The train

By the time I started medical school, the drive to succeed had impregnated my dura mater. It had always been all about getting the best grades, doing the best extracurriculars, getting into the best college, logging the best pre-medical school research, and finally, getting into the best medical school.

I went to a medical school that has the reputation of being ultra-competitive. It's easy, in that environment, to only know one direction: up. Of course I would continue on my trajectory, get the best grades, do the best extracurriculars, get into the best residency. Of course I would put career first for now. How would a family help me achieve? (I also was not married at that point, but still.)

When I heard the same lecture as Fizzy's OB, the one about rates of fertility declining after age 30 and rates of chromosomal abnormalities increasing, I have to admit, I, and I'm sure a good percentage of my female classmates, had a small identity crisis. I remember having conversations with my female classmates and friends about how would we balance the pulls to start a family and career. I remember feeling confused and frustrated and conflicted. As much as I wanted to succeed academically, I wanted to be a mother too. Maybe more so.

Nevertheless, I pushed on and got into that hard but glorified residency. Along with me, several of my female medical school classmates did as well.

Deborah* was one of my residency class who went to medical school with me. She was a serious student with a long history of overachievement. I was honestly surprised when she got pregnant during residency and even more surprised to learn she was planning to take a non-academic "cushy" job after finishing (that younger me felt threatened by the word 'cushy').

"I'm getting off the train," she confided to me.

Yes, I realized, I was on the train, sitting in one of the passenger cars, speeding ahead to some unknown destination. How did I get here? Do I want to get off? (I don't know; Not yet.)

Now, with my second child just being born, I've been thinking about the train. After residency, I transferred to a slower train (probably a local). The transfer itself was a bit unsettling: going from a modern, shiny, speeding express one to a bumpier, older, slower model, but I've grown to like this train. I'm still enjoying the scenery going by, and I've taken advantage of its multiple stops. I like the promise of a career destination. But, I also wonder if, in the future, I'll ever want to get off entirely and whether I could ever be okay with that. Or whether I'd ever regret not going faster.

*name changed

Advanced Maternal Age

My OB told me an interesting story during one of my routine pregnancy checks:

When she was starting her residency, one of the first lectures the residents got was about how fertility declines sharply after age 30. She said it was kind of scary the way it was presented. And sure enough, a few months later, all the female residents in program were pregnant. (Lesson: Don't talk to your female residents about declining fertility!)

I had a baby at age 27, which is above the mean age for a first baby in this country (25, I think), but well below the mean age for a first baby amongst my colleagues. Of the fifty or so women I went to med school with, I know of only FIVE who have had kids, even though the very youngest of us are almost thirty. I remember on my Labor and Delivery rotation in med school, all the girls in my class used to joke about how when they were up on the L&D board someday, there'd by an "AMA" note by their name. (AMA = Advanced Maternal Age)

When I first started my residency, I felt like a pregnant teenager. I was the youngest of all the residents (the oldest of the bunch being close to forty) yet I was the only one who was even close to being a parent. Of course, most of them were single guys, who talked about barhopping at lunch while I was feeling the baby kick.

I can certainly understand why female physicians wait so long to have kids. Residency is really hard as is and it seems like you've got to be out of your freaking mind to get pregnant during that time. But I saw my mother struggle unsuccessfully with infertility in her late thirties, so for me, waiting wasn't something I felt comfortable doing.

In less than a month, a new crop of residents will be graduating. I see a lot of the female graduating residents have little baby bulges and I admit I feel a little jealous that they managed to somehow stave off the baby fever through residency... and now they get the luxury of working a cushy part time job while taking care of their baby (or so I'd imagine in my jealous little fantasy). I wish I could do that, instead of doing my double baby/hospital calls.

But I'm happy with my choice too.

Mommy of the Year

Husband is out of town. The person who said she would be on call to pick Son up if I had to work late forgot and made other plans. So after calling half the world and not finding anyone at home or on mobile phones, I decided to pick him up from daycare and bring him back to the hospital. After all, I had only two patients left to see, and both were "easy."

First we went to the cafeteria, where I let him pick out his own dinner, which we put in a to-go container. Next we stopped at the gift shop and bought a coloring book and crayons. We then went to the telemetry unit, where Son was an angel. He sat at a desk eating and coloring while I saw a patient.

Next, and this is where I question my sanity, I decided he was so good on the telemetry unit that I could take him up to the mental health unit. One patient. One easy patient. And nothing ever happens there.

After asking the charge nurse if it was OK, I parked him at a desk in the nursing station and got him all settled in with his crayons. I kissed his cheek and told him I'd be right back.

