More Important Than Your Marriage, or Lessons from Old TV Shows

I've been re-watching The West Wing lately - my Netflix version of re-reading a favorite novel, which I also do frequently. In the episode Five Votes Down, early in the first season, Leo (the Chief of Staff to President Josiah Bartlet) forgets his anniversary and comes home at 2:00 AM in the midst of a crisis with Congress. The next day he sends his wife a pearl choker and plans a catered dinner, but it's too late. His wife has packed her bags and has a taxi waiting.

Jenny: I can't do this anymore. This is crazy. I don't want to live like this. I just can't.
Leo: I'm sorry about the anniversary. I just...
Jenny: It's not the anniversary. It's everything. It's the whole thing.
Leo: This is the most important thing I'll ever do, Jenny. I have to do it well.
Jenny: It's not more important than your marriage.

We all know what the right answer is here, don't we? We do. Leo knows, too - but instead he gives her the honest answer.

Leo: [emphatically] It is more important than my marriage right now. These few years, while I'm doing this, yes, it's more important than my marriage. 

Every time I watch it, this scene brings me to tears. This time, though, I watched it while I was doing the dishes at 10:30 at night on a day when I'd missed dinner with my family because I was at work until nearly 8:00 PM. That's not unprecedented; I'm lucky that it doesn't happen very often. One of the reasons we put off having kids was that I knew I would have a hard time leaving work at work during residency to be fully present for a small child. Sam was in graduate school at the same time and it was even more difficult for him. For many years, I was Jenny in that scene - I was afraid to ask Sam if his work was more important than our marriage. I was afraid he would say it was.

And now? Now I am almost always home for dinner, but I know I'm preoccupied with stress about work and thoughts about patients. I have to say "no" to my kid every third Saturday because I'm on call and I can't commit to whatever it is she wants me to do. There are a lot of mornings when I don't hear what's said to me because I'm in a fog from multiple overnight calls. Am I behaving as if my work is more important than my marriage? If I were answering honestly, how would I answer that question?

Overall, of course I would say my marriage is more important. Sam and Eve are the center of my life; I adore them and I want to be with them. I want them to be able to depend on me. In any one moment, though, I make choices that clearly put my work first, and those moments add up.

There's an episode of M*A*S*H in which the members of the 4077th invite their families to a party in NYC. Hawkeye assumes his dad won't leave, because he won't want to leave his patients. The elder Dr. Pierce writes back that of course he will go; "Yes, I'm attached to the patients I've brought into this world, but I'm more attached to the son I brought into this world." Hawkeye, brushing away tears, says "Funny, I always thought they came first."

I don't want my daughter to grow up thinking my patients come first. I want to show Sam and Eve now, in the moment, that they are important to me. And I want - I need - to keep the sense of myself that is only satisfied when I'm doing my work the way I know it needs to be done. Is my work more important than my marriage? No...and yes.

How Re-Taking the Pathology Boards Ruined My Year

With all due respect to the American Board of Pathology last year sucked.

I am both lucky and unlucky. I only have to re-certify every 10 years (so sad for my 6 year OB/Gyn friends and my 7 year Peds friends). Lucky. I was the first class in pathology - they were a little behind the rest of the specialties - to have to re-take my boards. Unlucky. I could combine my general and subspecialty re-certification into one test. Lucky. I think this whole process is a ridiculous money making scheme like most other doctors in the country. Unlucky.

I started studying in early 2015 on a plane on the way back from a lab inspection. I wanted to take it a year early in case I had to do it again. I was really frustrated that I would have to take it in Tampa - most other specialties could do it at a testing site in their city. I signed up to take a half a week off and fly there in August. My path bro-in-law was going to do it with me, and a friend. We learned early on that there was a study guide online, which made me so happy I took a deep breath and a couple of months off. Path boards are very comprehensive, and while I sailed through the first time, I've never studied so hard for a test in my life.

I geared back up again in the Spring until I got an e-mail from the Board at the beginning of June. They were offering for me to be a part of a pilot program to take the test online. Not in August, but probably in September. I was so excited (no flying to Tampa!) I signed up right away and took a breather. Still, having that test loom over your head is like that kid in Peanuts with the rain cloud over his head, even on a sunny day.

Even with the study guide it wasn't easy. There were three hundred topics. Some of the topics on the general re-cert were so broad - "drugs and their metabolites" and "cerebrovascular disease" - that it left a lot of material to cover (in the case of the latter - it left me wondering what the heck to cover). On the cytology subspecialty exam guide it listed topics like - "thyroid, benign nodules" and "thyroid, malignant neoplasms" - um ok, so pretty much all of thyroid. I took notes during the summer.

