Wednesday, February 21, 2018
Adventures in Pumping
Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.
However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.
I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic, the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.
I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.
I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.
If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.
Tuesday, February 20, 2018
Are residents worse post-pregnancy?
This is an interesting article about how peer evaluations of female
residents go down after pregnancy, while evaluations of men who have
children during residency do not go down.
I was wondering why this might be the case. I thought of a few possibilities:
1) resentment towards pregnant residents who took a leave and everyone had to do extra work to cover. I wonder how evaluations might be affected in other residents who took leave for other reasons. Of course, people generally think of pregnancy as “a choice“ so leaves for other medical reasons might be looked at more sympathetically.
2) performance may actually decline after having a baby. I don’t know about you, but if I am awake breast-feeding two or three times per night, I’m probably not going to perform at the same level as I was when I was well rested. Also, once you have a baby, no matter how good your support system is, you’re still somewhat at the mercy of your child’s health. Even if you have someone to watch them when they are sick, you probably aren’t going to be able to work when you are actively vomiting from the G.I. bug that they gave you. (I tried. I was sent home.) again, this is something where man should theoretically be affected as much as women, but there is probably more of a tendency for men who decide to have a baby during residency to have a spouse with a more flexible career. And also, they don’t have to breast-feed.
3) Other residents might not take you as seriously when you become a parent. They may feel your priorities are shifted, even if that’s not actually the case.
What do you think? If you had a baby during residency, do you think it changed what the other residents thought of you? Did you change your opinion of female residents that you worked with after they had a baby?
I was wondering why this might be the case. I thought of a few possibilities:
1) resentment towards pregnant residents who took a leave and everyone had to do extra work to cover. I wonder how evaluations might be affected in other residents who took leave for other reasons. Of course, people generally think of pregnancy as “a choice“ so leaves for other medical reasons might be looked at more sympathetically.
2) performance may actually decline after having a baby. I don’t know about you, but if I am awake breast-feeding two or three times per night, I’m probably not going to perform at the same level as I was when I was well rested. Also, once you have a baby, no matter how good your support system is, you’re still somewhat at the mercy of your child’s health. Even if you have someone to watch them when they are sick, you probably aren’t going to be able to work when you are actively vomiting from the G.I. bug that they gave you. (I tried. I was sent home.) again, this is something where man should theoretically be affected as much as women, but there is probably more of a tendency for men who decide to have a baby during residency to have a spouse with a more flexible career. And also, they don’t have to breast-feed.
3) Other residents might not take you as seriously when you become a parent. They may feel your priorities are shifted, even if that’s not actually the case.
What do you think? If you had a baby during residency, do you think it changed what the other residents thought of you? Did you change your opinion of female residents that you worked with after they had a baby?
Sunday, February 11, 2018
My almost-teen
“I saw J do the reading the other day at church, and at first, I thought it was you. She is becoming a young lady,” Maureen said to me on the sidelines of a soccer game.
My daughter is 12, soon to be 13, but has recently passed me in height. She is never far from a book – goes through them like that – and can’t help but blurt out her responses and reactions to the plot twists in real time to anyone around. “Anna betrayed her!” “I can’t believe he did that! They have the twins!”
She confides in me still, and each time we are there with the door closed to her room, and I am consulted in critical matters of friendship or fashion decisions, I try to proceed gently as if I’ve been let in to a secret society and don’t want to blow my cover. She recently cried into my arms over a friendship disappointment. I felt the same mixture of calm, responsibility, and honor I feel to be let into that moment as I do when a medical student starts crying in my office in my role as a student affairs dean. Or when a patient breaks down in front of me under the weight of a diagnosis.
She started taking martial arts recently since she wanted to learn self-defense. We found a low-key place that offers all types of classes for kids and adults. She does the kids Muay Thai and immediately following is the self-defense class for ages 13 and up; they allowed her to trial it to see how she would do. She texted me before the self-defense class and wrote “I don’t think I’ll do it,” and inserted a chicken emoji. I called her immediately. There were adults and older teenagers taking the class and she felt very intimidated.
“You should do it,” I said.
“But I’m scared.”
“Just try it! I can’t pick you up until after the class anyway.”
“Okay…” she said reluctantly.
I came to pick her up ten minutes before the end of the class and sat down on the viewing benches in the waiting room. There she was, practicing with her partner, a woman in her 30s in a pink hoodie. She was there among older teens and men and women—she seemed so grown up! She was clearly comfortable, holding her own, and loving it. The group huddled in closure and then started clapping and looking at J. She practically skipped out to me at the end of the class, face aglow.
“I want to come twice a week to this from now on. I’m thinking it might be hard in the fall with my two soccer teams, but I want to figure a way to do it!” She was breathless with excitement. “Can we get the gear? I’ll need the punching gloves and shin guards.”
