Eureka Moment

I was wrapping things up at a rare early 3:30 today and filed my slides. What to do? Attack the pile of journals three months thick sitting in the far left corner of my desk. I flipped through the Journal of Arkansas Medical Society, the latest CAP Today, and the Arkansas State Medical Board newsletter. Picked up the August edition of Archives of Pathology and Laboratory Medicine. Hit an article titled "Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees."*

I'm a sucker for the latest tech tools, so I read the easy page article eagerly. I was flabbergasted. I could hold up my iphone to the left eyepiece, steady the camera, and take a microscopic pic? One that rivals my $2K microscope camera that is so complicated I get anxiety whenever I decide to use it? Without an app or anything? Unbelievable.

I practiced the image capture that the article described - they were right the steadying of the phone while taking the pic at just the right moment took a bit of practice but five minutes later I had this:

Which I found in a gallbladder. Just kidding. It's a honeybee mouth. I got it at a local science store a few years back, along with a planaria and an ant and a couple of other fun bugs for the kids to play with under my scope when they came up to the office with me occasionally on the weekends.

I used the zoom function on my phone and got rid of the shadowed vignette, just as the article recommended:

Well it is still framed by iphone bars but I imagine this can be taken care of easily. Note how little energy bars I get in my lab basement. The ease and accessibility of this is astounding. Conferences. Sharing hard cases with co-workers (HIPAA restrictions intact and observed, of course). And as the article mentions, high-quality images suitable for presentations, posters, and publications. With your phone.

I ran around in nerdy glee showing off my newfound skill to my fellow pathologists - all as excited and disbelieving as I was and practicing with varying levels of immediate success. My fraternal rival good friend partner caught on quicker than I did capturing a fantastic picture of the lung pleura he was examining (he crowed that it must be his new workout routine). I copied the article and placed it in everyone's box, and noticed that it was written by a dermpath doc I haven't met who works at the University of Arkansas at Medical Sciences - he is a recent transplant and although I spent a day last week visiting all my former attendings and fellow residents (below me!) who are now attendings I haven't met him yet. I hear he's quite good but dermpath is one area I stay away from so I hesitated outside his door and decided familiarity was more important in my limited time off. I enjoyed chatting with a former co-resident who was just hired as chief of pathology at the VA, as well as many others. Man time flies.

*Smart Phone Microscope Photography. A Novel Tool for Physicians and Trainees. Morrison, A.S. and Gardner, J.M. Archives Pathol Lab Med - Vol 138, August 2014.

Guest post: Doctor guilt

I have been a faithful reader since sometime in med school (6 years ago?) and have so appreciated all of your posts! I haven't found a community anywhere else with as many talented, empathetic, articulate and amazing women. I'm a family practice doc in a rural town practicing full spectrum family medicine. I have been in practice for two years since residency and absolutely love my job, even when it is stressful and hectic. I am a wife to an underemployed lawyer and mom to a beautiful, sweet, developmentally delayed 11 month old girl with tuberous sclerosis. She is the joy of our lives.

Having worked my whole life, I was really looking forward to maternity leave. I thought, finally, time for a break! As any mom knows, maternity leave isn't any kind of a vacation, but it really was a much needed mental and physical break from work. However, it was also disorienting to not have a schedule and frequent social interaction. I absolutely loved maternity leave and I think part of what kept me sane was knowing that I was going back to work. When the time came closer, people warned me about how hard it would be, and that I was going to cry my first day back.

I shed a few tears the day before, but the day I went back to work I was 100% ok. I enjoyed it, actually. I felt like I was back at my second home with my second family. The first night back I assisted with a crash c-section and had a blast.

It's been 8 months and I'm still going strong. I work in clinic on Monday, Wednesday, and Friday. I do 4 to 5 24 hour ER shifts per month. I am there nearly every day rounding on patients, since I almost always have a patient in the hospital. In reality I probably average 40 hours per week even though I'm considered "part time." I love having every other day off. After a crazy clinic day it is nice to have the next day to decompress. After having a day of playing with my daughter and being at home I look forward to the fast paced environment of being at work the next day.

