In the dark quiet of the last day of 2016

Oh, no. Not a New Year's Resolution post. Who needs another "Live healthier, Be a better doctor, Be a better mom" post?

Well, I do.

Genmedmom here.

It's 6:30 in the morning on Saturday, December 31st, 2016, and I'm sitting typing in the quiet dark of our house. No one is stirring except for our two big spoiled cats, who relentlessly knocked things off of my nightstand until I got up.

You know how you get really busy, barely any downtime to even answer the texts from old friends, never mind call them, and all the very small spaces in your life are stuffed with overflow tasks, like making shopping lists on your phone on the train, and never going up or down your stairs without having something in your arms that needs to go up or down, like dirty laundry down and folded clean stuff up, empty tea mugs down and toilet paper rolls from the basement up, wrapped gifts down and unwrapped stuff up, so many goddamned toys and factory-new clothes and the boxes, tissue and gift bags that you can't bear to toss that will clutter your home until next year too, and even with your superior physician multitasking skills you realize you're screwing up, like forgetting to RSVP for that thing and being late paying that bill and getting lame last-minute crap for the important staff member you totally spaced out, and then even the doctor stuff starts slipping (which is always last to go, right?) like that you promised to personally get back to your longtime dear patient on a result that wasn't critical but it was important to HER and you totally intended to check that on the holiday weekend and simply send her a quick message through the online portal and you just did not do it.

Then the kids get sick, and you get sick, and any delusion of control you had goes down the toilet with the first bowl of vomit. Your Christmas agenda: poof.

Barf.

But life marches on and there's still things to do and when everyone is (mostly) better you try to keep going, get yourself and the family to rescheduled gatherings and pick up where you left off with the gifts and the cards and the outings for school vacation. Maybe you start losing track of what's really important and what's just life and lose your cool, show your frustration, yell at your kids when the situation just doesn't merit a freakout. No one is running towards a busy street or about to drink drain cleaner, they're just jumping on the couch and throwing pillows and wrestling and, well, not listening to you when you order them to get their shoes on because you're late or pick up that banana peel and take it to the trash or SETTLE DOWN already. And when they react to your red-faced temper with sass and disrespect, maybe you throw the remote control across the living room and when it lands on the hardwood with an unexpected clatter, your kids stare at you with a sad, silent combination of shock and wonder and fear that you hope you never see again.

You know you're out of balance and that this is not right and this is not you.

So in the dark quiet of a holiday weekend morning when, miraculously, there is no event planned nor pressing task nor other thing of perceived great import, you sit and breathe and resolve:

This year, I will live healthier, be a better doctor, be a better mom. I will do this by uncluttering my headspace. I will leave the little breathing spaces empty. For breathing. I will remain thoughtfully committed to my medical practice and remember the high standards I hold for myself. I will love my family, my children,  always reflecting on how blessed we are, how much we have and enjoy in this very difficult modern world. I will pray for those who are struggling and suffering, every day, I will not forget them.

Happy New Year and God Bless.

(all is not) lost

There was a heartbeat. I saw it on the ultrasound, but I knew immediately something wasn’t quite right. Was it too slow? Yes, the ultrasound tech said she noticed that too and gave me the wise, all knowing look of a Black grandma who can’t quite tell her granddaughter that something is wrong.

And then there was none at the ultrasound 2 weeks later. I asked the next ultrasound tech to angle the screen when I didn’t see movement. Saw the look on the Radiologist's face and then the Fellow. No heartbeat. The tears began to flow. My body began to shake. I held in the sob knowing if it began here with these strangers it wouldn’t end until I was safely tucked away at home.

You were there. I saw you. You were there. And now you’re not. When did you leave me? My heart breaks. I type through my tears.

I am at home. Grieving. Surrounded by loved ones.

I cry now as I type.

“Mama, are you crying? Did you have a nightmare? Are you frightened?” I stifle my tears. Say to Zo through closed door “I’m okay. Mama’s okay.” He calls out for me and O from his room after bedtime. O goes and comforts him and calls me into his room.  I gather myself, wipe my tears, blow my nose. Zo rushes into my arms “Mama, are you okay? I was having a good dream but then I woke up. Why are you crying? Everything will be okay.” As he gently rubs my face with his amazingly soft 5-year-old hands. As he pats my back. As he rubs my belly. As our family holds one another.

All is not lost in spite of this major loss. You were there. I saw you. You were with me. Now you are not there. But my husband is here. And my Zo is here. Their hearts are strong. My heart is strong.

The stories from friends poured in over the last few years. We are all in our 30s. Gut-wrenching stories of second trimester terminations due to fetal diagnoses incompatible with life. The heartbreaking call telling us of a stillborn nephew. Friends with years of infertility. A family member with seven losses. Stories of rainbow babies after loss. Countless miscarriages. Flashbacks from medical school of being present with sobbing women in the antepartum unit when their ultrasounds showed the absence of heartbeats. I didn’t understand then how the loss of something (a baby? A fetus? I didn’t know what to call it then) not yet realized could cause these women to sob uncontrollably. But I do now. From the moment I saw the positive sign I was hooked. Head over heels. Then the heartbeat. My growing belly. Zo’s “mama, is there a baby in there cuz I think there is.”

I was so excited to tell him he was going to be a big brother but I didn’t because I knew things weren’t quite right and it was all too soon, too early, too many things could go wrong - and they did. But he knew. He knew yet we feigned ignorance.Told him I would go to the doctor to find out.

All is not lost. You were there. We were together. Our family is still here and you will always be with us. We will go on. For we are not lost.

MiM Mail: Fourth year pregnancy?

Hi there!

I am currently a MS3, married to an amazing husband for the past three years, and strongly considering pathology. We would like to have a child in my fourth year. The question for us is when to start trying and hopefully have the baby, and to maximize our chances of having the child before intern year.

Our original plan was to start trying this summer, with the hopes of having a child sometime between March and May. But I'm not sure how that would work out with having a newborn as an intern. I would really like to avoid being pregnant during my intern year (or just residency in general) as well, and so I'm also worried about the short window that gives us to try for a baby.

I do not have any familial support where I live, and I'm not considering residencies that will be near family (they live in an incredibly expensive city and have very few programs around them). Our plan for childcare is my husband quitting his job and becoming a stay-at-home dad - any money he would make by keeping his job would probably not cover the cost of daycare.

At my school, we get two months off for vacation, one of which is mandated in the winter months for interviewing. I believe I can also have two more months of light rotations as well, giving me a total of 1-3 months to spend between my interview period and infant-recovery time.

So here are my current pros and cons for having a baby earlier (Fall-Winter) vs. later (Spring).

