I was at a conference a few weeks ago for rising chief residents. Hilariously, my husband (who had a few days off from work) decided to take advantage of the free hotel room and come with me, bringing out 20 month old. They had a lot of fun during the day, until he got a febrile URI and became a clingy mess. (Of course, then I felt guilty being wined and dined with the program leadership while he sat in the hotel room with a sick kid, but what else is new in Mom-land?)
But this isn't about that.
During the first day, the keynote speaker gave an address about carving a career path for yourself in academia -- life "after" chief year. He talked about the historic ideal of the "triple threat," where you succeed in teaching, research, and clinical time, essentially having a contract that allows you to spend 1/3 of your time in each area, adding up to a full time job. He reminded us, not so gently, that no one ever succeeds at all of these things, not as effectively as they could if they focused on one or two areas, and encouraged us to pick one or two when envisioning our future career.
And then he described the trajectory of a career in academic medicine: "The first decade is focused on establishing yourself, making a name for you and the research or clinical area you want to be known for. The second decade is to deepen that commitment to "your thing" -- publishing extensively, traveling, teaching, and speaking. By the third decade, you're known -- being asked to contribute chapters to books, leading courses with medical students, innovating as a clinic director. The fourth decade is a time to relax, to live in the space you've carved for yourself - and if you're lucky enough to have a 5th decade, you're an emeritus, enjoying the learning and not doing very much."
And as I sat in the audience, surrounded by future chief residents, I thought about how ~50% of us are women, and women who, most likely, will only be fertile during that first decade of our careers. What does that mean for the "most critical" decade of our work, to also recognize the very real demands that daycare and illness and doctor's appointments and soccer and pickups and dropoffs have?
Years ago, I once told a mentor that I thought that, realistically, this 10 years of my career would likely be my least productive, by publishing standards. I have a small child, I was planning on having multiple others. He was totally blown away, immediately shook his head, said there's no way that would be true, that he knew me and my work ethic, that lots of women "succeed despite kids." I left that meeting embarrassed, thinking that perhaps I shouldn't admit what I knew to be true - my partner works, too, and our lives have to adjust to the very real presence of our child.
This lecture was fresh on my mind when we returned from the conference and my husband went back to work. They've had some staffing turnover among the employees, and a new boss has been hired. Two leaders who currently work part-time (for various family reasons) were instructed that they would be welcome to sign a contract for next year in their current positions, but would not be able to work part-time - leadership requires a full time commitment. If they wanted part-time they could do a similar role, but without "a seat at the leadership table." This discussion among the staff at his job has been burning my brain ever since he told me - that two of the women (and, not-coincidentally, the only two mothers) on their leadership team were told that their commitment wasn't enough, that their desire to work part-time wasn't enough, that the hours they put in at night after their kids go to bed, and on the weekends, and in-between the other parts of their lives wasn't enough. I was in tears as he explained it to me, and I don't even know this women well - they work in another department.
I remember this keynote speaker, and I imagine the first decade of these women's careers. I suppose they didn't establish themselves, their credibility, their niche as clearly or as well as their male colleagues - that when it comes down to it, their skills are dispensable. The New York Times had a great article about this very topic yesterday - in short, that in heterosexual couples with children, employed mothers get the short end of the proverbial stick - faced with the demands of parenting and the ever-increasing demands of the work force, they end up forced to cut somewhere. For these women at my husband's workplace (and, realistically, for future me) - they cut back a bit at work. But working 25% less doesn't mean making 25% less, or being valued 25% less -- it means making 200% less, being valued 200% less.
I'd love to know reflections on your first decade at work, post-residency and fellowship and training. How did you carve out a niche for yourself? Or is that overrated in the first place? And what does it look like to parent when work is "greedy"?
I wake up at 7:30 before my alarm. Approx 10 seconds of quiet uninterrupted bliss ensues when I realize I’m the only one awake. I can’t wait to make Saturday morning coffee. Then Dog demands to go outside.
While dog is outside, I read the last few page stories of the mystery I’ve been working on. Toddler fusses. I think “only ten pages to go” and Toddler falls miraculously back asleep and I finish my book.
Toddler fusses again. No coffee yet. Upstairs I find Toddler covered in poo including pieces in hair and hands. Apparently letting him eat that much pizza last night was a mistake. Toddler is protesting in the tub but much much cleaner 5 minutes later. I peek out in the hall for backup, turns out Husband heard the commotion and closed the bedroom door for a little longer sleep in. Hmph.
Toddler is dried out of bath. I sit him downstairs with yogurt and all is forgiven instantly. He smears his yogurt-covered hands through his recently bathed hair as I rinse the poo off of sheets, his pajamas, my pajamas and throw in the wash. Coffeemaker is finally started. I sit down with my own yogurt, which Toddler immediately realizes is different from his own and demands some. We share a little more yogurt.
Toddler gets spot cleaned, and I finally pour my cup of coffee.
It’s a beautiful day. Toddler loves being outside. Dog, coats, boots are collected and I spill a little of my precious “mom juice” on the floor. (“Mom juice” is my explanation to Toddler for coffee, wine, diet Mountain Dew, etc.). Clean floor. I go out thinking I might sit outside a sip some coffee, watch the commotion and listen to the radio. Coffee is a little colder but still tolerable. Spill some coffee on my old white worn fleece
I drag my chair to the sunny corner of the backyard, before realizing I have nowhere to put my coffee down. Coffee sits on little mud pile.Toddler decides he wants to rock with me on the chair, then by himself. The ball is thrown to dog. Sip. Throw. Sip. Throw. Toddler gets stuck in his plastic car. Extract Toddler. Sip. Run around yard with Toddler and Dog. Sip slightly warm coffee.
Sneak inside to top off cup with warm coffee and grab Kleenex for Toddler.
