MiM Mail: Defer or start medical school with a newborn?

Hello MiM!

I am a mom of two kids - one in school, one starting next year - currently in university in and applying to medical schools in Canada. MiM has been an inspiration since I started working towards a career in medicine, and I am thankful for all the stories that have been shared here.

To get right to the heart of the matter, I am pregnant with our third child and due in late August. I'll likely be delivered 1-2weeks early due to my history, so by the start date of the med schools Kid 3 will only be a few weeks old.

Acceptances come out in the spring, and I need to decide (if I get in!) whether to defer for a year or whether to start med school with an infant just a few weeks old at home, which will also have meant a big move while 7-8 months pregnant. I would imagine, in the circumstances, I could likely get permission to do the first few weeks' work from home, something I have heard of med schools allowing before.

My husband will be taking eight months parental leave for Kid 3 in addition to any leave I take, so we won't have to deal with putting a tiny infant in daycare and I will have help at home during that transition time.

I am hoping to hear from MiMs who have experience with having babies during first year. I have a few months to mull over my options, and if I don't get any acceptances it won't be necessary to worry, but ultimately I would prefer not to take an entire year off from my education if I could be okay with just taking a few weeks at the start of the year.

Your input is much appreciated!

Thank you,
MiM in Canada

MiM Mail: Advice for non-traditional mom

Hello and thank you for your blog! I am wondering what advice you might give for a slightly older mom considering medicine after the baby-phase. My husband and I are both teachers at an international school and we are looking to transition to living back in the States near our families. I am considering applying for medical school for the fall of 2016 and have completed all the prereqs, taken the MCAT, and have all my letters of rec on file.

We have four children, ages 12, 10, 5, and 17 months. I would start medical school with my oldest beginning high school and my youngest being three years old. I am in my late thirties, and investing in a career in medicine would combine my pure love of science with a passion for extending the tremendous care-giving roles I have had over the years.

I have hesitated to go down this road because of the tremendous financial investment as well as the time required, but I have loved my various experiences in health care throughout my career up to this point. I would love any personal advice on whether this path is worth it!

Thanks,
Sara

Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.

-juliaink

MiM Mail: Med school with young children

My name is Megan. I have 2 children. My son is 2 1/2 and my daughter is 7 weeks old. I am only 20 years old.

When I was younger my dream was to become a physician, specifically an OBGYN. When I had my son at the mere age of 17, I figured that dream was over. I decided to settle on nursing with the hopes of becoming an L&D nurse. I started going to school; while taking pre-requisites for the nursing program, became a CNA. I started working as a CNA at a hospital and had my daughter when I was 19. Having a second child while still being a teenager didn't stop me from going to school. However, working in the hospital made me realize: I DO NOT want to become a nurse. Most of the nurses complained about their jobs, seemed bored, and I did not want that to happen to me. I want a fulfilling career that makes me reach my full potential in life. I didn't want to just settle.

So I decided to go back to what I really want to do in life: become a physician. I am really determined, and very excited, but it seems like everyone around me can't stop telling me how hard it's going to be.

I guess I'm writing this to ask for support and advice from mothers who went to med school with young children. My kids will be 5 and 3 by the time I start med school. Any support and advice is appreciated. And another question, did anyone with young children have anymore kids later on in life? I'm not sure if I'm okay with being done at 2.

Thanks in advance.

I'm too old for vacation care!

It's arrived.  The 12.5 year old boy child who already thinks he's 22 and in charge of his own life. Occasional glimpses of my sweet, tender, gentle boy peek out between the lashes of the billy goat gruff.  Sigh, always knew it was coming, still a shock when it's here!

 My problem, however, is not BGG, for I know it too will pass.  It's actually vacation care.  Entering high school next year, vacation care no longer exists!  The problem is, not only does he have a 9 year old sister, who will still require vacation care, but I actually think he's too young to be spending vacation days at home alone.  All that unsupervised internet at the very least.  He wouldn't be allowed out of the house, so I'm not so worried about his wandering the neighbourhood, although it's a slippery slope, and I'm sure it wouldn't be long before "Mum my can't I meet my friends at the wherever?"  The other issue of course is little girl then feels hard done by, if BGG is allowed to stay home, and she has to go to vacation care.  Another Mum at my work faces the same dilemma - her eldest is a girl, and she has two younger siblings.  Her daughter is already telling her she's too old to go to vacation care - at least my son hasn't cottoned on to that just yet, but I know it's coming (I wonder if I can still sneak him into vacation care with my daughter?)

I know many have trodden the boards before me - what does one do when vacation care disappears?
Or are the apron strings too tight?

Vacation care is an Australian version, I think, of Summer Camp - run by the YMCA (and other places), for days when school is not on, and held Monday to Friday of all school holidays (breaks?).  It's for ages up to 12 years and held at your child's school.  It's day care only, dropping off each morning, picking up each evening.  

Group think: What is the solution to the overwhelm?

It's 5:51am and I have 9 minutes to write this post. Well, I just spent a minute thinking about what I want to say and so now I have 8 minutes.

Lately, it's been feeling like I just can't do all the things I want to do, let alone all the things I've already committed to do, let alone all the things I have to do. This last year of residency has been a great one and I've become involved in many different projects that I feel passionate about: research, education, resident wellness. I feel an increasing sense of clinical mastery, which basically means I know what I know and also how much I don't know but it doesn't scare me as much. I've been active in my synagogue and at my daughter's school. I feel like all the pieces of the puzzle are, if not falling into place, at least face up on the table and waiting to find their place. But it seems like there is at least 100% if not 200% more to be done in every day and week and month than I can do.

Every email I write starts with the phrase "Sorry for the long delay in my response." Balloons that were up for my daughter's birthday party two weeks ago are still up and the stack of Thank You cards for her gifts still sits blank on the cluttered ledge between our living room and dining room, along with unopened mail and other flotsam from our stitched together life. I've been getting up one hour earlier than I have to for the last month to try and get on top of some of the research and scholarly work that I want so much to get done, and this has been helpful, but I'm so exhausted by the nighttime that I feel like I am not the kind of parent I want to be to my daughter in the few hours we have together during the work week -- I'm easily frustrated, less playful, and distracted, just waiting for the moment when I can lower myself into bed. I fall asleep in literally 5 seconds. The cost of starting a couple of new projects -- all of which I am excited by -- is that I'm spread thin on all of them, taking weeks longer than I promise to get things done, always twenty or thirty items deep on the to-do list. If I feel like I'm a leg up on the work side of life, I'm one step behind on the parenting side of the equation, with friendships and marriage and housecleaning and family always tap-tap-taping at my chamber door. And did I mention the emails? Oh, the emails. How and when will I master the emails?!

Sometimes I wonder to myself: Are we busier than people used to be? Am I uniquely incapable of multitasking? But wait, all I do is multitask. And is the overwhelm an external reality or is it a reflection of something about me? Would I be overcommitted and frazzled even if I were shipwrecked on an island with nothing but palm trees? Should I be doing fewer things? Or maybe this model of living is a successful one -- after all, in the end I do manage to do a lot and much of it at the "good enough" or even "good" level. But I long for a little peace.

I'm already over time by 9 minutes and 9 minutes and late for the shower that leads to throwing some kind of lunch in my bag that leads to hitting the road, so I'll pose my question and see what your thoughts are. Does anyone out there have creative strategies for getting on top of the overwhelm?

Thanks in advance for your thoughts!

MiM Mail: Year off

Hi MiM Community!

