Guest Post: Medical School Now and Then

I graduated from medical school in the 1970s. My daughter started medical school two weeks ago. Many things I thought were crazy in the '70s are still crazy today (like the schools requiring Calculus and Organic Chemistry for no reason I can fathom even after thirty years of working in hospitals and clinics). And why did I have to memorize the Krebs Cycle? But some things are vastly changed.

1. The Interview Process.
I remember the male interviewer asking me, "Are you engaged.........or anything?" I thought it was a fair question at the time. After all, letting a girl into medical school was risky. She might fall in love with a surgeon and drop out to get married. So I was quick to let the interviewer know that I was completely uninterested in ANYTHING like that. Little did I know that I would fall in love with a graduate student and get married at the end of my second year, right before National Boards.

I hear questions like that are illegal nowadays.

2. The male:female ratio.
My class was around 5:1. A group of us girls would sit in the back of the lecture hall dressed in jeans and men's shirts and hiss at the sexist remarks from the podium. We had a teacher who projected gigantic photos of scantily-clad models in front of the class between the pathology slides. I hear they don't allow that anymore. But looking back, that hissing and booing was a lot of fun; it was a great bonding experience for the women students.

Now there are more women than men in medical school, which is why the pay for primary care doctors is dropping compared to the rate of inflation.

3. The money!
The tuition that medical students pay nowadays is insane. I was upset when my tuition rose to $2000 my 4th year. With all the blood drawing, xray fetching, middle of the night foley catheters and EKGs, I thought the school should be paying us. I wonder if students today still provide all those services for the hospital even though they are paying $40,000 for the privilege.


"Fiddler" practices Internal Medicine in the Pacific Northwest. She has two daughters, ages 18 and 23.

Tucked in

As a resident running the family practice ward, I would come up to the unit in the evening to finish dictations and complete paperwork. At the end of the evening, I'd ask the nurse if there were any patients she was concerned about or orders she wanted written. Having tied up all the loose ends, I'd head to the call room.
I distinctly remember how I felt walking down the corridor at eleven at night. The ward was hushed and still, with the patients' lights off and just one or two staff at the nursing station. Heading back to the elevator, past rooms of four beds apiece with patients curled up under blue cotton blankets, I felt maternal. Or how I imagined maternal would feel, as I hadn't had a child yet.
It was a powerful emotion, a combination of affection and respect for my charges, the satisfaction of having managed the day's problems, the weight of responsibility, and humility and gratefulness for my own position.
These days, as I round on my own children every night before bed, the flood of feeling as I adjust the covers over small sleeping bodies is remarkably similar.
And I realize now that those late nights walking down the corridor of 7B, the sense was of having tucked the kids in for the night.

Backfired

Years ago, I heard my sister tell her then 2-year-old son that she was 'so excited' to go to work. I questioned her motive behind that statement, as I knew she would rather spend time with him.

"I don't want him to think I would ever leave him to do something I don't like," she said. "If he believes I love going to the hospital, it won't hurt him as much when I walk out the door."

Now that I, too, am a mother, I see the logic in her little white lie.

A few days ago, Son was quite upset when I left him at preschool to go across the street to my own hospital. I stooped down so I was at his level and explained to him that going to work was fun for mommy, that sometimes I need to have fun like he needs to have fun.

Today, we are staying home. I told Son our plan to meet our friends (a nurse I work with and her son, who is in Son's preschool class) for a picnic in the park. I suggested it would be fun for us both.

"No, Mama," he said sternly. "You go to work to have fun," he explained. "The park is not fun for you."

Sigh.

I guess I need to rethink that line.

You stink!

Another day in the life with kids:

Ooooh that smell
Can't you smell that smell
Ooooh that smell
The smell of strep surrounds you
(apologies to Lynrd Skynrd)
A few days ago Youngest spent some time with a family friend, returning home several hours sooner than expected. Coming in the door, he complained of a headache. Our friend explained that Youngest hadn’t seemed quite his perky self during their outing, adding he was surprised when Youngest abruptly asked to return home.

I put an arm around Youngest and he leaned in for a hug. I was initially repulsed at how warm he was – but shrugged it off to the heat of the day and the time he had spent outside. But what did I just smell? Only a quick whiff, gone before I could really say with certainty I had recognized it. Nonetheless, after our friend left, I put Youngest on the sofa and got the thermometer. 101.3 – not a typical temperature after spending time outside, no matter how hot it gets. Ergh. Let’s keep a close eye on this, I thought.
“How’s your head, bud?”
“It’s OK, Mom.”
“Any sore throat?”
“Uh uh.”