It is a lot easier to study for your boards when you are coming out of your residency and you are so stoked to finally be doing what you set out to do and getting a decent salary for it after years (10 in my case) of training. Stuffing tons of minutiae into your head for months is a challenge but hey! You are at the end - so close to the carrot. Ten years later you have the carrot - you are living the life. And it's hard, it's different than what you expected, there are unexpected challenges but if you are like me you also get really excited by what you do and that helps you get through the hard days. Studying ten years into your practice is hard because you know that all that minutiae is at your fingertips whenever you need it and it is so pointless to stuff it all into your head again just to spit it out and get a certificate saying you can continue to do what you are already damn good at doing. But we doctors are mostly type A by the book individuals. So we do it anyway. But it doesn't mean we are happy about it.

August came and went and I got a call from my brother-in-law, who did fly to Tampa in August. I was so jealous of him being done. "You'll do all right, but I'm sure glad I studied." When he found out he passed and elatedly called me in October, I was still waiting to get my two week window to take it online. The computer program they were using was delayed, still working out kinks. The woman in Tampa I corresponded with in frustration was very kind and empathetic, but still. Rain cloud.

October passed into November and we pilot computer people finally got a nice extended window right around the holidays. Again many apologies and an offer to let us take it in March this year because of the delays and inconvenient timing. Hell no. I was getting that monster over with. I downloaded the program with the link - can't remember now why but that process took hours. And I did it on my own mac laptop - no hospital PC would take it. My brother-in-law had a partner taking the same pilot and their group had to buy her a laptop with a camera because she did not have one.

The technology blew me away. I was able to sit at home - they recorded me taking the test and there were all these rules for bathroom breaks and such. I was sitting in the exact same room I am in now typing this blog. I did set up a desk and chair instead of sitting on the couch because it felt more official and I was so nervous. It was nice to be able to have a glass of water next to me, and being at home was a lot easier than being at a testing site. I took it in late November. I felt really good about part of it but not about others. Anyone who has ever felt like they aced a general exam I'm jealous; I always feel like crap after they are over.

Here's another beef and I know I was a pilot but come on ABP 6-8 weeks??!! My friend who took the peds boards re-cert a month before me knew she passed within that week! It's on the computer how hard can it be to grade? I waited over the holidays and finally got an e-mail in mid-January learning that I passed. I was so elated I couldn't get my work done for two hours and had to stay late.

When I look back at last year - skipping weekly lunches with my partner to squeeze studying in, ruined weekends of cramming because I refused to study on vacation or on my time with kids, and overall being more testy in general and pessimistic about life I get really angry at this whole process. I know that pathology is closely following what internal medicine does, and I hear rumors of making this process a lot more palatable (shorter intervals, smaller tests, more related to your current practice), but the nice woman at the ABP who was my phone buddy last year tells me that is years down the road. I hope not ten. I don't think I can do that ever again.

Thanks to my sweet boyfriend and wonderful kids for putting up with me last year. And congratulations to my friend Trishie who found out she passed her MOC boards today (that she took at the beginning of March!) on the way to Disneyworld. She got me thinking and inspired this rant.

Guest post: The Wandering Mind

The way my mind works as of late is akin to that of the ‘Tasmanian Devil’. I am constantly shifting focus. As a hospitalist, and probably like a lot of other types of physicians, I find myself switching my train of thought often every minute. Triggers of course are the barrage of pages, cell phone texts, acute patient care issues and the list goes on. Honestly, I was fine with this pattern because it has been going on since the beginning of my residency years, but now that I have a child….the rules to my crazy game of life have changed.

My baby girl who is now two years old is at this incredible age where every moment is of significance. She’s discovering her mind and the world that she is in. I realized I must focus and ‘be in the moment’ during the limited time that I have with her throughout the day.

So these past few weeks I’ve dived into the field of focusing. Strangely enough, after scouring the Internet and stumbling upon a TED talk about ‘happiness’, one main finding that I thought was intriguing is that the mere lack of focus or shifting of the mind can lead to unhappiness. The other activity that I’ve started are guided daily ten to fifteen minute meditations. It’s helping to drown the noise in my mind, and practice being aware of what is now.

I’m starting to see the effects of some of this and I’d love to hear what the rest of you brilliant moms out there are doing to hone your focus and truly be in the moment.



I'm an academic hospitalist at SFGH/UCSF. I have a 2 year old daughter. You can follow me on twitter @psanyaldey.

MiM Mail: Pumping while on call

Dear MiM,

I am nearing the end of my glorious maternity leave. As my first day back in the OR draws near, I would love any and all advice on how to make breastfeeding work while having to do 24-28 hour calls. Obviously I will be pumping as much as possible while on call, but have been warned by all (including lactation consultant and pediatrician) of the likelihood of dwindling milk supply given the long times away from my baby.