Back inside. Laundry gets done, clothes are packed and bathroom gets cleaned. Toddler finds the Swiffer cloths very interesting.. Now off to our parents for a weekend away.
I think I need another cup of coffee.
I can’t wait until I start my attending primary care clinic job this fall (yay!) and this becomes more of a typical than atypical Saturday (minus the poo).
For Christmas, we gave our 13-year old daughter tickets to a concert for her favorite band. She's played us songs ("Can I play you this song? It is sooooo good! *insert look on my face during song that looks like a shot from The Office when a character smiles uncomfortably into the camera*)
Let's just say that I feel too old to enjoy this kind of young boy band music.
But nevertheless, we gifted her tickets (#4) for her and her two friends and one very lucky parent chaperone (me). Please note my deep love and devotion for my husband to not even try to do rock-paper-scissors for the pleasure. Because I knew that he might die if he were exposed to that environment. He's more introverted and has somewhat elitist views on music.
I did establish some expectations with all parties to protect my sanity. Since it would be a school/work night (!), I declared that we would get there early and leave early, like before it ended. There's no way I'd be stuck in concert exit traffic late into the evening by leaving when everyone else did. No. Way.
So, on a recent Thursday night, I drove my daughter and her best friends through 1.5 hours of rush hour traffic to the concert venue. They were ridiculously excited, playing the band's songs and flipping through a coffee table book of said band the entire time. By the time we got to the garage, they were downright Giddy with excitement. I have to say that seeing them united in Giddiness gave me serious feels.
We walked a couple of blocks towards the arena, realizing that there was a huge parking lot right there and that we unnecessarily parked in a remote garage. Oh well (I followed the signs!). We were almost at the arena when I ran through the exit procedures with the girls. I would leave before them, get the car, then text them to meet up, before the concert ended.
We made it to our seats, and I noted that the median age of the audience was 14 and 90% female. Parents were on their phones. At one point, one of the two opening acts gave a shout out to the parents in the audience. That's when you know you're old and at a concert for a much different demographic.
There was a whole lot of screaming that night. Jumping. Glee. I loved seeing my daughter and her friends enjoy the moment so much. That made bearing the screaming and jumping and loud music I didn't care for, bearable. On the plus side, I could go get them food without feeling like I missed anything unlike most of my previous concert experiences. And the music, well, I had very low expectations and it exceeded them. (ears weren't bleeding; I refused to stand though)
After looking at my watch for the 100th time, I decided that it was time for me to make the trek to the remote parking garage ahead of time, trying to project what time the concert might start winding down and how long it would take to get everyone home. I left them there with the concert going strong and, on the way out, took advantage of zero merch lines to buy them all concert shirts as a surprise. Lots of parents out there, sitting in chairs on their phones.
By the time I came back around with the car, it was at exactly my pre-planned pick-up with them and they were out to meet me within a couple of minutes. The concert was just wrapping up and we made a hasty get away with zero exit traffic! It was a surgical strike! On the way home, the girls basked in their happy exhaustion.
"That was the best 2 hours of my life!" said one friend.
I dropped each one off at home and presented them with the surprise shirt. They were thrilled! We hugged (more feels). And I felt very good for helping to make that experience happen for them. I might even do it again.
It just looks like that girl has a hook for a hand. Also, that girl stood like the entire time.
A few weeks ago we took my kids on their first ski trip. Actually, it was the first time my younger one has ever seen snow!
The first 2 days, the kids were in ski school and my husband and I got to go ski the "fun stuff." We are both pretty advanced skiers so it was great going down the mountain, together, without kids, like we were dating again. I love anything outdoors and active, so this was the perfect antidote to the recent run of a lot of ED shifts.
But on the last day of our little trip, the kids revolted. They were exhausted from learning this new skill, in this new environment, in a new climate. No one wanted to go to ski school, and the only way we convinced them to get up the mountain was if we promised "family day." So, to the bunny hill we went.
The 4 year old rode the gondola down to town with me after 2 runs, but my 6 yo was still ready to show off her new skills. So she and my husband decided to try to ski down the longest run to the base of the mountain.
The look of sheer disbelief, awe and pride she wore when they walked off the slope 40 minutes later mirrored my own. She had "pizza turned"* the whole way down. Slipped and slid across parts of it, tumbled in others, but she did it. All 3 miles of snowy slope. Some of it way harder than her 2 day total skill level. All of it an entirely new experience.
I felt that way after running my first code. A mix of "what just happened" and "wow, I look like someone who knows what they are doing." Disbelief and gratitude and pride and fear. As this academic year starts to wind down and senior year is approaching, I look forward to having more of those moments. Medicine is humbling. The human body and whatever otherworldly spirit that accompanies it, is capable of incredible, unpredictable, and inspiring things. Our capacity to learn, study, and train in order to impact the course of the life of another person, or use our skills to intervene and directly affect their future, the future of their family, their destiny, is uniquely motivating.
I hope to keep motivating my children to push their limits and challenge themselves. Parenting my children gives me a window to parent myself. Motivate myself. As lifelong learning is a huge tenement of our field, I hope that lesson of small, slow, pizza turns, sticks with me.
* For those who don't ski, "pizza turns" refers to the wedge shape you make with your skis to slow down and control your speed.
I’m nesting. No, I’m not pregnant, and I’m not sure when it started exactly, but with the start of residency looming and more free time on my hands right now than I’m used to, l have this strong desire to declutter and reorganize. Thanks in part to a nudge from Mommabee’s recent post on feeling stuck, I dove into Marie Kondo’s Netflix series.