My almost-teen is growing up. I love that she allows me to be there for her. Mothering now is more coaching, guiding, discussing. It’s confiding and listening. It seems like just yesterday she was an exuberant 3-year old who loved Dora the Explorer and would grab my keys, throw them under the couch and say, “Swiper, no swiping!”
I’m amazed by the person – the woman- she’s becoming. She is still that exuberant child, but now with a playful sarcasm, insight, a deepened faith, and strong sense of morality. I’m navigating my new role: sensing, adjusting, responding, and still gently pushing her to keep growing.
We’re both growing, and I wonder how long I'll be a secret society member. Is it life long? Since that seems pretty amazing.
My daughter is 12, soon to be 13, but has recently passed me in height. She is never far from a book – goes through them like that – and can’t help but blurt out her responses and reactions to the plot twists in real time to anyone around. “Anna betrayed her!” “I can’t believe he did that! They have the twins!”
She confides in me still, and each time we are there with the door closed to her room, and I am consulted in critical matters of friendship or fashion decisions, I try to proceed gently as if I’ve been let in to a secret society and don’t want to blow my cover. She recently cried into my arms over a friendship disappointment. I felt the same mixture of calm, responsibility, and honor I feel to be let into that moment as I do when a medical student starts crying in my office in my role as a student affairs dean. Or when a patient breaks down in front of me under the weight of a diagnosis.
She started taking martial arts recently since she wanted to learn self-defense. We found a low-key place that offers all types of classes for kids and adults. She does the kids Muay Thai and immediately following is the self-defense class for ages 13 and up; they allowed her to trial it to see how she would do. She texted me before the self-defense class and wrote “I don’t think I’ll do it,” and inserted a chicken emoji. I called her immediately. There were adults and older teenagers taking the class and she felt very intimidated.
“You should do it,” I said.
“But I’m scared.”
“Just try it! I can’t pick you up until after the class anyway.”
“Okay…” she said reluctantly.
I came to pick her up ten minutes before the end of the class and sat down on the viewing benches in the waiting room. There she was, practicing with her partner, a woman in her 30s in a pink hoodie. She was there among older teens and men and women—she seemed so grown up! She was clearly comfortable, holding her own, and loving it. The group huddled in closure and then started clapping and looking at J. She practically skipped out to me at the end of the class, face aglow.
“I want to come twice a week to this from now on. I’m thinking it might be hard in the fall with my two soccer teams, but I want to figure a way to do it!” She was breathless with excitement. “Can we get the gear? I’ll need the punching gloves and shin guards.”
My almost-teen is growing up. I love that she allows me to be there for her. Mothering now is more coaching, guiding, discussing. It’s confiding and listening. It seems like just yesterday she was an exuberant 3-year old who loved Dora the Explorer and would grab my keys, throw them under the couch and say, “Swiper, no swiping!”
I’m amazed by the person – the woman- she’s becoming. She is still that exuberant child, but now with a playful sarcasm, insight, a deepened faith, and strong sense of morality. I’m navigating my new role: sensing, adjusting, responding, and still gently pushing her to keep growing.
We’re both growing, and I wonder how long I'll be a secret society member. Is it life long? Since that seems pretty amazing.
Monday, February 5, 2018
Going part-time
I have been a little MIA here since I've joined the chaos that is being an attending!
I was once told that the first year of being an attending would be the hardest. That is quite the understatement.
I was going through so many changes this past summer. I moved out of San Diego, a place that has been home for 14 years. I joined my husband in Los Angeles and after 2 years of long distance, we are finally under the same roof! Little C started her new school. It was basically a lot of change. It was all good but with any transition, it is never smooth sailing.
Fortunately, all that stuff mentioned above went pretty smooth. Kids are so resilient. Little C had a best friend by week 2 and by the second month, she was completely adjusted. It is definitely nice seeing my husband's face in person and not via FaceTime! But it turned out, the hardest transition was my new role as an attending.
I joined a private group. I remember posting on this website about what to ask in a job interview. To sum it up, I was way too excited that I was actually getting a job that I forgot majority of the advice given to me and signed a contract without really knowing what I was getting myself into. I had a sense of what the group would be like but I went along with their assumption that as my first year out of training that I would want to jump right in, make a lot of money and be on the full-time schedule, which included a lot of weekend call and evening shifts.
Initially, it didn't seem horrible compared to residency and fellowship. But my biggest dilemma now was how do I juggle being an attending and a mom without my own mom? My mom has been more than a grandma the past 4.5 years since little C was born. She was her primary caregiver for 2.5 years and the following 2 years of my long distance with my husband, she was available for every single sick day, call, evening shifts and weekend obligations. But I wanted to hold true to my promise that she would be a grandma once I became an attending. I think I really burnt her out the past almost 5 years and I think it was starting to put a dent in our relationship so this was new territory for me.
