get out much?

It's Saturday night and my husband and I have just returned from a very rare night out without our children Nearly Two and Just Four. So rare that it just may have been a first. Not that he and I don't go out, it's just that we do it As A Family. So, the four of us go out to lunch and the library and the park and the ice cream shop and the occasional museum. On weekdays we do go to work As Adults , but it is no Couples Time. This may come after the kids go to sleep, unless, of course, they are still awake.

All of our time when we are not actually at work is Family Time. We do not have a babysitter at the ready. Somewhat embarrassed to say how long it has been since I've seen a movie on the big screen. We put our children to sleep late, and we like to say it is simply in accordance with their natural circadian rhythms, but more accurately we've groomed them to fall asleep late enough so Working Parents can get in some quantity (quality?) play time at the close of day. Is it just us, or is this a modern day dual career family phenomenon? Actually, no one other than me or my husband has put our children to sleep in 4+ years, except for the one night when I was In Labor.

Even tonight, we rushed home from our Night Out to put Nearly Two and Just Four to bed , late as it was. Once home awash in hugs and cheers, we were surprised to find that they had a great time without us, feasting on fries with Recently Local Grandma. And we had a pretty good time being A Couple, as well. Maybe we'll go out on a date again, in another 4 years...

Taking my kids to work

Ok, obviously with a 3 year old girl and 4 year old boy, I do not take my kids to work for the entire day. However, when granted the opportunity for a brief run-in, I will snatch it up, whether it means 30 minutes in the morning for breakfast in the cafeteria or an hour over lunch. I can't help it--I love having my kids in my hospital workplace!

Truthfully, things never go as I anticipate. I always have this vision of my daughter showcasing her adorable made-up songs and my son making hilarious (though appropriate) jokes, thus bringing all my anecdotes and imitations into a stark and incontrovertible reality for my co-workers. In actuality, my kids have, over the course of several visits, managed to: 1) sit in a corner and pout, 2) scream at each other about who gets to push the wagon, 3) scream at me for not letting them eat a donut they dropped on the MRSA-ridden hospital floor, 4) pull my shirt down so that my bra is fully visible to a half-dozen people, and 5) inform my boss that he (my son) didn't want to be at this "stupid (retirement) party" (okay, maybe that last one was an avoidable error on my part, but they had food there).

Am I crazy? Why do I let myself in for this recurrent exercise in mortification? One thing I underestimated was the fun of seeing the hospital through my kids' eyes. My son's "favorite place" is the...cafeteria. Think about it - donuts, soft serve ice cream, juice, cookies, french fries. How cool is that to a 4 year old?! It's like working at a Luby's. They also think my microscope is one of the neatest things on this earth, and I have essentially no one else in my life who agrees with me on that.

Also, I have this irrepressible desire to merge my work life and family life. I want the people I work with to know my kids, and my kids to know them. I guess the folks at work are getting to know them in a certain way, which at the very least, should garner me sympathy for going home to a veritable nuthouse (or on the flipside, garner criticism for being a mom of two out-of-control hellions). But I don't care. Sooner or later they'll see the whole package, and until they do, they will just have to settle for my imitation of my daughter singing Rihanna:
My umbwelluh - elluh - elluh - eh - eh - eenee my umbwelluh!!

Vacation Over-Achiever

Like the majority of physicians, I have succeeded because of my ability to multi-task, set my sights high, and accomplish many things in small amounts of time. That combined with my "J" personality type on Myers-Briggs, makes me very capable of filling in the many boxes that define my day. While this makes me very efficient at my job, this doesn't work so well in my personal life.

The luxury of a weekend off is often overshadowed by the multitude of personal boxes to check off- trying to fit in all the things I missed out on working those other weekends- this was highlighted by my last attempt at vacation. In 4 short days ( I treated myself to a vacation day in order to extend Memorial Day for one more glorious day), I managed to plan stay with my parents almost 200 miles away and visit with my brother and sister-in-law and new baby, college friend, and high school Best Friend at beach house- for day out at beach and dinner for just adults- lugging with me dog, husband, and kid with associated luxuries packed into the car.

Although never amnestic to the trauma of childbirth and colicky baby, I always forget the torture of "vacation". Inevitably, the boxes of planned visits slowly got left unchecked as I realize that baby in tow to all of these occasions generally doesn't go off as planned. College friend was soon forgotten; dinner with Best Friend translated to running after our respective children as we tried to catch up on each other's lives- never eating dinner, since the kids wouldn't go to bed; sleep reminiscent of newborn days when the kid won't take a nap, won't sleep in borrowed pack n play- only sleeps lengthwise across my childhood bed kicking me all night.

Life's successes are defined by expectations. While I generally succeed in my professional life,-often because my expectations are that I will escape the house without child clinging his banana smeared hands on my newly pressed pants, I'll get to work relatively on time, check my boxes in a timely fashion and make it home in time to let the nanny go- I almost always fail in my personal life. Maybe because my expectations are those of earlier days when I could balance everything. Maybe because I always forget the take home points of pediatric behavior- you can't make a kid poop, eat or sleep- no matter how hard you try. Maybe my desire to be a "normal" adult is something that is unattainable. I have to learn that while maybe professionally I can do most everything I set my mind to, personally, I can't do it all. And I have to forgive myself for that. And maybe my next vacation means staying at home and doing nothing. I can underachieve once in awhile.
Jersey

Proud Moment

About half an hour ago, I was at a neighborhood pizza restaurant with Sister, her two kids and their two friends. Sister asked me to keep an eye on her kids while she used the restroom.