Maybe I was mistaken about that smell…

The next morning, Youngest was still febrile. Leaning close, the smell was unmistakable.
“How’s your throat today?”
“It hurts when I swallow, Mom.”
*Sigh*
“Open up. I want to look at your throat.”
“AAAHH” Youngest has an amazing ability to open his mouth when he wants to be cooperative. I was able to see almost down to his larynx, so I had no problems identifying the pustules along his tonsils. As he exhaled, the scent was overpowering. Strep. Unmistakable. I could have waved a rapid strep screen in front of his face and obtained a postive response.

“OK, time for some medicine for you.”
I knew he was really sick when he responded with “Can I have the pills instead of the yucky liquid?” instead of his usual protests against any type of medication.

So now we’ve been on antibiotics for 48 hours. The pustules are going away. Youngest is back to his usual bouncy self. And I’m hovering around Eldest on a regular basis, waiting for him to exhale, waiting for him to develop that smell.

A

photo from Medscape.com

Bittersweet weekends

"You're going to work?" says my three-year old daughter, taking a break from the business of a blueberry waffle and yogurt. "Why?"

("Why?" is the most repeated word in our house for the last few months.)

"Because there's a lot of sick people and I need to help them get better, " I say, as I kiss her on the top of her head and give her a hug from behind.

"Oh," she says, unfazed, her focus again on the waffle.

I slip away, blowing kisses through my lowered car window. Trading "air hugs." Just like any other day.

But today is Sunday. I also worked Saturday.

Today, it stings to drive away, as it always stings on a weekend day. You would think I'd be used to it by now, after three years. But, no.

Working on the weekend is by far, the hardest part of my job. It feels so anti-mother, leaving my babies on a day that is supposed to be time off with the family. I think of families everywhere, doing the usual weekend things. Brunch. The park. Even running errands. Do they realize how special uninterrupted weekend time is? Do they have any idea?

My job, while it does require some weekends, allows me flexibility at other times. During those other times, I really appreciate the flexibility as it relates to mothering. I can head into work a little later, after fitting in an extra nursing session with my 7-month old. I can get home earlier if I need to, to meet with my daughter's teacher. This flexibility, I often reason, makes the occasional weekend day tolerable. But, always, my reasoning and appreciation evaporate the instant a working weekend day rolls around. Poof. Like magic.

I always just want to be home. Like a "normal" mother. I always feel a twinge of guilt. Like a "bad" mother.

Yet, I love what I do. I love every other aspect of my job. I can still find joy in talking and joking with my patient's wife on a Sunday afternoon as we all talk about his progress, his recovery.

I think my daughter understands her mother is taking care of sick people and sick people need help, even on the weekend. I think she knows how much I love her, and how much I miss her when I'm away. Hopefully, my son will know this too, one day.

And when I have the luxury of an entire weekend to drench with family, it is all the more precious.

I soak it up.

Mothers, don't let your daughters be doctors

Stranger: "Little girl, what do you want to be when you grow up?"

Me: "A doctor." [Looks to mother for approval]

Mother: "That's right."

Before I even really knew what a doctor was, I knew that was what I was supposed to be. My parents, both doctors, expected it of me, and I accepted it, much like an arranged marriage. After all, there was nothing else I really wanted to be, other than maybe a ballerina (in retrospect, that likely wouldn't have worked out too well).

In high school and college, I entertained thoughts of other careers, but my father made some very compelling arguments for med school that I was unable to refute:

1) How many careers are there out there where you can really help people?

2) As a woman, this is one of the few fields where you will earn a decent salary and not have to rely on your husband to support you.

3) Just take the MCATs already and see how you do.

At the end of my sophomore year of college, I "just took the MCATs to see how I'd do" and when I got my score back, it was good enough to apply to medical school. And after having taken an eight hour exam, I already felt time committed. Why would I put myself through that and pre-med biology if I wasn't going to apply to med school?

So here I am years later, a new physician. I can't say that this was the perfect career choice for me, but now that I'm at the tail end of my residency, I'm not about to quit and start folding jeans at the Gap** either.

People ask me if I plan to encourage my daughter to become a doctor. At this point, I'd settle for her not coloring all over the walls, but my specific answer to that question is, "Absolutely not."

In fact, not only will I not encourage her to become a doctor, but I will actively discourage her from entering a life in medicine. I will tell her every awful story I can think of about the abuse med students, residents, and (I can only presume) attendings are put through. I'll complain incessantly about how being a doctor means giving up your life to your patients. I mean, yes, I'll buy her the toy doctor's kit, but that will be mostly for me to play with.