I hoped that I would get some practical tips for decluttering, and I did, but I also found something much more enlightening. It clicked during the 4th episode, when a family of four was working to control the clutter after downsizing from a large house to a 2-bedroom apartment. The crux of the episode was when it became clear that the mother was responsible for essentially all of the “stuff”, both physically, cognitively and emotionally, to the point where her adolescent children and husband would call her throughout the day because they couldn’t find anything. She had taken on the role and implicitly assumed the responsibility while working a full-time job outside the home. I won’t dive into a full analysis of the show (although there’s a good one on the show’s gender dynamics here). The invisible labor of womanhood and motherhood becomes visible.
Suddenly, I saw my impulse to reorganize our home and life in stark clarity. While I’m grateful that my husband is committed to gender equality in our marriage, we’re still fighting generations of inequality and implicit assumptions about men and women’s roles at home and in managing family life. So while some things are straightforward, ie, if I make dinner, he cleans up, and vice versa, other forms of emotional labor are not. Looking back, we can both see the impacts of very unequal emotional labor on each of our mothers. And the “stuff” is just one example. We both moved at least 10 times throughout our childhoods, sometimes internationally, and usually lived in rented housing. While my father was the “packing expert”, my mother managed the bulk of the organizing and cleaning and knowing where everything was, on top of knowing who needed what doctor/dentist/chiropractor appointment or freshly laundered uniform and what we were going to eat for dinner. And I subconsciously still assume that’s my role too. I’ve been able to keep up (mostly) with this invisible work while keeping up in medical school, although it’s gotten a lot harder since my son was born. I’m actually pretty good at managing a lot of this in my head.
But here’s the thing - I know it’s taking energy away from other areas where I want to be excellent, like being really present with my son when I’m with him, and developing into an excellent physician, and building the career that I actually want, rather than just slogging along on a one-size-fits-all career treadmill. I know the other members of my medical-student-mom squad feel it too. We’re constantly exhausted and we’re not even in residency yet. And while decluttering is helpful, it’s not the answer. Delegating is definitely part of the answer, but first I have to list out all of the things that I’m trying to do and then figure out how to delegate them. So keep an eye out for my household organizing/delegating app once I actually figure out how to do all of this. (I'm kidding - this is way beyond the scope of any app.) No, I put this out there not because I’m expecting someone has a magic answer, but because I’m grappling. And I’m also grateful. I’m grateful for my wonderful mother and mother-in-law, who managed two large, chaotic households with so much love and way more patience than we ever deserved. They fell into bed at the end of every day exhausted for reasons they couldn’t even name. I’m so grateful to them for managing all of our “stuff”, both physical and emotional. And I hope to honor them by finding a way to both love and care for my own little family while letting go of some of those expectations and responsibilities. I hope to honor them by sharing some of the empathy and intuitiveness that I learned from them with my patients and colleagues too. And I’m grateful for the #momsquad that lets me vent without judgement about how hard all of this is, and the husband and toddler who love me just as I am.
The other day, my 3 year old daughter said to me, "I'm feeling fat, so I need to go take a long walk."
Is this the start of myriad negative body image thoughts I will inevitably need to address during her life? Maybe she's just being a word sponge, but I can't believe she said this at her age. Where she learned or heard it, I have no idea. I just want to make sure I don't contribute in any way to it.
I've experienced my share of body image issues like most of us. When you have any unusual feature (in my case, it's being over 6 ft tall), your body becomes a point of commentary. And it can become part of your ego, regardless of whether that feature is considered positive or negative. Fortunately, comments made to me are usually complimentary. The other day, a woman in the gym locker room said to me, "Your legs are absolutely perfect. Amazing." Of note, this woman was herself tall, thin and beautiful. All I could do was laugh. I see my legs (and body, for that matter) as far from perfect - and that's ok.
Men vs. women... Although both sexes are prone to chasing perfection."Perfect" is a word we should stop using for many things. None of us can have a truly perfect body, be the perfect parent, the perfect spouse, the perfect doctor. There is no such thing as a perfect home, a perfect job, or a perfect anything. Someone's idea of perfect (in the case of my example, legs) is completely different than another person's vision. Maybe you value strength and thus enjoy the look of muscular legs, while another person desires very thin legs. You can soften the P word by saying "this is perfect for me", but I even have trouble with that. We're never done learning or improving. Why do we spend so much time comparing ourselves to other people and trying to measure up to some sort of perfection endpoint? Endpoints are for fixed mindsets.
Social media, which is a powerful tool for helping us as physicians reach a broad audience with our message, is also a huge conduit for comparison and the pursuit of perfection. And it's frighteningly problematic when it comes to our young girls, who tend to deeply value social inclusion and are very sensitive to shaming. I heard an interview with psychologist Jonathan Haidt, who recently cowrote the book The Coddling of the American Mind. He pointed out an alarming trend of increased depression and suicidality among young girls, which has suspiciously spiked with the ubiquity of social media.
I do love my own body, but I didn't always as a child. I remember wishing to look like "everyone else", to be shorter, smaller, etc. As an aging adult and physician who sees very broken bodies, I appreciate that my body's gotten me through some serious health challenges. I would never trade motherhood for a flat abdomen with no signs of a pregnancy. And I believe in striking a balance between accepting ourselves in the present moment while also trying to make improvements. However, my acceptance only came with age and life experience. I know it'll be difficult to instill these ideas into a young girl's concrete thinking.
What body image issues have you come across with your daughters, and how have you dealt with them? Do you let your girls have social media accounts? I'd love some positive solutions.
When my mother went in to have her diagnostic laparotomy for metastatic disease, my father said that he knew everything was going to be okay because the surgeon had "beautiful, clean, well-kept hands."
Since that day 10 years ago, I have started to take more notice of hands. As a doctor, the state of a patient's hands, and feet, can suggest underlying disease, hygiene, social situation. Manicured fingers, dirt under nails, dry skin, scabies rashes, diabetic ulcers, clubbed nails of hypoxia.
As I look down at my own hands, though, I'm constantly ashamed.