Thanks in advance!

Dear stay at home mother...

I recently came across this article and it really struck a chord with me. As a working mom, I have often felt the divide between the working mom and the stay at home mom. This is the article and this is my own article to the stay at home mother.
http://carolynee.net/a-letter-from-a-working-mother-to-a-stay-at-home-mother-and-vice-versa/

Dear stay at home mother,

I just wanted you to know that there is absolutely no judgment from my end. In fact, I think what you do is infinitely harder than what I do. Sure there are moments such as when I have to wake up little C earlier than she would like, force feed breakfast down her throat while trying to apply sunscreen all at the same time only to be late to work once again that I might think for a millisecond that it would be great to be a stay at home mom. However, the minute I do get to work and get to enjoy my morning coffee in silence. The thought crosses my mind for much longer than a millisecond that I don't know how you do it.

I am sure you are intimidated by me but I want you to know that I am also intimidated by you. I didn't breastfeed my little C the entire year. In fact, I had to hand off the role of primary caregiver to my parents for the first 2 years of her life. I had to be okay with not being the person who knew what her cries meant at all times and I had to be okay with not being the one she wanted at all times. Even now, I try but there are times we often settle on mac and cheese for dinner and I let her watch TV one too many times just so I can finish the work that I brought home with me.

I see you at the playground. But the minute I mention my occupation, I see that look in your eyes. It's as if we no longer have anything in common. But we are both mothers. I identify myself so much more as a mom than I do as a physician. So please don't be shy. I often find motherhood to be a sorority that requires an unending pledging process. How we do it is our own personal decision but we are all linked in our role as a mom, our role to take care of these little human beings and every day we wake up a superhero because what greater power is there than caring for the next generation?

So stay at home mother, please know I have nothing but respect for what you do. I had the most incredible stay at home mother growing up and often find myself at a loss, feeling unsure of how I can provide the love and security she gave me during my childhood to my own child. I had the best childhood because I had a stay at home mother so judging you would make absolutely no sense because I had the best childhood and the best mother.

However, I chose to work for reasons that are important to me. Just as I respect and understand your decision to stay home, I hope you can do the same for me. I love my child just as much as you loves yours. I constantly struggle with the working mom guilt and every day as I tuck my little C in bed, I question whether my decision to work will be worth it in the end.

Let's support each other. We are all united in the sorority of motherhood. Most importantly, I wanted you to know I get it. I really do.

Love, this working mom

The Return From Maternity Leave: Rusty or Rested?

This article on KevinMD was published a week or so before the end of my maternity leave. As I read it, steam emanated from my ears. How dare the author insinuate that physicians lose their technical skills from taking time off equivalent to more than a mere weekend? What about those who must take prolonged time off for sick leave? And what about maternity leave? Are all physician moms, by the sheer reasoning that they had babies, now deemed incompetent?

It goes without saying that we physicians are humans who need adequate time to heal physically in order to perform well mentally. We all need vacations (longer than a weekend) to help stave off burnout, and we all become sick from time to time. During my training and career as an anesthesiologist, I have taken significant periods of time off for vacation, maternity, and sick leave, and yet I've never had a problem integrating back into the basic flow of my job. In fact, on my first day back to work after three months of maternity leave, I had a patient go into anaphylactic shock in the OR - a very rare and deadly event. End tidal CO2 dropped from 37 to 10 and blood pressure was 50/30, but once I identified it I knew exactly what to do. I counteracted the reaction and saved his life with the fortunate and timely assistance of a couple of colleagues who I immediately called into the room (having extra hands is obviously essential in these kinds of situations).

I recently posed this question of competence to physician moms in an online discussion group. Most respondents agreed with me but cited other issues they had returning to work. Some had to regain their prowess with the EMR, others stated that they had a little trouble multitasking, but all felt confident in their abilities to do their required work tasks. I would say that the hardest part for me has been transitioning each day from Mom to MD and back to Mom again. Preparations the night before a workday seem endless, and morning routines take longer than they used to. Picking up my daughter from childcare after work increases the commute time and anxiety depending on how late my OR day has become. I have yet to be the last parent to pick up their child at night, but I'm sure there will be a day like that sometime. Evenings go by so quickly, and I feel I have barely seen my daughter before bedtime comes. Add in being a part-time physician, and suddenly I feel what some moms warned me about: not enough at work, not enough at home.

So Mothers In Medicine, I ask you: how did you feel returning to work after maternity leave? Rusty or rested? Share your experiences here.