And after all that, if she still wants to be a doctor, I can't say I'll be disappointed. What mom doesn't want her daughter to follow in her footsteps? But it's important to me that she gets to that decision on her own. Because medicine is not a career anyone should be pushed into.

And best of all, this way if she ends up hating it, I'll get to say, "I told you so." I've heard mothers love saying that.


**Favorite alternate joke career of doctor trainees who want to quit, for some reason

The Orchidometer

“Mom, do you have an orchidometer?”

“A WHAT?” I’m totally in mom-mode lounging and watching television with my tween son, Will.

“It’s in one of those books you gave me.”

“Go get it and show me what you’re talking about.”

He brings me one of his puberty books, and shows me a picture of varying sized beads on a string.

I hadn’t seen one of those since my peds endocrinology rotation fifteen years ago. It’s a gauge to measure the size of a patient’s testicles, and not part of my regular assessment in general pediatrics.

“I think I’m between a 4 and 6. Maybe about a five.” He offers me.

Great – I’m amused and relieved that he would even share this information with me. I am his go-to parent about all matters related to sexual development. My tween is in a very push-pull stage. There are days he’s my shadow, and can’t get enough of me. He strokes my back affectionately, and nuzzles up to my shoulder. I can barely relieve myself without his presence, and I’m mostly grateful that he still likes my company. I know there will be a day soon that my company will no longer be needed or desired.

I’m also horrified that he knows the information that he does. It gives me a small peak into what he is preoccupied with these days. It’s not the video games that I would like to lull myself into false expectations with. Who is he sharing this information with? Have I overeducated him? Is he overeducated in some areas and undereducated in others? (Probably)

“The book says that puberty doesn’t start until your testicles get to be about an eight or nine.”

“Good to know.” I blink hard.

“So I don’t think I’ve started yet.”

“Mmm.” is all I can think of to say.

So the acne, body odor, mood swings, and tiny peach fuzz over his top lip aren’t because of puberty. The frequent visits to my glass shower while I’m in it probably aren’t related to puberty, either. Boy, that’s a relief! For now I’ll continue to watch this surreal movie that is my life with a pre-pubertal son.

Moving On

I grew up as the daughter of a Naval officer. I have never, in my life, lived somewhere longer than 6 years. We would typically move every 2-4 years, finally settling once my father retired from the Navy when I was 12. I then went to college at 18 for 4 years in one location, and medical school for an additional 4 years in a different location. Mr. Whoo's childhood moves were similar. Since Mr. Whoo and I have been together, we haven't stayed in one place more than 4 years. To be quite honest, I really disliked moving so much. Starting over got more and more difficult each time we had to make a move. The leaving of friends, the packing, the unpacking (torture), the need to learn everything about a new area wore thinner and thinner with each new beginning. Once I finished residency, we agreed to make a concentrated effort to find a place to "put down roots." We thought we had found that in our current location, and we were so excited to settle in and become fully immersed in the community.

Then, slowly, it became obvious that my job was not as lifestyle friendly as it had promised. Instead of a 1 out of 3 call, I became a default solo practice Ob/Gyn physician (something that I never, ever wanted to be). In the last 3 years, not much has improved. I have managed to eke out 2 weekends off call every month, but it seems this is all the leeway with lifestyle that I am going to get. Our family life is severely affected by my call schedule, and I always feel like I have to have one foot ready to run out the door. It is time for a change, and, for us, that means moving....again.

Of course, all of the joy that comes with moving is expanded with small children, especially in the arena of finding reliable child care. Then I worry about putting them through a move and how it will affect them emotionally. For Bean, I am not so concerned, as he is small yet and likely won't remember the change. For CindyLou, this move is going to be hard. This is the only home that she knows. She loves her house, her play set, her room, her teachers, and her friends. I remember all too well the hurt of having to leave my friends and everything that I had known behind for the unfamiliar. Most of all, we want to have a stable place where our family can grow and thrive. As long as I am on call as much as I am, we will never be able to pursue extra curricular activities for the children, and I really can't bear the thought of not making it to baseball games and/or dance recitals.

Logically, I know that as long as we are together, we are home. A house and a town are just places, but a family is your true home. I just wanted to give my children the opportunity to graduate high school in the same place that they went to kindergarten. It is this little fantasy that I have entertained ever since I was a girl, having to move time after time. I am starting to worry that my childhood and schooling has triggered some kind of wanderlust, set to go off every 4 years or so! I never pegged medicine as a nomadic career, but I am taking careful steps to try to make this next move our last one for a very long time. How do you ease the transition of a move on kids that are old enough to understand?

