing the time outside or dancing and playing, and cutting out the cow’s milk would be enough in most cases to curb this trend.

We had a new neighbor in his mid-30s die of heart disease this summer. His obituary showed a child who has struggled with his weight since early childhood and multiple relatives with obesity. His story includes hypertension and pre-diabetes in his 30s. This story is going to be more frequent if there isn’t major policy and cultural change in America.

Thankfully I have had a handful of success stories and they keep me inspired to share healthy diet and exercise with all because honestly so many of my patients just don’t know. The toddlers who I have done intensive intervention with in my office and referred to our local childhood obesity program whose entire families have adjusted their diets and their weight gain has slowed and can run and play more. The adolescents who have lost weight since their last visit who walk in with their parents who are looking mighty healthy too and tell me about the weight they lost and how they no longer drink sweet tea every day and do take out much less. The mothers who breastfed for a few more months even though it was hard. The families who stopped giving their 2 month olds rice cereal in their formula (of note, the current recommendation is exclusive breastfeeding until 6 months old unless medically contraindicated. No supplemental foods - that includes rice/oatmeal cereal until the kiddo can sit up on his/her own usually between 4-6 months).

So while I lament, I press on because there is so so so much work to do. Now off to find a healthy early morning and I can’t sleep blogging snack for this 4 month old growing fetus of mine.

Panic on the Highway

Genmedmom here.

I'm like many physicians: a bit of a control freak. C'mon, admit it, it usually takes a Type A personality to push through all this bulls**t: Exams, applications, more exams, more applications, brutal working hours, exhaustion, fear, abject terror, hazing, insurmountable debt.

But sometimes, we're just not in control.

My very first panic attack, I was huddled in a sleeping bag on the cold floor of a medical outpost in El Salvador. It was 2001, the January earthquake. I was one of a small band of medical misfits on a disaster relief mission. I was a student, and my job was translator.

We were housed in the same clinic where we saw patients, on the concrete floor. That night, there were several aftershocks, but no one else on my team woke up. I imagined the ceiling and walls caving in. Some large bug landed on my face. Mosquito? Reduvid bug? Was I going to get Chagas disease? I began hyperventilating, I could not get enough air. I was panting and suffocating at the same time. Nausea overwhelmed. It was pitch black, no electricity. I would have had to crawl over my snoozing colleagues, or throw up all over them....

It was the idea of vomiting (and dealing with vomitus) that broke the spell. Even in my panicked state I had an idea that it was all in my head. Damned if I was going to puke on my attending.

Maybe it's not completely unreasonable to panic whilst in a bona fide disaster zone, although it would have been utterly humiliating, as well as inconvenient...

There have been a handful of episodes like this since, and none with such a good excuse.

This weekend, for example.

It was Labor Day weekend, and I was not on call. I was solo with the kids, and we went on a little road trip, to visit relatives a couple of hours away.

The ride home was ugly storming, the remnants of Hurricane Harvey. My kids are in this sibling rivalry phase, where rivalry means drawing blood by any means necessary. So I had the car VCR on for maximal distraction.

Still, they fought, and I fought to keep my full attention on the road as they yelled: "You wear poopy diapers on your head!" "Oh yeah, you smell like poopy and pee pee AND cat food!" "AAAUGH! MOM he kicked me!" "WAAAGH! MOM she pinched me!"

I was into a long sort of barren highway stretch when I realized that the gas tank was low. Really low. Sixteen miles of gas left low.

Hmmm. Miffed at myself that I hadn't noticed that earlier when we passed several rest stops, I paused the DVD and asked Siri "Where is the closet gas station?"

Siri paused and then ever-so-unhelpfully directed me to a gas station ten miles BEHIND us.

Okay. I kept driving South, looking for any evidence of a gas station at any of the very few exits coming up. They were all for major routes, not towns. No signs indicating restaurants, hotels, or gas stations.

The range dwindled. When the gauge read nine miles, I started to really freak out.

"Okay guys, I need to pause the show."