Confession:
I bite my nails. Not my nails, exactly, and not biting, technically. I pick my cuticles. It's gross, I know. Disgusting, I get it. It's an infection risk, a way for patients' MRSA, fungus, and ESBL infections to get inside. A risk for herpetic whitlow, paronychia. There is an official medical name: Onychophagia. It looks unkempt. I KNOW.
I've tried getting regular manicures, but that gets a) expensive and b) time consuming. I tried moisturizing, creams, potions, and lotions and gels and ointments. I've read blogs. (link below). This repetitive behavior is SO HARD TO KICK.
Over time, we as individuals develop so many different habits and routines. The way we brush our teeth, which side of the bed we sleep on, which shoe or pant leg goes on first. What we eat for breakfast, which coffee we order, what we reach for when in need of comfort. Take a minute to pay attention to the things that make up your daily routine. We are creatures of habit.
Diet and lifestyle habits and routines are hard to change as well. With all the focus on "new year new you," the explosion of health and fitness "influencers" on Instagram, and the renewed energy that comes with a dedication to a new diet, eating plan, workout regimen, or health motivation, it should be easy. We have so many cheerleaders; however, ingrained habits require a lot of mental energy to change.
So I definitely have a little more compassion for patients when they tell me it is hard to take a new medication, change their eating habits, work out more. I can't seem to do it myself, honestly. (My 15 lbs- 4 years post baby- prove that) The constant reminder of my raw hands is the sign of a continuous struggle.
How do you motivate change? Have you found success with breaking a habit or changing your diet or lifestyle? What resources do you use, or guide your patients to?
The first inkling I had that scheduling was going to be rough as a resident parent started before Toddler was even born.
I still loathe the woman at the front desk at my OB office. Every time I waddled in, I would have the upcoming 3 months schedule in front of me and try to schedule as far out as possible. I was charming, flexible on clinic location, flexible about seeing different providers. “How about Wednesday the 19th at 8:30 am?” “No? Well how about Thurs the 20th? At 1:20 pm?” “How about (insert particular hour) on (particular day)”. Eventually the receptionist snippily asked me to call the appointment line if it was going to take this long to pick a scheduled date. Note: there was no one else in line behind me. I fumed in the lobby as she clearly carried out a loud non-business call over her headset. Thank goodness for an uncomplicated pregnancy requiring infrequent visits and an office across the street from the hospital I work at.
Well child exams have been even more challenging to schedule as I’ve been trying to coordinate around when my child is actually well. I have the same conversations on the phone. No, Wednesday afternoons don’t regularly work for me, just the random one coming up. We have a great great great pediatrician - which means he’s always booked up. I had scored a rare 4:40 end of the day appt today, but alas - double ear infections and a cranky Toddler = a rescheduled appointment. At least today I’ve figured out how to schedule and reschedule online so I can least minimally annoy other people.
Also I’m getting a little anxious. We (gasp) decided to take a week long vacation this year but due to several medical reasons for my entire family... I’m down to 3.5 days off left before graduation. I used 2 in the last 2 weeks. I keep telling myself that hopefully the absolute worst thing that could happen is I make up a few days at the end of residency (as I already am doing) but still. We rolled the dice today and took Toddler to day care after a tearful sleepless night - but I haven’t gotten called yet and already got a photo of his grinning face so life can’t be too bad.
A nice reminder to myself to not get irritated over people constantly rescheduling with me in clinic. Who knows what they are all juggling. Often I can’t keep track of what I’m all juggling. Which reminds me I have to give tomorrow’s lunch lecture. Keep your fingers crossed as we will likely roll the dice again tomorrow.
One of my department faculty members is leading a day long seminar of Community Health.
She adds “If you really need guilt, keep it like a cat at home. Pet it every once in awhile, let it know you know it’s there - but when you leave the house, take determination with you.”
I love it. Even before Toddler came into the world, I told myself I would NOT be a guilty mom. I would logically know I was doing the best I could, logically know that I could not be in three places at once. I was going logic myself right out of guilt. Because we all know logic always wins.
I’ve been trying to be mindful when spending time with Toddler - no phones, no distracting screens, just him and me together. It makes me think of this post from Mrs Md PhD which is best characterized by the meme saying I WILL DO ALL THE THINGS WITH MY TODDLER!! (which is definitely due for a revisit if you haven’t seen it in awhile).
However since Toddler currently has the attention span of a small flea and likes to entertain himself a lot, a little too much mindfulness can send me off the deep end. So we’ll play legos together but a little podcast in the background goes a long way. Now that we’ve had a long awaited golden weekend together with minimal leaving-the-house plans, I was able to put that guilt aside for now.
One of my coresidents was feeling guilty lately about working her first week of nights while leaving her baby at home and I told her “you’re a better mom because you’re a doctor, and a better doctor because you’re a mom”. It took me awhile to realize that I really did mean it (at least about myself) and wasn’t just saying it to make her feel better. I appreciate the time I have at home without Toddler, but I also have a small glimspe now into why the nurses I work with who have 4 kids at home come to their busy shifts and sometimes consider it a “break”.
I also think guilt is ingrained into us in medical school. Guilt we didn’t present our patient perfectly. Guilt we missed that lab finding. I was with a second year medical student today, who kept saying “sorry” for things she couldn’t help - like the computer not loading or not having access to charts. It made me remember sitting with a co medical student on our internal medicine rotation watching her beg for an afternoon off for an appointment and constantly apologizing for having to leave. I’ve managed to cut out “I’m sorry” out of my vocabulary if it’s something I can’t help (unless expressing empathy for a patient). My feedback to her was to catch herself when she is going to say “I’m sorry”, see if it’s something she could have actually done anything about, and cut it if she can’t.
I’m sure there are still going to be times I feel guilty, especially if we have another day care drop off melt down tomorrow, but I’m going to do my best to pat Guilt on the head and leave with determination in hand.