Strangely enough, I never experienced the mommy guilt that is so prevalent among working moms of every profession. I love both of my jobs. I know my daughter is in good hands. (My husband is with her most of the time when I'm at work, and we have a wonderful neighbor who helps). I miss her when I'm working a 24 hour shift but that's not the same thing as feeling guilty that I'm not there. I don't know if it's because I'm the primary breadwinner or some other reason. I am 100% at peace with my decision to work. How many men who are breadwinners feel daddy guilt? Is mommy guilt something that is part of our genetic makeup or something that we are told culturally we are supposed to experience?

What I have felt sometimes is doctor guilt. I think part of this is because I was 32 when I gave birth so working is what I've known my whole life. I wonder if I should be working when I'm playing with my girl. I wonder if my colleagues are jealous that they don't get more time off to spend with their kids. (They never say anything - I just wonder). Maybe we'd all be better off as doctors, moms and dads, if we had the flexibility to have more time with our families.

Anybody else have doctor guilt, rather than mommy guilt?

MiM Mail: Two parents in residency possible?

Hello! I am a pre-medical student and wanted to share with you how much your blog has comforted me about my future in medicine with a family. Although I do not see kids in my near future, I have been with my boyfriend since freshmen year of high school and am confident that we will end up married (side note- he is also pre-med). I am one of those people who needs to have all their ducks in a row, so to say. I obsess over the future and planning, which I know is not always convenient when it comes to both motherhood and medicine. Upon looking for advice about when the best time to have children was in the medical career, I found many people who said that it was best to give birth during medical school. This just seemed extremely difficult to me because there is so much studying that needs to be done, and I don't want to add years to my training as I plan to do a general surgery residency and then continue to specialize for about another 4-5 years afterwards. I went on to search for advice/experience from women who were juggling babies and residency, and that's when I found your blog! It has been immensely comforting to read from women who have made it through and to not have to read comments from male doctors that "a woman should either be a mother or a doctor, because each one requires 100%" (seriously, one doctor ranted about this on a discussion board, but failed to explain why it was okay for him to work full-time and barely see his kids just because he was a male...)

My boyfriend and I are the same age, so we would be in the stages of our training at the same time....is it possible to manage children with 2 parents working in residency? (if it helps, he is interested in a radiology residency, although I know that both our choices could change over time). I know many of you have had such difficulties when only one parent is in medicine, so it scares me that my situation may be impossible.

Thank you again for writing such a wonderful blog for anyone interested in the medical field to turn to. I believe that as women we shouldn't have to give up what we love to do for our children, but I still want to be able to have a good relationship with my children. I realize my questions might seem premature considering I'm only pre-med, but the ducks must be in a row for me...... :-)

All Holidays

A friend of mine came to me with a dilemma I thought this community could be helpful in solving.

She is a nontraditional student who is midway through medical school. She is going through a divorce and about to become a single parent. For that reason, she asked me if it's possible to have a career in medicine where she could be off during all the school holidays. Not the entire summer, obviously, but during the Christmas break, the winter break, Easter vacation, all the major holidays, and the weeks between camp and school starting.

I told her probably not.

Considering in an earlier post years ago, I was skewered for suggesting that people with young children have some priority in getting to choose which holidays they needed off, I figured she would be burned at the stake for asking for every single holiday off every year. But maybe I'm wrong. Maybe there is some job for physicians that allows you that kind of schedule.

Taking Care Of Ourselves

Genmedmom here.

A patient of mine recently asked me how my kids are, and what cute things were they doing nowadays? I'm very open about my family with all of my patients. They've seen me huge and pregnant, and they've seen my colleagues during my maternity leaves. My kids' photos hang in my exam room. We often trade parenting experiences as part of the visit.

So, I was not at all put off by her asking about my kids. Her visit was over anyways, and we were only making small talk as we wrapped it up. I described how Babyboy is a little engineer, always building and figuring things out, and that Babygirl is full of sass and song, teasting and challenging and singing all day long. She laughed and said a few things about her kids, how they were all grown up, how she missed their little days, but didn't miss how hard it had been.

"Make sure you take care of yourself," she said, suddenly not laughing anymore. It was a bit abrupt, this serious turn of mood.

