Walking the Talk

After years of unhealthy living, midnight grilled cheese sandwiches with fries because I "deserved it" for working so hard, no exercise, two pregnancies, and too many nights of not enough sleep, I am finally at a place where I can turn my focus to my very own health. I am gradually increasing exercise, wearing a pedometer, and striving for 10,000 steps a day. I started a 3 month physician-directed weight loss program, and have seen a 7 pound weight loss in 3 weeks. I also found out that I am hypothyroid, so being on medication is likely helping as well. Mr. Whoo and I are signed up for a 5 K in January, so I am tackling my biggest hurdle, learning to run (without crying). It isn't easy. I am working harder than I ever have for minimal results on the scale, but the weight loss is real. If I can lose 8 pounds a month, 6 months from now, I will be nearly 50 pounds lighter. Real life weight loss isn't like "The Biggest Loser," and it is easy to get discouraged when the hard work and struggle doesn't result in game-show like transformation. Being overweight, I've never been unsympathetic to my overweight patients, but working this hard has made me a better counselor to direct their efforts, especially as they try to juggle work and family life. Just as having children has given me a unique perspective to counsel from the seat of experience as well as clinical knowledge. As a doctor, I am trying to heal myself. Have any of you had a health issue that made you a better physician? How has it changed the way that you practice?

Picking up Sushi

I’ve been reading this book called Nurture Shock, by PO Bronson and Ashley Merryman. It’s a gift from my friend who practices at Stanford – a gift she gave me on my recent trip to San Francisco. It is a parenting book, about relating to your child, and each chapter has evidence-based information, presented in a readable format, that blows conventional thinking out of the water. Topics like lying, and race, and the development of intelligence. I tend to gravitate toward fiction, but if you read one parenting book this year, or even this decade, I highly recommend it. It is changing the way I relate to my kids, already.

The other night I was on my way to the Sushi Café to pick up a take-out order with my four-year-old son, John. He had been away for a couple of days for the holiday, while I was on call. I intentionally turned off the radio so we could have conversation in the car.

“Mommy! I just saw a picture of a strong woman.”

“You did? That’s great. What made you think she was strong?”

“Um, I don’t know. She was strong.”

“Did she look smart?”

“Yes.”

“Did she have big muscles?”

“Uh-huh.”

“Was she beautiful?”

“Yes! She looked like the people in Aladdin, she was so beautiful.”

I immediately thought of the book, Nurture Shock. There is this one chapter on race, discussing how our children draw their own conclusions, based on their peers, if we don’t bring it up. Often their conclusions become hard-wired, by the third grade. So it’s not enough just to let them watch “Little Bill.” It’s important that we discuss skin color with them, as early as age three, to get our two cents in. We often think that if we just ignore skin color, they will, too. But that’s not the case. I was fascinated by the research, and resolved to start discussion with my own kids. But I didn’t want to force the issue, I wanted it to come up naturally. Here was the perfect opportunity.

“John, did you know that some people have different skin colors?”

He answered excitedly. “Do you mean like rainbow skin, mom?”

“Well, not exactly rainbow, but that’s a great idea. I mean like brown, and yellow, and pink. Is there anyone at your school that has different color skin?”

“Um, no.”

“You don’t know anyone with pink skin?”

“Yes! There is this one girl, Ella, not the Ella you know, but a different Ella. She has pink skin.”

“She does?”

“Yes! And then she turns into a fish. And she has rainbow skin. Then she swims. It’s sparkly. It’s so beautiful.”

This wasn’t going in the direction I had intended, but it was interesting. I pressed on.

“John, what color is your skin?”

“Brown.”

“And what color is my skin?”

“Yours is brown too, mom.”

We are Caucasian, but of the darker variety. Myself more than him.

“Brown is a great color. I love brown. Do you know people with skin color other than brown?”

“Yes!”

“Did you know that they are the same as us? With the same love, the same anger, the same feelings, and the same everything?”

“Yes! And they can turn into fishes too!”

I decided that was enough, for one night. The talk turned to gyoza, and sushi, and edamame, and whether or not there would still be a Halloween candy dish at the sushi place. I doubted it, and prepared him so he wouldn’t be disappointed. All in all, I was proud of my venture. Hopefully he got something out of it. At least I started the discussion, one that I plan to continue. Kids need experienced adults to guide them on these issues, not to ignore them and hope they will draw their own conclusions, correctly.

On the way back from picking up the sushi, I saw the billboard he was referring to. Someone was using the image of Rosie the Riveter, to peddle their wares. I love that John looked at this timeless Caucasian icon, and decided she looked like the people in Aladdin. He’s still blind to skin color, I guess. I’ve got lots of time. I hope he always sees a rainbow in every person’s skin.

