What is wrong with you??

Lately, I've been cutting back my hours at work for it to be more in line with the part-time job I originally signed up for.  This resulted in an interesting conversation.

Coworker: "Can I ask you a question?"

Me: "Okay...."

Coworker: "I don't want you to be offended."

Me: "Oh my God.  Just tell me the question."

Coworker: "Why would you want to work part-time?"

He wasn't trying to snark my decision, but was actually genuinely baffled.  Why would I want to work 60% time and earn 60% of the money everyone else does?  Many other people go in the opposite direction: picking up per diem work wherever they can get it.  I know one guy who does per diem work both days of every weekend after working all week.

It was easier to justify to others working part-time when I had babies, although in some ways, I'd rather be part-time now.  My kids are SO much more interesting now.  And while daycare always ended at 6:30, school ends at 3, and I actually have a chance to be there when they come home from school.  I can help them with homework instead of entrusting it to the afterschool program.  I can go to girl scouts.  I can actually be an involved parent.

And the other factor is we don't live large.  I don't like to travel. I don't like to go to expensive restaurants or shows. I'm wearing the same winter coat I had in college.  We have all the same furniture we bought a decade ago at a discount furniture shop.  And we live this way not because we're depriving ourselves, but because I simply don't long for anything different.  If I won the lottery, I don't know if my home would look that different.  But I would work part-time.  That's all I really want.

So if I can, why wouldn't I live like I won the lottery?  Why make a bunch of money I have no interest in spending just for the sake of making money?  We make plenty of money for the life that we live.

And going back to that conversation with my coworker, that was my answer:

"Why do you want to work so much?"

Tales from intern year

I am now several months into intern year. The first few weeks... months... of intern year almost seemed like a daze. Wake up. Work. Eat, sometimes. Sleep, maybe. Rinse and repeat. It was only a few short months ago, which almost seems like a lifetime ago, that I was looking back at the trek through med school and wondering what loomed ahead in intern year.

Several weeks after that, I was sitting in an orientation for newly minted residents, listening through a whirlwind of talks about figuring out the EMR system, deciphering HR benefits, wellness talk by the program director, who predicted our intern year trajectory would go thusly: "first 2 months being scared s#@*less, next 2 months starting to feel little more comfortable, and the next 2 months, which puts us squarely in the middle of the long dark nights of winter, being depressed, the gloom of which will start to lift off with more daylight hours".

The beginning of intern year felt so jarring, to one day suddenly have people refer to me as "Dr. Lastname" instead of "Firstname" or "yo medstudent". Not exactly an unexpected outcome, I got plenty advance notice that was coming after 4 years of medical school. But I was so used to being either ignored by nurses or being treated as a nuisance, that when they suddenly started asking or paging me about whether to give insulin to this patient or Ativan to that patient, yeah, my thoughts at the time are illustrated above.

I remember agonizing endlessly over the smallest of decisions in the beginning. "Doctor, this patient is asking for Tylenol". "Let me call you back in 10 minutes after I do a thorough chart review to make sure I don't harm this patient with Tylenol with some contraindication that I haven't thought of as yet". I distinctly recall the jubilant moment of the first day of intern year when my co-intern and I high-fived each other after our biggest accomplishment for the day, figuring out where the restrooms were!

As months rolled on, just by the virtue of doing the same thing over and over, I started to feel more comfortable. Though I have soooo much more to learn and improve upon, reduction of that initial cognitive burden (figuring out the EMR, where the restrooms are etc.) has helped with efficiency. Some things have started to become second nature, with enough jolts to snap me out if I become to reliant on heuristic thinking.

There was something to what our program director said in the beginning of the year. We mostly followed his predicted trajectory, cluelessness --> tenuous comfort --> gloom. Which now brings me to the deep dark cold months of winter, which coincides beautifully with the peak of influenza season, everyone getting sick, chaos of finding coverage, and on a personal front, uncertainties of kindergarten/pre-K lotteries. Perhaps his predicted trajectory will continue, and when things settle down, and there are more daylight hours, gloom will lift?

Doctors Make the Worst Patients (Part 2)

You can take the girl out of the mania, but you can't take the mania out of the girl.

That doesn't even make sense, I know, but most of December not long after I was diagnosed with hypertension was senseless. When I went for a follow up two weeks later the nurse asked if I forgot to take my medicine. "Are you on Adderall?" she asked. Heck no. This beta blocker is just about the only prescription drug I've taken in my life besides rare antibiotics. "Well take a deep breath. Maybe I can get some better numbers. You know you've gained three pounds." This, a pet peeve of mine. I hate when I tell them I don't want to know my weight due to my OCD tendencies with numbers and they make comments about it. I reminded her we are in the middle of the holiday, everyone gains weight. She smiled, shrugged, repeated the study. Still sky high. So my doctor started me on a second drug, told me to take my pressure once a day to make sure the numbers were going down, and come back in two weeks.