"I mean you need to take the time for care for you, because you need to replenish your strength, to be able to care for your kids. Exercise, salon time, friends time, it's really important. You need to do that." She was beseeching me.

"Uh, okay, yes, I know what you mean, absolutely..." We were moving towards the door.

She stopped, and said, quietly: "No, really, I can see how tired you are. You're really, really tired. Remember to take care of you. I need you to, too!" Here she smiled, and the door opened and she was gone, leaving me unusually flustered, standing there for a few seconds, wondering what next.

I know I carried on with my clinic, and then went home, and did the dinner/ bathtime/ bedtime routine with my kids. I know I crammed in some mail opening, bill pay, and reading. I know that sleep was likely disrupted by something... If not one of the kids (usually Babygirl) then the cats, or this nagging cough I've had. I know I am really, really tired.

Now, I have alot of help from a wonderful husband and my untiring mother. I do get to exercise twice a week. I write, which is therapeutic. Hubby and I sit down for dinner every night that he's not traveling, and we have family dinners every week. I don't shop much, or see friends that often, and I can't remember the last time I went to a salon.

I honestly can't tell if I'm taking care of myself enough or not. I think I am. But if patients see me as exhausted, drained, that's not good. I'm not sure how much more time I can carve out for "down time" things, and I'm not sure I feel that strongly about making that happen.

What do others do to take care of themselves? How much down time do you need?

(Don't) Hide your kids!

The first year after my daughter was born, my end of year evaluations digressed into a lot of talk about whether or not I was mommy tracking myself.  The criticism was not about my work ethic or my skills. Apparently, there was an extensive discussion about how overly preoccupied I seemed to be about my daughter.  I mentioned her too often.  The suggestion of part-time residency came up and the sentiment was that I would no longer reach my full potential.  These meetings are supposed to be confidential-ish but I was told afterwards that perhaps I should try to hide my kid.

The instructions to hide my daughter came from a good place.  It came from an attending who had my best interest in mind.  He mentioned that in this world even though I was working just as hard, family issues were going to be looked down upon.  I would be stereotyped.  People aren't used to mom surgeons, especially not as residents.  He told me a story about sneaking off from work as a fellow to pick up his sick son by making up some elaborate story to hide the reason that he had to leave.  “It is more respectable to meet friends for beer than try and pick up your child from daycare,”  he told me.  My response…I would talk about my child incessantly!

So, I did.  I figured, if the world wasn't ready for women to be both surgeons and moms, than I would help to make them ready.  The end result is that I feel this has brought me a lot closer to the other hospital staff who are sometimes more open about recognizing the importance of family.  Being closer to the hospital staff makes my job easier.  I chat with the nurses, scrub techs, office managers about our families.  I feel like it gives me a sense of legitimacy and realness which means we are all on the same team.  Also, an unexpected result was that I became the “mama hen” of the residents.  There are a few more junior residents with kids or husbands and the associated stress.  I try to keep an open door policy for them.  And we have real and frank conversations about how hard this can be.  The supportiveness of being able to have this dialog goes both ways!  Also, I find that many of my attendings take an interest in my family life as well as my surgical development.

This past year’s evaluations had no mention of mommy tracking.  In fact, I was made chief resident.  Last night, as I sat finishing up work in the chief’s office while my baby girl bounced around watching Dora and coloring, I felt I made the right decision.  She knows all the names of the other chiefs and incorporates them into her world.  She loves coming to the office and is well known throughout the department.  She chats with me at night about her day and asks about my day.  She tells me she wants to be a doctor like me when she grows up (well, a doctor and a cowgirl of course).  I’ll never hide this beautiful girl!

The things they carried (in their Dora backpacks)

I had been looking forward to the summer, thinking things would get easier once I didn't have to deal with making it to school in time to catch the late bell or nightly homework. I was really wrong.

With both kids in camp, the list of things I have to do prior to getting them out the door is overwhelming:

--breakfast
--pack lunch for both kids
--snacks
--if needed, diapers or wipes
--put both of them in swimsuits
--clothing over the swimsuit or packed in bags
--swim shoes
--normal shoes
--towels
--remember if there's a trip that day, and if so, the cut off time for arrival (anywhere from 8 to 9:30)
--if there's a trip, remember camp T-shirt
--remember to freeze water bottle the night before, then remember to remove from freezer
--sunscreen
--if Monday, remember to bring blanket for naptime

Honestly, it's a miracle we get out the door anytime before noon.

