Forty years and counting......

Random ponderings on turning forty........

• There is genuine sadness and mourning when a favorite piece of makeup is discontinued.......it has taken me years to perfect the “easy, 5-minute, naked-face” look. Now I have to start that one piece over again and it genuinely hurts me..... 
• Alternatives to having a kid: 1) purchase $12,500 worth of organic produce and just pile it up in your living room. Leave to rot. Periodically stomp through it wearing Peppa Pig rain boots and a set of PJ Masks jams. Sometimes pretend to clean it up with a set of tiny wooden cleaning tools. When it starts to smell, scream at your spouse that it is his or her fault that the mess is there. Then toss in an emphatic “you hurt me, you’re not my best friend anymore!!” when he/she denies it. 2) drive to a bank on a tiny pink tricycle with streamers, rob it using only the threat of violence with your ridiculously fast-growing finger- and toenails, then take the pile of cash you claw away from the teller and just light it on fire in the middle of your living room. Repeat monthly. At least 10,000 USD should equivocate the experience of parenting. 3) buy some clothes that you really love, but get them two sizes smaller than your fit. Then look at them hanging in your closet every day while you pull on big shapeless scrubs, or Lycra yoga pants stained with unknown substances and with a forgotten mermaid sticker on the bum. Tell yourself that someday you will wear those again, but know that you won’t. In fact, you never did. Also, download an audio file of Honey Boo Boo complaining about a lack of syrup on her hot dogs and play that on an endless loop in the background. You know, just to sharpen your mind. 
• There are many trade-offs for waiting until later in life and marriage to have a kid. For example, with the presumed extra patience afforded by years of taking so much crap from the external world comes creaky, swollen and painful joints, stretching to their limits with every game of “pretend to be a floor worm with me!” or kneeling on the bathroom floor next to the bathtub, eating invisible cake slices out of bathtub toys with all of her rubber duck friends. But, when your kid makes you some fake strawberry shortcake out of a washcloth and some Paw Patrol purple body wash and hands it to you in a plastic cup with a star-shaped hole in the bottom, you eat that shit. Heck, I’m just happy to be invited to the party. 
• Alone time is the greatest gift the universe has to bestow upon me. There is never enough of it, and it nourishes my soul for when it gets people-y out there. The kid gets the majority of my energy, followed by job and hubs, mostly in equal proportions. Regeneration time is critical, and I’m learning to not feel guilty about it. 
• The more that I age, the more that I learn to stand up for myself and what I believe in a more fierce and unapologetic way. Being told how to use my voice by any number of different people with different agendas and issues is becoming harder to stomach. I genuinely appreciate differing opinions and polite discourse (the more animated, the better!), but when people try to strong-arm their issues and life views on me with tone-policing and gaslighting, well, Iam done sitting back and taking it, especially in my own personal space. I’m too old for that noise.
• Work-life balance is impossible (at least for me). It’s never balanced. One thing is always outweighing something else. It’s more about trying to keep my head above water, occasionally being really good at one thing or another, oftentimes just getting by, and hopefully not letting anybody die on my watch. There is also reminding myself that most of the time, the job I’m doing is good enough, and I’m learning to be okay with that. Being a doctor isn’t for the weak of heart. And being a mom isn’t for the weak of head. Sometimes my heart prevails in medicine and I cry. Sometimes my head prevails in parenting and I cry. It’s all so, so hard. But also pretty badass and (mostly) rewarding. And being a wife is a delicate and ever-moving target of balancing head and heart. Sometimes this is the hardest job, loving the one you’re with and nurturing that commitment. 
•  My husband and I have had an awful lot of loss in recent years, to include both of my parents, and his mother. Raising our daughter without these loved ancestors has brought on a lot of pain in such unexpected moments. She never got to meet them, and yet we see each of them in her nearly every day. Nature is a remarkable thing, perpetuating itself in this way. I wasn’t sure that I wanted to do this whole parenting thing for a myriad of reasons, but catching glimpses of my mom and dad again every now and again in my daughter’s face or voice is about as spiritual as it gets for me. I embrace this fully. 
• I’m truly happy to see forty, and I hope to have sixty more. I do love this life, including the joy, the pain, the humor, the tears, the angst, the stress, the happiness, the closeness and the love. Each new day is not guaranteed. The first forty (wow!) have been pretty damn good. Looking forward to what comes next.......