As a resident, I rotate through a number of different departments and different hospital sites. This past month (or last month, because I'm late on posting this), I rotated through the trauma service.
On a string of nights, I met another strong, powerful, kick butt mother in medicine. A senior surgery resident on another surgical service, she was not my direct senior; but as we both set up headquarters in the trauma bay, we had the work equivalent of an all night sleepover, q3, for about 2 weeks.
It was so much fun. Being a resident who is also a mom is pretty lonely at times. I'm not free for most brunches, I don't party on weekends, I can't commit to an 8 pm weekly spin class. While I get along with most people on shift, it has been difficult to connect out of work- with both men an women residents alike.
How do you bridge that gap? Part of me likes having that separation of work life and home life. But recently, when a resident - who I always laugh with on shift and love working with- got married, it stung that I wasn't invited. I offered to cover her call, though.
So I will continue to look out for members of the club. Give a head nod to the pregnant resident on the admitting team, look out for the one with pictures of her kids on her phone background. It's nice to be recognized and it's nice to be part of a larger team.
Have you been feeling stuck? What are you going to do to get unstuck? Maybe start with your sock drawer? Or start with a vision board for your practice? Or start with a date night with your partner or a girls' night out with your friends. Or start with a breath. Whatever you do, just start!
For the last few years since finishing residency, I have been grappling with many things. After my disappointing first job as an academic pediatrician (my "dream job" I thought), and my foray into private practice I realized that the system of medicine many of us practice in, corporate medicine with the primary goal of seeing enough patients in the day, simply didn't fit with the what fuels my heart.
I spent two years during my American Academy of Pediatrics Leadership Innovation Fostering Education Fellowship researching physician wellness and in particular how systems and practices must incorporate wellness and burn out prevention at all levels. It is not enough to tell physicians to meditate if they are being "strongly encouraged" to see more and more patients, have burgeoning administrative tasks (click this meaningful use button), have mountains of debt, or are in jobs that they hate because of loan forgiveness, have less and less control over their schedules, and less time to make meaningful relationships with their patients. A mindfulness seminar won't cut it. Physicians everywhere are saying enough! It's to much! Record numbers of our colleagues are walking away from medicine or are joining the ranks of the hospitalists and specialists. What happens to our system when there are more hospitals, urgent cares, and intensive care units than quality, sustainable primary care practices? What will continue to happen when emergency rooms and surgical suites continue to be more lucrative than wellness centers and small, high quality private practices? Does it mean people will be allowed to get sicker and sicker? Does it mean that large hospital systems will continue to invest less into primary care and more into expanding their Emergency Rooms? Money talks, right?
This year I will be undertaking some exciting new endeavors. To try to get back to what inspired the premedical student who had all of the time in the world to sit with my patients, to commune with them, to build with them. We see it all around us. Patients who can afford it are flocking to naturopaths and integrative medicine doctors. The overwhelming response is that those providers listen. They have the time. So I have to make the time.
I have been hustling and working, but I still felt stuck. Stuck in fear. Stuck in a laundry list of things to do. Stuck in the what ifs. Stuck. So again, I use the tools that I have and start to research solutions.I have been listening to a lot of podcasts about following your dreams and reading books about decluttering and re-envisioning your life (see the list below). I even watched Marie Kondo's Tidying on Netflix. I saw the piles of clothes folks had and thought "yuck! How could things get so bad?" And then I did this while my boys are away:
(clothes stored in my closet, attic, and drawers - don't judge me until you try it! Very eye-opening!)
It's no wonder I feel stuck. I have been holding on to so much. I still have clothes from my first attending job and from my corporate job that I know I will never wear again. Letting go of them causes so many mixed emotions. Failure. Courage. Pride. Anxiety. Commitment.
It's time to get unstuck. The piles and piles of donations, maternity clothes to pass down, and work clothes to pass on won't unseat themselves. No one is coming to save me. I am saving myself. Starting right here. In this moment, again. And I will do it again and again PRN (as needed for those who don't abbreviate on their prescriptions). One day at a time.
Above references mentioned:
Podcasts:
Dreams in Drive
Side Hustle Pro
Therapy for Black Girls
Books:
Marie Kondo's "The Life Changing Magic of Tidying Up"
Dr. Dike Drummond's "Stop Physician Burnout: what to do when working harder isn't working?"
We have the same birthday, she and I. We were born worlds
apart, both geographically and culturally, but on the same day of the same
month in the same year. I noticed her birth date, right there on the front page
of her daughter’s, my patient’s, medical chart. Her daughter, who should have
been a princess. In a family full of men and boys, sons and nephews, the baby
was the first girl to be born in over 40 years. The family prepared for her
birth, overjoyed, buying frilly dresses and pink bedspreads and dolls. But it
was not to be. Mother was stricken with intrapartum hemorrhage and baby was
born with anoxic brain injury, doomed to be neurologically devastated.
And that’s not even the worst part.
She tells me that she and her husband sometimes imagine what
it would be like if her daughter, now turning one, were born healthy. They can
almost hear her say “mama” and “dada”, can almost feel her hugs as she runs, laughing,
into their arms. They wonder if she would be crawling now, walking now, what
food she would like best, and if her older brother would share his toys with
her. They mourn what could have been, what should have been.
That’s not the worst part either.
In their home country, they were told to leave her to die.
They were told not to pursue medical care, that God would take care of “the
situation.” And that’s when they packed their bags. They ravaged through bureaucratic
red tape and procured visas. They left it all, their supportive family, their grand
estate, and moved to a small apartment in the United States so they could get medical
care for their daughter in the first world. In their home country, they were
royalty. And here they work menial jobs to make ends meet. She works at a local
supermarket, bagging groceries. One day, she tells me, a customer was checking
out groceries with her own daughter, who was particularly rambunctious. The
customer was frazzled, stressed, in a rush, and frustrated with her daughter.