I am in the middle of a year off, and at a bit of a crossroads. I got pregnant with my second child in the middle of MS2, took the Step 1 7.5 months pregnant (not recommended), and gave birth at the end of August. My school told me that I would only be able to take 6-8 weeks off max (8 was stretching it) if I wanted to continue with MS3. If I wanted/needed more, I had to take a year LOA and come back next July to start rotations with the next class. When I had to be off my feet during my 9th month, I decided to just take a LOA and enjoy my year off with my new baby and toddler.

I'm now 4 months into the time off and unsure what to do. I have been dabbling in continued research, but my heart is not as into it as I thought it would be. I do miss school and really look forward to going back and finishing, but all the plans I had for this year pre-baby (research, volunteering) just doesn't seem as exciting. Is it so terrible to just be a mom for a bit? Am I selling myself short for future residency applications?

I did OK on step 1. Not great, not terrible. I am not necessarily interested in a very competitive specialty, but I am very geographically limited (to basically the one big city I am in now) due to the abundance of family and support, and my husband's job. I know that this is my last chance to take my older daughter to ballet, join mommy groups, take my baby to music class, etc. Can I just enjoy my time without feeling guilty about not progressing my medical career? Or is that just not realistic and I should "get my act together?"

Thanks again for being an amazing community!

-Boxes

I am a MS3- to- be with a 2.5 y/o and a 4 month old. I love having an active lifestyle and looking for interesting things to do with my family around our wonderful city.

I Don't Know How To Dress Myself

And I know I'm not the only one...

I was thrilled to see a physician-mom address this in the Atlantic: The Clothes Make The Doctor, by Anna Reisman. In this thoughtful and humorous piece, she describes how she met with a potential new primary care doc, and was put off by the sharp-dressed woman's stiletto heels and expensive suit. She then explores how physicians should ideally dress, and thus, present themselves.

She hit on a perennial topic of discussion and debate amongst my colleagues, both male and female. Male colleagues bemoan that they are expected to wear a collared dress shirt and tie, day in and day out. But female colleagues complain that they have no real "dress code", and thus, no guidance, on how to dress for patient care.

In my office, which is an all-female practice, the "work uniform" runs the gamut from: clean and pressed white coat over smart dress suits and heels, to dress suits and sensible shoes without the white coat, to business-casual with or without the white coat, and then, to me.

I'm usually in whatever Bargain Basement Clearance Store pants with less-dirty knit top and scuffed sensible shoes I can match when I get dressed in the dark at 5:30 a.m, with a reasonably clean white coat pulled over it all, like a disguise. I can't remember the last time I ironed anything; I think it stretches back a decade or more. I buy all permanent press or knit clothing. If something needs to be dry-cleaned, it's a once-a-year piece. Sweaters, slacks, scarves- they all must go into the washer and dryer, or be relegated forever to the back of the closet. This all is, I feel, most practical. Who has time to fuss over clothes?

I also LOVE a bargain. And while there are women who can browse Nordstrom Rack or Marshall's or TJ Maxx and put together respectable, even snazzy, professional outfits, I am not one of them.

Still, I can't let go of my old habits. In medical school, we had an informal group of women about the same size who met occasionally to "swap": everyone brought a bag of clothes they didn't want, all higher-quality stuff, and we had a party as we tried on each other's stuff. Everyone left with a "new" item, and the leftovers went to charity. If someone I knew suggested this today, I would so totally be there!

I even found my wedding dress, a 100% silk designer ball gown with an impressive train, for $250.00 at the Filene's Basement Run Of The Brides Traveling Sale, back in 2008. I considered it the find of the century, a total coup, and I told anyone who seemed like they cared how much I had spent.

I still have had no qualms with rooting through school fundraising secondhand clothing sales, and leaving with large bags of the clothes of people who are probably my neighbors.

I think some of my reticence on spending money on clothes stems from the fact that I've gone up and down ten sizes within the last five years. Yes, there were two pregnancies in there, but the ballooning waistline was not due to gravidity. It was due to the fact that I gained an unbelievable amount of weight with each pregnancy, on the order of sixty pounds, EACH TIME. Three months after my second baby, my daughter, was born, I realized that I had even GAINED weight while breastfeeding. My BMI was over 30. I was OBESE.

Then, with a two-year-long concerted effort at a low-carb diet and exercise when I could get it in, I lost fifty pounds. Babygirl is now almost three years old, and I've kept the weight off for almost a year.

Despite being back to my pre-pregnancy weight and size for this long, my closet is still filled with a mishmosh of sizes, and alot of "more comfortable" pieces, like Ponte slacks (read: knit pants). A friend and colleague recently pointed out to me, in a humorous way, that Ponte slacks are in the same category as yoga pants. Meaning, not acceptable work attire.

Unfortunately, in order to dress well, one needs two things: Time, and Style sense.

I know I will never have the time or inclination to study fashion magazines or follow style blogs. And for some reason, when I see someone who I think is dressed really well, meaning, how I'd LIKE to dress, I can't seem to replicate their look (probably because of my clothing care learning disability.)

But, I still want to look like a real, respectable, clean, practical yet SOMEWHAT stylish physician. Someone who is aware that it's almost 2015, but who is also willing to kneel down on the exam room floor to look at a patient's diabetic foot ulcer.

I know, I know. Time to grow up, learn how to iron, make the dry cleaners a regular weekly errand.

I also need a personal shopper. I have seen this mentioned on prior MiM posts (that I cannot locate right now), and people have suggested Macy's, as they offer those services free of charge. Of course, to take advantage of that requires several things: Making an appointment, taking some time, and investing in attire.

Sigh. With two children under age five, a working husband who travels alot, and boards study on the agenda every day, these things are not likely to happen anytime soon.

Tomorrow will dawn, and I will likely be pulling on a wool blend turtleneck, my black slacks with a little elastic in the waist, and Danskos.

But I will be comfy...

-Genmedmom

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!

T

Daycare better than me?

Last year, when I was on call a lot and very busy at work, I couldn't get enough time with my babe.  I always wanted more, more, more.  And I still feel that way--about the time I spend with her.  But lately, I've been feeling like I just don't do enough.  When I'm home, I sometimes just want to relax--I don't always want to be doing educational activities, or practicing walking, or force-feeding her.  Sometimes I just want to be at home with her and I don't want the work that comes with it!

But because we now have a nanny who does not provide much educational content during the day, when I get home I feel that I need to do more with her.  And because she is home all day, it's always up to me to provide healthy nutritious meals that are variable enough for her that she actually wants to eat them.  I frequently don't feel that I do a good job in either of the above aspects and I wonder if I would be better off sending her to a daycare where she is exposed to learning and a variety of food and time to play outside and when we get home, we can just spend time together and cuddle and kiss and love.

I know now for a fact that if I was a stay at home mom, I would not be a good one.  I just don't have the energy it takes to provide my Doll with all that she needs!  I'm grateful for my job, and I always want more TIME with my baby, but I just want it to be quality time where I'm not stressed with her.

Does anything I'm saying make any sense?

I am starting to hate the holidays

A few years ago, I made a post that really bothered some people, suggesting that people who have small children get first picks for holidays off, because it may be difficult (or possibly impossible) for them to find childcare. Several people suggested to me that I was a… well, I don't want to use language on this blog, but let's just say a selfish female dog who should probably be fornicating with myself.

I don't want to stir the pot but I will give my experience trying to find coverage for the upcoming holidays when I will be working:

--me: working
--husband: working
--Schools: closed
--afterschool program: closed
--daycare: closed
--babysitter 1: Will be in church and at family functions
--babysitter 2: traveling for the entire holiday
--me: screwed

I'm currently putting together a piecemeal of various elderly grandparents coming by to watch the kids, and working out a plan to come to work at odd hours. It's hard, to say the least, despite the fact that I actually have a very flexible job.