Pros for having the baby earlier:

Will have an older infant by the time intern year starts.
May be able to avoid interviewing pregnant.
More time to get pregnant.
May be able to still use my vacation months during interview season if I have my child around that time.

Cons against having the baby earlier:

May have to interview very pregnant or be at risk of giving birth.
Will probably be very pregnant during possible audition rotations.
Will probably need to have my husband quit his job (or scale down to part time) to take care of the child while I am on rotations.
Will be taking Step II pregnant.

Pros for having the baby later:

Husband can keep his job at full time for longer, maximizing our income.
Might be able to stack my rotations so that I can have 3-4 months "off" or with light rotations to be with the baby until residency.
Avoid being pregnant while taking Step II.
Will be less pregnant during interview and possible audition rotations.

Cons against having the baby later:

Will have to interview pregnant.
Stacking my light rotations and vacation at the end of the school year may make it so I have less flexibility when interviewing for residency.
May not get pregnant in the short window we have.
Would go through intern year with a <3 br="" mon="" old.="">

I would love any feedback on my tentative plans - which of these are important vs. not so important? How difficult is it having a 3 month old vs. a 9 month old baby during intern year? - and what you would recommend for my husband and I. Thank you!

Silent Day

Silence.

It’s golden right?

Silence.

I’ve craved it. Haven't we all?  As a busy doctor and mom, there’s always something in the background of daily living -- kids arguing, kids playing, kids giggling (my favorite!), the hustle and bustle of the life in the clinic, a shout of “mooooooooom” from upstairs or downstairs, the radio, the stove, the washing machine, the beeper, the pitter patter of fingers on my keyboard.  But, this minute, it’s silence. This hour, and for all the hours of today, it’s silence.

Right now, it’s feeling deep, dark, and deafening. I’m sitting on my couch in my house alone. It’s Christmas Day. I’m Jewish, so it shouldn’t feel sad or lonely. But, this is my first Christmas alone. I’m divorced now and my kids are with their dad. For the past decade, I adopted Christmas and it’s tradition of bringing families together. I cooked and baked and decorated a tree and made new traditions for my then-husband and kids. In those days, when I left work the day or two prior to Christmas, I said ‘goodbye’ to colleagues, wished them happy holidays, and looked forward to making my house warm for my loved ones and kids.  This year, I left on that last day of the work week with dread.  I savored the last few hours I had with my kids before my ex picked them up on Christmas Eve morning -- we snuggled in bed, watched tv, tickled and laughed. And then, they were gone.  And the silence set in.

That morning, I went to work as the ‘on call doctor’, seeing patients in urgent care, fielding pages from the answering service. And then about 1 o’clock, I left the office, got in my car, and wasn’t sure where to go. Others were out and about, finishing last minute shopping, or on their way to see friends and family (I presumed).  I stopped for coffee. And then I went home to The Silence.

Today, Christmas day, I slept in a little and woke to an empty house. I should be rejoicing. Free time to nap and read and sew and listen to music and clean my house is mine for the taking. Except, it just feels sad and lonely. The world is shut down today -- the stores are closed, there is no traffic on the roads, I have no where to be and I feel like an outsider again on Christmas.  My kids aren't with me on a day that is about family.

Late morning, I left the house for a bit to meet a friend and her family for lunch -- they are ‘in between’ religions, unsure how to celebrate this year after she lost both her parents in the last several months. I was glad for the company and an excuse to leave my house, and The Silence, for a little bit.  Her family welcomed me with kindness and warmth with an undertone of understanding that I am feeling like a woman without a country this year. Their hugs were warm, and lingered just a little longer than one might expect -- a subtle acknowledgement of the suffering they knew was behind my smile today.  

I have always known that the holidays are a hard time for people. Facebook feeds and tv ads are filled with the perfect storybook moments of families coming together on the holidays.  They don’t make commercials about the hearts of single parents breaking when their kids leave for the holidays.  They don’t tell you what to do all day when everyone else is home celebrating, and you are alone. No one posts a ‘’selfie” on facebook with a comment, “here I am all  by myself on Christmas. Happy Holidays everyone”. When I got a group text from a friend today, “Merry Xmas to all of you! Hope you are enjoying the day with your families!” I chuckled a little when I read it, and then felt nauseous, forcing myself to ‘stay positive’. My fairy tale family is split up and we don't fit into that cookie cutter holiday description anymore.

I don’t write this with self pity. It is more of a conscious exploration of this uncomfortable state of being. I am in a new chapter of my life. There are new realities that I need to accept about my life and my kids and my former relationship. I’m trying desperately everyday to be a mom who is present, navigating these treacherous seas for my kids and helping them get through it all, with all the usual background noise of work and schedules and a busy life.  While I should welcome today’s silence, I fight it and argue with it, and sit with it uncomfortably.  We are not friends.  

In a few short hours this day will end. We will all slowly get back to our routines. At the end of the week, I expect my house to be loud with the usual noises of kids and this heavy loneliness will abate for a time.  I’m hoping it gets easier someday.  

If you were lonely this season, I know how you feel.  No one has said that yet to me, but I'm going to say it to you. May the New Year bring warmth and light, joy and happiness. May we continue to harness our courage and strength to get through difficult times, and find ourselves better on the other side of them.  May silence someday feel golden and welcome, and envelope us with the promise of self care rather than with the dread of loneliness. I wish that for me, and I wish that for you, if you are out there and you know what I mean.

Celebrating with Gizabeth

Of course I had to attend Gizabeth's wedding party. I mean, the proposal was on this blog! Sure, I had only met her one time before in person, but through the blog and our communications, it's like we have been long friends. So, my husband and I took a quick trip to Little Rock to help her celebrate. We wouldn't know a soul besides her and her husband-to-be, and perhaps that just contributed to the adventurousness of it all. Plus, it would be just us, no kids -- bonus.

We went straight from the airport to lunch with her and her daughter. (This makes out of town guests feel very special!) She was glowing with joy; her daughter was smart and gorgeous. After lunch, we had the luxury of many hours before the big party, luxury to be work-less and child-less.  This included: a run, walking through downtown Little Rock, a pedicure (+trashy magazines +wine) and enjoying the southern sunshine.

Gizabeth and her husband were married quietly and privately at their house and then threw this massive party to celebrate at the Clinton Library.  My husband and I decided that weddings for more established adults are done right: it was so beautifully done from the white tufted banquette seating, to the flowers, to the great music.

In fact, the DJ was so good that after years of being dance-floor inhibited, I could not resist getting out there and dancing! I totally reconnected with my prior dance-loving self on that dance floor. Husband and I had a major blast. It may have helped that we didn't know anyone and thus had zero self-consciousness. (And I have a photo that is witness to this that perhaps should not be shared publicly.)