The kids actually quieted down. I explained that if we didn't find a gas station soon, we may need to pull over and call for help.

But I really, really did not want to do that, in the middle of a heavy late summer rainstorm and on a holiday weekend.

So I just kept driving-- like Dory, Just.. keep.. driving...

With SIX miles left, a lonely exit had a lone sign: "Gas: Mobil"

"Hallelujah!" I called, and gleefully flicked the blinkers on, aiming right, to salvation.

But: the signs then directed me to cut left, OVER the highway, towards the ramp going in the opposite direction. This required me to veer left. The car behind me honked loudly: They were going straight, and I had almost clipped them when I veered left.

Face burning (did I just almost cause an accident?) and heart pounding, I tried to sort out where the hell the goddamned gas station was. It looked like there was a small access road on the other side of the highway, but I would have to cut across two lanes of traffic getting on the highway going in the opposite direction to get there, with literally no wiggle room, just straight across.

There were so many cars! I couldn't make it! I was funneled back onto the interstate: going BACK from where we came.

I yelled, something unprintable, multiple times, banging the steering wheel, then "OH MY GOD WE ARE LITERALLY GOING TO RUN OUT OF GAS ON THE HIGHWAY IN THE RAIN! S--t S--t S---t F---k F---k..." I felt that familiar catch in my breath, that quick succession of gasps that means panic is beginning to overwhelm, except I was DRIVING on the HIGHWAY with my KIDS in the CAR.

The logical M.D. brain kicked in. Should I pull over now? But the shoulder isn't that wide, and the ground is soggy. Pulling over on the interstate could be really dangerous, and if I pull over onto the grass I might get stuck in the mud...

Hey, I can ask Siri! "Siri, where is the closest gas station?"

A Citgo twelve miles away popped up. What??? The Mobil we had tried to reach wasn't on Siri's radar. Maybe it had closed?


So there I was, speeding along the interstate, with five, then four miles left, not sure if there were any options... Crying. The kids were silent.

The next exit was coming up, for a busy route, no buildings, no towns anywhere nearby.

Deep breaths: "Okay, guys, I'm going to try to turn around and get back to the gas station that's supposed to be there that we just missed."

Blinking away tears, I managed to turn around, thinking Okay, at least if we have to pull over now, we're heading in the right direction, and I won't look like such an idiot.

Just.. keep.. driving... Three miles. Two.

I made it back to the same exit and the same veer left and over the highway and across those two lanes of traffic feeding onto the interstate... It was a miracle, there was a break in the cars, we zoomed across, and into the Mobil. With less than two miles of gas left.

As I pumped the gas, my legs shook. We took a little bathroom break. I splashed water on my face, and then felt silly for having had a truly unnecessary freakout in front of my kids.

I've since reviewed this whole incident with my husband, and we have some rules: ALWAYS gas up to the max before a long drive, and never freak out while driving. Pulling over and calling for help is way, way better than getting into an accident.

Still, another reminder that we are not always in control. (And neither is Siri, apparently.)

Photo credit Holly Mandarich: https://unsplash.com/photos/0317cop-0Ug

First Week of Medical School, and Our Uninvited Guest.

Medical school is starting up, and I have my game face on. I've moved into my new apartment with the tots (1.5 and 3yrs), and mapped out every second of every day. Wake at 6 am, take the dog out, shower, pack lunches, wake kids, dress them, and head out the door by 7 am. I soon discovered this was a little ambitious. My kids are used to getting up at 8, 9, 10am. No problem, I have to learn to be flexible, and moldable, like I said I was in my medical school essays. I tweak the schedule to start at 530am, and the kids adjust. I have interviewed multiple babysitters for evening and weekend help and found an amazing woman who is the mother of a 3rd year medical student at my school, so I know she can't be crazy. I have her come nightly the week before orientation starts so the kids can get adjusted. They love her, I love her, she loves us. Having this help reassures me that I CAN do this. Then life happens, and my first day of orientation she falls and injures her back. I'm relieved she is OK, but she will be out for 6 weeks. No problem. I am this flexible, moldable metal right? I'm flexible damn it! AND I prepared. I have multiple back up sitters with one who can step in immediately. Then my internet doesn't work, no problem, I can complete my last minute assignment using my phone, it just takes twice as long. The treadmill at my apartments don't work. That's OK, I can walk around the block. The washing machines are out. No worries, flexible, moldable, calm, cool me has enough clothes for the week. I will just wash them at my parents house on the weekend. I'm trying to be this person who has it all together, and for the most part, I am playing the part. I replay "Just keep swimming" from Finding Nemo in my head as I try not to let the little things unravel me. I like order, I like control, I like plans, but I know these things will continue to happen and if I want to be successful I have to let them go.