A Day in the Life

I’m going back in time, for this one. Back to residency, when I had only one child, my first – Sicily. She was six months old, and I often wondered whether I ever really knew the meaning of the word efficiency, before I had her. I also marveled that I used to look at the parents on the soccer field (my husband played soccer at the time), and feel sorry for their constant vigilance in keeping up with their babies and toddlers. Now I felt sorry for the childless ones.

3:45 a.m. Alarm goes off. Baby loves Bach. I don’t really know Bach, but I will forever associate this nameless (to me) song with this activity in this period of my life. I push snooze.

4:00 a.m. Alarm goes off again. I wander to Sicily’s crib down the hall, and bring her back into my bed to nurse her. Complete bliss. I smell her baby head and play with her starfish hands as she gulps down milk. I smell her sweet milky breath and soak in her long eyelashes by the light of the alarm clock as she falls back asleep, drunk and happy.

4:20 a.m. I put Sicily back in her crib, knowing that she will be out until 9:00 a.m., long after I have gone to work. I step into the shower to start my day.

4:45 a.m. I get dressed and dry my hair, careful to keep quiet as the rest of the house is still asleep.

5:00 a.m. I wander downstairs to spend an hour cramming for Step III. I chastise myself for saving Step III until the third year of my residency, but like I said, efficiency now has a new meaning.

6:00 a.m. My husband leaves for work. I heat up a bagel in the toaster oven, plaster it with peanut butter, and wash it down with strawberry milk. Nestle Quick, of course. Amazing how your childhood comforts return to help out during pregnancy and nursing. I pump off 10 ounces of milk in preparation for work.

6:15 a.m. My nanny comes so I can head to work. I march resolutely across the bridge to the Veteran’s Hospital, where I am doing research for a paper. Extracting DNA from paraffin blocks – a methanol extraction technique. I would later present this paper at a meeting in Vancouver. My presentation was on Sicily’s first birthday, so my mom took her to the meeting with me, so I wouldn’t miss it. Our departure was postponed a day, because I wasn't aware that I needed written permission from my husband to take my daughter out of the country (Canada counts??). When we finally arrived at midnight the next night, our room had been given away. We were thankfully placed around 2:00a.m. at a hotel I would later learn, on VH1, was Christina Aguilera’s favorite place to stay in Vancouver.

8:00 a.m. I report to my third year rotation – cytology. My first cytology rotation – a specialty I would later do my fellowship in. At the time, I was not aware of this. I shunned needles, or any extra work, due to exhaustion. But on this day, my attending had different ideas.

10:00 a.m. I practice performing fine needle aspirations (FNA) on an orange, after looking at pap smears for an hour. I am ready to head to the cancer clinic.

11:00 a.m. I watch my attending perform an FNA on an enlarged lymph node on the left neck.

11:15 a.m. I help stain the slides in the on-site clinic. I look into the extra head on the microscope. Squamous cell carcinoma, metastatic. We call the clinician to tell him.

11:30 a.m. My boobs are rock hard. Formerly small B’s are now at least double D’s. I need to find a place to pump. Apheresis lab usually has an extra room. I grab my breast pump and empty 15 oz. Quickly store in the fridge to take home to freeze and wash my pump parts. Head to conference.

12:00 p.m. Noon conference. Daddy’s Deli. Veggie sandwiches with sprouts, olive tampenade, guacamole, and mustard. Yum! Pumping milk starves me. Get pimped about liver unknowns over lunch. Performance OK, but not the best. Self-flagellate.

1:15 p.m. Back to cytology. Read fluids with attending. Pleural effusions, peritoneal fluids, cerebrospinal fluid, more paps. Spot Trichomonas before attending. Feel savvy and knowledgeable.

2:30 p.m. Back to cancer clinic. We walk in to see a 65 year old woman with a large sub lingual tongue mass. My attending decides it’s perfect for my first FNA. An easy hit. I brace myself against her cancer-ridden, tobacco-stench breath and dive in with the needle. I got cells. Stain them. No surprise. Squamous Cell Carcinoma.

4:00 p.m. Tidying up in cytology. Finish straggling pap smears and exfoliative cytology. Entertain my attending over the scope with stories. Hope like hell my nanny hasn’t fed my daughter in the last hour or so cause I am feeling full as a tick.

5:30 p.m. Home at last. Sicily is hungry, thank goodness. Feed her and play with her until her bedtime at 7:30.