Sure enough the numbers came down, but I was in despair. Two prescription drugs? Hypertension doesn't even run in my family. I bumped into my cardiologist friend in the cafeteria on call New Year's Eve weekend, and shared my story. He told me to get on a low salt diet, specifically the DASH diet. I promised and walked over to get my normal lunch - a cup of soup, which to my alarm had almost as much sodium as a normal person needs in one day. I withdrew from the soup stand in fear and grabbed some fresh veggies from the salad bar.

Now I've been on a lot of diets in my life for various reasons - gluten free to calm down IBD, watching calories, etc., but I learned over the next few days avoiding salt is like avoiding the AIR WE BREATHE. It's in everything. Last year I was so proud of myself for buying unsalted butter but I needed to get a little more serious this time. Soup was out the window. Soy sauce, even the low salt OMG. Salad dressings. All preserved and canned foods. Most things pickled. The yummy salami and pringles and cheese that my impossibly and aggravatingly fit husband brings to the couch to watch TV after a full dinner every night; somehow he can do this whether he's riding his bike or sitting on the couch for two months and gains not an ounce of fat. My body is not so forgiving. It has to go.

I made a quick trip to the supermarket and bought every superfood to lower blood pressure I could find on Google on New Years Eve. Ordered ground flax seed off of Amazon.  Have you ever eaten naked beet chips? If you do, when you go to get that little bit out of your tooth don't worry, as I did, that your mouth is bleeding. And I guarantee one naked beet chip will be enough for the rest of your life. I drastically cut my food intake. I went back to the doctor for my yearly wellness visit a few days later, ugh. I've visited the doctor more in the past month than I have in years. The nurse, again with the weight thing. "You've lost 12 lbs since you were last here." I was startled. I certainly did feel less bloated. I guess I was so salt overloaded I was carrying at dozen lbs. of excess water weight that took only 10 days to shed. In retrospect I did spend much of the first two days in the bathroom. Current in office blood pressure: 100/70. Whew. The doctor was so impressed he advised cutting back the water pill in half.

Well, that didn't work. The numbers crept up. And thanks to the nurse telling me my weight, I was manically stepping on the scale every morning. The cardiologist informed me that some people have a low tipping point, and mine is obviously one of those - losing a few pounds could help a lot. When four days later my weight hadn't changed despite severe food restrictions and my blood pressure was so sky high it scared me into taking the second half of that pill I had an uncharacteristic ugly cry meltdown in the shower, laced with intermittent screams of rage at lack of control. The very same me that read The Untethered Soul two months back and decided my soul had transcended any Earthly need for control. I took a deep breath. I am the same person that looked at myself in the mirror admiringly a month ago without knowing the numbers. No more numbers. And what was that diet the cardiologist recommended again? I googled and found there was a book! On the DASH diet. Whew. I can do anything with a book. I ordered it on Amazon and learned it is ranked #1 Best Diet Overall by US News and World Report. It was developed as a heart healthy diet and turned into a sensation. And better yet there was a new one published advertising eternal youth as well! Well, younger you anyway.

It arrived Sunday and I skimmed it over an hour. Got the gist. To my relief I can actually add food to my  current restricted diet, a lot of it, if I just eat the right things. And it's really easy, except the suggested recipe part that almost gave me a nervous breakdown. And the part where it gives examples that seem to require I quit my job and tie myself to the kitchen to create such a varied diet. Luckily I can largely achieve the basic formula with food at my grocery store and in the hospital cafeteria. Maybe try a recipe every few months if I get a day off. And it encourages daily red wine! Perhaps not as much as I'd like but definitely a plus. I'm just waiting on my food scale from Amazon to learn what four ounces of fruits and veggies are, guestimating in the meantime. Reminding myself that this doesn't have to happen overnight. Hopefully if I keep it up a few months I can get off of the meds. I'm 44 years young, I've got a lot of days left in this meat suit. I've got to keep it going - there's much more to do.

To OB or not to OB...that is the question

Career advice wanted

I’m having a mid-residency crisis. I’m halfway into my three year family medicine residency, which means in a year and half there will be much more independence but also much less of a safety net below me.   I want to practice in primary care - so I know that it won’t be hard to find a job, however will be much more difficult to find the right one. I’d like to continue doing underserved medicine of some variety - but not sure if that means staying in the city as I am now or moving to a rural area, possibly closer to family now that Baby is here. I’m currently ruminating on whether I’d like to continue practicing OB or not.

It was a surprise to me how much I liked practicing OB as a resident. I liked it as a med student enough (although I will forever hate ORs - I’m too clumsy with too little body spatial awareness) but doing deliveries of my own clinic patients has been so rewarding and energizing. When I find that precious time to devote to independent learning, I find myself reading OB literature (and staying awake through it) more than any other kind.

Today was the first call for a delivery I’ve had since our own Baby was born. As timing goes, it was perfect for me. I was called at 6 am, ran to the hospital, and was back after a beautiful delivery by 9 am. It was great for me - but maybe not so much for Husband. When I left at 6, Baby was just starting to wake up and Husband had stayed up late working the night before, was already awake and was very much looking forward to a morning nap. He didn’t say anything negative, but his expression was less than pleased.