I know I can't be the only one with this problem, yet it's clear that everyone feels really angry about the idea of making any accommodations for people with childcare needs. Maybe a better plan would be for there to be some sort of reliable group childcare out there for people like us (e.g. healthcare workers) who will be working at least some of the holidays. Because right now? The options suck.

I'm Thankful for a Bridge

photo credit WSMV

Three months ago, I woke up to the buzzing of news helicopters over my house. This is not a common phenomenon in my secluded suburban neighborhood. I quickly checked the news and learned that a terrible tragedy had occurred. During the night, a tanker truck full of gasoline had crashed into the bridge that connects my neighborhood to the interstate, causing a massive explosion. Only a month from retirement, the driver of the truck sadly lost his life. As I said a prayer for his family, I also said a prayer of thanks that the accident hadn't occurred during rush hour when hundreds of lives could have been lost.

Later that day, I learned that the explosion caused structural damage to the bridge. It would have to be replaced. Fixing this wasn't merely going to take days, but 3-4 months.  As the reality of being "bridgeless" sunk in, the feeling of dread deepened. This was the bridge that linked us to all the elements of our life: work, school, shopping, church. Our world was about to change. 

I normally have an 8 minute commute to work. With the bridge out, I now must take the winding back roads for 25-30 min. to get to the hospital. Getting the kids to school would take an extra hour a day. Many of you are rolling your eyes at this, as your commutes are likely much longer. However, my location is a big part of my well oiled routine that keeps me sane. 

Early in my "bridgeless state," I had a premed student who shadowed me for a couple of days. The small community hospital where I practice, isn't a teaching facility so I don’t interact with students very often, but this young lady was simply delightful. She was reapplying to medical school this year after failing to get a spot last year. She was compassionate, intelligent and her MCAT scores were higher than mine had been when I applied. I couldn't believe that she hadn't gotten in yet. 

I realized that I've been at this long enough, that I have forgotten about the angst filled years of simply trying to get into medical school. I determined to use my extra commute time, to reflect on gratitude, rather than wallow in self pity over my silly inconvenience.

I have, for the most part, kept my good attitude. While still annoying, the commute hasn't been as bad as I thought. It makes me triple check my grocery list, because there are no convenience stores nearby. And rarely do we eat out for dinner, because it takes too long to get home. The worst part has been missing extra time with my kids. My short commute usually alloys me to run home and tuck my kiddos into bed, even when I'm on call, but no so much these last few months. 

  

In this season of gratitude, I am thankful for two very simple things:

I am thankful that 17 years ago, a committee somewhere said yes to my medical school application and gave me the privilege of being a doctor. 

I am especially thankful that this morning {insert drum roll please}I drove across the NEW BRIDGE. I'm thankful to have my short commute back. I promise to never take that silly bridge for granted again.

What seemingly mundane items are you thankful for this year?

An extra cup at the Thanksgiving table

As a pediatrician-mama, I find that Thanksgiving is -- to use a timely cliche -- easy as pie. I don't have to search my mind for even the shortest moment to access my gratitude place: My child is alive and healthy (*gods, do not be tempted by this statement*). The ocean of gratitude I feel for this has no bottom. I am aware of it dozens of times in the course of my day taking care of sick children: How lucky my partner and I are. How tenuous and temporary and fragile our luck is. How we can claim no credit for this fortune. There are many, many other things I am grateful for, but even if all those other things evaporated, this one thing, this everything, would still fill me up on Thanksgiving day and every day.

Yesterday, as a pre-Thanksgiving treat, my partner came and picked me up from work so we could pick my daughter up together from school. It was a gray, cold day and little specks of icy rain were making it hard to keep my eyes open as I waited just outside the entrance of the hospital. I'm on Jeopardy call all weekend but if I'm not called in, I get to have four days with my family in front of our slightly creepy ventless gas fireplace. (Where does all that CO and CO2 go? Whatever -- pass the pumpkin pie!) So I closed my eyes and sent a surge of warmth towards each of my co-residents, wishing for their well-being and the well-being of their families. Sure, it started from a place of self interest and humor, but then it felt good and right to be sending them little non-denominational blessings in honor of the holiday. There is a special place in my heart forever for the people I am training with -- a certain affection and protective instinct and a huge folder of moments in which these people have awed and inspired me, sometimes unexpectedly.

Then my mind turned to all the families I have cared for who are without a child this Thanksgiving. The babies who never made it into the world, the babies who stayed for only a few hours or days, the babies who left this world after a long struggle in the NICU, the babies who arrived to our ED in the early hours of the morning already cold and pulseless, the children whose otherwise healthy lives were shortened by cancer or trauma, the children with chronic illness who were in and out of the hospital for months or years before a cold or stomach bug proved to be more than they or we could fight. Then I thought of all the children whose lives have been shortened by war or preventable or treatable disease or famine or -- this week especially -- by racism or homophobia or genocide or hate-motivated injustice of any kind. I thought of their parents and the huge, gaping unfairness of what they were given by luck, or the universe, or God, or just random chance, depending on what you believe. I wondered how they go on with things like Thanksgiving. Would I be able to? In Judaism, when someone dies, the thing you say to the people who love them is: zachur li'vracha. May their memory be a blessing. And so, my eyes closed against the rain, I sent this out to all the parents who have lost children: May the memory of your children be a blessing and may there still be things to be grateful for.

On the Jewish holiday of Passover, we leave a cup of wine out on the table for the prophet Elijah. The teaching is that Elijah will one day come as an unknown guest and you want to be ready to welcome him. This year at my Thanksgiving table, I'm going to leave out a cup for all the parents who have lost children, that they may know they and their children are not forgotten. That they should feel welcome back into the rhythm of ritual and community, whenever they are ready. Also, that we may never take our good fortune for granted. And that we may fight in whatever way we can to prevent parents from losing children needlessly.

Happy thanksgiving to you and yours today, from one mama to another! And a special shout out to all the mamas who are taking call today so that others can be with their families -- Thanksgiving is whenever you get home!

-Also posted at whatbeginswithm.wordpress.com

Vacation sans bebe

I read a few articles recently about Americans and vacationing. Of the only 25% of Americans who have paid vacation days, they have an average of 3.2 days left unused each year (OECD, 2013).

Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.

Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).

Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!

(scrambled eggs, french toast, and large mimosa from Slim Goodies)

Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.

(crawfish on grits, from Cafe Reconcile)

And the tie for best dinner - Bacchanal Wines and Houstons.

Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.

My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.

And then the CHICKEN arrived.

Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.

(courtyard at Bacchanal Wine, image from http://fleurdelicious-nola.com accessed 11/1/2014)

Beignets - and on our last night in NOLA, we toured the city, stopping in shops. Eating. Drinking alcohol-containing beverages in plastic cups while walking (crazy that you can do that legally in NOLA). We ended the night on the banks of the Mississippi eating beignets from Cafe DuMonde with B and R. We heard approaching music as a first-line band leading a wedding party approached. As is the customary, we all stood up and joined in dancing and singing “As the Saints go Marching in” under the twinkling night sky.

Here’s to the best vacation sans bebe, NOLA, we love you bebe!

(Voodoo Tour, St. Louis Cemetery #1)

Our recommendations for excellent food in NOLA:

Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).

Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.

References:

An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.

Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.

Work-life balance. Accessed Oct 16 2014.

MiM Mail: Middle of career life crisis

I feel like I am in the middle of a career-life-crisis.

I am a mother to an almost-3-year-old, and a 9 month old. I am an OB/Gyn. And, I love being both.