8:00 p.m. Pump for the last time before bed. Study for noon conference the next day. Clean and sterilize pump parts in preparation for tomorrow. Watch American Idol with my husband.

9:30p.m. Crash.

There it is. A day in a former life. Not one that I envy, at this point in my career. But I miss those starfish hands, and rubber-band wrists. Today, on the way to Thanksgiving dinner, my six-year old daughter was singing Defying Gravity, from Wicked, at the top of her lungs, over and over. “Mom, will you please take my jacket off? I’m so hot from singing.” That sweet little nursing baby is gone forever. A fleeting memory. One that was so all-consuming, at the time. God I miss it, so much.

I’ve Got to Crow: Notes from the Empty Nest

One of the great advantages of now having self propelling children is that I can go to conferences that rekindle my interest in more general professional topics. I just attended a meeting sponsored by the Society for Women’s Health Research on the topic of adherence to medication—what in the not so distant past was called compliance. Improving adherence to medical advice offers great promise as a strategy for reducing health care costs. And I was delighted to find that women physicians already excel in this area.

At the meeting I learned about a big review article (Roter, Hall and Aoki, Physician Gender Effects in Medical Communication: A Meta-analytic Review, JAMA 288:6 756-64)that showed that women physicians, at least those in primary care, spend more time with patients (10% longer visits—an average of only 2 minutes more per encounter). The researchers found women were better at enlisting patients as partners in their care, asking about the social context of illness, and focusing on emotion. I remember, still indignantly, being scolded by a resident for spending too much time “chatting” with patients on rounds. This study—a meta-analysis, please note-- firmly laid that shibboleth to rest. The extra time we spend with patients is not merely social conversation. Women use time with patients well, conveying medical information as thoroughly as male physicians. While the effect on medical outcomes was not reported, other people at the meeting provided compelling data that communication promotes adherence, and adherence promotes health and lowers costs.

These data are something we can all be proud of. I confess I would love to go back to my obnoxious resident and say it out loud: “So there !”

Life update

Sometimes I use this blog to whine about certain mother/medicine-related things that annoy me in my life. Then, because it's a group blog and not my own personal forum, I tend to not follow up because I don't want to hog the blog. (Hey, that rhymed!)

However, since it's been a little quiet on here, I thought I might give a little update on the last few entries I posted:

1) I started NaNoWriMo on Nov 1 and finished a "novel" of 69,091 words a few days ago. It is truly awful and I am terribly proud of myself. Now I can let Wonder Pets have a break from raising my child.

2) A couple of weeks ago, I camped out in the board of health and finally got an H1N1 vaccine for myself and my daughter. We got the intranasal one, so hopefully we've been shedding lots of attenuated virus for my still unvaccinated husband. My hospital still is not offering it, nor is our pediatrician (which may prove to be tricky when my daughter needs her booster).

3) I am currently reading Baby Proof by Emily Giffin, which someone recommended to me in the comments. See? I listen to you guys.

Also, I'm really enjoying life in fellowship. It's great. I'm not a resident, not yet an attending (all I need is time).

MiM Mailbag: Grades

Were you all straight-A students (undergrad), or did you struggle with some classes?  Did you have to take anything twice?

I ask because I have a few grades that are, um, less than desirable for a med student wannabe.  Not that I couldn't do well in those classes - I was just focused on other things (I didn't think I'd be going to med school at the time).

Thanks!
H

The Acela Express

I recently attended a medical conference in Philadelphia and decided to take the train. It seemed too close to fly, but long enough that I did not feel like road-tripping it. The thought of 3 hours of wasted time, driving, was almost too much to bear. At least I could bring my laptop with me and be productive.

I had to be there in the morning -was presenting in a workshop - but didn't want to spend an extra night away from the family, so I booked the earliest express train I could. The 7 a.m. Acela Express.

The gate was full of business-types in suits and briefcases, heading to Philadelphia or New York. I felt out of place in my purple dress and suitcase. But, what a great ride. It was amazingly fast and smooth. Plus, I got actual work done. When I stepped off onto the platform in Philadelphia, I felt decidedly more comfortable and more than a little disappointed to have booked the plain old regional home.

About a year and a half ago, I wrote about a different train, the slower train that my career was on since finishing residency and having kids. I just read that post again and marvel about how quickly things have changed.

I find myself riding the Acela Express, literally and figuratively. (How I ended up on it, I'm not so sure. It's all kind of a blur.) For the past couple of months, I have looked up to see the scenery flashing by the windows and the stops have become far less frequent. I have blamed the convergence of several deadlines and projects, yet I also wonder if this is the new reality.

