I'm Nervous, And I Think That's a Good Thing

I've been practicing pathology for about 6 years, after 4 years of medical school and 6 years of training.  Cases that I used to pore and sweat over have become routine.  Sure, there are always cases to challenge your brain, share with your colleagues, or send out for expert consultation, but after 6 years I have cruised into a "more comfortable" zone.  I can triage efficiently, and getting called to radiology for wet preps or to the OR for frozen sections is no longer a paralyzing experience (for the most part).  The wall I built around myself, the mask of confidence hiding insecurity, has slowly come down.  I can relax and banter with my colleagues while deciding if there is cancer on the slide or not.  I think this is true of all pathologists that are a few years in - I laugh when I think back to what I agonized over during my first two years in private practice.

Last year the partner in charge of CAP (College of American Pathology) lab inspections retired.  I volunteered to take his place, as a team leader.  We are in charge of lab inspections for three hospitals - every two years each hospital assembles a team to lead an inspection.  I did my first one last November - whew it was a blur.  I had a veteran compliance officer leading me through.  "Even a blind pig can find an acorn every once in a while," I kept thinking as I went through that inspection.  I was prepared, but shell shocked by the strange experience.  This time she is on vacation.  I am in charge.  Luckily I am leading a brilliant, experienced team that will make my job much easier.

I became a pathologist to hide behind a microscope.  With a few exceptions, such as being interviewed on TV with the Swine Flu breakout, I've been able to maintain my anonymity.  Lab inspections fly in the face of anonymity.  I interview the hospital CEO's, the lab directors, the medical Chief's of Staff.  The team has specific information to mine and report in a very short amount of time.  We summarize our findings in a large room at the end of the day.  Then we go out to dinner and celebrate a hard day's work.  That's the part I'm looking forward to.

I find, as I am preparing for this inspection, that I am grateful for new challenges and experiences to shake me up. It's what got me here in the first place, but it's easy to forget when it becomes, all too soon, remote.  And as the butterflies circle in my stomach as I am going to sleep, I wonder and hope that my fellow MiM's also have new experiences to keep them from banality and boredom.  They must.  It's a part of the job description.

So if you are reading this today, wish me silent luck.  I'm inspecting.

No Good Deed Goes Unpunished...

For a long time now, I've been feeling like I need to start giving back. You know: volunteering time, helping people, at least THINKING about others (who aren't my patients or my family). Not like I have alot of free time, as a primary care doc, mother of two little kids, loving wife, and caretaker for two large spoiled cats...

But, it's like a weight, a constant nagging wagging finger saying "YOU ARE SO FORTUNATE. WHAT ABOUT THE REST OF THE WORLD?"

I don't think doctoring counts, either, because it's my job. I try to be caring, and I try to go above and beyond (within reason), and I like my job, but it doesn't count. I get paid to do this.

Yeah, we go to church, but that doesn't count either, as we get more out of church than we give. I really, honestly, or perhaps predictably, don't do a hell of alot for others.

Not to get all religious on people, but honestly, my family, we're blessed. Or, you could also very agnostically say, we're very lucky. We have so much: good education, jobs, beautiful healthy children, a safe home and plenty to eat. Last time I prayed, I thanked God for all that we have, and promised to TRY to do more for others. TRY.

So this week, when my elderly neighbor called us out of the blue to say hi, I ended up asking her if she needed anything, like, say, a trip to the grocery store? She can't drive anymore, and as I chatted with her, it occured to me that our neighbors who usually take her food shopping are away on vacation. I suspected that her call was a way of reaching out for help.

She jumped at my offer, said she hadn't had some basics in some time, and we agreed that I would swing by and pick her up after work, yesterday. I offered up my offer to God as proof that Hey, I'm trying!

Well, yesterday I barely got out of clinic in time to make it to her house at the appointed hour. Then there were torrential downpours and flash floods... The sky dumped on me as I ran to my car, and of course I was wearing a long skirt, and the hem got soaked, and then it got all caught up around my legs, and then I tripped and slipped and cut my heel against a curb. I made it to my car, but only to sit in a massive traffic jam as one lane of the expressway was closed due to flooding. It was the worst traffic jam I had ever been in. I called my husband to say I would be late and asked him to call our neighbor.