Being On Call

When I was a kid, my dad was on call all the time. I am not exaggerating. He was in practice with my grandfather (his father-in-law.) Nat (my Popop) had been in solo practice for years and so when Dad joined him, Dad took over call. Nat was always willing to cover if my parents had plans; mostly Dad was just - on call. 24 hours a day. Seven days a week. My mother finally forced him to take an actual vacation after eight years.

Now, Dad would be the first person to remind me that this was in the 1960s. No ICU. No CCU. No tPA. No push to get patients out of the hospital - people with uncomplicated MIs (if they survived) stayed inpatient for at least ten days. You could admit people for evaluation of new diabetes. No urgent calls on abnormal labs in the  middle of the night. And he genuinely loved his work and his patients, and he didn't need all that much sleep, and of course he had no responsibilities at home because my mother did everything. But still - on call EVERY SINGLE NIGHT. I can't even imagine it.

I'm thinking about it now because last night was One Of Those Nights. I was exhausted after a long and difficult week and I went to bed at 10:00 PM. The beeper went off at 11:00 PM, 1:00 AM, 2:30 AM, 4;00 AM and 5:30 AM. The 5:30 call was from the ED about a patient who needed urgent admission to the inpatient hospice unit, which meant three more phone calls, so I had to get out of bed. I tried to go back to sleep - and then my daughter's alarm went off at 6:10. She's away for the weekend. She didn't turn her alarm off before she went.

I think I'm too old for this. And then I think of Dad and feel like a wimp. And then I remember that he was 20 years younger than I am now, so perhaps I should let myself off the hook.

Am I the only one who has grown to loathe being on call overnight?

When The Doctor Is Sick, Again

Genmedmom here. Coughing, coughing, coughing. This is the third respiratory thing to catch me in as many months. Damn germs, can't get away from them.


I'm apologizing to everyone: my husband, for waking him up all night with my uncontrollable hacking; my kids, for my medicated and exhausted attentions (or lack thereof); my patients, for spewing my droplets about the tiny exam room; my fellow commuters, for daring to get on the train sick.


I'm following all my own advice. I know I've got cough-variant asthma and I'm on top of the Albuterol. I'm taking Dayquil and Nyquil, and snarfing tea with honey and endless Ricola.


But still coughing, coughing, coughing. No fever, non-toxic, I'm eating and drinking and walking and talking and parenting and working and COUGHING.


Not sick enough to call out; miserable enough to want to.


Docs, what do you do?


Never mind, I know the answer. Suck on my inhaler, take Dayquil and Nyquil, snarf tea with honey and endless Ricola, and suck it up.

A Year of Change, and a New Sandwich

I rang in 2016 with visions of change. Change for the better. Growth. Development.

Well, 2016 is going to be full of changes alright. I’m trying to finalize my divorce, considering joining the dating world again, finding new feet after being partnered for such a long time. So, why does the tenor of this post not hold all the hope and light and optimism it should? My move mostly across the country for medical school, residency and career was not coincidental. It was therapeutic. Right now, my self created bubble is being tempered by reality.

I knew I’d be the child to take care of my parents. Neither of them have planned for golden years. Both have made poor financial decisions. I’ve tried to learn from their mistakes. Many of the decisions I’ve made in my life are a direct result of trying to exactly the opposite of what either of them have done. I’m the only child between them. Their other children, my half-siblings, are in no position to help.

I did not estimate that by trying to learn from their mistakes and deliberately making other decisions, I’d put myself in the supreme position to catch them when they fell. Of course, I love them deeply, fully. They are my parents. They supported me emotionally through my journey to get here, they brought me life, they gave me the genes to create the synapses that allow me to make the decisions I make which hopefully translate into quality patient care and contribute positively to the world. They have loved me, advised me, chastised me, praised me. They were fully responsible for me for seventeen years of my life… that means I’m responsible for them, right? Not now, right?

My dad has been diabetic for about twenty plus years now. It ran in his family. He was overweight. He knew it was coming. He ignored the polydipsia, polyuria, fatigue, headaches, weight loss.  When he finally presented to his physician with the aforementioned constellation of symptoms, they confirmed the diagnosis. His response: Eat a gallon of ice cream and drink a two-liter bottle of Coke. He tows his own line and nothing is going to happen unless he’s ready for it to happen. No one knows his diabetes better than he does. He knows how it “feels” to be 245. He also knows how it “feels” to be 120. He’s got this.