I can see why people choose the Acela. It is seductive, this speed. I can get places much faster. It is difficult to get off; the stops are few and far in between.

My problem now is not knowing if I can keep pace with the Acela. I've been more stressed than usual, working much harder, and burning the midnight oil. (And if I wasn't sure if I was stressed or not, I could just ask the sebum-producing glands on my face, or my stomach lining.)

I've talked about this with my husband (who is no stranger to the express train), who reassures me that this is all good. It's all about adapting to a new level of productivity and reaching the balance needed with it. I may feel out of balance now with work>life, but I will learn to adapt, as he has.

I hope this is the case. Because, I have to admit, this express train is kind of exhiliarating.

My reading list

Online drama can be very hard to resist.

Recently someone online was recommending that I read Jane Austen's Pride and Prejudice. The thought of it made me ill. I try to do a little reading when I can, but Jane Austen is pretty heavy stuff. I jokingly replied that I was a working mom and that I really couldn't focus on anything that couldn't be read in fifteen minute spurts with a toddler screaming in my ear. Jane Austen doesn't really fall into that category.

The person replied that she was working mom too and "I'm sure I'm not the only one who's managed to read Jane Austen or other books with at least a little substance." Ouch. It took every fiber of my being to end that conversation and not get drawn into an argument. Every fiber of my being.

But of course, I then went to look at my bookcase to verify that my reading list is not completely vapid (although I've been getting most of my books from the library lately). All right, there was perhaps an overabundance of books with the word "shopaholic" in the title. (Recently read Kinsella's "Remember Me?" So good!) I've been making rounds on the NYT Bestseller List with "The Time Traveler's Wife" and "Prep." I've also got a book called "Murder on the Rehab Unit" which, as a rehab doctor, I was compelled to purchase (although apparently, not read).

All in all, I'm not entirely sure I've read anything "of substance" lately. Actually, I don't think I've read anything "of substance" in years. Unless of course, you count all the zillions of articles that I read for work, the textbooks, and of course, EMedicine and UpToDate. I guess that's why when I read something for myself, I like it to be fun and light.

What about you? Is Jane Austen something you trudge through in your spare time? Do you try to go for the books of substance or do you unwind with the guilty pleasures?

A random day in my life

5:30 alarm goes off

6:00 get on tread mill at gym

6:10 officially wake up

6:20 fight the urge to get off the treadmill and begin dancing around the gym when “Hollaback girl” comes on my ipod. (Crank up the mph to 7.5 instead)

7:45 eat Cliff bar on my way to coffee shop

7:47 arrive a coffee shop where barista already knows my order

8:00 arrive hospital

8:10 round on postpartum patients

8:30 begin seeing patients in office

8:40 first patient is in her early 20’s. She looks at me glassy eyed as I discuss health issues, encouraging safer sexual practices, quitting smoking and healthy eating. Ummmmm….. I really just need a refill on my pills. Fine, I say.
While I’m doing her pap, she stops texting long enough to say “Why would you EVER want to be a gynecologist???”*

“I enjoy delivering babies and helping people live a healthier life.” me

“Oh” “You know I really HATE this!” her
(By the way, 90% of people say this during their pap smear)

“Yeah I’d be a little concerned if you actually liked it” I reply with my canned response.

The next patient wants to discuss hormones. She starts by saying “Well Oprah says….. “ at which point MY eyes glass over…

9:20 Labor and delivery calls with a patient in labor. I walk over and check her in. 2 cm with first baby.

See several other patients

Avoid several drug reps

Office manager stops me to sign some checks
We pay HOW MUCH for PAPER???? She tells me were getting a good deal because we’re buying in bulk. I believe her.

12:15 done with morning patients

12:20 do circumcision

12:30 eat canned soup and cookies

12:40 Labor patient is 3 cm

1:00 Afternoon patients start

I see an annual exam who I delivered 2 of her babies. We compare notes on Halloween costumes and chat.

Next patient comes for a “hormone check”… but is really just depressed.

Next patient doesn’t need me to fix her….. she just needs to talk to someone. I let her talk as long as my schedule allows (probably longer) and then get her a referral to a counselor.

Next patient comes in for a “yeast infection that just won’t go away that’s now blistering.” Sorry honey, but it’s Herpes….. pass the tissue box. That wasn’t a pleasant conversation to have.

Next I get caught up discussing Twilight with a patient (you better believe already have my New Moon tickets and my Team Edward T-shirt).

3:30 Labor patient only 4 cm. Call husband let him know I probably won’t be home for dinner.