Long story short, I was over an hour late to her house, and I saw her tiny, frail face peeking out through the lacy curtain on her front door window. I called out my apologies.

Not to worry, she said, I expected traffic would be bad with all this rain!

I (of course) had to pee, but she was all set to leave, and I was too late to go use my bathroom, and too embarassed to ask to use her bathroom. As she fretted with her umbrella and her house key, I decided to just deal with it.

I noticed that she had done her hair neatly, put on lipstick, and a nice blouse with a flowered brooch at the neck... This may have been her first foray out of the house in some time.

We got to the strip mall where her favorite small grocery store is, and she asked if she could also stop at the pharmacy there as well... Of course I said yes, and we agreed to meet up at the cash registers at the small grocery next door.

I figured I would be moving faster than she, so I dawdled and lingered over the fruits and vegetables. I checked out the gourmet chocolates and the imported Italian foods in jars. I tried not to think about how badly I had to pee, and thought about asking to use the grocery's bathroom, but then was worried it would be gross, or that my neighbor would come looking for me in the interim.

Time passed. I called my husband to let him know I would be even later than expected. I decided to check out with my groceries and put them in the car and then go looking for lovely neighbor.

I found her in the salad bar aisle, packing up this petite salad in an itsy little container, and she couldn't get the top on. I helped her and accompanied her on the rest of her shop. She actually needed help with alot of things, with reaching up to get things higher up on the shelves, to lifting a bag of discounted corn on the cob, to picking out appropriate sweet potatoes and finding the bread she likes (she can't see that well). We realized that we both love vanilla soy milk. I realized that life must be very hard for her, and my heart went out to her (even as my bladder was about to burst).

We made our way to checkout and then to the car and then to home, and I helped her with her bags. She said Thanks, I really appreciated your asking if I needed groceries, since I didn't have bread, and if I at least have bread, I feel so much better...

She has no family nearby to help her, and is completely reliant on neighbors and folks from her church. Again, I thanked God for all that we have, and especially for our family.
I made it home, and finally, after big hugs to my kids and a peck on the cheek for patient hubby, I got to thankfully, and gloriously, pee. I thanked God for that, too.
Next stops: our town's food pantry and the local animal shelter...

Bibliophile

Now that my baby is a little older, I've gotten back into the habit of reading chapter books to my oldest before she goes to sleep.

I started off by reading her books I loved from my childhood, like The Twits or Wayside Stories. But then I realized it's more fun if I haven't read the book and I'm curious to know what happens too.

Recently we finished Matilda, which I never read as a child. Loved it! We tried the Ramona series, but we both got bored on book one. Now we're reading a series called Judy Moody that's a little cheesy but Mel really likes it. Plus the whole series is available free on the Kindle library.

What do you read to your kids?

Life, loss, and celebrations of love

I have written and re-written this post several times. I felt some drafts were too personal and others too impersonal. I have so many thoughts and emotions, but here are the ones that I would like to share:

Today is Julian’s birthday. The day, my nephew was stillborn. Today I honor the life that he lived in his mommy’s womb. Today I send love into the world in honor of him. His life and birth have changed me in ways that I still am struggling to comprehend. Today I have greater compassion for families who experience the loss of their precious little ones. Today I have greater understanding of the grieving process, though not intimately and daily tied to it as a parent would, I have experienced it in waves and ripples as an Auntie does.

Today I send prayers out into the Universe for all those who experience stillbirth or the loss of a child. Today I send love to Julian’s mommy K and daddy T. K is a public health professional and T, an Infectious Disease Fellow, and together, they are one of our closest couple-friends. We rely on them in good times and in bad. And we are honored that they rely on us as well. Our friendships have grown over the years and we now regard them as family; especially over this last year.

As I reflect 1 year after Julian’s birth, I remember rubbing K’s baby bump, hearing her tell us about his development, all of the parent discussions we had had while we and they were pregnant (such as how to choose a Doula, risks and benefits of circumcision, feeling like a milk-maiden while breastfeeding). I remember the pain and grief we experienced learning of Julian’s stillbirth. I remember not knowing what to say or do. I remember our first conversations when he was born. I remember our continued conversations after his birth.