...and this is a best case scenario when I got called in. Our residents are continuously on call for our own patients with lots of back up as with residency schedule we may be working nights or a hospital shift elsewhere that we may not be able to leave. My husband didn’t realize it was a possibility that I would be going in today, but the reality is it’s pretty much always a possibility as I’m usually within 2 weeks of a patient’s due date and babies don’t always come on schedule. And I think as an attending, I’ll likely be much more responsible for my own patients’ deliveries - although having adequate back up is something I am definitely evaluating as part of my future job.

So my question is... can we do this? Or more accurately, will it be worth the effort to do this? We don’t have family close. We don’t really have an emergency contact nearby who can watch Baby if plans change quick. I think I can handle the lack of sleep and unpredictable hours, but is it fair to ask my family to do the same? What about when we want to leave town and spend time with our family? Husband and I have had several conversations and will continue to do so over the next 6 months as my patients continue to deliver and we’ll see how it goes.

 I just really wanted the advice of some moms who have been practicing outside of residency for awhile. Spoiler alert: this likely won’t be my last post asking for career advice. Are you doing what you want in your careers despite a somewhat demanding call schedule? Or did you find that giving up a bit of call was worth it for a little more overall family stability?

The Little Echo

Almost a year ago, I was worried about her lack of verbal expression. Now, she talks constantly. She knows so many words, it’s amazing. But I'm starting to realize that having a highly verbal child exposes your own verbal ticks.

She adorably engages in imaginary play with lots of critters and stuffed animals. When they “take naps”, she shhhhhs them really loudly and pats them quite vigorously. Hopefully that’s not how she sees my pats and shhhhs. She scolds the dog in the same booming tone and inflection as my husband. She rattles off “thereyago” all the time. Apparently I say this a lot. Along with some choice swear words, particularly the ones that start with S and F, when I drop things or mess up in some way. Bad mama.

But most concerning is actually her use of “sorry”. I’d rather have her throwing around an occasional swear word than apologizing for everything she does. I didn’t realize it, but I do this too. It’s such an easy word to say, yet the meaning is both diluted and potentially detrimental when used to frequently. Saying sorry is apparently epidemic among women. There have been so many pieces written about this in the past few years, but I found this one most entertaining (replete with GIFs). Sasha at Brave Enough gave examples of how sorry is frequently used by women in the OR. After reading this, I'm going to think about what I say the next time there is an anesthesia delay during surgery.

What about you? What do you say that your child echoes back to you, and has it prompted you to change the way you talk?

Chocolate Sprinkle Sandwhiches

I cannot believe it has been so many months since a post. A quick update...

1) Biking to work is so unbelievable. When we moved across the country, one promise I made myself was that if I had to fly 3000 miles to train in my dream specialty, there was no way I was going to sit in traffic every day. So we found a house that is a good bike-able distance from the hospital. I have composed so many posts in the many early morning and late (and odd, 2 AM post shift) rides home, but none have translated into an actual post. I'll catch up.

2) Time is a great healer. A great equalizer. A great decompressor. When we first moved, everything was so raw, so scary. It stayed that way for a while. That fear, uncertainty, difficulty, and stress was only compounded by having our moving truck arrive a month late, evacuating for a hurricane, and realizing that being a resident is really intimidatingly scary stuff. Also, my son HATED school. And my husband realized finding a job was not as easy as it seemed in a new city with no contacts or networks. But all that is over now.

Which brings me to now...

Some days I feel like super mom. I have prepped meal plan organized food in the fridge, menus written on the kitchen chalkboard, cut up fruits and vegetables to snack on. My kids have their backpacks and lunches packed by the door, clothing laid out on their beds. I'm rocking this mom/resident thing. But then there are days like tonight. I was coming off a really hard stretch of super intense 5 nights in a row. Working over Xmas in a vacation spot is like Target on Black Friday in the ED. So. Many. Patients. So. Many. Drunk. People. So. Many. Lacerations/Holiday Hearts/I left my meds in another state. Just. So. Many. So when I had a "switch day" from nights to days, I slept. Then I made a cake. Then I went out for a manicure. I had no energy for the market, meal prep, lunch making, and homework organizing, so we took a night off. But today, I had an early morning shift, that stretched from "I'll be home by dinner" to "I'll be home after a central line/LP/all my notes." Our wonderfully flexible nanny texted me at 5 pm asking dinner plans. At 5:30, I got a picture of my kids eating their favorite go to snack-for-dinner: Chocolate hazelnut butter sandwiches with rainbow sprinkles, on whole wheat bread. At least it's whole wheat? And the "healthy" brand chocolate butter instead of Nutella?

One thing I am learning as a resident/mom without my family around is that I can't do it all, and I can't pretend to do it all. I have learned to be okay not looking put together all the time (ie: show up to the holiday show post overnight in scrubs), be okay that my kids eat the provided lunch plan instead of a cute bento box, and be okay that I have yet to attend a single PTA function and don't really feel guilty at all.