I was in the process of sternly asking one of them to climb down from the skeeball machine when Son tugged on my sleeve. I shook him off and kept my focus on the skeeball climber. He tugged again. "Stop it, Son," I said, giving him the shake off again. Finally I turned to him, ready to sternly lecture him, as well.

Son stood at my side, a horrified look on his semi-cyanotic face, trying to speak, trying to breathe. Choking. Niece had asked me if Son could have a starlight mint. I said yes. He then tried to get my help and I brushed him off.

Before I could even form the thought to do the Heimlich, he coughed the piece of candy up. It went shooting across the room. Then he vomited, all over his neglectful mother.

"I'm sick. I need to go to the doctor," he cried.

But I am a doctor. And your mommy. And not very good at either right now.

"No you don't, sweetie," I said, cuddling him, "that was scary, wasn't it?"

He's fine now. Incident forgotten. But I'm still shaking.

Small Things

Tonight, I have to prepare a lecture for a group of healthcare professionals. I've known about this for nine months, yet I've put it off until the night before. Exactly 22 hours from now, I will be embarrassing myself with my unpreparedness. But I'm not thinking about isn't my professional reputation right now.

I'm thinking about Son, who is upstairs in his bedroom for the first time in two weeks. He's been sleeping with us lately. We don't know why. Tonight we decided to try him back in his room. We told each other he'd last five minutes, and we were OK with that. But five minutes passed a long time ago.

He's intermittently singing, though I can't understand the words. Every now and then I hear a knock on the door. "Mama," he calls, "where are you?" I ignore him, though it is so tempting to call back to him. He knows how to open the door, so if he really wants to come down, he will.

These small things are the challenges in my life. I know how to treat a pneumonia, how to run a code, how to track down the most elusive data using our complicated electronic medical record and how to work my patient onto the closed radiology schedule.

But how do I make my son feel safe in his own bedroom? It's a small thing, really, but aren't those the ones that perplex us? I wish being a mother were as "easy" as being a doctor.

By the way, it's now been 30 minutes. The singing and knocking have slowed down. I'm fighting the urge to open his door and look, but I know better.

After almost four years, I've learned a thing or two about being a mama, too.

Maternity leave for medical mothers

The association of directors of residency training in psychiatry has just started surveying program directors about their ATTITUDES toward maternity leave for residents. Years ago, when I was a member, I tried to survey them to find out what the range of actual policies might be, but no one wanted to disclose this for fear, I guess, that women would choose programs with better policies. Still, this punt is a form of progress, and the day may come when young women may have that kind of information, and not be penalized for making use of it.

Since I have changed to medical student education as my professional focus, I have become even more concerned about this issue. My first year in the job, an excellent student failed her clerkship exam about a month after delivering her first child. This led me to research the issue of "motherbrain"--cognitive problems women report after delivery. (I recall my pregnancy friend describing it as "someone took my brain out, administered a few swift kicks, and replaced it rotated 45 degrees.") Although the problem is one women commonly report, the research on it, like earlier research on perinatal depression, has been dismissive. Because the studies all exclude women with depression, severe insomnia, or medical complications, they have not found "objective" evidence of impairment on a limited number of tests.

Research or not, cognitive impairment (poor concentration and short term memory) may be a significant problem for women after delivery, lasting an unknown period of time. While I don't want to discourage anyone from working and demonstrating that mothers can be competent professionals, inadequate maternity leave and too early return to work is not a trivial problems. Students may fail their exams, and the rates of human error, already too high in medicine, may be affected as well. If I thought the information would be used in a non discriminatory fashion, I would be advocating for more attention to research in perinatal cognition. As it is, I try to warn students and residents not to underestimate the impact of childbirth, and to take adequate leave, even if it requires financial sacrifice or prolongs training.

Has anyone else been concerned about this?

Criminal

While in high school, I heard that some store managers were suspicious of teens due to shoplifting incidents. Afterwards, I felt guilty whenever just browsing a store with managers in view. I had no reason to feel guilty. I didn't have sticky fingers. But, somehow, I had already learned to internalize projected judgments of others onto myself.

I get the same slinking feeling whenever I'm leaving work on the early side, taking advantage of getting all of my work done early to get home to spend more time with my children while they're still awake. Even if I plan to continue doing work after they go to bed, I feel like a shadowy criminal trying to get away with something.

I dread running into people who may look at me with all of my bags and then glance down at their watch. I dread running into a supervisor.

It doesn't matter if I'm incredibly efficient and productive during my time at work. Or if I've worked through lunch scarfing down a sandwich in between keystrokes on the computer. It's what the hands on the clock read when I'm leaving the building that determine my innocence.