Is the summer over yet?

Where is the grass greener now?

An anecdote to describe my life:
I found a new work bag that I wanted, told my husband about it, he went out and got it for me in the color that I wanted, and I changed my mind the next day.  Returned that bag, bought a different shaped one (same company) in a different color, was finally settled with my decision, then decided I wanted the first one after all.  The grass is always greener on the other side right?

How does it relate to my more important mother/wife/doctor life?
I know a mother, whose life I so desperately want, but so do not want at all.  She is not a physician, she is a stay at home mother.  Since the birth of her first-born, and she has been for many years.

She has a lot of help, a housekeeper, a couple of babysitters.  Her kids go to school full time.  I so don't want to ask the awful and judgmental question 'What do you do all day?' But I wonder.

She leads the life that us working, 24-hour-call-taking mothers dream of.  But I saw her in her own zone recently.  Angry and yelling at her kids.  Frustrated with them, frustrated with her husband, frustrated with herself.  And I thought, "Wow, I hope I don't become like that!"

For once the grass was greener on my side.  But it didn't stay that way for long.  Maybe I should spend more time with her...

The grass didn't stay greener because soon after, I went to a playground with my baby after work.  It was an unusual thing for me to do after work, but I did it.  There was a mother there swinging her daughter next to me and SHE struck up a conversation with ME.  We talked for a while and I found her pretty likable, her daugher was my baby's age, and she was a stay at home mom, and I was even thinking that this would be a perfect opportunity to make a new friend with a baby that is my Doll's age in the area since I really don't know any moms.  I wanted to ask her if she wanted to do something like a playdate (which I have never done, because I don't know anyone around here and because I don't have time) and the entire time, I was replaying Fizzy's old post about playdates in my mind.  The post said that the stay at home mothers do playdates only during the week, because weekends are "family time."

To make a long story short, a friend of this woman came up to us and said, "Wow you guys are chatting away!" and this woman responded with, "Hey, she's firing out the questions left and right, it's not me!"  It seems the psychiatrist in me had reared it's ugly head...

I had not felt like I was asking a lot of questions, and if I was doing that, it was because I was so excited about meeting someone new.  I felt like she had asked a good number of questions herself.  But perhaps the conversation was more one-sided than I imaged.  I went home that day without a playdate and feeling awful about myself as a mother and as a person.  Was I really shooting out questions like I am so used to doing at work?  Am I really not able to put work behind me when I'm home?  Was her facial expression when I said I was a psychiatrist only in my head?

The mother I spoke of earlier in this post has playdates all the time (or at least had them when the kids were younger.)  She has other mother friends.  She used to go to the playground during the day in the middle of the week.

 I have always wanted to be an involved mother who provides a healthy and social environment for her children outside of daycare, and I just haven't been able to do that.

So... the grass is greener on the other side.  It is true.

MiM Mail: How happy should you feel in residency about your specialty?

I am a third year psychiatry resident and a mother to a precious 21 month old little girl. I often find myself wondering how happy I should feel as a resident in my specialty. I was very ambivalent about choosing a specialty and considered family medicine and pediatrics as well. I ultimately chose psychiatry because I felt it would be less stressful and offer a better lifestyle. I also tend to not believe in myself and wondered if I could handle the rigors of those other specialties. As a resident I often wonder if I made the wrong choice. I don't hate my specialty but often find myself wondering if my personality would have been a better for the aforementioned specialties. Sometimes i feel "too nice" for psychiatry and I despise emergency psychiatry and the legal aspects of the field. I have thought about finishing psychiatry and then completing another residency but I just don't feel that I have the stamina for that and want to work part time as soon as possible. I'm just wondering if others have struggled and ultimately found happiness in their field? I'm hoping my feelings are related to burnout and don't indicate I will never find fulfillment in psychiatry.

MiM Mail: Time for a second child?