Visited for my youngest brother’s graduation from high school. I was in residency at the time. That’s the first time I saw my dad have a low. Pale, diaphoretic, eyes glazed over, tremulous, almost myoclonic jerks. Orange juice spilled from the corners of his mouth as my adrenaline coursed through my veins, heart pounding. He finally came around. My ex-step-mother rolled her eyes, sighed in disgust. My brother sighed in relief. I was stunned. They had seen this before. They were well versed in dad, the brittle diabetic. I went back to residency and my life and put my dad’s hypoglycemic episode in a compartment. I went back to my other life. You might recall my compensatory compartmentalization if you read my first post,  The End... and the Beginning. 

More recently, I visited my dad’s town for a conference, took the little one and my mom (my dad’s first ex-wife) came to visit as well so as to spend time with the grand-baby. We all stayed at my dad’s house. I wake up around 3am to my mother screaming with surprise as my once again diaphoretic, hypoglycemic father, confusedly tried to crawl into bed with her. They’ve been divorced since I was two. She’s got not medical background, has no idea what’s going on. Here’s my internal monologue over the next 5 to 10 minutes:

I know he’s low. Don’t freak out or your mom’s going to freak out. Give her a task. Tell her to find his glucometer. She doesn’t know what that is. Tell her to find his shaving kit. There’s a little blue plastic machine inside. And a plastic container with strips. Tell her to look for the glucose paste. God, I hope he doesn’t wake the kid up. I’ve got no idea where his glucose paste is or whether he even has glucose paste. What’s in the fridge? Kiddo’s juice boxes. Great. Sit down dad. Sit down. Oh, super, your legs don’t work and you won’t cooperate. This is excellent. Drink the juice box. Seriously, Dad? Just swallow.Crawl into bed with mom and scare the shit out of her? Thanks for that. How much did you drink last night? How much sugar is in one of these organic reduced sugar things? How many is this going to take? What else is in the fridge? How much insulin did he take? He’s not drinking it fast enough. Shit. I’m an ER doc and I can’t fix my dad. What in the absolute fuck?!? What’s his renal function? More juice, Dad. Tell Mom to get a chair. Put it behind him. We have to make him sit so he won’t fall. Ok, Dad, you’re not sitting down… I’ll sweep the leg, just like Karate Kid. Great, now you’re sitting. This is taking too long. He’s not turning around fast enough. He’s not swallowing. He’s going to seize. Fuck it. Tell Mom to call 9-1-1. Tell them you have a diabetic who is hypoglycemic and you need help.

The paramedics arrived and by then, my dad was starting to come around. “I know exactly what happened,” he said. “I took my Humalog and forgot to have a snack. No big deal. I’m all set. No, I don’t need to go to the hospital.” Sure Dad. You know exactly what happened.

One of my dad's best friends asked me for my number that visit. He said "just in case I need to call you for something." He said there'd been times he'd supposed to meet my dad for golf and he wouldn't show. Then he'd come to my dad's house to find him in a hypoglycemic stupor, "sweaty, turning the lights on and off, not knowing where he was or what he was doing." So, it seemed this was not an infrequent occurrence. 

Ultimately, I didn’t think I’d be taking care of one of them now. My father who’s made some poor decisions has run out of options and was in financial dire straits. My dad was going to be homeless. He came to visit for my kiddo’s 4^th birthday. He’s not the picture of health. He’s stubborn and manages his diabetes between 6 packs of beer, packs of cigarettes and takeout food, often, unintentionally double dosing his insulin, or so he recalls when he comes out of a hypoglycemic episode. He finds himself in a diaphoretic, near seizure stupor which until this last year, I was mostly, blissfully unaware. Sure, I’d been to visit and he might have a low, scare the crap out of me, lead me to feel woefully ineffective as a physician, then he’d confabulate that of course he knew exactly what happened.

He asked if he can come live with my little one and I. I took a deep breath, clenched my jaw, said “of course.” He's my dad. I've got to take care of him. That's my duty as his daughter, right?

My dad's been alone for a long time. He's lived the bachelor life for a long time... probably close to 15 years or so. He doesn't take good care of himself. He doesn't eat properly. He doesn't exercise. I had this vision when I invited him to come live with us that magically some switch would flip and he'd suddenly be inspired to focus on his health and well being. I envisioned he'd start eating properly, start exercising, maybe catch up with old friends who are local, find a job, find his spirit. 

He's now been living with me for about three weeks. He's had at least 3 hypoglycemic episodes so far. I say at least because those are the one's I've witnessed. He drinks too much. Thankfully, he's not a mean drunk, but I do believe he is an alcoholic. I have observed his behavior, listened to his conversations with me, watched his interactions with my kiddo and I wonder if he's actually developing some dementia of sorts. Not sure if it's from repeated hypoglycemic episodes, some sort of microangiopathy due to his health, or if he's showing signs of Wernicke-Korsakoff. There's definitely some confabulation going on.