The customer turned to the woman, this grocery bagger, this almost-but-not-quite-bereaved
immigrant mother and said to her, “She’s driving my crazy. Do you want her?
Just take her.”
And that was the worst part.
Does she want her? Well, not her exactly, but yes, of course
she craves a normal, healthy daughter. What a horrible thing to hear. What a
horrible thing to say. It’s not even that the customer was trying to be mean;
it’s not human cruelty. It’s the cruelty of the universe, the cosmic unfairness
of it all, coupled with human indifference and sarcasm, that combine together
to create a vortex of heartbreaking tragedy.
I take care of children like this every day. Children with
chronic illness, children with neurologic devastation due to the unfortunate
hand that was dealt to them: prematurity, trauma, genetic disease. In order to
survive as doctors, there must be an emotional barrier. We can be empathetic,
but we cannot get too close emotionally, otherwise we cannot function. But this
one hit me hard. Maybe it’s the fact that we have the same birthday. Or maybe
it’s because I, too, suffered intrapartum hemorrhage, but because it was
expected and planned for, the baby and I did incredibly well. Or maybe it has
to do with the fact that I am freshly back from maternity leave after
recovering from said complicated delivery and I am physically and emotionally
exhausted. This one broke through the emotional barrier and catapulted me from
the land of empathy to the state of feeling.
I want to say to her: I feel you. I feel your pain and your
heartbreak and you are not alone. Let me bear some of it for you so you can
take a breath. Right now, as the discharge papers are being printed and you are
collecting your things, let me shoulder some of this pain for you. I don’t say
it. Maybe I should but I don’t. I squeeze her hand and wish her well and tell
her that her daughter is lucky to have her. I thank her for the opportunity to
take care of her daughter, and I say goodbye.
2018 was intense, harried, and a blur. There were highlights, like our first international trip to Italy in June (amazing, loved every minute, especially hiking through Cinque Terre and going on a timed family scavenger hunt through the streets of Florence), but there were also times that were just so busy that we were just trying to get through the week and not forget anything big (like that First Communion parents' night meeting that I totally forgot).
The busyness was entirely self-inflicted, a combination of too many kid activities, daughter applying to high schools (yes, it's a thing - a very stressful and energy-sucking thing), did I mention too many kid activities? There's three of them and we try to make sure they all get enriching experiences that they are interested in, but it's reached a comic/insane level if I do say so myself. Soccer alone.
Upon reflection during this sedate winter break, I've decided that I'd like to work on some life goals for 2019 for our family and home.
More time with friends. We once tried to have friends over once a month which was awesome until it petered out. I think this is important for all of us and also important to our house in terms of general upkeep. We are resurrecting Guests of the Month and thinking of our first invites!
De-cluttering. Our next door neighbors have the same exact house as we do but the mirror image. They had a holiday party which we attended last week and each time I'm in there, I marvel at their lack of clutter. They have NONE. Now I know it's a party and I'm sure they got it party-ready, but they are naturally immaculate (have 2 older kids) and spare. I came home from the party ready to donate 1/3 of the items in our house. We started with the Great Clean Out by having a family organization event of our basement storage room. The storage room has items like Rollerblades circa 1992, a small couch, and 5,395 other items strewn about in no particular order. It's level 2 Hoarders, Buried Alive. All 5 of us were down there, throwing things out, cleaning up, organizing, donating, and it looks amazing! No longer an embarrassment when the plumber needs to go in there! It felt good and didn't take too long. We also unearthed some forgotten treasures like my medical school commencement program and a birthday letter from a college friend.
Developing kid grit. Husband and I have decided that at least some of our kids lack grit and tend to give up easily. While watching our two boys, 7 and 10, on an unseasonably beautiful day during this break, I decided we needed to go on a Mom and Sons Run to enjoy the day and get some exercise. After the complaining and realization that I was set about this plan, we all ventured out to do a neighborhood run - just 1 mile! Now, we've all run a mile before- they've all run a 5K - so a mile is nothing right? Well, during that 1 mile, there were 40 stops, crying (someone fell), pushing (in play but still), a side cramp, and so much walking--I had to pause my activity tracker twice until we could continue. It was like the Bad News Bears Go On a Short Run. I told Husband and we decided there would be a repeat Family Run the next day as part of Grit Bootcamp. It was actually pretty fun. The 5 of us ran 1.25 miles with minimal stops and the 7 year old said, "We ran faster, longer, and it wasn't as bad!" We want to teach them they can get through discomfort and to be mentally tough too. More Family Runs to come!
Mangeable kid activities. I want to include a question mark here since I'm half-hearted about this goal. I think 7 soccer teams was definitely over the top last fall, but I also want them to have time to pursue their interests, develop themselves, etc etc. I guess my goal is to be more conscious of our whole family schedule and to make sure everyone has some down time. Spring means only 4 soccer teams so that's a start!
Be more connected to others. Beyond having guests over, I want to reconnect more with friends and make time for that. I want to carve out more time to be connected with my husband. And continue to have great family unit time. I think this means committing to the bullet point above because connecting takes time and time is of short order around here.
Any one else have goals they hope to tackle in 2019? I figure writing them down makes us more accountable so feel free to share in a public declaration. :)
Yes, this lovely photo of walnuts, dark chocolate, and red wine against the backdrop of Christmas was my real dinner.
This was several weeks ago. Hubby was traveling. I'd worked a long clinic day, and had just picked the kids up from my mother's. My school-age kids ended up with yogurt, fruit, and cereal, while I ended up with this dinner of champions.
But it's not a bad dinner, from a nutrition standpoint. Actually, I was rather proud of what I'd put together, for cardiovascular reasons.