Gizabeth was stunning. And everyone was so, so happy.

For the send-off, guests were given sparklers and lined the exit. NB: Do NOT put out sparkler by stepping on it since you will burn a hole in your shoe. Note to self: buy husband new shoes.

All in all, I had such a wonderful time celebrating with a MiM sister. Congratulations, Giz! May your joy and love cup overflow.

Richard Michael Nestrud: A Retiring Pioneer

I remember my Dad telling me of those days: the ones in which no blood was screened. A NICU doctor. He said when a baby needed blood, they would just find a health care worker whose type matched up, and would get the necessary vital life source to the baby, siphoning it.

I spent my college days writing checks at gas stations. Occasionally, a worker asked if I was related to my father. I would nod in the affirmative, and they would regale me with stories of how amazing my Dad was. "He saved my baby."

He saved my baby too. My son was born six weeks early. My water broke while I was walking on the treadmill. I mistakenly thought my bladder failed me, but soon realized it was amniotic fluid. I received surfactant on bedrest in the hospital. It definitely matured his lungs. When he was born, my dad kept him from entering the NICU - arguing with his partners to keep him by my side, nursing. I took him home, and when his jaundice required a bili lamp, my dad smuggled one home to me. I remember spending nights bathed in the blue alien light, marveling at my son.

The stories told by the nurses and doctors tonight, at his retirement party, were awe-inspiring. He and his partner were inspirations to his health care workers and patients and their parents. Their methods were unconventional, but vanguard. They saved many lives, some a testament in the room.

I never thought I would see this day. The man that kept me on my toes throughout my life is closing a chapter in his. He told a story, one that I didn't know, that brought me to tears.

Before surfactant, babies were trached, and became toddlers, and spent close to 16 months in the NICU. Many were destined to spend their short lives with that community. He told of a moment when his co-workers became a team. One child spent 16 months fighting for his life. The NICU adopted him, and they all became his parents. His death was inevitable, his life inspiring. They all mourned the outcome, and in their grief they became a team. A vital community that lives on to this day.

The man that I spent my whole life in awe of, aspiring to be like, closes a chapter of his life this week. I sat at a table with his partners - ones that told me I was garnering praise from the leadership of the hospital. After ten years, I am finding time to reach out and give back. "They say you are doing wonderful things. You are just like your Dad."

 I hope to continue the legacy. And I hope my Dad continues his legacy. He's young by current standards. He does and will continue to inspire me. The apple doesn't fall far from the tree. His roots are worth nourishing. He has my love, my adoration, and my aspiration, forever and always. Love you, Dad. You have saved many lives, including my son's, and will continue to inspire me throughout my career and yours, which doesn't end with retirement. You are my favorite doctor. The one that I modeled myself after, the one I will spend the rest of my life trying to emulate.

Maybe Later We'll See

I could go on and on about the ways that becoming a mother made me a better doctor. It's much easier to build rapport with families when you can throw a genuine, understanding "yup, my kids do that, too!" into the conversation. It helps me to give much better, more realistic, advice, especially to parents of very young children. (How I wish I could apologize to every new mother whom I advised to just "sleep when the baby sleeps.") Not to mention the fact that I didn't need to study developmental milestones for my General Pediatrics boards.

But until recently, I felt hard-pressed to list any ways in which being a doctor has made me a better mother. It has made me a more tired mother, a more guilt-laden mother, a mother who excels at multi-tasking, though I'm not entirely certain that that's a good thing. Because of my specialty, my kids are growing up with an exorbitant emphasis on safety (Safe sleep habits! Rear-facing car seats past age 2! No riding down slides on grown-ups' laps!). This will likely make their lives slightly less exciting than they would be otherwise, and might even be a detriment to their social skills; at two and a half, Bean regularly points to people biking through our neighborhood and shouts, "Ridin' bike not wearin' helmet! Need get helmet!"

The other day, however, I witnessed an interaction that shook me and has already changed, in no small way, an aspect of my parenting. As a fellow in Hospice & Palliative Medicine, I frequently participate in family meetings and discussions surrounding goals of care. I'm there when people learn that their health or that of their loved one is declining, that the remaining time is likely measured in weeks to months; when they hear for the first time that their end-stage organ failure isn't simply a chronic condition but one that will drastically shorten their life. When they learn that they are no longer a candidate for cure-directed treatment. Oftentimes I am the one to deliver these emotional blows. Regardless, whenever I am involved, my job is to help patients and families understand their clinical conditions and the options that remain - the pros and cons, best- and worst-case scenarios. Their decisions and goals don't have to make sense to me or coincide with my own values and beliefs, but my job is to try to ensure that the choices they make are well-informed.

I recently met a man and his family who quickly became one of my favorites that I have worked with. The couple were in their seventies, with several grown children and young grandchildren living nearby. His diagnosis was one that most in the medical community would consider devastating, though he and his wife maintained an upbeat attitude and an intention to pursue any form of treatment offered, no matter how severe the side effects or how slim the likelihood of benefit.

The first steps in his treatment knocked him down hard. He suffered debilitating side effects. He began to recover bit by bit, but then, still miles away from his pre-treatment baseline, he landed in the hospital with another complication.

I began to explore with him and his wife the potential paths that lay ahead. There was always the possibility of declining aggressive treatment and focusing on comfort, though he insisted over and over again that he would keep fighting his disease. But after yet another complication, it became clear that he might not, in fact, even be a candidate for any further treatment.

They had many appropriate questions, and I tried for days to get the primary team to sit down with this couple and give them some answers about what might lay in the patient's future. When they finally did, the meeting began before I could arrive, and I entered the room to hear them discussing a plan to wait one more week and then meet to assess whether or not he might be able to tolerate further treatment. The patient and his wife pressed the physician further. "How likely do you think it is that he will be strong enough to get more treatment?" the wife asked.

"Well, we'll have to wait and see," replied the physician.

And there it was. The line that I had been using as of late to side-step Bean's requests, to put them off in the hopes that he would forget, to deny without officially saying no. As he rounds the bend from two and a half to three years old, he has become quite a skilled negotiator; a frequent refrain is, "Later, nappy time over, do good listening, watch Cars [his current favorite movie]?" He'll ask even if he's just seen it the day before. And because I feel bad denying his request - and also because I would prefer to avoid a meltdown - I use a variety of stock Mom-phrases that I hadn't even realized I relied on until he began repeating them back to me in response to requests of my own: "We'll see." "Maybe later." "Wait and see."