After residency, I joined a large private practice. Even after I had my son, I was fairly happy with my schedule. I worked about 3 1/2 days a week in the office, one day on call per week, and one weekend on call per month. But, I thought it was a pretty good life for an OB-Gyn. I sometimes missed holidays, wedding anniversaries, and important family events, but realized that those things came with the territory. After all, babies don't take holidays from coming into this world.

About two years ago, we moved to our home state to be closer to family. In doing so, I changed career paths. I now work as an OB hospitalist, doing about seven 24-hour shifts per month. It's a different role than I ever thought I would have. I see patients in the hospital that have no physician and take care of OB emergencies when their on call physician cannot make it to the hospital in time. In short, I still get to deliver babies and help women in emergent obstetrical issues, which is very rewarding. And, I get to have a lot of time with my children. Now, for example, when we sign up for a 2 week swimming class, I only miss a couple classes, whereas before, I would have only made it to one class. I get to go to the park, the zoo, the mall carousel, and all the daily little things that a lot of mothers in medicine have to miss out on.

I feel guilty even saying this, but when I first transitioned to this job, I definitely had to adjust to being at home so much. I felt guilty at times, because there were definitely moments when I (and my son, for that matter) felt bored. I would call my sisters and ask what they do each day with their kids. But, now, we have gotten into our groove. We have play dates, learning activities, favorite fun spots, and of course, naptime. So, before I know it, the day has passed and we are on to the next. And, just when motherhood starts wearing me out, it is time for me to go to work the next day. And, actually, it is a nice break to get away and have some career time. My 3 year old son asks every morning if I am a doctor or a mom. With this job, most days I spend "being a mom", and only some days do I spend "being a doctor".

So, what's the problem? One of the reasons I went into OB/Gyn was the hospital-office balance. I loved forming long-lasting relationships with patients that continued throughout life stages, multiple pregnancies, and through difficult diagnoses. There is something about delivering someone's baby that bonds you to them. You become important to them. It almost feels like you should be invited to sit at their table for Thanksgiving dinner. And, now, I don't have that relationship. So, I keep looking at job opportunities and wondering if I should return to private practice so that I can have relationships with my patients like I had before. The thing is, that if I make that career jump back to traditional OB/Gyn private practice, I will be giving up a lot of time that I have with my kids. So, I worry that I would end up in a "grass is not always greener" situation. I'm not as familiar with the business aspects of medicine, but to the best of my knowledge, it is difficult to keep a practice afloat (paying overhead, salaries, benefits, malpractice) in the OB/Gyn world and work only part time, so full-time it would be.

I know you guys can't decide my future. The truth is, that getting it all in writing is actually helping me process it all. But, any advice would be nice. Is it possible to have a part-time OB/Gyn practice? Should I just count myself blessed that I get so much time with my kids, even though my particular position as an OB/Gyn is not quite as fulfilling as it once was? How do I not feel guilty thinking all these thoughts?

Sincerely,
Confused mommy doc

McDonalds dilemma

For a long time, I was not willing to take any time for myself. When I had a day off, I would keep the kids home and spend the day watching them, dragging them along with me to errands and doctors appointment, and not taking any time to relax.

Recently, due to my high stress level, I've decided to compromise. When I have a day off, I keep my youngest home in the morning, then bring her to daycare for the afternoon, when she would be napping anyway. (My older daughter is in school)

Initially, this didn't work very well. She would scream and cry during the drive to daycare and be inconsolable when I left.  To the point where I would practically be crying when I left.

The daycare wasn't crazy about this arrangement either. They said it was very disruptive to have her come in and be so upset.

Finally, I had what I thought was brilliant idea. There's a McDonald's on the way to daycare, so I would stop by the McDonald's and get her a happy meal to take with her. I did remove the toy for later, but she got to have the rest of it.

And you know what? It really worked. She was so excited to bring her little happy meal to school with her, and after a couple of trials of this, she was no longer upset about my leaving.

Of course, it's never that simple.

Apparently, there are a couple of kids in the class who cry inconsolably when my daughter is eating her McDonald's happy meal because they are so jealous. The teachers have tried to arrange things so that my daughter won't share a table with them, but it makes me feel bad every time I hear about it.

It's sort of silly because it's not any kind of amazing meal. It's a few chicken nuggets, apple slices, milk, and a handful of french fries.  She doesn't even get a dessert, which many other kids have.  I mean, I have literally seen kids there eating Dunkin' Donuts donuts for breakfast.

The daycare hasn't said a word to me about it or implied that I shouldn't do this anymore. But I still feel a little bit guilty. But maybe I shouldn't worry so much about other people's kids and worry more about my own.

How Do You Discipline Your Kids- In Public?

Genmedmom here.

Last week, on my usual Thursday off, I was on kids' dropoff and pickup duty, and I had a very difficult time with pickup.

Both kids are in preschool: Babygirl, almost age 3, loves her Bright Horizons daycare/ preschool, and Babyboy, age 4, is becoming more fond of his public Special Ed preschool program, as his teacher has really connected with him. Getting them up/ fed/ dressed/ out the door is always a bit of a challenge, but manageable.

Pickups, however, are getting dangerous. And not just for me, but also for my mother, who is most often on pickup duty.

Given the timing of school dismissal, we need to pick up Babyboy first, and then swing by Babygirl's school. Since you can't leave a four-year-old in a car by themselves, he has to come in with us to retrieve his sister. For the past month or so, once inside, Babyboy finds something he wants to play with in her classroom, and won't leave. He gets obsessed with completing whatever project he's invented, like lining up the construction toys or building something with Legos. I get it, he's autistic, and tends to have these sort of OCD-like moments. If you try to stop him before he's done with whatever it is he's determined to do, he throws himself on the floor in a tantrum. A loud violent tantrum. Even when he doesn't engage in something in the classroom, when it's time to leave, he gets wild, and runs away down the hallways, laughing at me when I call to him.

Babygirl is also now commonly protesting leaving, and has thrown herself on the floor, or also run away, giggling.

All of this is totally disruptive. Not only for the kids in her classroom, but for everyone in the whole school, as my kids scream and shriek and wreak havoc. Heads pop out of doorways, teachers checking on us, kids asking what's going on. If I yell, I'm just contributing to the mayhem.

Last week was the worst for me. It was him running away, and her tantruming. We were in the hallway, me kneeling on the floor trying to dress Babygirl to go outside, as she rolled around screeching, fighting me. I gave up on forcing her into rain gear (it was pouring) and hoisted her up, flailing and screaming. Meanwhile, Babyboy was running up and down the hallways, throwing himself on the carpet and rolling around, laughing defiantly. I had to chase down my son, grab his arm, and struggle out of the building. This was while carrying Babygirl, her lunchbox, raincoat, and backback.

I lost the backpack somewhere (and didn't realize until we got home), probably when I opened the heavy door. I had to let go of Babyboy in order to open it, and as soon as I did, Babyboy bolted out, across the driveway, and into the parking lot. In the rain.

There were no cars coming at that moment, thank God. But I yelled and yelled: Get back here! You hold mommy's hand in the parking lot! It was a safety issue. I had to get him and us out of the driveway and the parking area, and into the car. I yelled, I threatened, but he would not cooperate. Then Babygirl hurled herself down and I had to wrestle her back up, while attempting to run after a defiantly giggling Babyboy. The more I yelled, the worse he got. I caught him, and fairly dragged him to the car.

Finally, I jammed Babygirl into her seat and buckled her in- safe at least! And threatened to do the same for Babyboy. He got in his seat.

I was fairly shaking by the time I got into my seat. My throat hurt from yelling so much. It was so embarassing... What do the teachers think? What do other parents think?

"You both were very bad today," I admonished. I wasn't sure what else to do. They're in the car, so can't do a time-out. I'm not sure a delayed time-out would be helpful. I think spanking solves nothing, and would look awful in public as well!