But no amount planning could have prepared me for what was going to happen the weekend after orientation. A category 4 Hurricane (quite uninvitedly) hit our coast and caused devastation 200 miles south. Our first 2 days of classes were cancelled, then the whole week was cancelled, then after Harvey died down to a tropical storm, classes were resumed as our administrators assumed we were out of the waters. My kids 'daycare was still closed, so I slightly panicked as I tried to find childcare for the week.  There was no need to panic, I have lots of back ups. I'm still learning to stay cool. 

But the admin spoke too soon. The city that I have called home was drowned overnight in what is being called catastrophic, historic flooding. All of a sudden my plans didn't matter. I watched on Facebook live feeds as friends of mine were rescued from their houses that had become an island surrounded by water.  I watched a local news crew drive through the streets near my house, near my kids' old daycare, in a boat. I watched the roads I take regularly become rivers. Addresses of people who needed rescue kept popping up on my Next-door and Facebook feed. Businesses were lost. Homes were lost. Lives were lost.

I also saw a tremendous outpouring as locals responded to a call for help. People brought their boats to help with the rescue efforts. Impromptu shelters have popped up all over town. Donations are being brought. Neighbors are offering their homes to those who have lost. My neighbor across the street went out in a row boat, rescuing elderly a few blocks away who were trapped in flooded homes. Those of us who were safe helped coordinate boats to pick up those who were stranded. The Cajun Navy from Louisiana even showed up immediately. Many friends of mine, including my kids' dad, are on day 3 of 4, or 5 working in the hospitals, or as first responders. My old coworkers are evacuating the hospital where I learned to be a nurse. They are strong, and resilient. They are flexible and moldable. I could use a few lessons from them. 

It's still raining here, it's not over. Evacuations and rescues are still taking place. For now, I am safe at my mom's house, an hour away from Houston. The tots are enjoying their time with grandma and grandpa. My sister is stuck in her apartment, but stocked up on chips and water for a week. Our home in Houston didn't take in water, and my apartment in Galveston is fine. I have no idea what is going to happen next. I don't know when the rain will stop, when my classes will start, who will watch my kids, if they are going to try to shove 8 weeks of Gross Anatomy and Radiology down our throats in 7 weeks, or if they are going to take away our Christmas break to make up for it. It doesn't matter. It only matters that my city and surrounding areas stay safe, and soon we will come together to rebuild and restrengthen. I'll be getting a sledge hammer to help with rebuilding, and I'm sure I'll still be singing "Just keep swimming" when I start knocking down walls. It seems like an appropriate song. 

Guest post - 7 going on 37: my baby boy gets surgery

“Mommy,” my six-year-old says to me as he stands over the toilet. “There is a big bubble on my penis.”

“Heh?” I say. “A big what on your what now?”

“A bubble. On my penis”

So I go over to take a look, and am astounded to find what looks like an adult sized left testicle – kudos to my kid for saying “penis,” and not, like, wee wee (though I thought it was awesome when he came up with “pointer” all by himself at age 2ish, and I mourn “pointer’s” passing to be replaced by anatomically correct terms), but he actually meant testicle. It’s a double mom fail: 1) I failed to teach him the difference between penis and testicles; and 2) I’ve been giving him regular baths right along and never noticed that his left one has apparently been exponentially increasing in size.