And then it happened in a flash.

A wild man, twenty-something, ran out down the hall screaming, "I'll kill you all!" Nurses surrounded him but he was very, very strong. Security guards appeared out of nowhere and tackled him.

Needless to say, Son didn't need to see that. I was nuts to think he'd be OK up there. So I got him outside and we sat at a picnic table and waited for PaniniFreak to come get him. And then I went back for my one easy patient. Funny, that patient wasn't so easy, after all.

At home, I asked Son if he had been scared by that man yelling. He seemed to not know what I was talking about.

Mommy of the year I'm not.

Unfit for Duty

The pediatrician diagnosed Squirtlet (age 7 months) with an ear infection today. ‘Yup, left ear looks really red. That probably hurts.’ She’s been sick for 5 days. I keep telling my husband that it’s just a cold, a virus, and will get better. After all, look at all of the goop draining from her nose. Last night she screamed for half an hour, despite motrin, tylenol, and the panacea for all things, nursing. This delightful episode triggered the inevitable call to the pediatrician’s office, where Sue, the efficient RN who triages sick appointments, got right to the point. ‘Does she have a fever? Is she pulling at her ears?’ We were deemed worthy of a visit, although I got the sense that Sue could make this diagnosis over the phone.

In the interest of full disclosure, I work in an emergency department. I diagnose otitis media several times daily. In kids. With confidence. Yet, I find myself curiously unable to make clinical judgements for my own children. Is that ear really red? Did he just scratch his face, or is it impetigo? (answer: impetigo).

I feel like I need to find the ‘right’ time to take the kids to the pediatrician – that day when the cold turns into the ear infection, or the fever has gone on just one day too long. Yet, I become a victim of my own anchoring bias: if I waited too long last time and the ear infection got really bad, then THIS time I show up on the pediatrician’s doorstep for a temperature of 100.1 and an isolated sneeze. She reassures me in her best Doctor-to-Mommy voice that my wee one will be just fine, while I apologize profusely for wasting her time. On the way home I resolve, yet again, to exercise my clinical judgement the next time around. This sets me up neatly for another episode like today’s.

Tonight I am combing the internet for the perfect pediatric first aid kit to keep at home in case of a Real Emergency. I hold out hope that, when something serious happens, I will know what to do.

NOT SO FUNNY MOMDOC

Okay, you guys are all so FUNNY!! I am not. I'm a very serious but very very very happy momdoc. I just wish I could split myself in 7. One for each of two kids, one for hubby, one for violin, one for dressage horseback riding, one for work, and one for friends. Well, and maybe one for fun. Then I could be doc oc!! Instead I intensely devote each waking moment to dividing up what little time there is in a day. The trick I found is being in the moment. When at work enjoy work and forget about home and kids. When with family, forget about work and revel in the family. And the violin and riding - well you have to concentrate only on that to do it - it's my meditation, release, and my source of renewable energy and happiness. The problem I have is how to shift the time - and how to deal with that overriding sense of guilt that the others are not getting enough. So, I tell myself (and it's true), that if I gave up any one of these things I wouldn't be so happy and able to deal with the every day frustrations and problems. But there are ever looming questions: do I take more time to write papers and go for the promotion? Do I forget the promotion and watch everyone else get it but know that I have more time for the other 7 things? Do I do less riding (my only exercise) and spend more time with family but be a lot grumpier? Do I play less violin to have more hubby time and cut myself off from my only social network? I feel like I'm very happy where I'm at right now, but need to decide from here to continue as is, or shift time one way or the 7 others...

You didn't tell me you're a doctor!

Our painter, a fifty-something fellow, has done many jobs for us over the years. He works hard, grunting and thumping and wheeling the roller around whatever room he's working on. I commented once on the superb quality of his work. He responded kindly, "I'm sure there's something you're good at, too."

Months later, touching up our living room, he caught sight of my medical degree tucked in a corner of a bookcase. "You're a doctor!" he said accusingly when I saw him next. He felt deceived because I hadn't volunteered that information.

This has happened to me on many occasions, where someone who has known me only as a mother discovers that I am a physician. A neighbour is seated in the clinic waiting room and is shocked to see me with a stethoscope around my neck. A mother at the playground asks why I'm carrying a pager, and is taken aback when I explain that I'm on call for the clinic. The response is usually dismay, and I know it's because they are madly working to mentally recategorize me. They're disconcerted because they realize they've been using the wrong set of assumptions.

The response to both occupations bothers me. I resent being patronized as a mother, and I feel embarrassed when I'm congratulated for being a physician.