They've been much the same for my mother all this week. So me, my husband, and mother have talked about this. We're struck with the difference between the kids when they're together, and when they're apart. One-on-one, they're little angels. Barring hunger or naptime, when it's just one by themselves, they're model citizens.

And, occasionally, they're OK together. I've taken both kids to restaurants, just me and them, and they've been wonderful. Random elderly women have complimented us: "Good as gold!" "So nice to see such good behavior!"

We can't figure out why Babygirl's school pickup has become such a trigger for terrible behavior. Sibling rivalry, like, they're competing for attention? Normal toddler/ preschooler defiance, like,as their sense of self forms and they're establishing independence?

We have consulted with a child psychologist in the past, and we will again. But I know there's alot of experience out there. Anyone else sometimes struggle to control their kids in public? What sort of discipline tactics work?

Genmedmom

Guest post: United we stand, divided we fall

Editor's note: MiM contributor juliaink came across this blog post and thought it would make a good guest post here. The author was gracious in sharing it with us.


I was going to write about how new parents need to come together to create a “united front” when it comes to how they’re going to raise their baby, but because of a great thread I’m following on Facebook, my focus is beginning to soften and is more inclusive. There is a need for new parents to really hash out all the key points on how you intend to raise your children – before the baby arrives. If there are any big differences in your parenting styles, it would be best to know before your little person comes into the world to shine a spotlight on them! And if there are challenges between the generations, and there almost always are, it’s important for the couple to unite together for the sake of their own relationship. If a particular issue with a grandparent comes up, their child should speak directly to them about it – not the in-law child. This is just basic information that you’ve probably already figured out as a couple, but has special importance when you become new parents.

Having acknowledged all of this, the thread I’m following on Facebook talks about how grandmothers might experience postpartum mood disorders as their own daughters become pregnant and give birth. This was nothing I’d ever considered before, but makes complete sense to me upon hearing it. What a woman experiences during her birth will remain with her for always, her whole life. As a woman’s own daughter begins her journey toward motherhood these emotions and feelings from so long ago might begin to resurface. This can cause strain in the mother/daughter relationship as the soon-to-be grandmother revisits her own experience. If it was negative or traumatic for her, than there will be challenges that come along with this remembered event. If there were no real issues at her birth, there can still be some challenges or feelings of judgement if her daughter decides to do things differently from the way she did in her early years of mothering.

The same can be said for fathers and grandfathers. We live in a very different time with new research and lots of ideas about best practices during pregnancy, birth and parenting that just simply did not exist when our own mothers and fathers were on their journey. It’s no wonder that we have plenty of families having discussions with soundbites like this:

“When we were having babies, we just did it! What are you so worried about?”

“Well, that’s not the way we did it when you were a baby, and you turned out just fine, didn’t you?”

The health care system I work for has a fairly new class called “Grandparents Today” and it’s geared toward softening these conversations between the generations. It’s taught by a retired L&D nurse of 35 years on the floor who also happens to be a grandmother herself, so this is peer-to-peer education. The class brings to light all of the current information we have on how to keep babies safe when sleeping, why there is such an emphasis on breastfeeding, how and why it makes such good sense to wear your babies and have them skin-to-skin as much as possible, etc. The grandparents who take this class absolutely love it! They come back to their own children and school them about these best practices and everyone lands on the same page – at least about the things that are taught in the class.

I’d like to propose these two generations take this opportunity of bringing the newest family member on board as a chance to unite the whole family around raising this little person to adulthood. It’s a ton of work to do this job well – if you’re lucky enough to have your parents nearby and can count on them to assist with the day-to-day care of your newborn, this can be a lifesaver for you and your relationship. But even if they’re far away, relying on the wisdom that they possess – just from having more years on this earth than you – can be so helpful.

When talking with them about your challenges, try hard not to compare your situation to theirs. Yes, you might be going back to work full-time and they stayed home, but every parent works – just in different locations! Include your father in this new stage of his life without resentment – it was a different time and he was not encouraged to take part in parenting the same way you are today. If your mother never breastfed you, remember that as she’s learning right along with you, her words don’t mean to be unsupportive, she just might be feeling a little guilty about not doing this when it was her turn.

Having a new baby means stretching, growing and making room for this little person. Everyone examines who they are in relationship to this new life and it brings up stuff for each member of the family, some of it good and some of it not so good. Don’t assume anything in communication with one another. If the words you hear sting, instead of getting defensive, pause and try to imagine where their hurt might be coming from. Ask lots of questions. Look for understanding and common ground.

Having a baby does not have to be something that divides a family – it can be something that brings you all together. Being aware of these multi-generational challenges can be one way that you get closer to your own parents. Isn’t that something worth fighting for?

When you had your baby, did issues arise between you and your own parents? How did you handle them? Did the baby bring you closer together or drive you farther apart?


-Barb Buckner Suárez, a childbirth educator
Originally posted at Birth Happens

MiM Mail: Residency limit for leave and having children

First of all, thank you for this amazing blog that provides me with so much inspiration. It's so nice to hear from other women at all stages of training on their struggles and triumphs.

I'm specifically looking for anyone out there who had a baby during an anesthesia residency program. I'm hoping to have #2 while still in residency, but the ABA states that no one can take more than 20 days of leave per year during residency without making up the time. I know, based on my first little one (had during med school), that I will need at least 8 weeks, ideally 10. But I'm also poised to do a fellowship! Has anyone gone through this and found a loophole? Or convinced a fellowship program to let them start a month or two late? I feel that if we wait until I'm an attending, the age gap between our little ones will be too big (7 years).

Thanks in advance for your help!

The New Four Fs

Last year, I spent a couple of months doubled over with post-prandial pain after dinner. We’re talking pain that would sometimes incapacitate me, having to lie down while my husband tended to the kids and got them ready for bed. I’ve been lucky to be generally healthy so this was a fairly disturbing turn of events—was I now starting to fall apart physically as I neared 40?

It turned out to be a gallstone. A single but determined gallstone: too large to pass, too much of a drama queen to peacefully co-exist in my right upper quadrant. Of course, I remembered that mnemonic from medical school about the Four Fs of risk factors for cholesterol gallstones: Fat, Female, Fertile, Forty. This did not improve my “downhill” meme. As a 23-year old medical student, hearing that mnemonic involving 40 was downright depressing. That was my future: declining bone mass, fertility, metabolism and physical health. Awesome!

Back to those fun months of pain, I was given a referral to see a surgeon. I made a joke about the Four Fs and my meeting multiple risk factors. He shot me down, “Those are not true.” Hmmm. Apparently I never got the updated gallstone mnemonic memo.

Having recently crashed the “now 40” party, I have decided that I will ascribe to a new 4 Fs system going forward:

Fit, Fearless, Fabulous, Forty.

Fit. I am fitter than I have been in years. Sure, I don’t have the time or will to work out daily like in college and medical school (and probably that was a little pathologic anyway), but I have been consistently exercising about three times a week. I rarely have enough time (or will – time is not the only barrier) to do more than 30 minutes at a time, but I’m really proud of sticking to a routine even if I am traveling. My body is not built for running long or hard but it can do 2-3 miles if gently prodded without disintegrating into a rubble of bone fragments. As a family, we’ve taken to going to the nearby high school track on the weekend so the kids can ride bikes, run, or play while I do my laps. I have no lofty aspirations of marathons or anything of that high-achieving jazz but to stay committed to regular exercise for stress relief, brain preservation, and of course all of the physical benefits.