3:40 OB comes for 12 week checkup. US reveals no heart beat. She had no reason to think anything was wrong. They had been trying to get pregnant for over a year. Telling her that she had lost her baby made me feel physically ill. I hold her hand as she cries. Big tears. My own eyes sting as I fight to hold my tears in. I take her to the back door to let her out so she wouldn’t have to walk through the waiting room, as I closed the door I get a stat page to L and D. I race across the parking lot to the hospital…. The baby’s crowning. I quickly gown and in one push, a beautiful baby girl is born. I lay her immediately on the mom’s belly. Blood, vernix and tears are everywhere. The daddy cuts the cord. I have to guide his hand because he’s crying so hard he can barely see. Pictures are taken. Hugs are exchanged.

The grandma looks at me and says , ” You have the most amazing Job in the world.”

“I’m very blessed”

4: 15 I thank my NP for helping see my patients while I was out

5:00 Finish seeing patients and start catching up on charts

5:20 Get home

5:40 Eat left over pizza

Play with son and talk to husband

8:00 Multiple books read to son as I put him to bed

8:15 Drink large glass of red wine and watch Flight of the Conchords on DVD with Hubby curled up the couch. Laugh.

9:00 Reflect on the craziness of my day. How I can go from tears of profound sadness to tears of joy in a matter of minutes. How I can love and hate my job so my all in the same day.

9:45 Fall asleep in bed reading a book.

*Which inspired me to write this post

The antidote: knitting

Ariana at 3 weeks, wearing a sweater I knit during my pregnancy. Had she been a boy, I would have still made him wear it home from the hospital.

Eight years ago I agreed to join a friend for an evening knitting course taught by a black heterosexual volleyball player named Steve out of a converted Vancouver warehouse. I've not stopped knitting since. It has proven to be the perfect antidote to medicine and parenting.

I'm working on a spruce-coloured cabled vest for my five-year-old, and when I knit a few rows in the evening the steady soft clicking of the needles work the yarn into perfect V's of stockinette stitch that are blessedly tangible. Row by row, cable by cable, visible results emerge. Measurable progress is directly proportional to the work I put into the project. Such is not the way of medicine or parenting.

The stitches behave. My needles cooperate. I control every aspect of the garment-making process. When I put it aside for a week, it is exactly as I left it when I retrieve it. Unlike disease, patients, offices or children, it has no life of its own. There are no surprises.


Leif reading Beatrix Potter on a Sunday afternoon. Vest not limited to professorial pursuits; also good for walks in the woods or autumn beach visits.

There is every opportunity for perfection. It is possible to knit an item flawlessly. If this were only true at home or in the office: all errors can be undone, most with nothing more than a crochet hook.

In The Artist's Way Julia Cameron discusses the importance of filling the well - replenishing our creative resources. She gives another reason to knit:

Any regular, repetitive action primes the well . . . Needlework, by definition regular and repetitive, both soothes and stimulates the artist within . . . [and] may tip us over from our logic brain into our more creative artist brain. Solutions to sticky creative problems may bubble up . . .

I do love the organic, messy, unpredictable nature of medicine and mothering. But that's what fills most of my days, and a moment stolen to give my hands over to bamboo needles and wool grounds me, lets my whirling thoughts settle and the most worthwhile rise to the top. An inch or two of knitting later - of perfect, even, countable stitches - I am ready to get on with real life.


Toque for early morning September blackberry picking.

MiM Mailbag: Working guilt

Hi Mothers in Medicine,

First of all, I want to thank you guys for sharing your lives and experiences with the general audience. I am a person who aspires to work in the medical field some day and reading this website allows me to think that maybe I can have both work and family equally balanced. Recently I have come upon a question that I was asking my self and was completely stumped. I was wondering, if you guys be so kind to help me and give me advice on this matter, I would greatly appreciate it.

The question as follows: How do you guys deal with the guilt and sadness in the event of missing a chance to spend time with a loved one because of work? What do you guys do to make yourselves feel a bit better and be able to continue? Now I'm not referring to missing daughter/son's dance/theater rehearsal, or Auntie's 50th birthday celebration, though those events are quite important; however that kind of guilt one can live with and eventually assuage--I am referring to the lost of a loved one, or friend and that dinner or visit was that last chance one would get. How do you guys work under that cloud of what if that chance is that last chance? Or do you guys eventually learn that life is what it is and come what may? I hope I am not generalizing too much here and not being too naive and callous in asking this question. If this question offends you guys in anyway, feel free to tell me off.

Thank you for your time.

Sincerely,

A