While doling out hot dogs and orange drink to my kids at the school barbeque recently, I remarked that the energy and enthusiasm of students made teaching look attractive. A teacher grasped my arm and replied earnestly, "And I'm sure you could do it, one day!"

What was I supposed to say? I just nodded and thanked her.

Cross-posted at www.freshmd.com.

Cinderella isn't pre-med

The vast majority of our TV viewings these days are dedicated to the Disney Princess Sing-along videos. The songs in these videos feature only the princesses of the Disney movies, such as Sleeping Beauty, Snow White, Cinderella, Princess Jasmine, etc. Melly loves them so we've been subjected to each of these videos roughly five thousand times in the couple of weeks since we've discovered them. It's gotten to the point where I'm subconsciously humming "A Whole New World" while examining patients and they look at me like I'm nuts.

Between each of the songs, there's a narrative that I find rather disturbing. For example, after the Cinderella song, the narrator states: "Cinderella finally lived out her dream of going to a ball in a beautiful dress. Is that your dream too?" And so on.

It sort of emphasizes the point that Disney movies have two kinds of female characters:

1) Princesses who have developed a deep malaise, which can only be cured by an exciting new man.

2) Poor girls (usually also abused by their stepmothers) who are eventually saved by a handsome prince, often met while wandering through a forest and singing.

Between the popular Disney movies and dolls that pronounce "Math class is tough!" it seems like a miracle that so many women have high powered careers these days. My husband and I get nervous that if we don't turn off the Disney videos, Melly is going to end up doomed to a life of dancing in forests with strange princes. (My dream for her is to be a mathematician, which is about as far as you can get from going to a ball in a beautiful dress.)

Moms in Medicine

When I was in medical school a male attending physician told me that no matter what I did, things would always be different for me because of my gender. His words rankled - this couldn't possibly be a good thing - so how I tried to prove him wrong! Anything that a male medical student could do, I could do better - and was rewarded by all of the "perks" that came along with great performances. When it came time to match, neurology was my program of choice and I started my program with the same gusto I had shown as a student. Oh, there was one exception: right after graduation from medication school, I got married.

But being married didn't seem to put too much of a damper on my enthusiasm for throwing myself into my work and I continued to shine, collecting various awards and accolades through the first 3 years of residency. As my final year of post-graduate training approached, it became time to name the new chief residents. By then, I had an announcement of my own - I was almost 3 months pregnant. I had told only my program director, believing that he should be able to schedule around the time I'd need to be away from hospital duties as early as possible. Shortly after giving my news to the program director, the chief of neurology summoned me to his office. As I sat down, he greeted me warmly and spoke in glowing terms about how well he thought I had performed during my residency. Then he said this: "Artemis, I think you should be chief resident. Everyone that I've spoken with thinks you should be chief resident. But I'm going to name John Smith* chief because you're pregnant."

You can be angry for me because of this. I'm not (anymore). I'm not sharing this story because I've carried a grudge through the years; I'm sharing it because it was this event that brought me full circle, depositing me right back at the attending who stated that things would always be different for me due to my gender. Ultimately, he was right: I'm a woman, and I'm a mom - and this will always color the way I practice. The stories we share here have a common thread, but are unique to us because we're moms. You won't find these same stories on a blog written by men, even if they're up for Father of The Year award, because things are different for us. And that is a good thing.
Thanks for sharing our times and our stories.
A
*name changed

Warped

To say that pediatrics has altered my outlook on life is the understatement of the last general election. Take my children, for example. Most of my parenting decisions come from 1) gut response 2) experience from pediatric residency 3) pediatric practice or distant #4) indoctrination from my own parental units.

For several years William and Harry have requested some type of reptile coming to reside at our house. I have a difficult time calling a reptile a pet since they are neither cute nor cuddly.

Gut response says “Hell, No. No slithering critters with tails who can escape from minimally-lidded glass aquariums.”

The joint Pediatric camp says “Are you crazy? Turtles, lizards, geckos, etc. carry salmonella and shigella and can give you bloody diarrhea just to start.” Flashback to PICU patient seizing with generalized shigella infection.

Finally the Parental/Growing up experience has no comment because I grew up in a house full of girls who had nothing to do with reptiles.

The issue of “heelies” has also come up with the two boys in my life.

“They’re fun.” Says Harry

“We won’t get hurt.” Says William

“What about the classmate with the two broken elbows from last week?” The Pediatric Camp volleys.

“We’ll wear pads.” H and W say simultaneously.