Hope to post more often,
Boxes

'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy

I've always been slightly more than casually OCD.  Not the flip-the-light-switch-seven-times-then-tap-dance-thru-three-choruses-of-I-Could've-Danced-All-Night-before-leaving-the-house kind, but more like the picks-stray-hairs-from-my-pillow-before-laying-down-and-always-on-the-lookout-for-dead-bodies kind.  I can't explain away the hair thing, but you try working for the body pickup service contracted to the medical examiner's office of a major metropolitan city for a year and *not* look for corpses on the side of every road and behind every hydrangea.  They're there, people.

Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery.  "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top".  But let me tell you, shit got real when Punky arrived four weeks early.  I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind.  I had no idea that this was even a thing.  You learn some (but not near enough) about post-partum depression in med school.  But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period.  It was absolutely heinous.  I've never been so terrified in my whole life.  I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze.  And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene.  I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four).  I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in.  I visualized her tiny electrocuted body lying next to a wall outlet, no joke.  My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find.  Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time.  And a little bit of me mourned her faux death, so many times a day.

But that actually wasn't the worst of it.  The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it.  It was me hurting her in all of those ways every time.  In the bath tub.  In the kitchen.  In her nursery.  It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind.  The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having.  I was beyond terrified.  I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her.  A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior.  It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple.  They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen.  And he was the one doing it.  On one hand, he just *knew* that he had no desire to harm his wife in the least.  But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?

Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self.  These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)

So, I went back and listened to the episode again, and I felt an immediate sense of relief.  I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard.  However, at least I had some hope that perhaps I could fix this somehow.  So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment.  And, I did.  And doing so was the first step in my journey toward recovery from my post-partum Harm OCD.  And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.

And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues.  Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening.  Gives me the sense of control that I need to feel comfortable and safe.  And then I can go about my quirky day.

Watching a toddler eat peanut butter off the floor of an airport.  Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim.  Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy.  It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light.  And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience.  It was a super gross experience, but she thoroughly enjoyed it nonetheless.  And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house.  There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good.  And the older I get, the better of a handle that I have on my weird brain.  It's actually pretty interesting in here most of the time.........  :0)

My DIY Kitchen Makeover: The Affair Is Over, But It Was Worth It!

Genmedmom here.

Last month, I posted about my crazy DIY kitchen makeover project. Well, we finished weeks ago, and we're thrilled. It just took me forever to figure out how to make before/ after photos. (FYI, the Scrapcollage app is fantastic, very easy to use.)

Our kitchen was perfectly nice. Nice and yellow. Honey oak cabinets and floors, yellow-beige walls. The overall effect was that anyone standing in our kitchen immediately developed jaundice.

Plus, we've lived here for almost ten years, and we've never painted the kitchen. It was time. Farmhouse is in, and so farmhouse we got.

So here we go, Benjamin Moore "Slate Gray" Cabinets and "Hardwood Putty" Walls. My uncle is a contractor who helped immensely with the priming and painting of the cabinets. Kudos to my mom as well, who did a whole lot of Ikea shopping and wall painting with me:

Our main entryway is the back door leading into the kitchen, and we have no closet there. The freestanding coatrack would get so heavy it fell down numerous times, so we were throwing overflow crap on the floor and a chair. That whole situation had to change. So I bought a cheap standing coat and hat rack at Ikea, which my uncle attached to the wall:

I also bought cheap Ikea bookcases which we made into storage benches, and my mom sewed removeable pillow covers out of the water-resistant fabric I'd bought on sale at Fabric.com. (Thanks again, mom!) These benches are game-changers: so super-sturdy, and useful:

We were sick of looking at the kitty litterbox, so I ordered a hideaway one on Amazon that's disguised as a little table, and stuck it under our new location for the message board (which is still a mess, but hey, it's the message board):

I repurposed a particleboard pantry I'd bought at Home Depot for sixty dollars like five years ago and was using to store all sorts of mishmosh. Painted it Benjamin Moore "Apollo Blue", changed the location, and now it holds cookware:

The best part about this makeover is it was mainly done for organization purposes, to help us to de-clutter. It certainly did that, and more. Overall, we are very happy!

We also did the dining room and bathroom, but those are posts for another day.

Got a project you want to tackle? Go for it!

When You're Happy Being a Mother, But Not In Medicine

Lately, seeing patients has really taken a toll on me.  The need of parents to "quick-fix" their child that very likely has spent many years getting to the situation that they are currently in (perhaps aggression, depression, etc) has really been weighing on me.  I sympathize with parents of difficult children, I really do.  This past weekend, every time I had an enjoyable moment with my own children (or a moment of peace away from my own children), I thought of the families I see that do not get such luxuries.  It was quite difficult; I was not able to enjoy even the littlest of moments with my family.

In the past, I had spent much time looking into non-clinical careers and I'm at it again.  However, nothing ever seems to be "attainable", even for me, a board-certified physician.  Everything seems that it is outside of my area of expertise, everything except clinical care.  But today, and actually for several weeks, I've just been feeling more and more that I will not last in this career.  I won't make it at the rate it's going.  I need an out, but what? And most importantly, what's an out that will still allow me to pay off my student loans?