So today I celebrate Julian’s birth. I still wish we could have held him. I still wish he could have breathed and been nurtured by T and K, but those months he lived in his mommy’s womb were filled with soo much love. As I celebrate Julian’s birthday my heart is filled with joy that T and K will be welcoming a new baby to the world this January. In many ancient spiritual traditions, there is the belief that those who are lost are always with us, that they watch over us, and that they return to us when they are ready. This belief comforts me and gives me strength. I know that this experience with loving and losing Julian has fortified my friendship with his parents, it has increased my compassion for those dealing with loss and has made me more loving and understanding. In this I celebrate Julian’s life, I grieve our loss, and I celebrate the love that we all have shared.

MiM in Stanford's SCOPE

MiM was recently featured in Stanford's SCOPE magazine. Here's the interview. Thanks for being a part of this community. Our voices matter.

Strangers and my Renewed Fear of the Dark

Sometime during pregnancy, I began to see issues facing families and children through different eyes. I began to see and feel them using my newfound “mommy-sense”.

When I first heard of the shooting death of Trayvon Martin, a man-CHILD, my heart ached. His family had allowed their son to go to the store and he never returned.

My first thoughts were what his last moments must have been like. My mommy-sense took me through the events time and time again. I try to block it out, but I keep going back to it: 

Walking home in the twilight, almost dark. You are approached by a STRANGER. What do you do? 
I was taught and had planned to teach my son to:

1. Never talk to strangers

2. If necessary, run away from a stranger

3. If absolutely necessary, fight (because you don’t know if that stranger is trying to kidnap or hurt you)

My heart hurt because what I was taught and what Trayvon may have been taught resulted in his shooting death and the MAN who shot him has been acquitted of his murder. Regardless of your belief in the legal validity of the verdict, a child was approached by a stranger (not someone who identified himself as a police officer) and that stranger ended up fatally shooting him.

I talked to a Public Defender family member today and I am trying to understand the specifics of the law, but my mommy-sense keeps taking me back. Back to what I should and will teach my brown son who will someday become a tall brown man like my husband. My husband has shared countless stories over the years about how women clutch their purse when he walks by even as he is holding our infant son, how he has been profiled by the police, how he began feeling hostility from female strangers even as a child. I shudder that someday we will have to help our son navigate these prejudices.

Also, what, as a Primary Pediatrician should I teach the young male children of color that I work with every day that is within the harm-reduction paradigm I soo often defer to? We have fought in my state to have the right to discuss gun-safety (do you have a gun in your home? Do you keep it locked?) with parents and we often teach about car safety, but what are we teaching the brown boys for whom homicide is a leading cause of adolescent death?

Do I teach these young men and my son, as my father and my husband were taught, that many people will see them as threats regardless of where they are going and what they are doing? How do I instruct him and my patients to be strong and proud, to not bend to stereotypes, when at any moment they may be seen as a threat, challenged, harassed, assaulted, and possibly killed? What do I tell them to do when approached by a stranger, not a police officer, on the street? What do I tell them when our justice system still hasn’t figured out what to do with these prejudices?

I now fear strangers more than ever. I fear them for myself and I mostly fear them for my son, my nephews, and my patients. I am now more afraid of the dark than ever before. I shudder for the day when I have to allow my little man-CHILD to venture unaccompanied at night. I fear the prejudices others may have of those who look like him. I fear the advice I may give to him about strangers: don’t talk, run, and fight if you must. I am fearful that this evasive tactic may itself be seen as a threat. I am fearful that adults can kill children and it be brought into the light and nothing happen.

What will you tell your children? What will you tell your patients? What will you tell parents after such tragedies? Are you as afraid as I am?

MiM Mail: Choosing a specialty when you like a lot and love nothing

Hello MiM,

I am new to your blog but have recently spent countless hours reading past posts to hopefully gain some insight (and to avoid studying for step 2). I am a MS4 who just finished 3rd year rotations and am desperately trying to figure out what I am going to do with the rest of my life. Honestly, I did not have that "Ah-ha" moment in medical school when I found something I absolutely loved and knew it was what I was destined to do. I liked most of my rotations, of course some more than others, but nothing blew me away, and I am very disheartened by this.