Slime and Slides and Sutures and Fireworks

Since I'm a resident and my husband works full time, our kids are in full time camp this summer. Which has worked great. The availability of pre-care and after care in a fun environment without the bustle of the school year has allowed us to let go of our nanny for the summer and just be us. Which has been exhausting, but surprisingly really rewarding.

However, without that extra piece of our childcare puzzle, days like July 4th posed a conundrum. My husband works all holidays for the overtime pay and I had conference in the morning and a swing/evening shift. And no camp.

So, come the morning of July 4th, my Monkey (4) and Chicken (6) got to experience an EM conference. Set up with ipads, snacks, markers, crayons, peppa pig figurines, and donuts. They lasted for almost half way through, but finally got antsy that the little "bring kids to work day" experience ended 3 hours in.

As a reward for being great sports, I promised them that we could make slime when we got home. I hate slime. It's sticky and slimy and is a sensory overload of amorphous blob. But it's all the rage this summer and my daughter's "best wish," so slime experiments it was. After trecking to Target to buy all the necessary ingredients, and a cart full of not-on-the-list other Target "necessities," we made 3 kinds of slime. 2 were successful. One was so gross and mushy and was such an utter fail. Not sure how Pinterest parents do it- this was  hard and messy work!

At 5:30, my husband came home and we switched shifts. I went to work and he manned the barbeque and firework portion of the day's festivities. While I experienced the rest of the night vicariously with videos watched later, hours after they were sleeping, I smiled at the dichotomy of my life as a resident. At our lives during this residency. So thankful my I have an awesome flexible co-parent and that my kids get to learn the importance of hard work, while having all the same fun as well.

One of the unique parts of going into EM is the variety of work hours. Yes, I work a lot of nights and weekends and holidays, but I also get to be home a lot in the mornings, early weeknights, and  random Tuesday afternoons. Hopefully, I continue to enjoy it as much as I have this first year!


For reference, here were the winning slime recipes: (adapted from links from littlebinsforlittlehands.com)

Basic Slime (from
Ingredients: Elmer's Glue, saline solution (Target Brand - any saline with boric acid and Sodium Borate), water, baking soda, food coloring

Recipe:
Mix 1/2 cup glue and 1/2 cup water. Stir until well mixed
Then add food coloring and/or glitter
Stir together
Add 1/2 tsp baking soda and 3 Tablespoons saline solution. Mix REALLY FAST.
Keep mixing, then kneading, until you get the consistency you want.

Tip: hands get messy so wear gloves or be sure to wash them after to prevent staining from food coloring.

Fluffy Slime:
Ingredients: Elmer glue, shaving foam (old fashioned barber shaving foam. Gel doesn't work- we had better luck in the men shaving section), saline solution, water, (if you want)

Mix 1/2 cup glue and 1/2 - 1 cup of shaving foam (depends on how fluffy you want it- we played around so didn't measure exactly). Add color/glitter.
Then add about 5 TBS of saline solution. We added a bit of water to make it more workable, but experiment.
Mix/Stir/Knead together. This one is SUPER STICKY and very stringy and messy. So be aware.

Enjoy!

Hello from LlamaMama

Hello MIM!

LlamaMama here. I'm an MS4 going into Pediatrics, wife of my college sweetheart, and proud mama of an energetic 1-year-old (how did that happen?!?!) boy. I've been reading this blog ever since I was thinking about becoming a mother in medicine. I've always known that I wanted to work in a health-related field, but a bad case of imposter syndrome, coupled with worries about work-life-balance kept me from pursuing a medical career for far too long. There were no physicians in my family, and most of the women had given up their career ambitions to focus on their families, which made this career decision that much more intimidating. MIM was the first space where I found women honestly sharing about their joys and struggles in prioritizing their medical careers and their families. In the last few years, I've found lots of awesome women physician mentors, in addition to continuing to follow this blog. I'm so excited to join the list of regular contributors!

A little bit more about me: I grew up in a few different countries, and am now married to a wonderful man who also grew up in multiple countries, so when we do get free time, we love to travel (we've already taken the baby on two international trips and several cross-country!). I love to cook and eat delicious food, and I'm working on finding an exercise routine that I enjoy enough to do consistently. I am a social introvert, figuring out how to balance deepening relationships with my husband, son and close friends while still making time to re-charge alone. I look forward to sharing my joys and struggles with you all.  