This may sound like burn-out to some of you wiser ladies.  And it very well may be, and maybe if I just took a step back and re-assessed the situation I would feel differently.  But the reality is that I disliked medical school, residency, fellowship, and now attending life.  All the while, I told myself it would be better; that I picked a good career; that I had a good job; that I was able to live comfortably with decent hours of work; that at least I didn't hate what I did (I do not hate child psychiatry, when parents are reasonable); and most importantly, I always told myself, "It will get better one day" and one day hasn't come. Is all of my life going to be tolerating what my job is, or will I ever be excited to go to work? What kind of career would that even be for me to be excited to go to work?

So I wanted to ask you ladies.  Have you ever considered a career away from medicine? What did you consider? Why didn't you do it (or if you did, how's it going??)  I know I'm not alone in this.  How can we help each other?

Doctors Make the Worst Patients

     I have always been blessed with great health. When I got my life insurance a few years ago, I got the best rates because my blood work was so good. I have always taken pride in that, kind of like getting straight A's or being number one on a test in medical school (ok, that only happened once, and in pathology, my future profession, but it happened! Out of a class of 150!). So you can imagine my despair last Fall in the midst of wedding preparation when my OB incidentally discovered I had hypertension. I'm not talking minor hypertension: my systolic would swing up in the 2 teens and diastolic would go over 100 easily. I know, because I bought a sphygmomanometer (I love that word) for home and work, and became obsessive.

     My OB recommended a family doctor and he prescribed me with metoprolol. I have been long acquainted with beta blockers - learning from a friend in med school that they are good for anxiety inducing situations such as giving talks in front of large groups of people. I applied this knowledge to many situations - that time I was interviewed about the swine flu on TV, going out on excruciating first dates on match after I was divorced. They are great for calming your physiologic response to stress without messing with your thought process. But the same bottle lasted me almost ten years and learning I had to take it daily really upset me. I have always run low, why the sudden change? I learned that I accidentally gained 26 pounds after I got engaged, and was determined to lose half before the wedding.

     That was two months of mania. It didn't seem to me that the beta blockers were doing much - I checked five or six times a day and my blood pressure was all over the map. I was religiously weighing myself every morning - something I normally stay away from doing. I managed to carve my weight gain in half before I got married. I was texting my cardiologist friend and hospitalist friend weekly with my numbers and quizzing them on how to get them down. "My systolic is way over 200! My diastolic is over 100! Should I take another beta blocker? Go to the ED? AHHH."

   About a week before the October wedding when I finally fit in my dress I had bought in June I was like ENOUGH. I made myself stop getting on the scale. I stopped checking my pressures. I was determined to enjoy my wedding and honeymoon. On a follow up appointment with my family doc in January, my pressure was fine. Not low, but systolic was 130, diastolic mid 80's. "I wouldn't treat those numbers," he said, and I breathed a sigh of relief. It was the weight gain, the wedding, the holidays, I told myself. This is over now. I'm back to perfect health.

     So you can imagine my surprise three weeks ago at my yearly OB check-up when the nurse asked to take my pressure again, "These numbers cannot be right. Are you symptomatic? Do you have a headache or anything?" No, never. My OB recommended another appointment with family doc. His nurse measured it twice too. 164/100. "Stop talking take a deep breath let me do it again." 152/90. I looked at her expectantly, "That's not very good, is it?" The doctor in me knowing it wasn't but the perfectionist in me wanting reassurance. No such luck. "No, it's not. Are you stressed?" I told her no, I was on vacation, I spent the entire weekend watching Homeland on the couch.

     Family doc decided to re-start the metoprolol daily. I told him I cannot go back to the manic numbers oriented person I was last Fall. I made him laugh describing crazy texts to mutual colleagues. I said, "This is your territory, not mine. Can we keep it that way, is that ok?" He laughed and told me to come back in six weeks for a physical and we would check it then. I asked him to review my blood work from last fall. He said it all looked great. Cholesterol was fine. Then he said something with utter surprise that filled my bruised ego with pride. "I think that is the best LDL I've ever seen. Yup, I've never seen one lower than that."

     I could think of worse things than having to take a daily beta blocker. It sure made me chill in the face of a large cooking project yesterday - not my area of expertise. I had to call my pulmonologist friend in Philly in a panic when my Instapot wasn't working, but I managed to figure it out without blowing up the kitchen or burning myself. I guess I keep going on as usual - working out a few times a week, eating as normal (my low salt diet attempt last Fall was dismal but I'll keep it in mind) and healthy as possible. Aging is tough, but I guess we all have to do it.

this little wiggly squirming miracle in my belly

I just stopped on the MiM website when it dawned on me, I haven’t posted in 3 months?!? What in THE world?

I realized it’s because I’ve been holding my breath for the last few months. Putting all of my energy into cooking up a healthy baby. Doing my dag-on best to not stress and submit to this process of life after loss.