Right now I am trying to choose between applying to Ob-Gyn and Internal Medicine. Very different, I know. But I like Ob a lot - dealing with relatively younger, healthier patients, working with just women (mainly), and being a surgical and medical specialty is appealing. It was definitely my favorite rotation of third year. However, I never pictured myself as an OB and to be frank, I am quite terrified of their perceived lifestyle. I am 27 years old, married to my high school sweet heart and love of my life, and my family is everything to me. We do not have any kids yet, but definitely want 2 or 3 in the (near) future. My mother was a stay-at-home super mom who never missed a school function or dance recital. Obviously, choosing a career in any field of medicine means that that won't be me; however, I feel if I become an Ob-gyn it will be that much more difficult. I really like delivering babies, but am I still going to like it when I am 45 years old at 3am or when I am missing my child's school play?

If I chose internal medicine, I am basically saying "I haven't decided what to do yet" and it gives me an extra year to put off the decision. Internal medicine has so many different fellowships that I feel I will be keeping my options open. And although I am a big fan of the OR, a non-surgical specialty will help with my hours and my call schedule.

Basically, I like a lot, and love nothing and I am hugely disappointed by this. I have wanted to be a "doctor" since I was a young girl, and have worked so hard to obtain my MD; but, right now I feel lost.

As a woman, I feel it is so much harder to choose a specialty. At the end of the day my family is number one and I want to do what is best for them. At the same time, I have spent so much time and money and worked so hard to get where I am that I don't want to sell myself short. I feel like I have to choose between what is best for me personally and professionally.

Sorry for the insanely long rant. I just really need some solid advice - really ANY advice at all. Please help me, MiM!

Sincerely,
One confused MS4

Birthday Party Beef

Since when did birthday parties become glorified babysitting?

My son celebrated his 8th last month.  I invited his class (18).  One mother stayed.  Luckily I had enough family to help control the kids.  One mom dropped off three children - I realized in retrospect that her son was in another class and hadn't even been invited!

I was complaining to my partner, who always throws big parties.  He once decorated his entire backyard in the theme for CandyLand.  Last year he switched his kids to my school.  He told me that he had one birthday party for his daughter, she is in the second grade, and it was such a disaster he will never do it again.  He invited all the classes - 50 kids in all, and got 40 drop offs.  One mother stayed for the party.  It was such chaos that it scared and angered him.  One dad came to pick up his child at the end of two hours and was angry when he asked "Where is my child?" and my partner was not able to answer exactly where right off the bat.  "I thought I saw her entering my study a half hour ago but now, who knows?"

We both empathized.  Of course that child was found in a bedroom happily and healthfully, but how can you expect two parents, much less one (I am a single) to manage an entire party for two hours alone?  Is this a cultural thing?  Is it age related?  When my kids were younger, I had big events with bounce houses and arts and crafts booths and all the parents stayed and enjoyed getting to know each other.  I, like my partner, will never host a birthday party again in my own home.

Thoughts?  Experiences?  I think this is insanity.  Am I the crazy one?

Guest post: A hard decision

My parents emigrated from Korea to America with hope of providing a better future for their unborn children. Fast-forward 28 years later and here I am, the product of their sacrifice.

My name is Geri. I guess we can add the M.D. after the name since I have graduated from medical school 2 years ago. I am currently a radiology resident. After 4 years of college and 4 years of medical school, I am about to start year three out of five in order to complete my residency to become a board-certified radiologist.

Somewhere in the middle of this process, I met the love of my life and we got married 3 years ago. He’s also a resident in the field of orthopedic surgery. If that wasn’t complicated enough, I got pregnant. I spent my maternity leave in Orange County with my parents, which was the hardest thing I’ve ever done. The anxiety of becoming a new mom was compounded with the idea of going back to residency. Simply put, the hours and demand of residency was just incompatible with raising a child. 

It was then my mom sat me down and said “Leave Chloe with me.” It sounded crazy but she was right. There was no other way to do it. It was the hardest decision I’ve ever made. 7 weeks later, I left Chloe in Orange County to resume my residency.