What I believe I've learned in this short time is that I had no clue what I was getting myself into. So many of his behaviors and attitudes and coping strategies mirror those of my ex, which makes this whole thing even more challenging to swallow. I do know that I cannot be his doctor, his therapist or his best friend. I cannot control his behavior or effect the changes I believe need to be made. He is likely clinically depressed, though this is clearly complicated by his alcohol use. It was naive of me to think by some magic that he'd do a 180 by coming to live with us. I'm trying to encourage him to seek the care he needs both for his psyche and for his health. I can lead the horse to water, but I cannot make him drink... Why can't I make him drink!?!?

Permanent cohabitation is not going to be an option for me and my well-being. I have to make sure that my little one and I are taken care of and that my child's environment is safe and stable. Friends have suggested that I impose rules upon him with the threat of kicking him out. Trouble with that is I won't kick him out. I'm not going to put my father on the street. I'd rather find a way to get him his own living space so he does impinge on mine. How does one make rules for their own parent? 

The DC public school lottery struggle is real!

I will paraphrase my mommy friend C when she said “we literally have spent hundreds of hours on this”.

We moved back to DC June 2015 and since then have spent hours and hours touring and talking about schools. My husband O and I are both products of public education - we know it has many challenges and limitations but we are both committed to having our son Zo in a public school that all children have access to. We were extremely blessed in North Carolina to find our outstanding Spanish-immersion daycare. We never ever ever worried about him while he was there. We hope things will work out with public school, but thankfully being a doctor-mom, private school is a viable option.

WHAT WE ARE WORKING WITH:

Flash forward to public school in DC and we have had issues with lack of supervision in the bathroom for the preschoolers, lack of vision, organization, and communication from the administration, teachers who rely too heavily on strict discipline and quiet, homework for preschoolers, and the disorganized and understaffed aftercare that we promptly pulled him out of. What we have loved about Zo’s school - that he really likes it, the Principal Mr. L (he is truly wonderful, so committed to the students and parents), meeting wonderful families and making new friends, the beautiful playground, being a Parent-Teacher Organization parent (I feel like I’m becoming my mom every time I attend a meeting), and the overwhelming majority of his teachers.

MOVING FORWARD:

In early April we find out the results of this year’s lottery. For those who don’t know about DC public schools - there are public schools and separate public charter schools. Some participate in the common lottery and others have separate application processes. All super confusing and overwhelming unless you live in an awesome neighborhood with in-bound preference which we don’t. We based our rankings on a private session with Educational Consultant EV Downey (I still shake my head writing this cuz’ who thought you’d need to pay someone to figure out where to send your kindergartener but I quickly realized there were way too many schools I didn’t know about and I am all about tapping into my resources so we went ahead and paid her and it was well worth it), hours and hours spent touring schools in our preferred neighborhoods, countless conversations with each other, friends, and school administrators. There are so many different schools. So many different neighborhoods (drop off process and location is of prime importance in DC), school buildings with very diverse architecture, philosophies, discipline plans, and aftercare programs. So many different “vibes”.

A few of my favorites (in alphabetic order):

- Capital City, a well-established charter school with the most perfect natural outdoor space and great reputation. Too far out of our preferred neighborhoods, but if I could it would have been in my top three

- DC Bilingual, a well-established Spanish-immersion charter school. In a really nice building, but they might have to find a new site next year. Ranked low for us as not knowing where the school building will be was a deal-breaker for us.

- Mundo Verde, a Spanish-immersion charter school focused on environmental justice and study of world cultures. We love their vision.

- Two Rivers, we preferred the Young Campus as its closer to our preferred neighborhoods and O really liked the Principal

- Tyler, a public school with a Spanish-immersion and arts program that O loved

- Van Ness, newly renovated and reopened public school in Navy Yard (prettiest public school I’ve ever seen though in need of a new playground; which I hear is in the works)

Guest post: Why I can’t be Mom and Doctor to my own kids

A few years ago, my eleven year-old came down with something. He felt horrible, and after a long day in the clinic, I dosed him with ibuprofen and tucked him into bed. I reassured him that he would feel better soon. I’ve got this, I thought. I’m a doctor. I wasn’t going to panic about a day of fever and malaise. I pulled out the Gatorade and chicken soup and enforced naps. My quarantine was effective, and no one else got sick.

Four days later, he was still vomiting. He stopped drinking. He had no interest in his favorite ice cream. Soon, he was barely making urine. Kicking myself, I imagined simultaneous appendicitis and rhabdomyolysis, Occam’s razor be damned. Or instead, rashless HSP. My quarantine mocked me: no one else had caught it because it wasn’t contagious. I called my pediatrician and showed up in the office with a child whose moaning broke my heart and accused me of neglect. Had I waited so long his appendix had burst? What good was all my training if I couldn’t even trust my own abdominal exam?