After all, I've done my research: I've just published a book on this! Healthy Habits for Your Heart is a behavior change focused evidence-based diet and lifestyle book for heart health. I was a bit insane about including the supporting science, so the references section is way larger than the publishers wanted. The first section of the book is all about how our behaviors impact our heart health, and how to approach habit change. Then, for each suggested diet and lifestyle habit, I've included tips to make it stick.
Want a free preview? Here you go! Pasted directly from the book, to you!
I hope folks find it helpful for them and for their patients.
From Chapter 5, Eat For Your Life: Nutrition Habits, here is the lowdown on nuts, chocolate, and wine: #34: Eat Four Servings of Nuts Per Week Nuts are good for your heart and your life. Research shows that eating four
servings of nuts per week was associated with a significantly lower risk of
having coronary heart disease (19 percent) or any type of cardiovascular
disease (28 percent). ere was also a significantly lower risk of dying from
coronary heart disease (22 percent), cardiovascular disease (22 percent),
sudden cardiac death (75 percent), or anything at all (19 percent). e
studies looked at tree nuts (which include almonds, walnuts, pistachios,
and hazelnuts) as well as peanuts (which are technically a legume but
nutritionally similar to tree nuts).
Another study found that for every one serving per week increase in
nuts, there was a 10 percent lower risk of having coronary heart disease.
is may be due to the fact that nuts are a rich source of healthy oils.
Nuts also are great sources of both soluble and insoluble fiber, as well as
vitamins and minerals. Nuts are an important part of the classic Mediterranean diet, which we know is a very good diet for heart health. (Allergies
are a consideration here. For people who are allergic to nuts, this habit
doesn’t apply. As a doctor, I’m going to remind you to update your epinephrine auto-injector and carry it with you at all times!)
What Does One Serving Size of Nuts Look Like?
Per the National Heart, Lung, and Blood Institute (NHLBI):
1⁄3 cup nuts (equal to 11⁄2 ounces)
2 tablespoons nut butter
Tips to Make the Habit Stick:
Regularly stock up on nuts, but keep budget in mind. Nuts are
cheaper when bought in larger quantities or ordered online. Shop
around for your favorite sources.
Nuts can go rancid. Store them in airtight containers. Glass is ideal.
Make a portion of your favorite nuts a regular go-to snack. Have
some in your bag or desk at work at all times.
Get in the habit of adding a handful of nuts to your meals, be it
yogurt, oatmeal, salads, or stir-fries.
Try these recipes: Apple Cinnamon Walnut Overnight Oats; Fill-
ing Fruit and Nut Bowl with Greek Yogurt; Nutty Tabbouleh
Salad (in Appendix A).
#35: Enjoy Two To Three Servings of Dark Chocolate Per Week
Research has consistently shown that people who regularly eat chocolate have
lower blood pressure, blood sugars, and less heart disease. Chocolate comes
from the toasted seeds of the cacao plant, which is rich in healthy plant chemicals called flavonoids, specifically cocoa flavanols. Cocoa flavanols have beneficial effects on our blood vessels by neutralizing toxins, which helps prevent
stiffness and plaque buildup, as well as promoting healing.
The darker the chocolate, the more cocoa flavanols it has. Milk chocolate sometimes has barely any (it can range from 10–50 percent) and also
tends to have more unhealthy fat added. For this reason, I recommend
only dark chocolate (at least 60 percent cacao, though the darker the better) and only a small amount. One serving is two small squares (about
50–60 grams total), and science suggests that two or three servings per
week provide the most benefit.
Do you like chocolate, but not dark chocolate? It is less sweet but definitely much better for you than milk chocolate. e intense cocoa taste is
what can help prevent us from overeating this calorie-dense treat. Start with
a small amount and build up over time. The less milk chocolate you eat, the
more dark chocolate will begin to taste like normal chocolate to you.
Tips to Make the Habit Stick:
Add a teaspoon of pure unsweetened cocoa powder to your co ee
in the morning for a mocha treat.
Use only dark chocolate chips or chunks (60 percent or higher
cacao) in baking and cooking.
Try these recipes: Dark Chocolate–Dipped Strawberries; Orange
Pistachio Dark Chocolate Bark; Cherry Chocolate Overnight Oats
(in Appendix A).
Use pure unsweetened cocoa powder in your savory cooking as
well. Try the Antioxidant Chili recipe in Appendix A.
If you have a tendency to eat more than a serving (two small
squares), consider buying only small amounts at a time or dividing
what you buy into serving sizes as soon as you get home.
#42: Limit Alcohol, Although A Small Amount Daily Can Be Heart-Protective
People who drink a small amount of alcohol every day tend to have lower
risk of coronary heart disease when compared to people who don’t drink or
to people who drink heavily. Research shows that light drinking can lower
the risk of developing heart disease a great deal (between 40 and 70 percent)
and also lower the risk of related diseases such as strokes, aortic aneurysms,
and peripheral arterial disease. Wine (red wine especially) seems to be the
best choice, though the protective e ect is seen with all types of alcohol.
e active component in red wine is thought to be an antioxidant plant
nutrient called resveratrol, but studies that have isolated this compound and
given it to participants as a supplement have not shown any promising
results to date. (Of note, that seems to be the case with all supplements.)
But this doesn’t mean it’s advisable to pick up a drinking habit. Alco-
hol won’t erase the risk brought on by other factors. Drinking any amount
over what’s recommended will actually increase the risk of heart disease
by causing high triglycerides (a form of cholesterol), high blood pressure,
and weight gain. Alcohol can also be directly toxic to the heart and is asso-
ciated with arrhythmias like atrial brillation. Drinking too much—even
just a little too much—also increases the risk of cancer (particularly breast
cancer), liver disease, and, obviously, alcohol addiction.
For all of these reasons, the American Heart Association recommends
that people do not start drinking alcohol as a means to lower their heart
disease risk.