When I returned, everything changed but nothing changed. Residency is still residency. There is work to do and an endless list of expectations. I feared judgment from other people. How can a mom be away from her baby? This one was the worst. My husband was given the “advice” that he had too many “distractions” and what he really needs is a stay-at-home wife who can fully support his career. That one really got to me. 

Yes. I am a doctor. I am also a mom. I am also married to a doctor and no I am not going to end or put my career on hold. I put in my time too. I deserve this just as much as he does.

But…there is a huge but. This is not one of those feminist proclamations where I say I can do it all. Becoming a mom changed my life. There’s nothing more I want to do than spend time with Chloe but I know completing my residency is what’s going to allow me to be an even better mom and role model to Chloe.

My life in a nutshell exemplifies the sad truth that women can’t have it all. As a mom to a daughter, this is not what I want to say, but I don’t say it with pessimism. There’s just too much on my plate. When I am in a place where I get to choose what stays on my plate, what does stay on it is what really matters. In my short five months I’ve been a mom, I already know that yes, I love my job and I love being a doctor but I was born to be a mom. I’m not a superhero. Every day I have to remind myself this is just temporary and that there will be a day that I get to set the work-life balance. Yes, I may never be a pioneer in the field of radiology but I will be there for every birthday and Christmas for Chloe. There will be family vacations and impromptu mother-daughter dates. I will know the names of all her friends and teachers. I am going to make up for all the lost time during residency.

On the outside it looks like I have it all, including a future career as a radiologist, an orthopedic surgeon for a husband and a wonderful mother who’s taking care of my beautiful, healthy baby, but I don’t. The guilt kills me every single day. I am extremely grateful for what I have but nobody, including myself, has it all. Residency just exacerbates the challenges that any working parent faces and even when I’m done, I know I’ll be constantly making adjustments and sacrifices, but I have made the choice early on. Family will always come first.


Geri blogs at www.chloeandresidency.blogspot.com.

Easy Fashion Tips to Avoid Dressing Frumpy

I’m not sure I've ever had a “sense of person style.” In my life, I went straight from private school uniforms to medical scrubs. We'll just ignore college, which consisted of a mash up of baggy jeans and Pearl Jam t-shirts.

When I started practice 8 years ago as a very young looking 30 year old, I attempted to dress older to appear more professional. My interpretation of this was solid dress pants with men's style dress shirts, both starched to the point they would stand on their own.

Over the years the patients have slowly stopped asking me “if I’m really old enough to be a doctor.” I'm maturing. There are a few 'wisdom lines' around my eyes. Yet, I remained in my easy fashion rut. Then last summer, one filter-free patient came right out and said it,“Dr. RH+, your clothes are too plain and boring, you need to accessorize.”  Not exactly what you want to hear first thing on a Monday morning.

At first I blew off the comment, truly I wear lots of different colors…. of brown, I thought indignantly.  Later that day, I noticed a headline on one of the magazines in my waiting room: “How to know if you dress too old?” I reluctantly picked it up, only to discover I was sadly answering yes to nearly every question:

Do you wear matching twinsets? yes

Tan panty hose?  yes

Matching shoes and bag ? yes

No jewelry? yes

I realized I needed to get with the times. My ‘professional’ wardrobe from 8 years ago needed a lift. Having recently reached a fitness goal, my current clothes were a little big, so what better excuse to do some shopping. Only I have neither time or fashion sense.

Over the last year I've set out on a mission to update my look. Here's what I tried to get with the times that has required the minimum amount of time and effort:

Pintrest. I hate fashion magazines. I find them overwhelming, but Pintrest is a beautiful stream of adorable clothes and outfits. It's filled with real life ideas and models who aren't anorexic. It's much better digital entertainment than Facebook or Twitter.

Gut Your Closet. This is a hard, but necessary step. As I cleaned out my closet I discovered I owned 5 dark brown sweaters and I'm embarrassed to admit to you how many pairs of brown pants I found. Get rid of anything that doesn't fit or you haven't worn in 5 years. If you don't love it and it's not a staple, then chuck it.

Schedule a Haircut. If your hair still looks like your high school yearbook picture, you may need to get with the times.

Shop with a Plan. When you do get precious moments to shop, use them effectively. Use your pinned images or a running list of staples on your phone. Don't forget to try on everything. If you're like me, you never get around to taking things back.