I posted in August that we are welcoming our second child. This little baby is now about the size of a butternut squash, just shy of 29 weeks and the third trimester. It wiggles and flips, squirms and dips all of the time. I’m in love.

I’ve been holding my breath. The first 12 weeks I fretted every time I used the bathroom with a prayer of “please no blood, please no blood, please no blood”. And there wasn’t any blood! 4 early ultrasounds later I knew this one was a strong one with a heartbeat like it’s big brother Zo (many thanks to the sweet Ultrasound Tech at my hospital and at my obstetrics office who let me see the baby’s heart beat so many times and hugged me as I cried each time). It’s been strong since it made its first appearance with my linea nigra at 3 weeks.

Balancing part-time work with a first grader and tenure track husband is no small feat. I am so thankful that pursuing medicine has afforded me with the ability to work part-time and still live quite comfortably. I am able to eat delicious, healthy food, attend prenatal pilates class weekly., see a chiropractor for my aching back and hips twice a week as prescribed, volunteer at Zo’s school, be the Parent Teacher Association Co-Secretary, and have days every week to myself with my favorite Netflix series (Supernatural season 4 of 28 and She’s Gotta Have It!). Though I am exhausted at the end of my office days seeing pediatric patients, I am so thankful for those days. I get to see my patient grow. They get to see me grow. And I am now getting advice from everyone about welcoming another baby into our world. I love my staff. I love my patients.

I love this little wiggly squirming miracle in my belly. Here’s to 10 more weeks of us being conjoined. Please stay healthy. Please stay healthy. Please stay healthy. You are so strong. You are so strong. We love you so much. We love you so much. We love you so much.

Kindergarten lottery

Yesterday, I saw a post on Facebook about the lottery for full day kindergarten in my town.  And suddenly, all the fear I'd felt a year ago came flooding back....

What if my kid doesn't get into full day kindergarten?  (Which only goes till 2:30pm by the way--it's just short of criminal to call that "full day".)

What will I do with her for those three extra hours when afterschool doesn't start till 2:45?

What will I dooooo??????

Fortunately, we got a spot in the lottery.  Most people did.  If I had moved to our town in February with a pre-K kid, I would have been out of luck for the next year because there were no spots left by then.  Oh, and if I didn't already have my kids enrolled in the afterschool program the year before, I would have no chance of getting in.

Sometimes it frustrates me that the school systems (at least, outside of big cities) are not set up for working parents.  Most moms I know work, yet we all have to scramble.  Holidays are always rough.  And what about that stupid week between school and camp?

I keep telling myself that someday things will change.  The powers that be will realize that with so many women in the workforce, there needs to be good childcare options.  But I'm giving up hope.  Women have been in a workforce for a long time, and it doesn't seem like there's any movement to help us, at least where I am.

I'm really glad women are coming forward in the media to discuss their experiences with sexual harassment lately and I hope some progress is made because of it.  But now maybe we can discuss the sexual oppression women face when society makes it so challenging to go back to work after having a child.

Surprises

Hello everyone! Kicks here, and happy to announce the arrival of Baby! He is doing great and we are so in love. I am sitting in my rocking chair where he fell asleep in my arms contemplating how things have gone so far

I was surprised...

L&D:
...that after signing up for an induction, my water broke in the hospital with no pitocin needed!
...that I was such a puker. I have delivered about 40 babies thus far and I haven’t seen anyone puke like I did.
...how much I HATED the nurse who wouldn’t give me an epidural at 3 cm
...how much I liked her after getting me through early active labor and getting me to 8 centimeters before my epidural
...after how nervous I was to deliver at the hospital I will soon be working at, how much I am going to enjoy working with those fabulous nurses. I always seemed to have the right nurse at the right stage of the process, and we bought them all chocolates for the nursing station on day of discharge
...how well my husband did. He feels lightheaded at the sight of blood, but stayed by my side through each yucky moment. And even watched baby be born (we had a mirror at the end of the bed) which surprised us both
...how wonderful that first hour of skin to skin was. I always counsel my mommies that we will try to get them that moment but no guarantees, as many times something happens where we’re not able to make that safely work - however it was AWESOME. Baby and I cooed at each other for so long we completely lost track of time.
..how little I have learned about breastfeeding and breast pumping despite being interested in newborn care and OB. All I knew was breastfeeding is best for baby and Mom - but the mechanics were completely new. And that pump was so intimidating. I brought it out of its box a month before delivery just to stare at the pieces. And I had no idea what people were talking about “flanges” and “membranes”. Yish.
...how many interruptions we got during our hospital stay. I wasn’t completely clueless since I am frequently one  of those interruptions myself. So I expected baby’s doctor, and my doctor, and frequent nursing checks. But then early childhood stopped by to invite us to a new parents group. The discharge planner (who said she didn’t mind that I was nursing even though I was trying to make it clear I was new at this and I happened to mind at that time). Being  offered essential oils so many times I started to think the hospital was getting  kickbacks from Big Lavender (one nurse even taped a cotton ball to my little table while I was eating breakfast so I had a lavender flavored omelette). It got to the point that my last visitor on my second day was an adorable little old lady who goes around offering blessings to the baby - I was very short with her in my declining and trying to scoot her out of the room - even though later I felt bad and really wished I would have let her as she seemed so sweet and nice and I just snapped at her to get out.
...how ready we were to go home (see above)
...how hard it is to put babies in car seats