“Yeah, right.” We’ve already paid a small fortune or at least a couple of house payments to our friend the orthopedist. Let’s not add our friend the ED doc to the family payroll. Another flashback to PICU patient with head injury seizing in the unit – maybe I just have Pediatric Post-Traumatic Stress Disorder.

And then there are the video games which are heavily regulated by the Homeland Parental Unit (HPU). E rated and the occasional T rated games only. Every now and then the HPU catches Harry sneaking next door to play M rated games with the neighbors. Gut response wants to know how long it will be before William or Harry go postal and wind up on E! television as a True Hollywood Story about serial killers. The Pediatric camp wants to know how much weight they’ll gain from playing 2 hours a day instead of being outside. The Growing up response again has no comment because I’m a girl and too old to have dealt with this issue in my own childhood.
Ok, I’ll admit it. My career has warped me into an overly neurotic, lizard-hating, heelie-avoiding, E-rated un-fun (but safe)parent that I am today.

Multi-tasking

Today was one of those insanely busy days, the kind that I had never come close to encountering prior to having my first child. On top of my regular clinical duties, I had additional responsibilities that had been "saved" for me since I couldn't do them while (inconveniently) out on maternity leave. The end result was that I ran around like a headless chicken trying to round with my housestaff, see consults, see clinic patients, fit in two pumping sessions, and deal with some seriously crazy patient scenarios, straight out of Grey's Anatomy.

Today, multi-tasking was the only way I could survive. I seriously had almost no time to sit still, I barely ate lunch (two hours after I initially heated it in the microwave), and always, always took the stairs.

My most peaceful moments were, coincidentally, while pumping. At least then I had no choice but sit in my office and internet surf or read my email (probably against OSHA regulations to walk around the corridors while pumping).

Of course, during my second pumping session, I actually paged the resident I was working with on consults to discuss our patients, you know, seriously multi-tasking. I made no excuses for the background whirring noise. "I'm pumping," I announced unceremoniously at the beginning. There was no time to be modest.

(I knew she was a mother; I certainly wouldn't have said this if she were a man.)

She chuckled. "I've so been there."

Which is why I love working with housestaff who are mothers themselves. There's an unspoken understanding.

They get it.

Pretty in pink

Whenever we go to Toys R Us, my husband and I always gaze wistfully at the toys for older kids. We can't wait until Melly is old enough that we can buy her some awesome toys for us to play with. There's only so much fun we can have with a rattle.

On our latest trip there, I was practically slobbering over a toy doctor's kit. And it wasn't just a doctor's kit... it was a doctor's kit for GIRLS! Now you ask, what made this kit specifically for girls? Why, it was PINK, of course. There was a little pink stethoscope, a little pink BP cuff, a little pink syringe, a little pink otoscope, and a little pink thermometer. Unfortunately, it was for ages 3 and up. (Although the "and up" probably didn't go all the way up to 30 years old.)

Me: "And look! It comes with a little pink doctor's bag!!!"

Husband: "Do you want to buy this for Melly or for you?"

Me: "Ooh, there's a pink penlight too! Do you think it actually shines light?"

Husband: "You know, you have real versions of all this doctor's equipment."

Me: "Yes, but mine isn't pink."

Also, I'm missing my otoscope. Tell me, how hilarious would it be if I were examining a patient's ear and I pulled out that little pink otoscope? Answer: very.

The doctor's doctor

I kind of feel like a failure when I bring Melly to the doctor. Because, you know, I'm a doctor. (Sort of. That's what it says on my badge.) So naturally I should be able to diagnose any medical problem that comes up. Then prescribe amoxicillin to treat it.

My current excuse for my poor pediatric diagnostic skills is a lack of proper equipment. I don't have the tiny stethoscope like my pediatrician's. (And I'm fairly sure the stethoscope I use for work is colonized with MRSA and every other bug I've come across in the six years I've owned it... it's pretty much a petri dish. Melly tried to lick it once and I almost had a heart attack.) Also, I left my otoscope at my mother's house and there's absolutely no possible way I can get it, short of some sort of experimental matter transportation device (a la The Fly).

Yeah, if only I had my otoscope, it would be NO PROBLEM to stick that thing in her tiny ear to visualize her eardrum while she's flailing about wildly. Because I was just so good at it as a med student.

The sad truth of the matter is that I'm lucky if I can even get a temperature for her. That ear thermometer we bought is very suspect. I took her temperature on it once and got 102.4, then took it two seconds later and got 97.5, so what am I supposed to do... average the numbers?

Part of the problem is probably that I have too much knowledge for my own good, but not enough knowledge to do anything useful. Like when she's drooling a lot, instead of assuming that she's teething, I think to myself, "Oh my god, is this epiglottitis?? Will this require intubation???" And slowly I lose my mind.