Hi there,

I've been enjoying and learning from MiM for several years - since before medical school and before I was a mother. So thanks for creating such a great forum.

Now I am a second year medical student with an almost-3-year-old. She is great. And for the most part, medical school is great. But that's right now. My husband and I have been through a lot in the last five years to get here. We've both gone back to school and dedicated ourselves to new and intense professional fields. These changes have required two moves. In that time we have also both had pretty significant medical problems that have since resolved, but that caused a whole lot of disruption and stress, including stress on our marriage. In my case, this lengthened the medical school process.

Things have finally settled down. My husband has recently found steady work that he loves and provides him exciting opportunities. And our daughter, almost 3, is thriving. And now I feel like I can fully enjoy her.

Some years ago I thought I'd be trying to get pregnant right now. I put that thought out of my mind as we worked through all our many challenges. But as things settled down recently, I started thinking about a baby. The timing of things are no longer what I'd planned. We could try to get pregnant very soon - in which case I'd take Step 1 very pregnant. Or we could wait another year. Another year means an almost 5 year gap between children. (I am trying to prevent another year of school, hence the timing constraints).

I think our daughter is ready now for a sibling. She is becoming independent, potty-trained, able to start to share, etc. And if it weren't for all the circumstances, my husband and I would be more than ready. But I am concerned about perpetuating that pattern of being in constant stress, in constant needs-only, no time for fun mode.

On the other hand, some of that is inherent to the early childhood period, even if we were not dealt a few additional challenges. We all have to balance family and career and if this time is not going to be great fun anyway - why not create another awesome creature while we're at it?

I worry about some of the details. Would being 35 weeks pregnant affect my ability to maximize my step 1 score? (I have lots of interests right now, including one that is very competitive). And would having a baby in early 3rd year be crazy? I was back at work with a lot on my plate three years ago. I know I can do it. But doing it while missing two kiddos instead of one seems worse.

These are all details. And big picture is that family is important to me. And living the kind of life I want to live and become a doctor (rather than living life to be a doctor) is important to me. But so is happiness. And I don't want to push myself and my family so hard we can't enjoy what we already have.

Thoughts?

A Scientifically Stellar Lunch Date

"Education is the kindling of a flame, not the filling of a vessel." - Socrates

I was trying to set up a science birthday party for my son back in May. He was turning nine and wanted a mad scientist theme. I wanted a mad scientist to take the pressure off of me. I hit a wall with the local science museum, and decided to try the school to see if any high school students were interested. As the upper school administrative assistant was giving me the names of the science teachers, one rung a bell.

"Did she have an old last name that was -----?"

"Well, I don't know. Since she has been working here that has always been her name. I could ask."

"That's ok, I'll just ask her myself. Can I have her e-mail?"

After I sent a query I remembered a few months back when I was sitting at a low bleacher in the gym. My daughter was picked as the lower school representative to read a passage at a convocation and I got covered to watch and support her. She was confident and well spoken; it was a thrill to witness. As I glanced back at the audience I saw someone who looked like my high school physics teacher, plus 24 years (both of us!). Surely not, I thought. Now I knew I was wrong.

I left my phone number and she called me that evening. We were both rushed and excited to catch up (me more than her - she is eternally calm). She said, "I told my husband this is a first. To have students matriculating toward high school that are the children of a former student. I am overwhelmed." We planned an early morning before school meeting within the week. I met her in her classroom and we reminisced. We were her first class. I remember relating to her because she was young and enthusiastic and intelligent and female. She reminded me she had just come from California after training back then, but grew up in Arkansas. She charted her career trajectory - teaching to business then back to teaching - and I reciprocated. She promised to try to help me find a student for the party. She reminded me of the plaque we designed for her to commemorate her first class. I told her I thought I had a picture of our class giving her that plaque (it was a small class - numbered in the teens) and I would try to unearth it when I moved later on this year.

The students didn't work out, but that was for the best because my son was the scientist at his party and he was awesome. But the door I opened to my teacher was worth the effort. I e-mailed her after the party was over and invited her to lunch and to tour my work. I told her that if she had any interested students I would love to host them for something similar - I am always trying to recruit future pathologists. I was over the moon when she accepted and we set a date for mid-summer.