I shared my broad and crazy differential diagnosis with our pediatrician, who gave my son one dose of ondansetron and sent urine, blood and a rapid flu to the lab. While we waited, the magically dissolving tablet did its job, and my son sat up, asking for a drink. When our doctor came back in with the lab results, the patient was begging for apple juice and Dairy Queen. I hung my head in shame. Ready to do an appendectomy for Influenza B, I had become the hysterical mother I routinely saw in my own office.

Once the sting of fear wore off, I realized that while being a mom has made me a better doctor, being a doctor hasn’t necessarily made me a better mother. I have yet to locate the elusive sweet spot between the extremes of doctor and mother. I cannot be objective when it comes to my own children. Which is why I keep my pediatrician on speed dial and a supply of ondansetron in my cupboard.



--Ann Dominguez, mom to four children, writer and Family Practice attending. I have been in community health for 16 years. My novel, The Match, came out in November, and is available on Amazon, iTunes and Kindle.

Surviving long distance

It's been awhile since my last post so a quick update before I go into this topic. I am currently 11 weeks away from finishing my radiology residency! I will be continuing on at my home institution for my breast imaging fellowship. My little C just turned 3 in January and is doing very well in pre-school (and an update to my prior post, she is finally pooping in the toilet!! It turned out she was just very stubborn and decided one day to do it and never looked back.). My husband big C is finishing up his fellowship in spine surgery on the east coast and will be coming back home at the end of July. He got a job on the west coast, which is about 2 hours north of my home institution so we'll be doing another year of "long distance" but I don't consider a 2 hour commute "long distance" after a year of "west coast and east coast, 3 hour time difference, and 2 flights and a layover to see each other long distance."


I am by no means an expert on long distance relationship and this year has been my first year of ever being in a long distance relationship. I was definitely a hot mess for a good part of it but now that we're less than 4 months of it coming to an end, I am starting to see the light at the end of the tunnel and wanted to share how we, me and little C, survived a year alone.


1. Communication. This is the biggest part of any relationship especially in a long distance relationship. Big C and I talk every single day usually via text message. It's hard at times especially when he is doing a 9-10 hour case but he always manages to text me in between cases. It's important that we check in on each other and know what we're doing even thought there is an entire country in between us. This is our way of maintaining our adult relationship and marriage because when we do FaceTime in the evenings, we try to make it about little C. Usually from the hours of 6 to 8 PM (west coast time), we have our FaceTime on. We usually aren't talking the entire time but big C is able to see us eat dinner and our usual bedtime routine. This way little C gets to at least see her daddy almost every day. No matter how busy we are, we always check in on each other!


2. Don't forget about the light at the end of the tunnel. I am guilty of forgetting this at times. As a single mom this year (minus most weekends when we go an hour north to my parent's house), my days just revolve around surviving. I am just trying to make it to bedtime but it's important to realize that there is an end goal. There is reason why we are doing this. It's easy to get caught up in the stressful moments but whenever I am feeling stressed, I think of our family living under the same roof once again and being able to provide for little C all the things we talked about and hoped for in the near future and the stress does melt away some. It definitely helps to know that it is only temporary because there is a bigger picture in mind!


3. Making each moment count. I am not brave enough to travel with little C alone to the east coast, mostly because where big C is training, there is no direct flight and it's a whole day ordeal to get to his place and his place = bachelor's pad. I've been out to the east coast a couple times this year when my mom graciously watched little C. We didn't get much sleep but in its sacrifice, we got to treasure these few days of adult time and made memories to last us to the next visit. When big C visits us here, which is about once every 6-8 weeks, we will fill every minute with family time for little C whether it be going to an amusement park or something as simple as going to the playground. We just strive to create memories and experiences for little C as a family of three.


4. Be considerate. Sometimes it's very easy in a long distance relationship to get caught up in your own life that you forget to think about what it's like to be in your partner's shoes. I am very guilty of this as well. I often lash out at big C about how he has no idea what's it's like to be a single parent doing residency.  But at the end of the day, I am so grateful I get to snuggle little C in bed and how she gives me 3 kisses, 1 on each cheek and 1 on lips right before bed and she calls me her favorite. I get to pick her up from pre-school every day and I get to come to a home filled with pictures and memories of our family. There are hard days but I am not alone. I remind myself that he might not be here but he has his own battles. He lives alone and away from his family. He's experiencing a rigorous fellowship that often involves 5AM days that sometimes end at midnight. He's on call constantly. All 3 meals are often from the hospital cafeteria. He's in a new environment where he doesn't know anyone. And at the end of the day, he's not just doing this for himself. He's doing it for our family and for that, I am truly grateful to have such a hard working, selfless husband.