After a brief talk, we determine that it doesn’t hurt and that sometimes, it’s bigger than others. I’m thinking I know what this is, even though my experience with penises and testicles, especially six-year-old ones, is limited. I have a friend who’s a pediatrician, so I text her asking if she’d mind a penis pic being sent (that’s actually not the term I used, but I feel funny putting the term I did use out there in relation to my kid because I feel like it might be inappropriate and possibly frowned upon), and she actually says she doesn’t mind (she must be used to crazy parents), and when she looks at it, she confirms what I had been thinking: Munchkin has a hernia.

I tell hubby that we gotta take Munchkin to the doctor to check on the lump, and unfortunately, Munchkin overhears me. He’s a very conscientious child, and that is not to say anxious. No, you know what, I’m gonna say it, he’s an anxious child, and at the time this all was happening, he was going through a phase where he was very concerned with death and dismemberment, and other forms of bodily harm and injury.

Like, we had gone on vacation that year, and there was a man who didn’t have an arm staying at the same hotel. Oh. My. Goodness. My son was so affected. “Why doesn’t that man have an arm?” “What happened to his arm?” “Where did he lose his arm?” “Can kids lose their arms?” “I don’t think I want to be a policeman because I might lose an arm…” I tried to tell him that clearly, the man without the arm is doing well, because he looks happy, and he’s here with his beautiful family, but it was to no avail, we could not stop talking about it all week. And wouldn’t you believe it, on our last night we went out to a nice dinner, and guess who they sat next to us? Yup. I was basically using my body as a shield to keep Munchkin from seeing the man and saying something stupid. It was quite the ordeal.

So, when he overheard that I was concerned with his “bubble,” and that he had to go to the doctor, he was immediately all wound up about the possibility of something bad happening to his nether-region. “Why do I need a doctor? Is it because something bad is going to happen? What is going to happen?” And every day he’d ask me when his doctor’s appointment would be, and if I think the “bubble” can kill him.

The day of the doctor’s visit arrives. It’s a female pediatric surgeon, and I love her immediately, because she talks to my kid the way I talk to him: like a grownup, with big words.

“We’ve got a bubble on our testicle,” I tell her.

“I see,” she says with a straight face.

“It’s not always out,” Munchkin says. “It’s only sometimes out.”

“Well, let’s see if it’s out now,” she says.

She confirms that this is a hernia, and that he will need surgery to correct the situation. She explains the operation to me in medical terms (I told her that I’m a doctor. Why do I always feel like such as asshole saying that?).

Then, she turns to him, sitting up on that examination table, and says, “Do you have any questions?”

Munchkin very seriously says, “What bad things can happen during the surgery?”

The surgeon explains that it’s very unlikely, but there could be some bleeding or infection, or a reaction to anesthesia.

Munchkin nods, and then says, again, very seriously, “What bad things can happen if I don’t have the surgery?”

The surgeon explains that probably nothing, but the “bubble” could get stuck and hurt a lot, and it could get progressively more uncomfortable to walk around.

I’m sitting there thinking, this kid is asking more intelligent questions than some of my grown up patients! And I don’t even know whether to be proud or scared or what, since he’s clearly probably smarter than I.

Satisfied with the explanation, Munchkin says, “Ok, I’m ready, let’s book the surgery.”

Well, he probably didn’t say “book the surgery,” but he might as well have, because he did hop off the examination table, and briskly lead the team out to the scheduler’s desk. I’m still gathering my things and frantically stuffing papers in my purse, and he’s already seated in front of the secretary, and I could have sworn that he was signing consents. Even the surgeon’s trainee, who up until then had maintained perfect decorum, had to laugh.

The offer us a few dates, and he picks the closest one, next Thursday, and I say to him, “Are you sure you want that day? That weekend, you have a birthday party, and graduation from karate, and you’ll probably have to miss those things if you have the surgery. Are you sure you don’t want to postpone it?”

He says, “Oh, please, let’s not postpone it, I want to have the surgery because I don’t want anything bad to happen.”

Like, seriously? Who is this kid?