Fracture

My three-year-old broke his arm this weekend.
Technically, he fractured his left radius and ulna, but when I saw him running toward me with a sickeningly unnatural curve to his forearm, I said only, "He broke his arm." I immediately noticed that I didn't use medical language, but at that moment I was solely a mother.
We were visiting family, and Leif had fallen from a four-foot slide. As we headed to emergency, minutes up the road, he kept insisting through his sobs that he needed nothing more than a band-aid. "That always made it feel better before!"
Lying on the gurney in the emergency bay, much more comfortable now with his arm draped carefully over his chest, Leif's chief concern was that the IV not interfere with the (temporary) tattoo on the back of his hand. "Why don't you put it here?" he suggested to the nurse, gesturing to his shoulder.
Hooked up to the monitor, he announced cheerfully, "That's my heart. Did you know it made that little beeping sound?"
I don't think he's ever been cuter. Of course, at home his running commentary has to compete with his two sisters', and we're often distracted by making dinner or driving the van or whatever activity we're engaged in. But lying on the cot, with both his parents directing their full attention and concern at him, the kid streamed charm.
The physician arrived and asked Leif what colour cast he preferred: "Blue? Green? Soccer balls?"
Leif considered the options and replied, "Pink." The lad doesn't have two sisters for nothing.
"Your father will be relieved to hear that we are out of pink casts," replied the physician. "But we do have red."
Leif had to be put under conscious sedation to have the fractures reduced, and as they prepared for the procedure the nurse measured a tiny blue airway against Leif's jaw. "Do you like the colour blue?" she asked him pleasantly.
"What's that for?" asked Pete.
"In case he stops breathing," she replied matter-of-factly.
Once Leif was sedated, hooked up to monitors with on oxygen mask on, his little arm being manipulated by the doctor, I heard Pete make a small distressed sound behind me. I was thinking purely medically at that point, watching the effects of the ketamine and noting the doctor's technique.
I didn't volunteer that I was a physician, as I didn't see how it would influence Leif's care, and there was no natural way to do it. But eventually the physician asked casually, "So, are one of you in health care? Nurse? Doctor?"
"I'm a physician," I admitted.
There was a chorus of Aha!'s, and the remark that we were unnaturally calm.
In fact, I felt grateful throughout the visit. Grateful that in six years of parenting this was our first emergency visit; that the injury was relatively mild; that there was no one to blame for the accident; for the family that visited during our short stay and took care of the girls; for the availability of excellent medical care (working with refugees makes me especially appreciative of our system).
As for Leif, he disregards the cast completely. He's not the least bit frustrated to be constructing forts with one hand, and has been climbing the furniture as usual and threatening to break the other arm.
When I gave him his grape-flavoured ibuprofen this morning, his baby sister asked for some.
"This medicine isn't for you," Leif told her, "It's only for little boys with busted arms."

Sick mama

I'm sick. Again.

Ever since we started Melly in day care six months ago, I've been sick more than I ever have before in my life. People are beginning to think there's something seriously wrong with my immune system and the jokes about sequestering myself in a germ-proof bubble really aren't funny anymore.

"You're sick again?"

"Yeah."

"Again??"

"Yes!"

"But you were just sick like two weeks ago."

"Yes, I know."

"Boy, you get sick a lot."

"Thanks for noticing."

Aside from some more minor viruses, I've completely lost my voice on two occasions and had two pretty bad stomach viruses. I haven't had a stomach virus since I was four. And now I've got a runny nose and cough in the summer, which hasn't happened to me since I was twelve.

I understand that babies get sick a lot because their little immune systems are still developing, but why do I (presumably with a mature immune system) have to catch every single one of her colds? And how come my husband NEVER catches ANY of her colds? (As if we really need to ask why the resident who barely sleeps is more likely to get sick. Hint: it's not because I'm drinking cups of baby saliva.)

I could deal with being sick, except for how it affects my work. I always try to at least show up, no matter how awful I'm feeling, but I can't dictate or interview patients if my voice is gone. And patients don't want me to touch them, even with gloves on, if my nose is running. I try to hide it the best I can, but every now and then I can't take it anymore and actually do the unthinkable and blow my nose in front of the patient. I got thrown out of the room for that little stunt.

Too bad I don't work in a field where it's possible to call in sick. (As if it's possible for a mom to EVER have a real sick day.)

FMLA Guilt

A birth mom chose us. We don't know the baby's gender. It was so easy, really fell into place with minimal effort (but a lot of stress) on our parts.