Home:
...how natural it was to slip into the role of Mom
...how hard it is to find good advice on the internet at 3 am
...how other moms survived before internet delivery services like amazon
...how defensive I was at Baby’s first doctors appointment despite the constant praise from Baby’s doctor. Must remember to try and do that for my own patients.
..how much I question everything I do with baby. Am I holding him not enough or too much? Am I giving him enough attention or should I get out of his face for a bit? Etc.
...how much Baby sleeps. And how deep Baby sleeps, where it’s still hard to resist the urge to poke him and make sure he’s still alive.
...how much Baby grunts or makes weird noises. Seemingly all the time
...how lucky I am to have family med docs and pediatricians one text away.

Work
...how fast maternity leave went. I thought I would be itching to leave the house but I really really didn’t want to go. I cried the whole way in my car to my first day back at work.
...how much I both enjoy being back and enjoy the people I work with - but also can’t wait to get home
...how much my patients asked about Baby and how things were going. And how much I missed some of my frequent patients.
...how happy I am to go back 2 days a week only for the next month. Jumping back to full time would have been overwhelming no matter how many weeks of leave I had.
...how much more like “myself” I feel after putting real pants on and using my brain a bit more. I didn’t feel “not myself” at home with Baby, but feel a little more normal now somehow.
...how much it is going to suck to try and fit things in between work and bedtime especially once I go back full time
...how awesome my family is at stepping in to take care of Baby when I go back part time and going to extra mile to help clean and cook us dinners.
...how much I love coming home to my little peanut!

Cheers!

The good kind of pain

I seem to always forget exactly how much pain I'm in over Thanksgiving weekend, after running a 10K on Thanksgiving Day. I'll think of Thanksgiving in my mind with warmness: family, food, friends (and sometimes work) but not the stifled screams of anguish that my leg muscles dare me to emit when I get out of bed on Friday morning. Repeat that with any movement all day Friday > Saturday > Sunday.

I remember one year, I was on the consult service the week of Thanksgiving and while I had Thanksgiving Day off, I had to come in on the Friday. A nurse asked me while I was making my way down the hospital hall whether I was okay. I didn't realize exactly how debilitated I appeared. Just walking a bit slow today *shuffle, shuffle, shuffle*!

This year, it has been no different. I should be more prepared after the same sequence of events every year for the past 4 years but, no, I stepped out of bed on Friday morning and was like - WHOA: IS THIS RHABDO? HOLY CRAP IT HURTS. If I wondered whether I pushed it hard or not, there was my answer. Yet, something about the pain with every step (all day and all night) is nice in a weird way. It's proof that I did something hard.

Thursday was my fifth race this year. I've realized that training for a race keeps me motivated in a way that plain old hopes and goals don't. With my work schedule and everything going on, it used to be so easy to make excuses why I couldn't run:

• It's too late
• It's too early
• I don't want to do my hair again
• Everyone else is hungry
• I'm hungry
• I have low energy (related to the above or separate)
• or almost anything else

Also, my time on last year's Turkey Chase 10K was almost the same as the prior year.  That was kind of anticlimactic. So I asked my husband to help me work on speed over the last year. He's always designed workouts for his own bad Ironman self, so let's just say I was a little scared of what he might design for me in terms of training. Keeping in mind that he went to a military service academy and I went to a college where you could design your own major.

Turns out, I love me a training schedule! I run 4 times a week and have easy and hard runs each week to complete. (I particularly enjoy the easy runs.)  I train for the next race and have had PRs each time.  I really love that in my 40's, I can get better and better at something physical. (It's not all downhill!) Granted, I started from a very low bar of speed. But, it has channeled my previously hibernating competitive streak into something productive.

During the Turkey Chase this year, I tried to use my Fitbit Blaze to track my pace. At the starting line, as I was trying to start the app, it kept saying "Check Fitbit App." Awesome.  Last race, the display was showing me "Calories Burned" instead of my pace which was the last thing I want to know while running a race. So I felt that my contemporaneous race tracking was doomed which turned to be true as my watch kept giving me wrong distance tracking and pace estimates that were way slow. By just the time, it seemed as I was running fast, but I wasn't sure with all of the inaccurate data floating around on my display and my math skills have deteriorated a long way since college calculus.

The race results posted yesterday, and I was thrilled to see that I beat last year's time by almost 6 minutes! That felt great. Mentally, not physically, since physically I'm still decrepit. But, it's a good pain, the kind that comes from trying hard and accomplishing something. I may even miss it when it's gone.

Not pictured: heavy labored wheezing/breathing

Guest post: Mommy guilt - the struggle is real

One of the first things I did when I got a job that paid money was hire a cleaning lady. It was a given that I would, since I hate housework, and am no good at it. I actually suck pretty hard at it.