It was a Monday not too long ago. I was covering cytology, so radiology needles. I checked the schedule in the morning and asked for a window so I could eat lunch with my science teacher. The tech told me that 11:30 would work best, so I texted my teacher to set it up. The radiologist covering that day was accommodating.

"You are taking your high school science teacher to lunch? That is so amazing and inspiring. You are making me want to do something similar. But I didn't have any good mentors that I remember."

"You mean that you can't find anyone in your history to give credit for your current awesomeness?"

He smiled. "Well, maybe I can think of someone. I'll work on it."

After my third needle of the day I raced to the lobby to meet her. We hugged and had a good heart to heart over soup and salad - she insisted on picking up the tab. I showed her pictures of my son's birthday party. She said, "You are a true scientist. You hit some obstacles but didn't let it stop you from formulating a new plan. And it looks like it was a great success." I glowed in her praise, just as I did when I was 16 and I figured out a physics problem or successfully completed a lab experiment.

I showed her the Gross Room and Blood Bank and Microbiology and Histology and introduced her to most of my partners. I think she had as much fun experiencing a different world as I did when I alighted her classroom a few weeks back. We were interrupted by a student who was taking a make up test and needed help. I was awed by her calm reassurances and professional demeanor. I cannot wait for Cecelia and Jack to soak up her carefully and expertly doled out knowledge like the sponge I was back then. I hope she inspires them as much as she inspired me.

They are well on their way to becoming scientists. A little expert guidance always helps to kindle the flame.

Guest post: The whole truth

"Tell all the truth but tell it slant" (Emily Dickenson)

Much is written about how women, and mothers in particular, hurt each other by only showing their competent and successful side. I agree. This isolates us. I’ve had people ask me: “How do you do it? How do you manage being a doctor and a mother at the same time?” Most of the time I say “I don’t know," and that is true in part. I am just doing the best I can and it never feels good enough.

But here is the whole truth. I have a LOT of help. An insane amount of help that I feel embarrassed that I need and for which I feel undeserving. Particularly here in Utah where many women have a lot of children and do a darn good job taking care of them all while looking fabulous in the process, I admit that I feel guilty that I don’t measure up. I feel silly that I have a hard enough time taking care of two.

So here, in a nutshell, is a list of all of the help that I have: a housekeeper a morning per week. And in addition, gulp, a lady who comes two times a week to help with laundry. I shop online and save most errands this way. As if that weren’t enough, I am fortunate enough to have my parents here in Utah. In addition to watching Adelyn during the day, if we are late for school pickup, or if I have a late meeting, my mom is there for backup. Oh, and since we are in full confession mode, also a therapist to help me deal with all the damage done to my psyche by medical training. Have I suffered any real trauma in my life that would actually merit a therapist? Nope. Yep, I am a spoiled white WASP (I’m not actually sure what that is but I think that that is the category people would put me in.) So what am I doing with all this help? Am I volunteering for humanitarian causes? Am I the PTA president? Nope and nope. Here is what I am doing with that time: spending it with my kids mainly. All this help allows me to spend a lot of quality time with my girls. I hope it is doing them some good but I am never quite sure. I desperately want to volunteer to help disadvantaged kids but right now, I have all I can do to take care of my own children. And so I am an armchair do gooder, making donations and all that other useless stuff. I cook several times a week. I sometimes have people over for dinner if the house is presentable enough (though I should do so no matter the condition of the house…foolish pride). I read I bit. I run. When I am feeling brave I take the girls to church on Sunday. I garden and putz around our property. I sit on the front porch and drink iced tea. I occasionally get together with friends or talk on the phone with them or write a letter. Oh, yeah, and I'm a doctor. A decent one most days, and some days a downright good one. If I didn’t have all this help, none of this would be possible.

What are my kids doing while I write this? Watching a dumb cartoon with negative educational value. It’s 90 degrees and in the heat of the day and we already read, and done 2 crafts and some homework pages and eaten and cleaned up and attempted naps and I have no more tricks up my sleeve. And darn it my husband has just arrived home early and caught me ignoring the children while they watch TV.