How to plan our FMLA has been a nightmare. If she goes early, the following will have to be adjusted.

She is due 12/3, but it is a planned section, so we think she'll probably be scheduled at 38 or 39-ish weeks and her state is half the country away from ours. If we are lucky, they'll deliver her 11/24, the Monday before Thanksgiving. I'm off from 11/24 through Wed 12/3 and then start a week of nights on 12/4. We have to stay in the state of the birth for 7-14 days for legal shenanigans before we could bring the baby home. I could, if need be, fly back a.m. of 12/4 if we still aren't allowed to leave the state and leave Husband there with the kids (pleural...neato!).

We think Husband, whose job is in accreditation, will work from home in December, something he is able to do in around the holidays. I will go ahead and work through my current schedule, which is set through January 4th, then take eight weeks of FMLA.

Why, as an adoptive mother, do I feel guilt for taking FMLA? If they were to cut this baby out of my own uterus, I wouln't think it extraordinary to stay with the baby for awhile. I haven't gotten a lot of flack for it at work, but the discomfort I feel is totally self-inflicted.

As Mothers in Medicine, sometimes we have to be better, stronger, faster than our colleagues to avoid being judged. And sometimes, we do it for ourselves, as in, "Look at me. I'm still a good doctor even though I have a new baby."

Meanwhile, please pray this goes through. The birth mom is mature and intelligent and already has three children, but we know this could go wrong anytime, even after the baby has been born.

Isn't it amazing that we could be so attached to a person we've not met, who hasn't even been born, who isn't our blood relative?

Love is amazing.

kid bodies

I think one of the most amazing things in medicine is having the privilege of seeing ALL of kids' bodies - all of it - inside and outside. I'm always amazed at their little tiny livers, kidneys, wormy moving intestines, beating hearts, and my favorite - those always expanding lungs. So when I go home and I watch my kids play, or snuggle with them I often just look at them in awe and imagine their insides too and how it all incredibly fits together, continues to grow and works! When they're tired or snugly and not running around like madmen, I hold their rib cages in my hands and feel their breathing and beating hearts, and I trace out their internal organs with my fingers for them (of course they like to concentrate on the food in and poop out part). If I think too long on it I almost always feel like squeezing them, crying and thanking the universe that they are healthy and whole and ALIVE.

Lucky Mother of Daughters

Being a mother of daughters provides excellent cover for rereading the classics of childhood, to see if they would appeal to my children. Although the girls are now somewhat out of range, reading sci fi, feminism, and Dostoyevsky, I still enjoy the guilty pleasures of the Little Princess and Little House on the Prairie. This week, I fell into Eight Cousins and Rose in Bloom (Louisa May Alcott). I hadn't really reflected on these as a physician before, and I was struck by several thoughts. In the modern age we tend to forget the catastrophic role of illness in many lives, since few of our patients come down with "malignant fevers" or die of sudden injury. But to those patients who are afflicted (lovely Victorian word), the experience is as devastating as it ever was. Conversely, the role of the doctor who can be trusted to know what to do is extraordinarily valued and important. To be a doctor is a burden, without doubt, but it is also an enormous privilege. And the guilt we feel not being with our children as much as women in some other professions may at times conceal or be compounded by the guilt that comes from our enjoyment of our professional work. When I am arguing with an insurer, or dealing with a messy and uncertain medical situation after hours, I resent the demands of medicine, but when the door is closed and I am deep into session with a patient, I imagine it is like being in the middle of surgery. There is no where else, including home, where I would rather be. Accepting that half measures in two demanding arenas adds up to more than one whole life has helped me navigate the shoals of combining medicine and motherhood, even when the tide is ebbing and the sailing requires some tricky maneuvers to keep the ship afloat.

Seriously, I wanna know...

T's post about her future career as a daycare owner left me wondering. What would be your next career move? Would you pick medicine again?

Age-appropriate reading material

Because I was kind of lazy about moving my books up from the bottom shelf of my bookcase, Melly got into my books while my nanny was watching her and appropriated several of them into her own book collection.

I managed to retrieve most of them from her, but she's managed to hang on to a few of her favorites, including several of my medical "pocket guides". They're small enough to easily fit in a baby's hands and usually are brightly colored. I've kind of given up and decided to just let her have them.

So as a result, right now I'm looking at her bookcase and some of the books I see are Peekaboo Kisses, Little People Go To The Zoo, Internal Medicine Pocket Guide to Critical Care, and Where's Baby's Mommy. Typical one year old reading.