As time went on, I outsourced more and more stuff. Some of it was because we suddenly had things we never had before, like backyards–who’s got time to mow that? Landscaper!–and children. Oh, children. They’re outsourced more than anything else. They’ve got daycare, tutors, and a babysitter. And right now, we’re pared down, because there is only one babysitter. There was a point in time when I had two: one for drop off and one for pickup.

Apparently, getting a cleaning lady is a source of shame or guilt for some people–women, mostly–because they take it as a point of pride that they clean their own house, even if they could afford help, because it makes them a real woman. Or something. Some even insist that they [airquote] like it or even that it [airquote] relaxes them. (You should see the face I’m making right now. Hint: it’s full of skepticism) I work in a highly Portuguese area, and these women are nuts about their houses. But not me. I hate cleaning and I outsource it. And I never felt badly about it, until I was told I was supposed to, that is.

Same with being a working mommy. Everyone always worked in my family, and I never thought it was any big thing, but now that I have kids, apparently, I’m supposed to be torn apart by guilt, or so TV, BabyCenter.com, and social media tell me. And you know what, their influence is not to be ignored, because the struggle has become pretty darn real.

Any working mother knows the awful tug and pull of the mommy guilt. You’re tired and you need the help, but you also want to do things for the kids and the house because it makes you a true mom. Or something. The more you suffer, the more it shows that you’re a tough mother, so to say.

The guilt is terrible, and it has so many layers. It’s a freaking milhojas. Behold: a) you feel guilty that you’re not doing enough for and with your kids; b) you don’t want to do stuff with your kids and you feel guilty about that; c) you work and you feel guilty that you’re not home; d) you know you’d suck at being at home (because see the first paragraph. I suck really hard at all that stuff), and you feel guilty about that; e) you don’t want to stay home anyway, and… you guessed, you feel guilty about it.

And do not underestimate the power of other mommies. The good ones say, “Everyone makes the choices that are right for them and their family,” with the subtext being “the only right choice is my choice.” The mean ones straight up put you down for your choices. “Nothing like being with mommy!” vs. “Contributing nothing to society.” It’s a big deal.

Just the other day, I ran into a fellow young doc at the hospital, and via smalltalk we figured out that he had just had his third baby, and that his wife was staying home.

“And let me tell you,” he adds. “The behavior in our younger children? Huge difference.”

Now granted, I was annoyed and due to my own insecurities, so the next statement does me no credit.

“Oh,” I say. “So should I quit my job and go stay home with the kids?”

No sooner were the words out of my mouth, and Fellow Young Doc didn’t even have the chance to utter some PC comment, a random nurse, whose name I don’t know and who was not a part of the conversation, sticks her nose, literally, between the two of us, and says, emphatically:

“YES!” I kind of looked at her, open mouthed. She then elaborated, in case I didn’t get the point: “Yes! I stayed home with my kids, and let me tell you, it’s always better when mommy is around!”

She said it a couple of more times too.

Fellow Young Doc removed himself politely from the conversation, and I was left to pout and seethe.

Here’s a paradox, catch 22, predicament for the modern woman today. We’re supposed to have all this choice, but what happens when we make the choice? If we choose motherhood and family – we’re wasting female brainpower and negating years of the feminist movement. Don’t you want more for yourself? If, on the other hand, we choose career and work – we are a failed unfulfilled woman. What is a woman without a child? If we do both – we are doing a half assed job at both. What’s the point of having kids if someone else raises them? (which, by the way, is something I have heard multiple times as well from random judgmental people). And if you’re working part time, do you have the best or the worst of both worlds? Or are you just doing a half assed job half of the time?

So, here I am feeling guilty about the fact that yes, I work, but I don’t work that hard, and I still have a nanny, a cleaning service, a landscaper, and now we’ve even found a service that will deliver delicious home cooked meals twice a week. And I’m all, Oh boo hoo, I only see my kids for an hour each day….

Then, I picked up Mary Poppins to read to my son. By the way, have you ever read the actual book?? Julie Andrews has it all wrong in the movie with her sunny disposition. The real Mary Poppins from the book is very unpleasant, and I really don’t understand why the kids were so smitten with her because she’s kind of mean to them, and she’s always sniffing and paying herself compliments, and looking down her nose at everyone.

Anyway, the book starts with the old nanny leaving, and Mrs. Banks being incredibly stressed about that. Meanwhile, remember, Mr. Banks had told her that to have 4 kids they’d have to live in a shabby house because they aren’t rich. So they’re living in a shabby house with 4 kids, a nanny, a cook, a maid, a lady who does, and a gardner. And the mom presumably doesn’t work, because people didn’t back then. And she’s so stressed out about having lost one of her 5 staff, and having to spend time with her children. And not an ounce of guilt.

Yeah, so now, I feel guilty about feeling guilty. I really seriously cannot win. Can’t we all just give ourselves a break? I have no helpful advice. I just wanted to point out the struggle because I know I’m not the only one.

-Sasha Retana, MD.