And it’s not the first time he leaves me somewhat speechless. Most recently, when he found out we were moving, and he’d have to switch schools, I was agonizing about how he’d be upset, but he said, “Okay. It’s time for a change.” Who says that?

Unbelievable.

And then, just like that, he’s a kid again. After eating a giant bag of ketttle corn, he bounces off walls for about an hour and the passes out in the middle of his Spanish lesson that afternoon, head down on the table. Whattayagonnado.

The surgery went fine, by the way; I think it was worse for me. Watching my little old man’s face as he was put out with a mask was distressing, I realized as I walked out of the OR on rubbery legs, and watching him wake up and crying “ouchie, ouchie” in the PACU was really upsetting, even though he didn’t remember it after being properly medicated.

I feel like it’s always harder on the mom… When Munchkin was a baby, and I had just gone back to work, I accidentally caught a glimpse of a baby of the same age in the OR, and almost fainted. One of our techs saw me, and said, “Funny how things change when you’re a mom, eh?” I never thought I’d turn into such a delicate flower.

Munchkin, though, he did fine. He marched in, got rolled out, and the next day was out on the playground already, showing off his battle scars and refusing to skip a beat. Mommy got a talking to by daddy though, for allowing this and not being firm enough. But I figure, kids know what they’re doing. If he were in pain, he wouldn’t have wanted to go to the playground.

How about that kid, though?? He’s 7 going on 37, I swear to God. How did I get so lucky? (poo poo poo, spit three times and knock on wood)


-Sasha Retana, MD. Originally posted at  https://andwhynotshesaid.com/

clocking

I have never been one to track my periods, but then life happened and now I am tracking them religiously.

I think back to when it all began. I was one of the last of my friends to get my period. Even though my mother had prepared me with books and talks, I still thought death was imminent when it started. So once they occurred regularly, I just went with it. No charting. No tracking.

Fast forward to my mid-twenties as a medical student. My husband and I decided to have a child before starting residency because it seemed like a good plan. Thankfully Little Zo established himself promptly after discontinuing my IUD. 3 weeks after. I had little knowledge of how truly a blessing that was.

And then life happened. The stories of loss and infertility began to trickle in. A cousin whose first child was conceived in our 20s using in vitro fertilization and who is still paying bills for it; she has been trying for years for baby #2. The friend and aunt who have both suffered multiple miscarriages. The friend who experienced a molar pregnancy and had to consider radiation therapy. The best friends who suffered a stillbirth that I wrote about here: http://www.mothersinmedicine.com/2013/07/life-loss-and-celebrations-of-love.html

Once settled into attendingdom, O and I decided to try again in order to give Zo that sibling he sometimes mentioned. I wrote in my post on December 29, 2016 entitled “(all is not) lost” about our miscarriage (http://www.mothersinmedicine.com/2016/12/all-is-not-lost.html). It was devastating.

And now, without even realizing it, I have begun tracking my cycles. 3 after the IUD was removed and then we were pregnant with number 2. And then the miscarriage.

My D&C surgery was in January 2017. And every month thereafter I prayed my cycle would return. Was that pinch the beginnings of my cycle? Was that the beginning of ovulation. 3 months later, my cycle returned. And each month that went by we still weren’t pregnant. And then. Last menstrual period May 17, 2017. We are overwhelmingly happy, frightened, joyful, petrified, and elated. Big brother Zo is happy. Thus begins a new clocking of days, weeks, and trimesters. Second trimester begins this week. So thankful.

Street Cred with a Belly

Hello everyone - I joined this blog so hopefully I would remember to take a moment to reflect on my experiences and have the chance to learn and share from you all, so I wanted to share some reflections from my last couple months.

I've always joked with people that I planned on starting a family as a family medicine resident to give me a little more street cred. I am one of those people that still gets carded walking into 18+ establishments - and hopefully someday I will be grateful for this, but at times it's hard to take advice seriously from your teenage-appearing doctor. The most common look I get when telling parents they need to wake up their baby more often because they are not gaining enough weight is the one-eyebrow-raised "mmhmm. Get back to me when you've had kids" look. So I thought on some level, baby = credibility.