I forgot to worry about that!

Hi! So excited to join this sisterhood. I am a pediatric hospitalist at a mid-sized children’s hospital. I am blessed with 3 amazing children and a supportive, talented husband who is thankfully not in medicine but rather works during normal human hours.

I am pregnant with my fourth child. I have had 3 normal, healthy pregnancies and delivered 3 healthy, full term babies. I was apprehensively hoping for the same this time around. No such luck; at my routine anatomy scan, I was suspected to have placenta accreta. For those of you who don’t remember from medical school, here’s a crash course. Normally the placenta adheres loosely to the uterine wall, and is able to detach easily following delivery. With placenta accreta, the placenta adheres to the uterus pathologically. It invades inward, doesn’t separate spontaneously after delivery, and can cause massive hemorrhage if manual separation is attempted. Most patients who have placenta accreta require a life-saving hysterectomy. There are 3 subtypes: in a standard accreta, the placenta simply attaches too deeply to the uterine wall; in placenta increta, it invades into the myometrium; and in placenta percreta, it invades through the myometrium and serosa, and occasionally into surrounding structures and organs (most commonly the bladder, but any organ in the vicinity is potentially at risk).

I immediately transferred care to the placenta accreta referral center in the nearest big city. Within 2 weeks I had an appointment and within 2 minutes of meeting my MFM she told me I was a “hot mess.” I have placenta percreta. Go big or go home. (I think I want to go home.)

People comment on how “well I’m taking it.” How “strong” and “resilient” I am. “You look great; you don’t even seem worried,” people tell me. I don’t seem worried? That’s cool. Because I am worried. I’m worried about a lot of things. In fact, here is a list of things I’m worried about.

• The very complicated cesarean delivery, complete with a hysterectomy. I will be on the table for about 6 hours, and there will be various surgical teams parading in and out of the OR.
• Intraoperative blood loss, with potential for massive hemorrhage. I will almost certainly require multiple blood transfusions, and if things go particularly badly “massive transfusion protocol” will be initiated, which puts me at risk for complications including fluid shifts, electrolyte derangements, DIC and ARDS, to name a few.
• Damage to surrounding structures, including but not limited to my genitourinary tract. That placenta is freaking close to my bladder, people.
• Let’s just put this out there: death. There is in fact a 7% mortality rate for cases like mine. Even in the major centers, even if the operative teams are prepared.
• Oh, and the baby. In order to reduce the risk of these complications, the baby will need to be delivered preterm. And not late-preterm. Preterm preterm. Like a preterm baby who is at risk for sepsis, IVH, chronic lung disease, NEC, and all the other preemie ailments.
• And the more minor things too. That pesky surgical incision that will extend vertically from my pubis up to my xiphoid. Recovering from this surgery, which will render me essentially nonfunctional at home. The possibility that breastfeeding may not go well, and may not be possible at all. The fear that this pregnancy may become even more complicated, and I may need to deliver even earlier than planned. The fact that I don’t have enough paid time off, and I will need to take unpaid leave for several weeks, something that I’m not sure we can handle financially. The loss of my fertility, completely and forever.

But life goes on. Thankfully the baby is fine and the pregnancy is otherwise healthy, so there’s not much to do between now and delivery. So I get dressed, get in my car, and go to work. I take care of sick patients, supervise residents, and teach medical students. And on nights in the hospital when things are slow I work on my mandatory compliance modules. Every year we are obligated to do like 40 of them. They range from mildly clinically interesting (preventing central line infections, reporting suspected child abuse) to stiffly corporate (anti-kickback statutes, reminders not to commit fraud) to downright irrelevant and time-wasting.

One night on call I had some free time so I decided to bang out a few modules. I was up to “Preventing Operating Room Fires.” Groan. This one was not only completely irrelevant (I wasn’t even allowed in the ORs! Not even to, say, do an LP on a sedated child!) but it was an 18-minute-long video. As I started watching the video, I froze. I realized that even though I wasn’t allowed in the OR as a doctor, I was about to be in one as a patient. And I slowly but suddenly wondered: WHAT IF THERE IS A FIRE IN THE OR??? THIS COULD TOTALLY HAPPEN TO ME! And it dawned on me, that with all the things I was worrying about – the massive blood transfusions, the damage to my genitourinary tract, the 7% mortality rate, the preemie baby – there could ALSO be an OR fire and I FORGOT TO WORRY ABOUT THAT! How could I forget to worry about something that had a nonzero chance of happening and could have devastating consequences? I didn’t sleep for the next 3 nights.