When I heard it from a fellow physician in such a loaded setting, I grew angry. Of course nothing is certain in medicine and our prediction skills are often poor. But when I looked at the patient before me, knowing his course and his current condition, I knew that I would be utterly shocked if he recovered to the point of being able to press onward with treatment. And the other physician - as he admitted later when we spoke outside of the room - knew it, too.

It made me think hard about the responses that I present to my own child. Yes, it's easier to give some hand-wavy answer in an attempt to move on, change the subject, dodge the thing staring you in the face. And yes, a toddler's request for more screen time is exponentially less serious than a family's request for a clinical prediction. But in both cases, I think that we as humans should show one another the respect that comes with an honest answer, no matter how uncertain, no matter how difficult to deliver and to hear.

So I have started explaining to Bean what we are waiting to see. "It depends on how much time we have after we shop for groceries and take baths," I'll say. Or, "Well, let's see if it's nice outside; if it's sunny, we should go to the park instead." He doesn't always love my answer, but he knows where things stand and what it is that we are waiting to see.

*Cross-posted at The Growth Curve (www.thegrowthc.com).*

Some day I knew I would write this post.

Last year I posted about trying to cope with my moms breast cancer recurrence.  Four years ago my mother was diagnosed with Stage I breast cancer.  Less than three years after her diagnosis she recurred as Stage 4.  She did not make the 5 year survival mark.  If you look up Stage 1 Breast cancer on the American Cancer Society website, you will find this quote: "The 5-year relative survival rate for women with stage 0 or stage I breast cancer is close to 100%." Irony.

This last year has been spent with me trying desperately to treasure every moment while also trying to stop a boulder.  I have made appointments, had family strategy meetings, endlessly researched and relentlessly picked the brain of her oncologist.  I have tried to make moments out of every pause.  I would often sneak away from my clinic to sit in the infusion room.  We would watch soap operas and chat about bits of everything while I would chart.  My mom worked from home for the last year, and I would occasionally spend my administrative time in her home office. We would gossip and look at shoes online while trying to work.  These moments are some of the most cherished, just the two of us.  Our family tried to band together.  We reinstated family Sunday dinners.  We all visited as much as we could manage.  We organized family outings.  We took advantage of all the grandparents days at the local museums and kids theaters.  But many days were post chemo days or too much pain days, and on those days we just talked and sat.

Thanks to our move, my daughter got a full year of Grandma time. A year I pray she is old enough to remember and cherish.  I will fight to make sure she doesn't forget.  Their love for each other was magical.

My daughter was with us in the hospital intermittently up until my mothers death.  On that final trip she saw something in our urgency to get back.  She asked me, "Mommy, did Grandma's cancer get stronger than the chemotherapy?"  In her pure and innocent love, she drew a final picture of Grandma holding all of our hands, each of us smiling.  At our daughters request, we buried that picture with my mother.  She said, this way we would always be with Grandma.  I am continually in awe of the simple wisdom of children.

I have seen many people die.  I have cried with families in the hospital.  I have sat vigil in the unit trying to will patients back from the precipice.  I saw the scans, I knew this was coming.  But, there was no preparing for this feeling, for this moment.  I have never felt this.  I have no words for it.  As I move past the initial shock I am just trying to exist in this new reality.  I am trying to be normal because it's been a month and now people expect me to function and be "back." But I am still in phase 1 and I have no idea what to do.  I am constantly searching for something...a memory, a piece of her jewelry, a picture, a video, anything to fill this chasm.  I have filled my house with old purses and pictures and clothes and plates and spices and cakes she made from her freezer and each thing is like a single speck of sand. I talked to her every day.  I texted her between cases.  I dropped by to see her on the way home.  What do I do with all of these things I would have told her, what do I do with all of these words that are words only for her.  Who do I give them to, where do I put them.  I re-read every e-mail from her.  I started at the present and just kept reading until the e-mails ran out.  This little journey just confirmed why she is so important to me.  There were encouragements from every moment - before big operations that I was nervous about during residency, before interviews, presentations at conferences, client pitches from my finance days.  She called me before EVERY SINGLE test in medical school.  Somehow she never forgot a single one and she would call me on the morning of the test, making sure to wake up early (she was on central time and I was on eastern) in order to catch me before I left my room.  She was my cheerleader.  She believed in me unfailingly and with such purity it was impossible to not just believe her and strive to be what she saw in me.

I will end with this.  I have been so moved by the outpouring of love in the final days of my mothers life and since her death.  It has come from friends old and new.  Friends who I haven't talked to in years but have reached out to me in a way that erases those years.  New friends and colleagues have been there, supporting me in ways I didn't even realize I needed.  Women I don't even know in Facebook mommy groups have sincerely reached out because they too have experienced the loss of a parent.  These women have been a wall for me to lean against when I felt I couldn't stand.  I am so grateful and thankful for this love.

Love is what feels most like my mother.

Guest post: Our scars are our torches

Women are mothers, teachers, healers, and crusaders. We are slowly entering a revolution for women where sexual assault and abuse are a topic of national conversation now more than ever before.

Let me tell you a story about myself. When I was 14 years old, I had my first chaste kiss at a summer camp where I was volunteering. When I was 15 – I was a junior in high school that year, moved ahead for academic reasons - I was asked to a Christmas formal by a 17-year old boy who had just transferred to my school from another state. I was shy and introverted and hadn’t dated much so was thrilled; he was very handsome. We went to a party after the dance where there were no parents and alcohol was in abundance, but I wasn’t very experienced with it so I only had a few sips. Any slight head change was immediately extinguished by excitement when he asked me to go to a park with him in his car and make out. I hardly knew him but was heady with youth and the clear starry night and the possibility of fun.

In the car on the way to the park – a park that happened to be across the street from my house, we had the windows down and the wind was whipping through my hair. He put Bad Company in the tape deck and I was pleased because I knew the words to a lot of the songs and I have a decent singing voice I was proud to show off. We pulled into the parking lot and awkwardly started to do what a million 15 year olds do every day and it felt wonderful.

Then something happened; it took a turn for the worse. He got rough, and I wasn’t prepared for that – what to do, what to say. I don’t even think I knew there was a name for it at that age. I tried to push him away. My clothes were torn. He became violent. I remember staring off into the trees, trees I had run and played under when I was younger, trees that had sheltered me from the sun at the adjacent swimming pool for many years, trees that still shelter me now from the memories of that experience. I disappeared into the moonlight as it shone through the trees. As an adult I know this is dissociation. As a teenager it allowed me to go on.