I am enjoying being pregnant and seeing patients much more than I thought I would. I'm 31 weeks along now with a very obvious belly. One parent recently pointed at my belly in the office and told her 2 year old "See, she's having a baby too!". I am having so so so much fun seeing my OB patients in the office and commenting on our bellies at the same time. I feel like my advice is taken a little more seriously ("I know it's hard, but..."), but it's more so I am developing wonderful relationships with my patients. I have one patient that is due within a week of me - so we are hoping she goes first so I can still deliver her before having my own. We are delivering at the same hospital, so chances are, we'll be right down the hall from one another if that plan doesn't work out.

Something else that has been surprisingly enjoyable is the change in my interactions with patients in the hospital. Especially my lovely little old ladies. My rounds have become much less efficient as my patients are starting to ask me more about my life as I try to ask about theirs - but again, so much more enjoyable. It reminds me why I like medicine and connecting with people.

My favorite patient encounter this week was with one of my stroke patients in the hospital. She was recovering well from her stroke physically, but she continued to be unable to speak and express her thoughts. I was going in the room with one of my other senior residents to try and assess how much she was able to understand us. While the other resident was talking to the husband, my patient looked at me, looked down at my belly, looked up with a confused look at my face, looked at my belly again, and looked up at my face and smiled. I thought to myself "Ma'am, you know exactly what is going on here". She just left to a rehab facility and I hope she's doing well.

Thanks for letting me share with you all :) I am just eternally grateful for this experience right now. If you have any stories from times you were glad you were a mom or expecting while you're a doctor I would love to hear more!

Charlottesville

I've been watching the events unfold in Charlottesville, VA, over the past two days. I was already sad; now I am scared and angry as well. I wrote about it on Medium.

None of us is safe. Hate touches us all. Hate threatens us all. If you are white and your first thought is “that’s not me,” then you are not listening. You are not listening to my voice. You are not listening to the voices of people of color. They are telling you we are being murdered. We are being systematically eliminated. We can’t breathe. If it’s not you, then you must work to stop it. We all must work to stop it.

We must. Our children lives depend on it. Our lives depend on it.

(Helicopter) Doctor Moms

As my toddler becomes more and more active, I've been grappling with an internal conflict: how do I balance my desire to let her experience life and take chances within the reality of my risk-averse, medical background? The other day, my mother almost had a stroke in the park, watching my 20 month old girl teeter along on the edge of a three foot tall retaining wall while she laughed with glee at her cousins. Below was grass on one side and a stone tile on the other. "Get her down from there!" she cried. I hadn't thought anything of it: if she had fallen on the grass side of the wall, she would have been fine. She would have learned a lesson on how to place her feet to balance. If she had fallen on the tile side, things might have been fine... or they might have resulted in a broken ankle, or a broken head. Flashes of my baby intubated with a head injury in the ICU swirl through my head, and I have to slap myself to break loose.

So much potential badness and goodness in this picture

I don't want to be one of those helicopter parents. I want my child to learn problem solving, to take chances and learn consequences, and to feel the exhiliration of meeting physical challenges. And yet, as an anesthesiologist, I've seen the worst. I've seen the pediatric traumas and the burn unit cases. I've heard the PICU stories ("How did this happen?"), and I'll admit that I absorb these details differently now that I'm a mother. The information is clouded by a background wonder of what I would do if I were in the parents' situation. Sometimes I see my own child's face in that hospital bed or on the OR table.

As a teenager, I had some friends whose fathers were policemen. They always had lots of restrictions, and because their dads had similarly clouded lenses through which they saw everything, I now understand why. But overbearing parenting has been associated with what Jessica Lahey, author of The Gift of Failure, describes as "emotionally, intellectually, and socially handicapped children." How do we as parents allow our children to grow up with freedom, autonomy, and challenge while still appropriately protecting them from physical harm? If anyone has some good insights on this, I'd love to hear them!