Fearless. I have had plenty of fear and anxiety in my life. Do they like me? What if I say the wrong thing? Who is that man on the bike path? What if I get pregnant? What if I don’t get pregnant? Why didn’t my husband call me at the agreed-upon time during his deployment? Etc etc. My goal now is to be more mentally strong. Easier said than done, but I think understanding myself better, having more internal security in who I am is the key – and that’s happening as I get older. I’m not trying to morph into a daredevil risk-taker (although, I did recently swing on a rope, suspended in the air by a cable, into a large aerial web of rope and climbed spider-style onto the adjoining tree platform – THAT was fun), but to doubt myself less, believe more. That brings me to the next F.

Fabulous. Fabulous is not just how you look but also a state of mind. It’s feeling amazing and worth it. I have outfits that make me feel fabulous. I have work that I engage in (particularly involving education, research and leadership) that I know I have talents for and thus makes me feel fabulous. Being able to make my family (children and husband included) individually and collectively feel loved and important = more fabulousness. No one can feel fabulous all the time, but doing things that make me feel this way as much as possible is my goal.

Forty. Forty is nowhere near downhill. I feel like I am at my height as a mother, as a contributing member of society, as a partner, as a physician, as a human. I would not want to trade places with my 20-year old or 30-year old selves, even if she did have higher bone mass, faster metabolism and better skin. I have come so far! (Products also help, skin-wise.)

So those are my new Four Fs. What would be yours?

Go vote!

Last week I got off early and took my 'lil bit with me to vote (aka "bote" according to her).  This is the second time in her little life that she's come with me to our local library to get her "Merican flag" sticker.  Now that she's almost 4 we had a little lesson on the drive over about how girls and people with brown skin like us didn't get to vote a long time ago.  She was adoringly APPALLED!  She said that the people who don't let girls and brown people "bote" were not acting "nicely." I agreed.  So, today, for all us moms in medicine who are walking paths blazed by amazing women before us - HAPPY VOTING DAY!!

MiM Mail: Types of practices and family life

Hello fellow Mothers in Medicine!

I am a senior resident in a medical subspecialty, about to graduate next year, and am in need of frank advice on different types of practices and having a full family life. I have a child under the age of 1, and plan on having a second child within the next few years. My specialty allows for some flexibility, and I think that either solo practice, small private practice, or hospital employment are all viable options. Ideally, I would like to work part time while my children are young. I am hoping to gain some perspectives on others experiences with the varying different practice types, what worked well for young families and what presented challenges. Thank you in advance for sharing your experiences and thoughts!

Guest post: It takes a village . . .

...and my village includes a housecleaner, a nanny, a back-up part-time nanny for on-call days, an amazingly flexible husband who works from home and one amazing non-medical friend I've made in this new city. Plus, in really important crunch times, a family willing to fly across the country for weeks at a time to care for my family so I can focus on studying. I come from a family whose resources definitely did not allow for hiring nannies or housecleaners, so I always feel a little self-conscious about it and hesitate to seek help, even when I know it’s needed.

Before medical school, and even during the first two years, I could usually balance the work of school with the work of home. Between studying for Step 1 and then starting 3rd year, with two young children, I realized something had to give! I finally accepted the fact that extra help was necessary, for my sanity and for my success in medicine. While I don't mind cleaning the tub or mopping the floor, I would rather spend that time playing with my children, hanging out with my husband, trying to maintain some relationship with my friends and family, and of course, reading, reading, reading for school!

Since I've relinquished control of keeping up with the cleaning, and since my husband has taken over the cooking (mostly), I'm amazed how much time and mental energy I've been able to devote to school. I'm also pleasantly surprised at how much this extra time to study has boosted my confidence on the wards and subsequently my performance. Meanwhile, at home, I'm actually more likely to tidy up and clean a bit every day, since I don't feel so overwhelmed with the amount of cleaning to be done. This makes my husband, a neat freak by nature, extremely happy. Historically, every woman who could afford to hired people to help manage the house, so why do we try to be superwomen today?

I'm interested to hear how other mothers in medicine have found ways to expand their village of support and if they noticed a difference in their professional lives. I’m also interested to hear if you received any negative responses from your family about hiring help?

Ley is a medical student with two children under age 5. She lives on the west coast and remembers enjoying running, cycling and camping before medical school happened; she hopes to return to those hobbies sometime in the next decade.

MiM Mail: Advice for a MiM-to-be

Dear MiMs,

I have to start by saying that I love that this exists, and I truly appreciate every post on here. I'm a senior in college currently in the process of applying to medical schools all over the country. I have a loving, wonderfully supportive boyfriend on track to becoming a nurse next year. I'll call him J. (Side note: he's not bothered by having a "lesser" career than me, he doesn't see it that way. Being a nurse allows him to pursue other passions that he wouldn't have time for as a doctor.) We have been together for years, and are planning on getting married and having kids down the road, but not just yet (we're young!!!). J will likely go back to our hometown for the year after graduation, and while I hope to end up at school there as well, I may be anywhere. J plans to move to wherever I am, once I'm settled in, though we may be apart for quite a while. I get a lot of advice from people with no experience in this arena, so I figured it was time to ask some who actually know what they're talking about... Is it crazy to get married in med school? Assuming an ideal world, when is the best time in med school/residency to have kids? Is there a best time? Right now I want to be a pediatrician, but many people (often well-intended, but lacking expertise) recommend dermatology, pathology, anesthesiology, etc., for better hours. For all I know, I'll love those when I try them, but my heart is set on peds right now. Has anyone sacrificed the preferred career option in favor of more time with kids? I know I'll want lots of time with mine, but I don't want to feel like I'm not living up to my potential. The work/home balance seems to be a constant and changing thing, but I'm willing to figure it out!

I hear criticism from all angles about my desire to be a mother and a physician, as well as my interest in primary care, and I would love some encouragement. J is supportive, but still a 21-year-old guy, so he's not always the most helpful... No need to sweep the bad parts of MiM-ing under the rug, just point me in the right direction to find a handful of great parts!

Thanks for being such an inspiration to this MiM-to-be!

E

Incentivizing Grades

I really don't think incentivizing is a word, but you know what I mean.

My daughter made it through the first quarter of middle school, and she's doing quite well. But I can tell that things aren't coming quite as effortlessly as they were for her in lower school. She seems to have an external locus of control about studying and grades - her friends that study just "know how to do it and I don't." I'm working on changing her worldview here - giving her more of a sense of control. I'm not really worried about her grades so much as her learning that effort brings results. Natural talent can only take you so far. I'm reminded of David Brooks' 2009 opinion article about 10,000 hours.

I get that organization is a learning curve when you go from having primarily one teacher to having a complex schedule that changes every day with seven different teachers. My daughter is very organized and is slowly learning to be tech savvy; the school posts most of the assignments and tests online.

Her dad and stepmom and I have recently been having discussions around putting incentives around grades - just to make her a little more motivated. She gets lost sometimes in back episodes of Glee on Netflix - a recently discovered obsession. I worry about putting incentives on grades but the more parents I talk to I realize that this is common. Some even put incentives on practicing sports and music. I'm primarily bumping into monetary incentives - like $20 an A at the end of each semester.

One mom told me, "I go to work because I get paid. Why shouldn't my kid get something for his/her effort?" I'm not sure I'd like my work quite as much if I didn't get monetary compensation but I do love what I do. And I've got to pay mortgage and bills and student loans somehow.

Any advice or thoughts on this subject would be very much appreciated. My feelings are all over the map.

Taking calls

I love my iPhone.  I take it with me everywhere I go: into meetings, into patient rooms, into the bathroom. (I don't use it in the bathroom, I swear.) 

Part of the reason I am so unwilling to separate from my phone for even a minute is that my phone is the only contact number that the daycare and the school have to reach me.