When it was over he offered me a ride home but I opened the door of the car and ran. I hid behind some bushes and stared at the front door of my parent’s house until it was light enough outside to go knock on the door, pretending that a friend had dropped me off after a sleepover. I have no idea how long I waited, but it must have been hours in retrospect. I remember aching with pain and dripping blood on the ground as I leaned against a fence and peered through the leaves, still frightened since I was alone in the dark. I finally gathered the courage to knock and when someone opened the door, I hid the areas of my torn clothes with my hands as I rushed up the stairs to my room. I cleaned myself up in the bathroom with the door locked. I called a friend from another school in another town and told her that all men were brutes, and that I would never trust them again. I was too ashamed to tell my parents.

I convinced myself that it was my fault; that I had asked for it. I wore turtlenecks to school for weeks until the bruises healed – luckily it was winter so it was easy to hide them. I managed to make his presence, one that persisted until graduation, invisible to me. I beat myself up inside my head for singing “Feel Like Making Love” on the way to the park – I still cannot listen to that song and have to change the station or remove myself from the situation if it starts playing on the radio or at a restaurant or bar. My singing that song felt like giving permission for what had happened, even though the words were in no way a description for what occurred.

I beat myself up even worse when a six-foot tall confident blond tennis player asked me how my date with him went – he had asked her out. I told her it was fine, didn’t meet her eyes, shrugged my shoulders underneath my turtleneck, then turned around and walked away. She angrily sought me out the next week because he had tried to lock her in a room and assault her and she had to kick and scream and fight and forcibly push him away and run through a door to escape. “Did that happen to you?” She asked angrily. I shook my head no and burned with shame. She got away, I thought. She is stronger than me. I’m a failure.

Predictably, my mental health deteriorated. I became so thin and pale I looked like a ghost of myself. I became a career bulimic. I started having suicidal thoughts. A teacher was worried about something she saw in my private journal for writing class and alerted me that she was going to talk to my parents. This was my breaking point. One of my parents walked in on me trying to slit my wrists with a steak knife that morning. I didn’t want to end my life, they were just chicken scratches; a cry for help. It was a necessary turn of events to get me into counseling.

I finished my senior year of high school and graduated at 16 as Valedictorian. I went to a month of inpatient rehab for bulimia and learned that I was raped and was able to tell my parents. I still carried the shame, but started to gain some weight back. I found the courage to go to the police station and report the incident with my mother by my side, and was happy that the statute of limitations was up so I could not prosecute; that would have been too painful just as I was starting to heal. I felt I owed my statement to other women: to the tennis player I wasn’t able to protect from his violent advances, to any future woman he might assault. I was proud.

I started college close to home; I wasn’t strong enough to move away. I learned by word of mouth about two other women my perpetrator had sexually assaulted. I watched the Clarence Thomas/Anita Hill trials and patted myself on the back internally about not speaking out. I walked on the sidewalk the morning after a No Means No demonstration – they had painted it in colorful sidewalk chalk all over campus. A group had snuck out in the middle of the night and wrote “unless she’s drunk” after half of the statements, and I patted myself on the back for keeping silent and not going to those demonstrations.

Once I learned that my perpetrator had come to a college party I was attending and my normally passive self physically fought my college boyfriend to keep him from going to beat him up. “Take me home now,” I screamed at him while pulling his arm. I didn’t want a scene I wanted out of the situation. It took four of his friends to help me hold him back. He finally took me home and I cried in a closet.

After graduating Magna Cum Laude, I had a brief stint as a psychiatric counselor at an inpatient child and adolescent ward before starting medical school. I read the files of 5 and 6 year old children who were being used for child pornography by family and friends and then went to tuck them in for bedtime. I remember one little boy grabbing my head and forcibly kissing me on the lips and trying to put his tongue in my mouth. I tried to hide my shock not to hurt his feelings, teaching him gently with my actions how to give a proper good night hug and peck on the cheek. Two days later I held him in a basket hold in the safe room for over an hour so he wouldn’t hurt himself or another child. My relief was palpable when he finally fell asleep in my lap.

On the adolescent side, I met a girl who was 13 and pregnant. This young girl the same age as my daughter is now was so proud of the pregnancy because she had been “sexed” into the gang. I learned this meant she was gang raped, and that because she got pregnant during the gang rape that the child was a child of the entire gang, and her status was elevated above other women in the gang.

I went to medical school. I listened to a friend talk about being sexually harassed by a surgeon, all the nurses around rolling their eyes as if to say “that’s just him we put up with it,” and decide not to report to protect her future career. I watched her decision reinforced when a student reported a notorious sexually harassing doctor, one that I intentionally stayed away from, only to become the butt of every joke on campus. I became a doctor. I listened to a friend share in residency about an attending who was sexually harassing her in a creepy way and the department’s solution was to keep her away from him – to not put her on any rotations with him. I later learned the creepy attending was transferred to another academic institution after a surgeon learned from his tween daughter that he harassed her at a school bus stop. So this is how they take care of this, I thought. This is so crazy.

I became a wife. I became a mother. I got divorced. I went to therapy, again as an adult. I’ve never asked or heard what happened to my perpetrator. Thankfully he has not attended any class reunions.

After a few years of dating my current boyfriend, we became engaged. I’ll never forget the first time I told my fiancé about the rape. We had been dating about 6 months and things were getting serious. I was terrified of his reaction; terrified he wouldn’t love me. It was the middle of the night; we were on a long weekend away. I went to the porch of the bed and breakfast and stared into the trees watching the moonlight. I drank a glass of wine and gathered the courage. I crawled back in bed with him, woke him up, and we started a conversation where he told me he loved me. I awkwardly confessed that I had been raped. He looked into my eyes and said something no one has ever said. “I’m so sorry that happened to you. Want to tell me about it? I’d love to listen whenever you feel like it.” Tell my story instead of sweep it under the rug, or awkwardly dismiss it? I felt like I had been doused with a bucket of cold water. I found the courage to tell him I loved him back, and shared a truncated version of this story.

It’s not men’s fault that they don’t always find the right words when hearing about sexual assault, or women for that matter. It is hidden in a cult of guilt and shame, passed down generation after generation. Women are speaking out now more than ever before: carrying their mattresses across campuses, trying and more often succeeding in prosecution. Every time I read a story about a woman with a successful prosecution, I cheer silently on the sidelines as a member of her team. Every time I read about a woman who is penniless and suffering from mental health disorders after being kicked out of the military, her bright and promising future doused by rape, I cry silently on the sidelines as a member of her team.

In therapy I mourned my lost innocence. In solitude I forgave the little boy who grew up in a house where the possibility to do what he did to me was transformed into a reality. My therapist told me that my empathy did not need to extend to my rapist, but I couldn’t help it. And in some small way, it helped me heal.