Ditch the Mommy Jeans. Buy your t-shirts at Target, but high end denim is worth the price. Don’t believe me? Then check out this site. When you shop for jeans take the most honest person you know and try on several styles until you find what works for you.

There are Other Stores besides Ann Taylor. Ann Taylor is great for staples, but for me a least, I just got stuck buying different shades of brown pants every year. Venture to the other end of your mall. No time? Try online stores like  Boden and GarnettHill. Though I'm still not sure if I'm hip enough to shop there, I love Anthropologie as well.

Accessorize. My husband bought me a lovely pair of simple diamond stud earring for our 14th wedding anniversary and they have not left my lobes for the last 3 years. Jewelry seems too complicated for me, but I have really tried to make an effort over the last year. Honestly, I like to BUY scarves and necklaces more than I like to wear them, but I'm trying. This is another place where I have found Pintrest to be helpful, if I'm not sure how to accessorize, I can usually find some excellent examples there.

Stitchfix. The discovery I most excited about is stitchfix. This is an ingenius company where an online stylist sends you a box of clothes to your house whenever you like. You try everything on, keep what you like and easily return for free what you don’t. When I see the box on my porch each month, I literally squeal with delight. You initially fill out a style quiz, give them your measurements and price range and that's it.


I doubt I’m the only doctor mom, who has neglected her own wardrobe over the years as she slowly managed to spend most of her shopping time at Target and Gap Kids. I have also found a little piece of myself along this journey that I didn’t realize I’d lost. With years spent immersed in the roles of doctor and mom, with most of my focus on caring for others, I think I was starting to lose a little of my spunk. As I’ve made a small effort over the last year, I definitely feel more put together with an added spring in my step.I’m sure I won’t be walking the runways anytime soon, but I do get compliments on my appearance rather than suggestions for improvement.


What stores do you find that work best for you? Do you have specific fashion blogs or people on Pintrest that you follow who give you great ideas?

{Sadly, this is not a sponsored post, these are only my honest opinions.}

Guest post: Who do I beep?

I'm a Internist and a Nephrologist (in my country, first you must go through Internal Medicine Residency and then through Nephrology Residency to finally become a Nephrologist). And since I  enjoy getting my hands dirty, I work more-than-sporadically as an ICU resident. I'm also the proud mother of a 4 1/2 month old.

One of the things I love about ICU is protocols (and of course the possibility of breaking them as needed) and the support you get from other areas of medicine. For instance, having gone through Internal Medicine and Nephrology residency, I find myself quite comfortable with vascular access. If by any chance I fail at establishing one the old fashioned way, I always have my faithful portable ultrasound by my side. If that doesn´t work, well, I can  beep the anesthesiologist on call, not without being absolutely embarrassed, but hey, the job has to be done. And if the anesthesiologist has a rough time placing the catheter (which I secretly hope, that way I feel less like a failure) or if he misses too (which of course I do NOT hope for), the vascular surgeon will do.

But now, I find myself with a four month old low weight infant. I went through a C-section due to IUGR and Preeclampsia and babyboy was born weighing 4 pounds. He has recovered quite well but still is below average. And he only dreamfeeds! When he is awake, he is so distracted by the world around him he will only feed 1 or 2 ounces at a time. No matter what I do, I can be standing on my head, singing, waving all his toys in front of him, or feeding him in a dark quiet room, nothing works. Needless to say, he rejected my breast almost a month ago.  And when he dreamfeeds he always eats less than he should.  Also eating so little by day, even If I give him a last 23:30 bottle, he still wakes up several times at night. The good nights at 4 am and 6 am, so we start the day at 6 am. The bad nights.... well at 2, 4, 5 or 6 am...

I´m the kind of person who always believed that you could accomplish anything if resourceful enough, but this little person, my little "bundle of joy" has my whole world upside down

How do I do it? How do I "get the job done"? How do I get him to be hungry enough to finish the bottle, to sleep more than two hours a night without waking? Who do I call, who do I ask for support, ..... who do I beep?

And the answer is no one; in this one I´m alone by myself (my dear hubby helps a lot, but let's face it, he has less patience than I do). And that is probably why, and hopefully why, I´ll end up being a better mother than a central-venous-catheter-placer