I assume when I get a call from daycare that whatever they are calling about must be vitally important. I'm immediately filled with terror until I answer the phone and discover that:

--my daughter was bitten by another kid

--my daughter bit another kid

--my daughter has a tummy ache

--my daughter is out of clean pants

--CONJUNCTIVITIS 

But it doesn't matter that the content of basically 100% of these calls has always been non-urgent. If I get the call, I feel like I have to drop whatever else I am doing and answer it.  So I excuse myself from the patient I am with or the meeting, and I take the phone call.  Then I apologize profusely when I return.

I'm sure in the days before cell phones, the daycare would be less likely to call me, knowing they would have to go through a receptionist or page me. But it is what it is.  

I suppose I could not take the calls if I am with a patient. But I'm pretty sure that I would be so distracted, I would be completely worthless. I mean, what if it's not just that they're out of pants? What if something is really wrong?

MiM Mail: Respond to the itch?

Dear Mothers in Medicine,

I am a 29 year old single mother of 2 boys, ages 7 and 3. I'm not in medicine as of yet, but about 6 months ago started getting the itch that my calling is to be a Family Practitioner. I'm so glad to have found your site, as I am torn between following my dreams and putting my childrens' needs first. I wonder if anyone has advice - is there any way to do both?

I live near Cleveland, Ohio and moving isn't really an option (to my knowledge) since I am divorced and share the children with the ex 50/50 (I have them every other week). It also might be good to know that my 7 year old has ADHD. Some people consider this to not even be a true condition, I understand, but my child is severe and cannot even attend school without receiving his medication twice daily. I am really the only one who understands him and can give him the love he needs unconditionally. So I am definitely a huge part of his healthy well being. My younger son needs me too, of course, but is very close with his father. So I worry less about my younger son.

Currently I am a Sign Language Interpreter. For the past 11 years, 90% of my work has involved medical settings. So, I've had the opportunity to shadow just about every aspect of the medical field. It has been an amazing experience! And that's where the hunger to become a physician myself began.

I noticed that for just about any other foreign language you can find a doctor with whom to communicate directly, if you look hard enough. In Ohio, however, there apparently are no physicians fluent in American Sign Language whatsoever. Because of my passion for the deaf community, this saddens me. Even with extremely skilled interpreters facilitating doctor/patient communication, I truly feel that some (possibly cruicial) nuances of the language are lost in translation. I want to close that gap in patient care. We really are behind the times in this, as a society.

Other reasons I long to enter medical school: I have a strong passion for the sciences, math, and especially solving mysteries. What better mysteries to solve than those which could save or better someone's life? I was standing outside a patient room in a dermatology office and happened to overhear the conversation between the attending physician and one of the residents there. I immediately saw myself on both sides of the conversation - first as the resident, sharing the information I had gathered from the patient with my attending and gaining confidence in my abilities to correctly diagnose and treat each issue, taking into account the special circumstances of each individual patient. But I could also see myself as the attending physician. I know I would love using the leading questions to help new doctors grow and learn in their profession. I can see myself there, as if it is as close as tomorrow.

Now, I don't know if my background will be a hindrance, as I was home schooled, and only have my Associate's degree so far. I pressed forward and earned my degree from a local community college despite my family's protests. My family is very grass roots and took offense to me wanting to go farther in my education than anyone else in the family ever has. But I did it. I am a very determined individual, so I know I could get through medical school. Afterwards, I would strive to be the very best of physicians by always being willing and ready to learn everything I can - never being satisfied with my current knowledge.

So I guess what it all boils down to is this: Would it be possible for me to be a medical student and a good mother to my two children? I know my life will never feel complete if I don't reach my full potential educationally/vocationally, but I don't want to ignore my childrens' needs either, as my parents did. They should come first.

At first glance it might be easy to say, "Well, its too much if you have children. You'd never see them," and that might be the bottom line. But currently, my income is barely enough to survive. Being a med student would actually increase the funds I have to use throughout the year substantially as compared to working all that I can currently.

So I'm just looking for options and advice. Is there a way in Cleveland to be a part-time med student, perhaps? Or set your own schedule somewhat, since I have every other week without the children?

Thank you so very much for your time and consideration. I truly value any gems of insight you can provide.

Sincerely,

Torn

Would You Care For A Patient With Ebola?

Genmedmom here.

Last week, a patient with risk factors for Ebola exposure, and who had medical issues, walked into our office.

Kudos to our N.P., who handled this very well. Upon learning of the potential exposure, she called infectious disease at our hospital, and they walked her through the appropriate screening interview questions. It took awhile, but she was able to determine that this patient was extremely low-risk for direct contact with the Ebola virus, and was not exhibiting any suspect symptoms. She was given the all-clear by infectious disease, and proceeded to take care of the patient.

Of course, this drove home very quickly the fact that any of us could be called upon to make a similar evaluation at amy time. I know I opened our hospital-issued Ebola risk stratification and action guidelines and read them over several times.

All day and on the long drive home, I imagined what I would do.

My first instinct was: Of course I would step in and help, no matter what any patient had or may have. I'm a healthcare provider. That's my job.

But.

There are now two nurses who contracted Ebola through caring for an infected patient in Dallas, despite knowing the diagnosis and wearing all the recommended protective gear. This is a virus with a 40 to 50% case fatality rate (now reported as closer to 70% in West Africa, due to lack of resources and care).

I'm a mother to two very special little kids. Could I justify knowingly exposing myself to a highly contagious virus with a grim fatality rate?

I went back and forth in my mind.

There are many healthcare workers in this country... But my kids only have one mom.

On the other hand, I do think that nurses and nurses' aides are at far greater risk of exposure, due to the inherent nature of their jobs and the mode of transmission of the virus. Now that I am an outpatient attending, I am rarely exposed to patients' body fluids.

But.

It only takes one, tiny exposure.

Of course, we have had a providers' meeting about this, and we did review our office protocol again. If needed, we have the "moon suits" and a designated isolation room. We have all the phone numbers to call to arrange transport of a suspected case. We have solid resources, so unlike our counterparts in West Africa. My heart goes out to them and to all the poor people suffering with this. We are lucky over here.

But.

I don't know much about donning layers of protective gear. I would likely screw it up. It only takes one, tiny exposure.

How would I then limit contact with my family, not get too close with my kids, for twenty-one days? I'm always clearing noses, changing diapers, wiping binkies... it would be near-impossible, and nerve-racking.

Ugh.

I don't know what I will do, given the choice.

I know that many hospitals are compiling lists of volunteers, staff who are willing to care for patients with Ebola, including aides, nurses, physicians.... I understand that most of these lists are pretty short. I have no idea what our hospitals' list looks like. I know I am not on it.

I am very curious what others have thought about this, especially the hospitalists and nurses out there, who would likely have more direct and frequent contact with a case should one come in.

Healthcare provider-moms, what are your thoughts?

And if you haven't thought about it, you should....


--Genmedmom, also at www.generallymedicine.com

Journal Club: Women in academic medicine

In March, the Annals of Internal Medicine published a study by Jolly and colleagues  demonstrating that women in academic medicine -- those holding K grants, or career development awards -- do more domestic work than do their male counterparts. There are a lot of reasons: more women had working spouses than did men in the same position, but that didn't explain the whole difference. The article itself is quite interesting, but the editorial that went with it (accessible by same link) -- written by two women in senior academic roles -- was what really got my attention. They suggest that the differences are really a matter of choice, and that disparities are not as disturbing as the study authors suggest.

They ask: "...is the fact that talented women may choose to shift a few hours from research to their family roles until the youngest child is in high school a threat to academic medicine? We certainly do not think so."