We need to remind men and boys that the porn they can so easily google as a teenager at a sleepover is not reality. We need to tell them if they are in a gamer chat room online and a girl walks in they cannot verbally assault her just because everyone is anonymous. They cannot rape her at a college party, even if she drinks too much. They cannot call her bad names and treat her with disrespect, even if they witness it growing up in their own house.

This is a cultural ill. We need to change the fact that women on Indian reservations are so easily raped by men who know they can escape prosecution. We need to change the fact that sports institutions objectify women and value the achievement of their college and professional athletes over disciplining those that have no boundaries with women. We need to change military culture around women. We need to stop human trafficking. It’s a worldwide disease, and our country may be healthier than some, but it is still very sick.

Last week the election of a president that boasts of sexual assault and promotes intolerance and hate struck my core as a human being, but also hit me on a much more personal note. I woke up at 5am and the confirmation of what I dreaded was happening at midnight spun me into outer orbit. I sat on the back porch, had a glass of wine, and sobbed. It felt like decades of achieving and therapy and reaffirming my worth in society was erased by half of America.

A few days later I sat in a Sunday school class with a group of strong, mostly single mothers and was reassured. The current leader (we all take turns – well, them anyway I’m a slowly reforming atheist looking for faith who does not yet feel qualified to lead in this arena) spoke of a Saturday spent in a prayer house. She, a Methodist, said that she was reminded by an Episcopal leader that all lives have value, and that we spend too much time, especially in America, measuring our value by our achievements and our wealth.

She spoke to my 15 year old soul. That girl had promise and value – no different from the doctor I am today. That incident no longer defines me, but it does shape my future actions. I vow to revolt against hatred, not with anger or blame, but with love and action. I vow to value every human being I encounter no matter their origin or political inclination. I vow to use my scars to help heal others.

-Anonymous

You don't need me to go pee and other 4am thoughts

I am at a crossroads with my 5 year old. It’s 4 o’clock in the morning and I have just been woken up from some amazing sleep for the countless time with a scream of “mom, I have to go to the bathroom”. I grumpily yell back “go by yourself” and my husband mumbles “that’s not nice!” and said 5 year old yells at me from the bathroom. I get up and our little tyrant is perched on the toilet going to the bathroom by himself. The bathroom is lightly illuminated with a night light. He pees as I gently say “please stop waking mommy up. I’m very tired and it makes me cranky when you wake me up.” “Cranky?” he says. “Yes, cranky because I’m tired” I say. I tell him he’s a big boy and can go pee by himself. He says “okay” then walks to his room leaving the door cracked. I tell him it’s okay to leave his door cracked and he says “okay”. I lay down in bed, he says “please close the door” I don’t respond, hubby gets up and closes the door. I lay awake in bed recounting all of the things that I am doing wrong with him, the things I am worried about with professional drama, good things that are going on (woo hoo congratulations on the new professional leadership program acceptance!), but sleep eludes me and I am so tired. 

This and worse accounts (one particular evening I had a screaming match with him because I wouldn’t come back and put his covers on him just right) document our nighttime ritual. He sleeps completely through the night less than once a week. He pees on himself at least once a month. Me remaining awake for several hours after being woken up is much more common than me going peacefully back to sleep. My husband is usually not woken up, but when he is he rarely has a problem going back to sleep. 

And I am at a sleeping crossroads. Being woken up for months and months and years and years makes for an unhappy mommy and I can feel the effects of my sleep deprivation. I am cranky when he wakes me up and if the sleep is really good I am downright angry. I know he needs sleep, he goes to bed at 7:30pm and wakes up between 7 and 7:30am. If he goes to sleep after 8pm for more than a few days, things don’t go well for anyone. I on the other hand know I need more sleep, but getting in bed before 9pm is rarely an option, but if I could just sleep uninterrupted it would be so much more restful. Tonight though I was in bed watching TV by 8:30pm. 

I don’t know what to do. It’s 4:10am. My shoulders hurt, it’s cold (autumn in the mid-Atlantic in our 1938-built home mean it’s chilly literally all of the time). I want to be asleep, but I can’t go back to sleep. So here I type after sending my husband a “I can’t do this anymore” email that I’m sure will make for great breakfast conversation and texts back and forth all day. 

I know I have options, but in my 4am research I can find very little about nighttime awakenings. Lots about 5 year olds being scared of the bathroom in general, but nothing specifically about what to do when he wakes you up at night and won't go back to sleep. Should I start sleep training again; this time using the same techniques of slowly responding less to his demands each night (but it takes so long!)? Light his room up with an additional night light to illuminate the dark corners? Make my husband do it alone? Refuse to get up with the tyrant anymore? Ship him in a box to my parents? Put a small potty seat in his room as my girlfriend, also a Pediatrician recommends (this seems so gross to me though and all I can think of is tripping on it and pee flying everywhere)? 

Please help! I’m so over this. It’s now 4:25am and I’m going to see if I’m tired enough to fall back asleep.

What's This Week Been Like For You?

I’m sure we all have an opinion about the election outcome; most likely, a strong one. I was following with intense anticipation as a Canadian. I am utterly despondent with the result. The day after, I met a friend for coffee and together we tried to process the reality. It felt much like the morning after 9/11, where we knew we were facing a ‘new world’ and an uncertain future. 

Our national public radio station’s coverage was filled with interviews with Americans relaying their uncertainties about the future. One gentleman felt a sense of betrayal by his neighbours; that he did not feel he really knew his city as he thought he did. I know that some of you are heartbroken, as I am. Others may be elated, or at least satisfied with the outcome. Some of you may feel conflicted. Still others may be Republicans who feel dismayed that Trump was their candidate. Maybe none of these captures your sentiments. I know many people are struggling to talk to their children about the outcome. Many American citizens and residents of colour and other vulnerable populations are especially worried about the “Trump effect” on their children, and perhaps some of you are seeing its effects in your daily life in medicine. In Family Medicine, it's not uncommon for some patients to bring up political topics, but I try to stay pretty balanced and general.  Personally, I found inspiration here, which cites this great article about talking to your kids about the result. Reading personal accounts and opinion pieces by those who are processing the results thoughtfully is helping me deal with the result. 

I realize that politics in general, and this election in particular, can be polarizing to discuss, and I know this blog does a great job of being a safe space. A refuge from the constant barrage that was so consuming during this campaign, perhaps. I think we can maintain that safe space by respectfully sharing our own personal experiences, fears, and worries. Because no matter your political stripes, I think it’s fair to say that the months ahead are uncertain for the United States, and the world.  