I found an incredible nanny to help with picks ups and drop offs but I was often very frustrated as to why I was working this hard and still not getting the work life balance that I thought I would ultimately have once I became an attending. I grew very unhappy, bottled it all up inside and did something I never thought I would do.
I quit.
But the most surprising twist of all was that my resignation wasn't taken and instead I was asked what would be my ideal schedule. I was shocked. I didn't expect such encouragement and flexibility. It took some convincing because I didn't think I deserved this kind of special treatment being so fresh out of training but it turns out, there were many people in the group who had different contracts that accommodated their lifestyles.
I thought I would let the group down if I didn't work the regular full-time schedule. I thought I was selfish asking to be taken out of the call pool and to only work from the hours of 8-5. But trying to quit ended up being the best decision ever. I got my dream schedule. I finally have time to work out for the first time in 5 years. I have the luxury of dropping off and picking up little C from school on Tuesdays and Thursdays. And the idea of second child is exciting now, rather than terrifying!
I feel like I can finally breathe now after 6 years of holding my breath and just trying to survive during residency and fellowship. I finally did it. I got my work-life balance. It's never perfect but I can work with this. So my take away lesson from all of this is don't be scared to ask for what you want, preferably without having to go through an almost resignation like myself!
I was once told that the first year of being an attending would be the hardest. That is quite the understatement.
I was going through so many changes this past summer. I moved out of San Diego, a place that has been home for 14 years. I joined my husband in Los Angeles and after 2 years of long distance, we are finally under the same roof! Little C started her new school. It was basically a lot of change. It was all good but with any transition, it is never smooth sailing.
Fortunately, all that stuff mentioned above went pretty smooth. Kids are so resilient. Little C had a best friend by week 2 and by the second month, she was completely adjusted. It is definitely nice seeing my husband's face in person and not via FaceTime! But it turned out, the hardest transition was my new role as an attending.
I joined a private group. I remember posting on this website about what to ask in a job interview. To sum it up, I was way too excited that I was actually getting a job that I forgot majority of the advice given to me and signed a contract without really knowing what I was getting myself into. I had a sense of what the group would be like but I went along with their assumption that as my first year out of training that I would want to jump right in, make a lot of money and be on the full-time schedule, which included a lot of weekend call and evening shifts.
Initially, it didn't seem horrible compared to residency and fellowship. But my biggest dilemma now was how do I juggle being an attending and a mom without my own mom? My mom has been more than a grandma the past 4.5 years since little C was born. She was her primary caregiver for 2.5 years and the following 2 years of my long distance with my husband, she was available for every single sick day, call, evening shifts and weekend obligations. But I wanted to hold true to my promise that she would be a grandma once I became an attending. I think I really burnt her out the past almost 5 years and I think it was starting to put a dent in our relationship so this was new territory for me.
I found an incredible nanny to help with picks ups and drop offs but I was often very frustrated as to why I was working this hard and still not getting the work life balance that I thought I would ultimately have once I became an attending. I grew very unhappy, bottled it all up inside and did something I never thought I would do.
I quit.
But the most surprising twist of all was that my resignation wasn't taken and instead I was asked what would be my ideal schedule. I was shocked. I didn't expect such encouragement and flexibility. It took some convincing because I didn't think I deserved this kind of special treatment being so fresh out of training but it turns out, there were many people in the group who had different contracts that accommodated their lifestyles.
I thought I would let the group down if I didn't work the regular full-time schedule. I thought I was selfish asking to be taken out of the call pool and to only work from the hours of 8-5. But trying to quit ended up being the best decision ever. I got my dream schedule. I finally have time to work out for the first time in 5 years. I have the luxury of dropping off and picking up little C from school on Tuesdays and Thursdays. And the idea of second child is exciting now, rather than terrifying!
I feel like I can finally breathe now after 6 years of holding my breath and just trying to survive during residency and fellowship. I finally did it. I got my work-life balance. It's never perfect but I can work with this. So my take away lesson from all of this is don't be scared to ask for what you want, preferably without having to go through an almost resignation like myself!
Thursday, February 1, 2018
The MiM Book is out!
Chapter authors include MiM contributors T, Cutter, Genmedmom, Fizzy, Jay, m, Gizabeth, PracticeBalance, Emeducatormom, and Beckster. We also were fortunate to have authors with expertise in their areas write other chapters (e.g. an amazing student affairs dean writing with one of her former students, a thoughtful internist who chose to leave her job, private practice partners who learned to negotiate the hard way). Physician writer mom Danielle Ofri writes a lovely Foreword.
Sprinkled throughout the chapters, we feature blog excerpts and comments - some of you faithful readers and commenters might find your comment included! You all helped make this book a reality. Thanks, as always, for being part of our community.
Happy reading!
*Springer, our publisher, has offered a 30% discount through a discount flyer that you can access through the tab "The Book" above. (They don't do discount codes apparently.) The discount is good through June 1, 2018.
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