I remember my last night on call before delivering my youngest child. I was 38 weeks along and healthy. One of the patients I admitted was a 4-month-old infant. She had had corrective surgery to repair anorectal atresia with a rectovestibular fistula and needed to be monitored post-op. As I took the history from her parents and discovered that they did not know about this condition until after she was born, I remember having a similar realization: I had been worrying about all the usual things – prematurity, infection, birth hypoxia. But anorectal atresia with rectovestibular fistula? I had completely forgotten to worry about that!

Worry is a funny thing. Psychologists postulate that worry is beneficial insofar as it helps people do the things they need to do to keep themselves safe. Studies have shown that people who worry about skin cancer are more vigilant about applying sunscreen than those who don’t. But I already transferred to the regional center and am compliant with my prenatal care, all the things I need to do to optimize my chances for a good medical outcome. At this point most psychologists would agree that worrying won’t do me any good. It doesn’t help anything. But that doesn’t stop me.

A few friends jokingly suggested that I focus all my energy on worrying about that potential OR fire and not bother worrying about anything else. It’s not a terrible idea.

Summer reflections

Hello! My name is Michelle and I am brand new to the world of blogging (so be gentle with me). I am a Mom to two energetic boys who keep me on my toes. I also spend the rest of my time taking care of other people’s kids as a pediatrician.

Since we are now knee deep into summer (I don’t know about you but it feels like school just let out and already we are starting back to school shopping!!) I was reflecting on our busy summer days and how they are different then the laid back lazy summer days of my youth. Summers are a funny time when you are a working Mom. It starts a few weeks before school lets out when Moms start speaking of how they are looking forward to lazy days and all the fun summer projects they are going to accomplish. I often feel envious of the stay at home Mom’s summer. (And this is not meant to spark the stay at home vs working Mom debate. We are all valuable in what we do - we are all good people doing good things.) What I mean is I have a longing for lazy days with no schedule and no commitments. The ability to lounge in pajamas all day if that’s what we choose to do. I see facebook posts of cute kids with bed hair and pjs captioned ‘just woke up’ at 10 a.m. and I sigh. I hear my patients tell me that they are getting ready to go away for the summer and think ‘what is it like to take 6 weeks off’ and I sigh. I talk to other Moms and listen to them tell of putting their kids in day camps for a week to break up the boredom of their carefree summer days and I sigh. The fact is in my family our summers look a whole lot like our school year does. Summer camp is not a boredom buster for us but a requirement for our two working parent family. We still get up at the same time and leave the house at the same time to get to summer camp everyday. I still try to get them in bed at a reasonable time at night while allowing for some ‘it’s summer can we stay up late’ requests. Aside from not having homework to do and after school activities we have the same rhythm to most our days. And at times that is a great thing - because my kids do thrive on a schedule (and really so do I) But there are many moments that I long for the lazy days of my summer. When I was a kid we didn’t have summer camps and scheduled activities. We woke up whenever we wanted to and watched way too much TV and swam most of the day. We rode our bikes back and forth from my Grandma’s house where she would make us grilled cheese sandwiches and let us eat popsicles in the hot sun. I wonder sometimes if my kids are missing out on that and wonder how I can get that for them. Which is ultimately ironic because I work hard to make a better life for my children and now I contemplate a life not working to give them a more schedule free life. I know this is my own internal debate because my kids are having the time of their lives - they are doing Hogwarts camp and Lego camp and all sorts of fun things. I hear no complaints from them at all. I do worry about their need to be on the go all the time and wonder if that is a byproduct of our scheduled life. My oldest, especially, has a hard time when there is no plan for the day and has a hard time with unscheduled down time (which of course as a parent is the thing of my dreams!) So I worry - as we all do - about making the right choices knowing all along that the choices we make are often not in our control at all. But I still can daydream and live vicariously through those stay at home Moms leaving with their kids for their long lazy summers on the lake and think ‘maybe someday’.