I have great faith in the American people, and the American system, to uphold their democratic values. I believe that most people are decent and that political and social tides ebb and flow throughout history. Let's help one another navigate the best way forward for our families, communities, countries, and the world. 

The Soul Condition

The day to day practice of General Internal Medicine can be particularly challenging and trying, but also thoroughly rewarding. I have found that the most incredible moments of privilege and wonder in this profession come in the most unexpected times and places. Especially during this past year, which has been particularly trying for me personally, just when I think I can’t bear any more suffering, there is a surprising glimmer of light that penetrates the darkness. I’m thankful for those moments, and being mindful of recognizing them when they present themselves.

One morning recently, I entered an exam room to see a patient of mine during a busy Tuesday morning clinic. He was sandwiched in my schedule between a lovely middle aged woman with a newly diagnosed metastatic lung cancer (sigh) and a young adult patient with a sore throat. I saw him on my schedule for that morning and smiled – he was a lovely elderly man that had a difficult past few years with depression, obesity, and was ever skeptical of my western medicine approach to his longstanding hypertension. Despite it all, we always found a way to have a good talk, able to cross the chasm of our cultural and religious differences and find a way to speak a common language with each other. I take care of his wife and his adult daughter, as well, so I have a multi-dimensional sense of his life at home.  In the flurry of the day, I closed the door finishing with the patient across the hall and stepped in the doorway of his exam room to say a big hello. I looked up and barely believed my eyes – “Oh my goodness, how are YOU?!” I said. There he was, big sparkling smile, bright eyes, “Hello there, doc!” He looked twenty years younger than his 74 year old self, and strong and happy.  This was such a stark contrast to our last meeting, about year ago. “Well, doc, I thought you’d be proud. I lost 70 pounds.”

I smiled. I paused. I looked at him lovingly and proudly and then squealed with excitement as I gave him a hug. “How did you do it? And how do you feel?”  He went on to tell me how he feels terrific, both physically and mentally.  When we last saw each other about a year ago, he was sad, lacking motivation, irritated with his wife who was ‘nagging’ him, and about ready to move away to a warmer climate.  He was morbidly obese, had aching knees, and just didn’t feel like himself. I recall distinctly (one of these moments that just are quite captured in the EMR documentation!) at that visit we talked about “why are we all here?” –I had referenced a friend who had recently passed away at the age of 49 and I was feeling great loss at the time – he too was feeling loss and disappointment about moments in his life and was reflecting on his 73 years, having an existential crisis of sorts. We hugged at the end of that office visit. And now here we were, a year later, and he is bright and happy and has lost so much weight. 

A year has changed so much of who we both were. I was about to hear about his year long journey. Over the last year, I had seen hundreds of patients while I tried to keep my own tattered life afloat. My marriage broke up, I sold my house, I moved, and have tried to weather the storm of a messy divorce while parenting two little kids who were trying to understand it all. I couldn’t help myself as these thoughts rushed in--the year since we saw each other last had affected us both so profoundly. And here we were, again. And I think we found unspoken strength in each other.

“Well doc, this is all about my ‘Soul Condition’.”  I looked up, saying nothing, but my eyes gesturing ‘tell me more.”  He went on to tell me that he thought a lot about his life after our last appointment. He realized that his poor health habits, for him, were about failing to care for himself and his ‘soul’. He realized at some point he is worth more than his poor health habits, so slowly he started eating better and exercising. He said “Doc, you told me to go for a walk. So, I’ve gone for a walk everyday ever since I saw you last.”  Wow! I admit I had a moment that I couldn’t believe someone actually listens to me!  We went through the rest of the visit, me with genuine joy for him, him with the pride of a child reporting back a good deed to a parent.  And then we finished, as he and I somehow always do, sharing tidbits of our lives and hopes, and he teaching me more about the Soul Condition. He said “Doc, if you are unhappy, just work on your soul. You should tell your other patients that. I’m not even tempted to smoke or drink alcohol, or eat ice cream. Why would I now that my Soul is so happy in this body?”

I’ve thought of him a lot since that day. I could certainly learn a few tips from him – or at least my Soul needed a new kind of condition after all I’ve been through this year.  I couldn’t help but wonder if he saw it in my eyes, if he knew I needed this advice.  Divorce is ugly and bitter and deeply devastatingly sad – it does break a soul as it breaks a family.  I bear witness to so much human suffering on a daily basis in my role as physician, and sometimes the only thing I can do is sit with a patient and listen and hold his or her hand, offer a supportive word or a hug.  I have found it an incredible burden to also carry my own suffering into the room with my patients as I listen to their stories, offer kindness, support and advice. I’ve often wondered over the last year if I’m good for any of them and if I could possibly bear any more. During that 20 minute appointment, I earnestly rejoiced in his improved health and happiness and learned from his wise counsel. 

Just like my patient worked to make his Soul happier, I’ve learned I need to deliberately take steps to do the same. I savor my kids’ giggles, and give more hugs, and spread more love, and have learned my own needs count.  I have long taken care of others, and I’m just now learning the skills to recognize my own Soul Condition, and tend to it.  Today I went out of my way to spend time with a long lost friend, take a walk, and bake banana bread. I went slowly through my day, took note of how I felt, and listened to what my Soul needed today.  I also held my son, as he cried in my arms for a half hour after coming home from a weekend with his dad. He wanted to know “why can’t mommy and daddy just live together?”  And so I hold these things, some so difficult, some so beautiful, and think about what we all need to care for ourselves and our Souls. In this moment, my heart ached wide open for my sweet child, and was also warmed by his earnestness and his openness and his absolute softness in my arms.  My Soul has a little farther to go to feel healed, but I’m listening and trying. My patient is a beautiful man and a special, special Soul. May both our Souls triumph in a beautiful year ahead of us, until we meet again.

Childcare Options for Doctor-Moms

Genmedmom here.

Childcare is such a huge issue for working parents. It can be so expensive, and it is so important. With me in outpatient primary care and my husband traveling for his work pretty frequently, we needed to figure it out.

Thankfully, we have my mom who lives close by and provides the bulk of childcare for our little ones. We have also used daycare, as well as nanny services, both to give her a break and to provide socialization for our kids.

Family help is the best, but it can't always work, for many reasons. Daycare has the advantage of providing key socialization, as well as building relationships with other working parents, a bonus that I didn't realize would be until it was. However, if we didn't have my mom to pick up our kids at the end of the day, we'd be pretty miserable. It probably wouldn't work at all.

I found nannies to be the most difficult. It was almost a part-time job to find a decent nanny, even with Care.com. And, they weren't always decent. Plus, that option can be very expensive, prohibitively so. Upwards of twenty dollars an hour in the Boston area, for a nanny with experience.