There you have it. Judge away. Or maybe, just maybe, cut me some slack. Cut other women some slack too. And if you do more than me with less and get by without any help at all, I am truly happy for you. But it's okay that I'm not that way.

I realize that sometimes women take offense when you say things like “I don’t know how you do it.” But when I say that, I am being genuine. The woman with 5 kids--you are my version of a rock star. If I have a lot of questions for you and ask you how you do it, it is because I admire you, like some people might do when they meet a world class athlete or a famous author. To me, you are doing the impossible. The woman staying home with 1, that’s a huge job too. The woman with no children-- wow you must be able to accomplish so much, and gosh it must be so nice to be able to read the paper in bed or join friends for cocktails at night or have a glass of wine on the plane without a small person dumping it out and making the whole aircraft smell like a vineyard and good for you for knowing yourself well enough to make that choice (and if it is not a choice but one that has been forced upon you by infertility, I am sorry and this is why I try not to ask women if they have children lest I hit a sore spot). The woman who has made it to the top of her field? Thanks for paving the way. The woman doing important work to end social injustice? You are ALL my heroes. And I’m grateful to have so many of you in my life.

-a geriatrician and mother of 2

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?

I Spanked My Kid.

Genmedmom here.

I spanked my oldest last Wednesday. Twice. He's only four, he's autistic, and I hadn't seen him all day. I am such a jerk.

My day had started at five a.m. I had several extremely complicated and sick patients and several extremely complicated phone calls and a load of logistical paperwork and an inpatient to see and it was downpouring when I left work and I had to walk a mile to my car and the afternoon rush-hour traffic was standstill in the tunnel and I was forced to breathe car exhaust and I felt sick all the way to Nana's house blah blah blah.

I had been truly looking forward to seeing my little man and my little bug. But all the way to my mother's house (she picks the kids up from school/ daycare), all I was thinking was that I had to get the kids rounded up and in my car and back home for baths and bedtime, and I wasn't sure what time Hubby was coming home. I was stressed that I might be solo for the whole night-night routine (Panic!!!!)

When I got there, Babyboy had a poop and a terrible diaper rash, and he didn't want to be changed, so he twisted and turned, and he started grabbing things and throwing them at me, including poop-covered baby wipes, and I yelled STOP IT and swatted him on his butt. Then five minutes later he shoved a throw pillow at my infant niece, and I yelled THAT'S IT and I spanked him.

Now I feel terrible.

I've yelled and spanked before, and it always makes me feel like the most ineffective, inept, stupid, bad mommy. I intend to avoid this primordial parenting technique. But when I'm exhausted, and I can't seem to get control of my kids, I just get so frustrated and angry, and I can't seem to access any of the more advanced parenting skills I've read about.

And, spanking works. In the very short term. Very, very short term. Babyboy stopped throwing poopie wipes the first time, and he stopped shoving pillows the second time. But he cried and wailed for Nana, who never loses it and is always calm.

So, obviously not a great parenting tactic. And if my colleagues and patients saw me lose it and get physical over poopie wipes and pillows, I would be mortified.

The best book on parenting an autistic child that I have encountered so far has several wonderful lessons and suggestions on this very topic. I've dog-eared the pages and read them several times.

The book is Ten Things Every Child With Autism Wishes You Knew by Ellen Notbohm (Future Horizons, 2012), and chapter 9, "Identify What Triggers My Meltdowns" is applicable to any parent of any child who ever throws a tantrum for any reason.

She writes: "If you react with anger and frustration to your child or student's meltdowns, you're modeling the very behavior you want him or her to change. It's incumbent upon you as an adult, at all times and in every situation, to refrain from responding in kind. Be your own behavior detective. Figure out what triggers your own boiling point and interrupt the episode before you reach that point. When your thermostat zooms skyward, better to temorarily remove yourself from that situation."

In my case, Babyboy may have been overstimulated, and then protesting. There were many family members in the house and in the room; I had just arrived; the television was on; it was stormy outside... and I was pinning him down to the unpleasant and even painful task of a diaper change. When he acted out, I could have held in all my frustration, got the poop reasonably cleaned up, and put Babyboy in time-out in another room, away from everyone. That may have avoided the second outburst and spanking.