For people who can safely drink, and who partake regularly, here is
what is recommended:
Men: No more than one to two drinks per day Women: No more than one drink per day Definition of a Drink:
5 ounces of wine
12 ounces of beer
11⁄2 ounces of 80-proof spirits
1 ounce of 100-proof spirits
Tips to Make the Habit Stick:
Hydrate well before you have any alcohol. If you’re thirsty, you
may unintentionally drink too much too quickly.
Measure out your drink (5 ounces of wine, 12 ounces of beer) and
then put the bottle or six-pack away.
If you’re having mixed drinks, specify how much hard liquor you
want and watch the bartender measure. Some bartenders are a lit-
tle heavy-handed with the bottle.
If you’re entertaining, mix up a pitcher of a tempting mocktail and
have plenty of healthy and delicious appetizers on hand. It’s good
for you and everyone else as well.
Try the Bubbly Minty Mojito Mocktail recipe in Appendix A.
References:
Research shows that (nuts)... A.J.
Mayhew et al.: “A Systematic
Review and Meta-analysis of
Nut Consumption and Incident
Risk of CVD and All-Cause
Mortality,” e British Journal
of Nutrition 115(2), 28 January
2016, pp. 212–225.
Another study found... Y.Q. Weng
et al., “Association Between Nut
Consumption and Coronary
Heart Disease: A Meta-analysis,”
Coronary Artery Disease 27(3),
May 2016, pp. 227–232.
Research has consistently... E.
Higginbotham and P.R. Taub,
“Cardiovascular Bene ts of Dark
Chocolate?,” Current Treatment
Options in Cardiovascular
Medicine 17(12), December
2015, p. 54 and S. Yuan et al.,
“Chocolate Consumption and
Risk of Coronary Heart Disease,
Stroke, and Diabetes: A Meta-
analysis of Prospective Studies,”
Nutrients 9(7), 2017, p. 688
and C.S. Kwok et al., “Habitual
Chocolate Consumption and Risk
of Cardiovascular Disease among
Healthy Men and Women,”
Heart 101(16), August 2015, pp.
1,279–1,287.
Research shows that... and
Drinking any amount (alcohol)...
S. Bell et al., “Association
Between Clinically Recorded
Alcohol Consumption and Initial
Presentation of 12 Cardiovascular
Diseases: Population Based
Cohort Study Using Linked
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22 March 2017, p. j909 and
P.E. Ronksley et al., “Association
of Alcohol Consumption with
Selected Cardiovascular Disease
Outcomes: A Systematic Review
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22 February 2011, p. d671.
Alcohol can also... C. Tangney et
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... UpToDate, updated March
2018, https://www.uptodate.com/
contents/cardiovascular-benefits-
and-risks-of-moderate-alcohol-
consumption.
I learned a beautiful new word this week - exceptionality
I am on my community health rotation. One of the best parts of being a resident are the off-service rotations, which means less time at the grindstone of patient care after learning after patient care after learning and a little more time to breathe. I got to spend a day with a public school nurse in the metro area school system. I graduated with less than 50 kids in my rural high school graduating class, so touring a public metro school system was eye opening, especially as I toured the schools where the kids were >90% free/reduced lunch. Both as a doctor and as a mother.
The school nurses I met were all so gentle, patient, and kind. I watched at the elementary school as 3 kindergarteners came together for their pre-recess albuterol inhalers and impatiently watched the clock together with their little spacers in place. We talked about the special needs kids there as well. I don't remember the issue we were talking about in particular for one of the kids, but I remember the nurse saying (instead of "part of his disability is...") "Part of his exceptionality is _______". She said it with a knowing smile and a twinkle in her eye despite what I'm sure was a frustrating and time consuming issue for her.
We never really had a schedule. We floated around an elementary school, a middle school, and a high needs school. The nurses were so proud of their schools and their kids and talked non-stop about their goals and wishes and kept pulling me aside to show me other students that had made great strides. One of the middle school nurses was one of the most reflective listeners I'd ever met, and as she told me about the difficult parent interactions she's had, I thought about how much she could teach us as doctors about how to handle difficult patient interactions.
The last school we stopped at was specifically built for high needs cognitively impaired students. We walked into the school nurse's office just as she was calling an ambulance for a child's third seizure of the day. They told me they call 911 approximately once a month. I was additionally interested in this school because I'd never heard of it before 2 weeks ago - when a new teenage patient with significant cognitive delays and no prior records showed up in my office appearing agitated and on the verge of violence. I had a 15 minute appointment with them and wasn't sure what to do. I was referring him to the appropriate specialists but was debating whether I needed to start behavioral medications in the meantime as his grandma had told me he had been on some medication in the past. I had found out through the school system that he was already getting hooked up with basic therapies and they thought they were meeting his school-based needs at that time. Now I was at that school. I met the therapists, the numerous paraprofessionals, and peeked at the kids in wheelchairs and helmets and in all manner of disarrayed behaviors. I saw my teenage guy too. He waved at me across the cafeteria and when I talked to his teacher, I learned he was a "delight" and they had no behavioral concerns - and they spent all day with him. I learned about their functional based classes and even got to sample a cookie from the morning's cookie class.
I won't be in this metro area much longer. As I've said before, I'm looking for jobs - I have had several interviews and don't have a finalized plan yet, but I probably won't be in this community. It gave me professional inspiration to connect with my future school district and learn more about my community wherever I practice, but more importantly I have a new deep and profound appreciation for all teachers, especially for kids with complex medical/social/emotional needs and even more importantly school nurses. Especially the ones that appreciate the exceptionality. And as a mother of one healthy toddler, I appreciate all those that willingly spend their time among hundreds of children and/or teenagers every day.
May this inspire you to appreciate rather than tolerate an "exceptionality" this week. :)