Other docs have written about au pairs, and that options sounds wonderful, but one has to have a place for the person to sleep, and we just never had that. It's a small house, barely enough room for us and the two kids. Au pair, sadly, was never a possibility for us.

What childcare options have worked best for others?

Help with attending job interviews!

T minus 8 months until I join the real world.

I am now 4 months into my breast imaging fellowship. It's about that time I start looking for my first attending job!! As someone who went straight through in my medical training, I have no idea what a job interview truly entails. Yes, I've done plenty of interviews. I know what it's like to sell myself as a medical trainee but as for joining the real world, I have absolutely no idea.

My experience looking for a job might be a little different than some because I am geographically limited. My husband started his (first) attending job in a city 2 hours away from where I am doing fellowship. On a side note, this situation is so much better than our west coast east coast marriage while he was doing fellowship last year! As much as I am looking forward to joining the real world, I am really looking forward to our family of 3 to finally be living under the same roof!

I went on 2 interviews so far. The first one was not the same location but same group as my husband's place of work. Given that it's part of the largest managed care organization in the United States, questions outside of who I am, what I can offer were really not asked. Details of what the contract would entail, how much I would make, what my benefits were and etc. were not discussed. Mostly because I already knew the answers to these questions and the fact that I was told that there was no need to go over a contract from this place as it was standard across the United States. I came back from this interview thinking it went well and that it wasn't much different from a fellowship and residency interview. A downside to this job is that it will be a 45 minute commute to where we will most likely settle down.

The second interview I went on was a large private practice group in the city where my husband practices. It's a group of approximately 80-90 radiologists. We talked about my dual boarding in radiology and nuclear medicine. We discussed the possibility of working within my preferred subspecialties (breast imaging and nuclear medicine. We discussed the possibility of working part time, which got me really excited. I also met some of the radiologists in the group, who all seemed very nice. However, I came back after my interview most of my conversations with my attendings at work went like this.

"How was your interview?" "Good. I really liked the practice"

"What is your base salary?" "I don't know..."

"What is your retirement?" "I don't know..."

"What benefits are offered to you?" "I don't know..."

"What about maternity leave? " "I don't know..."

"Do you get paid overtime for call?" "I don't know..."

"How many years until partnership?" "I don't know..."

Basically, I felt like an idiot. And now, I am waiting to hear back from both jobs but I feel like I cannot really compare and contrast since I don't know the answers to these questions!

How do you go about asking these questions during a job interview? Do you ask right away? Do you wait until there's a proposal? Is these anything else I should be asking? Do you need a lawyer to review your contract?

Thank you in advance for your help!

How Do You Do It All? (i.e. The Art of Being Imperfectly Perfect)

Genmedmom here. 

Let’s face it: working moms have alot on their plate. A patient recently complained to me how guilty she felt because she couldn’t be a perfect mother, wife, accountant, and friend, all at the same time. If she felt really good and strong in one area, she was slipping in another. “No matter how much I try, I’m a failure!” she declared. 

Okay, look, despite the expectations on us, no one can achieve perfection 100% of the time. No one is going to excel in all of the areas of their life always. But we can manage. We can do our myriad jobs well enough. And we can be happy. 

On a weekly basis, I usually manage: four clinic sessions a week (approximately twenty hours seeing patients), one morning precepting in the firstyear medical students’ interviewing and communications course, co-parenting our two school-aged kids (with lots of family help), regular blogging on three separate blogs, kids’ dinner/ bathtime/ bedtime virtually every night, about three good workouts per week, church and big family dinner on Sundays. 

Is it all done perfectly? Hell, no. I wish I could get to all the patient phone calls, emails and lab results every week. It would be great if I could do the reading before the medical school course. Our kids are late with homework probably at least once per week. We never seem to know what's going on at school until the last minute. My blog posts often have typos, and could have used a little more editing. My workouts are sometimes really short. We don't get to church or have family dinner every Sunday.

But I can say this: We fit in what we need to fit in. We do what we feel needs to be done. It's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

I am often asked “Geez, how do you do it all?” 

Well, if what you're aiming for is happiness rather than perfection, then I’ve thought about this. It will be different for everyone, but generally, I suggest: 

Identify your time-wasters and eliminate them. What time-consuming things in your life do not help you to achieve your goals, and do not serve a healthy purpose? For me, that’s television. I do not watch television unless there is a really good reason. I’ll watch a Disney movie with the kids once in awhile, all snuggled on the couch. And, of course, once a week our whole family watches my husband’s football team play. Other than that? No sitcoms, no news, no movies. Social media can also easily become a time-sucker, so I limit that to my train commute.

Hire cleaners, if you can. Yes, we all know that we are capable of cleaning. But how much is your time worth? You are an M.D., and if you were paid by the hour, you would earn $100, at minimum. Multiply that by a thousand- no, a million- and that’s how much your hour is worth to your kids. Though we couldn’t afford it when we just started out, as soon as we could, we hired a cleaning service. They are worth every penny.

Order anything online that can be ordered online. We have groceries, pet supplies, clothes, shoes, furniture, books, et cetera delivered right to our front door. 

Stay local. Need to run an errand? If possible, avoid driving time, and support local businesses to boot. 

Schedule carefully. There are so many options for kids’ activities around us. It would be very easy to slip into driving-everyone-all-over-the-place-for-this-or-that-thing. We were forced to hold back quite a bit, as our son with autism doesn’t handle a busy schedule very well, and doesn’t do drop-off events at all. So, we have a music teacher who meets them in my mom’s home after school one day. And we choose family activities like hikes, trips to the farmer’s market, and scouting (Boy Scouts), rather than kids-only classes like dance and tae kwon do. We’ve realized that this quieter, easier, more familiar approach results in less hustle and bustle, and doubles as “family time”. 

Identify toxic relationships and avoid them. Okay, I'm wandering into therapeutic territory here, but the truth is, people who make us feel bad are a real drain on our precious time and energy. Conflict and negativity are distracting. We can't be our best selves now if we're re-living an argument or re-thinking that weird conversation from yesterday. If there's a person around who consistently brings conflict and negativity into my day, I avoid them as much as possible. Likewise, if there are good, psychologically solid people who support me and boost my mood, then hey, I want to spend more time with them.

Keep reasonable goals. I’m not striving for crazy achievements in any area. I’d like to take good care of my patients, be a solid teacher for my students, raise emotionally well-adjusted kids, keep on writing until it goes somewhere, stay as healthy as possible, and be actively engaged in our community. Like I said, it's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

What about other mom-docs? How do you "do it all?" What do you do to save time? How do you keep you and your families happy?