I recall in med school that my worst exam grade was in my pediatrics rotation. Damn, if only I had studied harder... I could have saved myself so many $20 copays.

Following in my footsteps....

...by compulsion. For the record, the pictured garb were provided by my father. He is a doctor himself, and had to have the grandkids participate in his medical clinic-sponsored float during our home town's fall festival parade.

So literally, I was parading my kids around in these.

Although I don't have expectations that my kids will become doctors, it would be nice to think that, should they opt to go that direction, I inspired them that way. Of course, my husband is a physician too, so it would technically be difficult to tell who was the primary influence.

Okay, I'll admit something. I not only kept my last name upon marriage, but tried to persuade my husband to adopt mine. This was not a battle that I won, nor did I really expect to. I just thought it was worth the argument.

Sometimes, though, I think about what the difference would have been if things had gone that way (indulge me for a minute in some unladylike egotism). My kids would bear my name, and if they became doctors, they would be the next (third) generation of doctors in my immediate family with my surname. If people called me and asked for Dr. ______, I might have to ask clarification for which Dr. ____ (and yes, I realize this would also have been the case had I taken my husband's last name, so don't bother pointing that out, that is not the point).

Mothers are not so different than fathers, after all. Sometimes we just kind of want our kids to follow in our footsteps.

It's a shame though. I guess the world will have to do without two more "Dr. Singh"s.

Perspective

I'm a highly trained physician, but I can't put drops in my kid's eyes. He fights, and I'm afraid prying open his eyes will hurt the recent sutures.

I seriously believe every physician should have children before telling mothers how to give medicines. I used to prescribe 10-day courses of antibiotics all the time. Now that I realize how difficult that is, I would never do it to anybody else.

Just sayin'.

Herbal Suspect

I first learned about the potential dangers of taking herbal supplements in medical school. The point was driven home by a patient with rhabdomyolysis. Another with acute liver toxicity. Many an attending warned us to ask about supplements or instilled the fear that anything could make it's way into an herbal pill, and thus their usage should be actively discouraged.

I frowned at the lack of strong evidence supporting their usage. I have to admit that I grouped those who used herbs (and usually it was multiple offenses) as a little bit out there. You know, a crunchier sort, not grounded in science or rigor.

My mother, as luck would have it, would fall into that group. She is all about the holistic and the natural. Her evidence has always been in the form of testimonials and N=1 logic. A friend cures constipation with mega doses of Vitamin C? She's on it. Her cousin's babysitter ate flaxseed once and had more energy? Done. A friend of a friend of a friend of a friend (who is wife to a physician!!!!) swears by walking on her hands to cure the hiccups? She asks for how long. I've often wondered how half my genes are from her.

I, on the other hand, harbor a healthy fear of supplements, with herbs topping the list. They frighten me because they can very well be biologically active in non-perfectly-elucidated ways. Perhaps it's the complete lack of control in terms of production, dosing, effect, and potency that scare the OCD scientist inside me. Then, there's the fear of hidden toxicity. Who knows what could happen? A couple of years ago, I would have never thought I would ever try taking herbal supplements. No way.

Yet, when I started stressing about returning to work and pumping enough to keep my newborn son fed exclusively on breastmilk a few months ago, I read with interest about fenugreek and Mother's Milk Tea. Really? Increase milk production? Mine more liquid gold with every pump? Of course, I didn't look into possible negative side effects at all; I didn't even care. If it meant being able to nurse longer, I would consider trying it. Fear of the unknown and the unaccounted for never entered the equation.

I decided to try Mother's Milk Tea. The ingredients include fennel seed, anise seed, coriander seed, spearmint leaf, lemongrass leaf, lemon verbena leaf, althea root, blessed thistle herb, and fenugreek seed. Listing out those ingredients makes me feel like a witch mixing a potion in a cauldron in my backyard.

I drank my first cup excitedly, thinking about how much more milk I'd produce that day. It tasted slightly bitter and medicinal, certainly nothing I would voluntarily choose to drink if given the option. Over the next few days, I diligently brewed my herbal concotion and did notice an increase in how much I pumped if I drank two or more cups a day. Maybe.

So, now, it's been a little over the month, and I have often wondered aloud why Costco doesn't carry Mother's Milk Tea by the crateload. For my child, I've recklessly turned from a science-based pragmatist into a herbal-tea-chugging junkie who's just looking for her next fix.

Which makes me think about how much motherhood (and the compulsiveness to be a "good mother") has changed me.

Also, if I grow a third eye, you'll know why.