5. Make short-term plans. This was more relevant when we first started our long distance relationship. I would make a big deal at each 10 week mark. I still continue to make a big deal for each time he gets to visit. There is a light at the end of the tunnel but we still need something to look forward to get through the day to day. Now, we're days away from April and making plans to attend each other's graduations. I still can't believe we have survived this far!

Doctor Day advice

The teacher at my younger daughter's preschool says that they're going to start a unit on different careers, and she asked me if I could come talk to the kids about being a doctor. Of course, I said yes.

While I did this once before for my older daughter's class many, many years ago, I feel like recently what I do has diverged significantly from what little kids think of when they think of a doctor. I still have the equipment, but I can't even remember the last time I took someone's blood pressure. (And that person was probably my husband, who is always convinced his BP is high.)

Has anyone else done a Doctor's Day for your child's class? If so, what did you do? What was a big hit?

The Most Intimate of Jobs

A random Saturday earlier this month marked the first time I provided sedation anesthesia for patients in the same IVF clinic where I was a patient for 3 years. It was surreal and a little emotional driving up the hill to the clinic and thinking about the many times I went there as a patient myself. All the shots, the blood draws, the ultrasounds, the procedures... Also all the letdown and disappointment that was flanked before and after by hope and excitement. I now have a beautiful baby girl to show for my time as an IVF patient!

A friend of mine who is also in the medical field said to me, "I bet it took a lot of courage to do that. Creepy and scary". While I instead had viewed the experience with gratitude and excitement at the ability to give back to a group of people who had given so much to me, I can understand what she meant. As physicians, we are faced with daily reminders of unpleasant things. Things that have happened possibly to us or to our loved ones, or things that are at the very least reminders of our own mortality.

I think these reminders are a gift, one that doesn't come with many other lines of work in this world. They keep us appreciative of what we have, what we've been through. Has anyone else had an experience like this in their practice? Share your thoughts with us.

I matched!

Match Day has come and gone, and I have to admit that life looks so much brighter on the other side of that big white envelope. The months leading up to last Friday have been filled with more ups and downs than I care to count. I know I'm not alone in feeling grateful that the entire process of residency applications, interviews, ranking programs, and waiting, waiting, waiting is finally over!

Now that I've got that Match letter in hand, telling me that I matched at my first choice program (my home institution - hooray for not having to move across the country with a toddler and baby-on-the-way!) I am feeling humbled, grateful, and honestly somewhat astonished to be at this point. There have been so many times in the past 4 years that I wanted to walk away from medical school - studying for Step 1 while trying to conceive, battling first trimester nausea during my surgery clerkship, leaving my baby girl in the care of others when it was time to return to rotations, pumping when I'd rather be nursing her, hearing from my husband or mother-in-law or babysitter about the milestones she reached rather than experiencing them first-hand, tiptoeing out of the house before she awoke in the morning and coming home long after she'd been in bed...the list could go on.

But I count myself blessed to have had the support of my husband, parents, in-laws, and wonderful community of friends during this time - I know from reading this blog that many mothers in medicine are shouldering far heavier burdens with far less help. And it's largely because of those supports that I made it to Match Day. They are the ones who listened when I was frustrated, cared for me when I was exhausted, and lifted me up when I was discouraged. They are the ones who made sure that my daughter always had a safe and nurturing environment to be in (and that mama always had plenty of pictures to keep her going through the longer days and nights). My Match Day belonged to them as much as it did to me.

Even though we are staying put for residency, there are big changes on the horizon. I am thankfully finished with all of my clinical requirements for medical school, but there are all those little administrative odds and ends to take care of. And Baby #2 is due in less than 5 weeks! I still need to dig out the newborn clothes and bassinet from the first time around, maybe review our birth plan/what to expect during labor, think about preparing some food for after the birth (emphasis on think about rather than actually prepare) and pack that hospital bag. Now that the stress and excitement of the entire Match process has subsided, I'm grateful to have the time to prepare, physically and emotionally, for our transition to a family of four.

Congratulations to all the other medical students out there who matched last week - I hope that you are enjoying some well-deserved relaxation after passing this milestone in medical education! I know that Match Day is not necessarily a joyful occasion for everyone, whether it be due to an unexpected placement or not matching at all. So to anyone who is not celebrating this year, I wish you strength and courage for the discernment that lies ahead.

Please share your own stories of this Match Day and those past!