Of course, there are many people who feel that spanking is acceptable parenting behavior, and Ellen Notbohm has these questions for those folks:

"Consider:

Does spanking follow careful weighing of alternative responses and a reasoned decision that, yes, striking someone one-quarter our size is logical, provides a good example for them to follow, and will produce the desired long-term result? Can we be sure that it teaches the child what she did wrong?

Does it give her the knowledge and skills to correct the behavior? Or does spanking spring from aggravation, wrath and desperation?

Does it foster respect and understanding, or humiliation and bewilderment? Does it enhance the child's ability to trust us? Is it a behavior we want the child to emulate?"

Of course, this all makes perfect, clear, sane sense. And I've read it, and I get it. But in the moment, I haven't been able to consistently refrain from yelling and spanking. And I'd like to.

I think the real answer is in identifying Babyboy's triggers and trying to avoid them. In my case that day, there was an even better potential solution: I could have taken him to another, quiet room to change his diaper, and, after a bit of cuddly mommy time, I could have given him some control over the process, a job to do, like handing me the wipes or unfolding his clean diaper.

That response would have been ideal. It would have required some thoughtfulness, some space, some time.

As Ellen Notbohm writes, "Many will be the wearying moment when the root cause of your child's meltdown won't be immediately evident. There may never be a time in your life when it's more incumbent upon you to become a detective, that is, to ascertain, become aware of, diagnose, discover, expose, ferret out..."

As a physician, I am so accustomed to multitasking, problem-solving, wasting no time, get the job done... With Babyboy I need to slow down, breathe, and think. Study him, and anticipate the acting out, the outbursts, the tantrums, and steer around, or make them disappear. I do think it's possible...

Has anyone else out there had any similar experiences/ got any suggestions to share?

MiM Mail: Disclose family in residency applications?

Dear Mothers in Medicine,

I was so excited to have found this blog! What an inspiration! I'm a 4th year medical student with a busy little 12 month old. My husband is wonderfully supportive and great at stepping up and taking care of our son when my schedule gets crazy. To be honest, when I first found out I was pregnant I would have never thought that med school + a baby would be so doable (ridiculously hard at times, but totally doable). Sure, there were many times when I was ridiculously sleep deprived and didn't get to see my husband or baby awake for a day or two. And sure, there were several times where I spent my pumping session crying in addition to stuffing a sandwich into my mouth as quickly as possible. But I did it, and I *think* I did it well. I don't mind anonymously tooting my own horn on this one because I'm darn proud. This past year has confirmed that I'm on the right track-I love being a mom, and I love being in medicine!

I am now preparing to apply to residency positions. As much as I tried to like a field with more potential for control over my schedule (peds, PM&R, pathology?), I realized that I would never be satisfied if there wasn't a significant amount of OR time in my future. I even almost let a few of my attendings talk me into going into general surgery, but in the end I decided that my passion is for OB/Gyn. I'm struggling with this decision because of the many hours/days that I know I'm signing myself up to spend away from my family. My husband tells me that I can always quit and be a SAHM, but that is not my calling and I know it. I'm already feeling guilty about putting my career in front of my family and now I'm faced with the decision of whether to disclose in my applications that my family even exists! I've been told that when selecting residents, if two applicants are otherwise equal, they will pick the one without commitments outside of the hospital. It's illegal, of course, to base decisions on these factors, but it's undeniable that it happens.

I think I've decided to leave any mention of my family out of my personal statement, but there are many other areas in the application process where this information could potentially come out. There are two different areas for explaining any breaks and extensions of the normal 4 year track. I took a LOA after I had my baby. Do I just say I took a medical leave and not explain? Is this a red flag? (Is this going to happen again? What if it was a psychiatric reason and she's unstable? Etc) I have heard of people bringing their kids/spouses to interview dinners. Do I leave them behind? Not talk about them? Hide my wedding ring? How far do I take this? It just feels wrong to hide the two most important and influential people in my life. I used to think that if a residency program doesn't want me because of my family, then I don't want them. However, in an increasingly competitive market, it may be naive and foolish of me to sabotage myself by disclosing personal information that won't even potentially benefit me. It just all feels wrong.

Thanks!