I think the perspective of these very successful editorialists is one of hindsight rather than foresight: we made it work, in traditional or non-traditional ways, and so why are you so worried about a few hours here and there? The answer is that we won't have the jobs we love if we can't make it by the standard criteria -- these being acquisition of grant funding, publishing papers, and providing patient care. I certainly appreciate, and have taken advantage of, the flexibilities of my research time -- but flexibility is an illusory concept. The hour I spend (or that my husband spends -- I think this equally applicable to both genders in many ways) taking the kids to school or getting home earlier is at some price, either in late nights or in projects unfulfilled.

You can see my response, written with two colleagues in similar positions (we are all women with K grants, patient care responsibilities, and families, trying to make it in academia) with the original article.

What is fascinating to me about the dialogue that goes on in these letters is the span of decades of women's perspectives that are included among the letter writers. This is a pesky problem and it won't go away soon.

Dena

Guest post: Taking a year off before medical school

I found MiM while studying abroad, trying to decide between PA and medical school, and being thoroughly terrified of not being able to spend time with my future family if I became a doctor. Reading all of these amazing stories from mother doctors helped erase my fears. I just wanted to give back to the blog, if possible. Also, I thought there might be some other undergraduates out there who can relate. So, here are some recent thoughts:

Had anyone asked me three short years ago what I would be doing after graduation, I would have immediately replied, "going to medical school." After three long, but fun and enriching years at a small liberal arts college known for it's rigorous science reputation, I'm ready for a break.

How did I get from that young, enthusiastic 18-year-old to a 21-year-old who self-professes her exhaustion from school? How did I decide that I am probably going to delay motherhood for an entire year, since I'm planning on waiting to have a family until post-residency? (that was a pretty large factor in my thought process) No, I didn't have a horrible college experience. I didn't have to retake classes, or even get "lost" along the way. Honestly, I just grew up. Needing a break isn't something I'm ashamed of. In fact, as my aunt said, it's probably one of the smartest things someone looking at graduate/professional school can do. I realized I'll have one year in my 20s not in school-- whether I take a year off or not, so why not make it now? A year off will grant me the opportunity after 18 years of education to stop stuffing equations and facts into my brain and fit in some life experiences to look back on and utilize. I will be able to start medical school refreshed and ready to learn, not just going through the motions to add "MD" to my name.

So many people reply, "Oh," when I say I'm taking a year off. I practically have to convince them that I'm genuinely excited to have time to experience more of the world. I believe it's perfectly acceptable to do whatever is right for you, whether that's powering through, or taking a break! However, I think some people need to realize that we don't always need to be in such a rush to get done with something to move on to the next phase. Slow down and enjoy today because tomorrow may be completely different.


From a "traditional" college senior at a small liberal arts university in the Midwest who plans to become a pediatrician. 

Flowers for KC

Our fearless leader KC organized a meet up - first IRL (in real life) for MiM's in DC this past weekend. I can't remember the birth date of the blog because I wasn't here but I've been around for a few years.

It was small - we are a busy group so many couldn't make it but I got to meet T, Mommabee, Juliaink, m, and KC.

KC sandwiched us between two conferences - one in New Hampshire on education and another in Chicago on blogging. She coached soccer Saturday morning for her son then met us at the Smithsonian Museum of Natural History. It's her I want to write about here.

Although I hadn't yet met KC in person, she is an incredibly supportive ringleader for our unruly bunch. If I e-mail her a question at midnight I have an answer waiting on my phone at 6 am. She has guided me in the perils of people trying to pull you in to advertising a seemingly worthy cause just to promote a marketable item. She has listened to e-mail rants I would like to make online about working situations or frustrations, knowing that it would be inappropriate because they were too fresh in my head. It's better to turn that anger into thoughtful pieces once the mood has passed. And she probably does that and more for all the other MiM's here - that's a big responsibility.  She protects us like a guardian angel - she saw too many negative comments a few years back and made the commenting process less anonymous, not only for the writers and guest posters but to keep the community supportive and the commenters accountable.  When I write on MiM I'm writing to an audience, but I also feel like I am writing to KC since she invited me here in the first place.

Mentors are people that you encounter in your life that create a space for you to grow and flourish and learn. I've been lucky to have many, and I definitely count KC as one of them. I had seen her picture in our Big Tent discussion group, but I wasn't prepared for her huge presence. I say huge, but she is a petite beautiful woman whose Chinese roots are evident in her features; dark hair, tea-colored skin. She has a bright smile that made me feel instantly welcome in DC, a city I was becoming acquainted with for the first time. Her fashion sense is impeccable. I learned she grew up in a New Jersey town not far from where my boyfriend, who accompanied me on the trip, attended high school.

My emotions surrounding the weekend were enormous - I imagined breaking down upon meeting her but it was just like meeting the popular girl in high school you were so intimidated by but she turned out to be a really cool person. Her accolades, at a year younger than myself, are astounding. Woman Physician of the Year for creating this space. Three amazing children - I delighted in conversing with her older son about animals and following her daughter through a museum crawl space that took us to a display about common insects we reside with in our homes. Mommabee instantly charmed the youngest boy; if she was here in Arkansas I'd recommend her as a pediatrician in a heartbeat. KC's supportive husband whom she met in medical school was entirely focused on the children and not at all interested in being the center of attention at our meet up at the museum.

Dinner with KC and m Saturday night was incredible - we chatted about posts and long time followers whose comments we loved and future directions and personal goals. KC seemed to take the back stage - she did all weekend - I convinced myself it was by design to let us shine. When drawn out in conversation her words were sparse but invaluable. More substance than fluff. M asked her, "What is your favorite outcome of starting the blog?" Her answer was immediate. "The readers. Whether encountering them face to face, or through e-mail. When they tell me how much it means to them to have found it. How it helped them." It was almost 11 pm when I met my boyfriend at the Metro to head back to our hotel.

I reflected on some of KC's words at dinner on the Metro. "I am invested in creating a space for our contributors and guest posters to write about what they want, when they want to say it. I don't want to control the content, I want to support creativity. A space for people to just be themselves." I must admit, I've been angry at KC. Misplaced anger, derived from guilt over not writing for months when I have had trouble writing. Anger that she didn't hold me to my pledge to post once a month. Then intense gratitude when she welcomed me back into the fold when I was ready to write again.

After some fun spa time on Sunday morning I learned a little more about KC. She has blogged in the past about her husband's year long deployment to Afghanistan when her youngest was two weeks old and her older two were toddlers, but I learned more about the challenges and fears surrounding that time. Another mentor-worthy feat - the insurmountable becomes existence and manageable day to day. Because if you look at it from a distance, how could you handle it? I asked her, "So is it done? Is he home for good?" She replied, "No, he could be called out any time."

When T showed up for brunch Sunday morning with us, she was full of regret. "I wanted to stop by a florist. But it was closed. I wanted to bring you flowers in appreciation for all you've done for us." T lives close to KC - they have published many articles about social media and medicine together since they have met. Juliaink was a pleasure to meet - I got to tell her in person how much I loved a poem she wrote years ago. I couldn't help thinking during the brunch, what a perfect idea for a gift for KC. A flower. A mirror image of her - something that packs a powerful punch with its image and color and strength, all the time belying a fragility that lies within it - within us all.

She is more than a flower, though - she is the gardener here. She planted the seeds. She waters us and helps us grow and find our own voices and learn from all the amazing voices in this community. I have had many mentors in my life, fabulous in their different ways, but none shares the quiet but unyielding support of KC. Now that I've met her maybe I can get her off of this pedestal and be her friend.

Happy birthday KC. You deserve much appreciation. My emotion didn't come out in waterworks this weekend, but hopefully it can be conveyed in this post. You are an inspiration.