Guilt and Determination

Quote of the week:

“Guilt is useless. Determination is important”.

One of my department faculty members is leading a day long seminar of Community Health.

She adds “If you really need guilt, keep it like a cat at home. Pet it every once in awhile, let it know you know it’s there - but when you leave the house, take determination with you.”

I love it. Even before Toddler came into the world, I told myself I would NOT be a guilty mom. I would logically know I was doing the best I could, logically know that I could not be in three places at once. I was going logic myself right out of guilt. Because we all know logic always wins.

I’ve been trying to be mindful when spending time with Toddler - no phones, no distracting screens, just him and me together. It makes me think of this post from Mrs Md PhD which is best characterized by the meme saying I WILL DO ALL THE THINGS WITH MY TODDLER!! (which is definitely due for a revisit if you haven’t seen it in awhile).


However since Toddler currently has the attention span of a small flea and likes to entertain himself a lot, a little too much mindfulness can send me off the deep end. So we’ll play legos together but a little podcast in the background goes a long way. Now that we’ve had a long awaited golden weekend together with minimal leaving-the-house plans, I was able to put that guilt aside for now.

One of my coresidents was feeling guilty lately about working her first week of nights while leaving her baby at home and I told her “you’re a better mom because you’re a doctor, and a better doctor because you’re a mom”. It took me awhile to realize that I really did mean it (at least about myself) and wasn’t just saying it to make her feel better. I appreciate the time I have at home without Toddler, but I also have a small glimspe now into why the nurses I work with who have 4 kids at home come to their busy shifts and sometimes consider it a “break”.

I also think guilt is ingrained into us in medical school. Guilt we didn’t present our patient perfectly. Guilt we missed that lab finding. I was with a second year medical student today, who kept saying “sorry” for things she couldn’t help - like the computer not loading or not having access to charts. It made me remember sitting with a co medical student on our internal medicine rotation watching her beg for an afternoon off for an appointment and constantly apologizing for having to leave. I’ve managed to cut out “I’m sorry” out of my vocabulary if it’s something I can’t help (unless expressing empathy for a patient). My feedback to her was to catch herself when she is going to say “I’m sorry”, see if it’s something she could have actually done anything about, and cut it if she can’t.

I’m sure there are still going to be times I feel guilty, especially if we have another day care drop off melt down tomorrow, but I’m going to do my best to pat Guilt on the head and leave with determination in hand.

Kicks

Looking how to complete the medical equivalent of #squadgoals

As a resident, I rotate through a number of different departments and different hospital sites. This past month (or last month, because I'm late on posting this), I rotated through the trauma service.

On a string of nights, I met another strong, powerful, kick butt mother in medicine. A senior surgery resident on another surgical service, she was not my direct senior; but as we both set up headquarters in the trauma bay, we had the work equivalent of an all night sleepover, q3, for about 2 weeks.

It was so much fun. Being a resident who is also a mom is pretty lonely at times. I'm not free for most brunches, I don't party on weekends, I can't commit to an 8 pm weekly spin class. While I get along with most people on shift,  it has been difficult to connect out of work- with both men an women residents alike.

How do you bridge that gap? Part of me likes having that separation of work life and home life. But  recently, when a resident - who I always laugh with on shift and love working with- got married, it stung that I wasn't invited.  I offered to cover her call, though.

So I will continue to look out for members of the club. Give a head nod to the pregnant resident on the admitting team, look out for the one with pictures of her kids on her phone background. It's nice to be recognized and it's nice to be part of a larger team.

When it's time to get unstuck

Have you been feeling stuck? What are you going to do to get unstuck? Maybe start with your sock drawer? Or start with a vision board for your practice? Or start with a date night with your partner or a girls' night out with your friends. Or start with a breath. Whatever you do, just start!

For the last few years since finishing residency, I have been grappling with many things. After my disappointing first job as an academic pediatrician (my "dream job" I thought), and my foray into private practice I realized that the system of medicine many of us practice in, corporate medicine with the primary goal of seeing enough patients in the day, simply didn't fit with the what fuels my heart.

I spent two years during my American Academy of Pediatrics Leadership Innovation Fostering Education Fellowship researching physician wellness and in particular how systems and practices must incorporate wellness and burn out prevention at all levels. It is not enough to tell physicians to meditate if they are being "strongly encouraged" to see more and more patients, have burgeoning administrative tasks (click this meaningful use button), have mountains of debt, or are in jobs that they hate because of loan forgiveness, have less and less control over their schedules, and less time to make meaningful relationships with their patients. A mindfulness seminar won't cut it. Physicians everywhere are saying enough! It's to much! Record numbers of our colleagues are walking away from medicine or are joining the ranks of the hospitalists and specialists. What happens to our system when there are more hospitals, urgent cares, and intensive care units than quality, sustainable primary care practices? What will continue to happen when emergency rooms and surgical suites continue to be more lucrative than wellness centers and small, high quality private practices? Does it mean people will be allowed to get sicker and sicker? Does it mean that large hospital systems will continue to invest less into primary care and more into expanding their Emergency Rooms? Money talks, right?

This year I will be undertaking some exciting new endeavors. To try to get back to what inspired the premedical student who had all of the time in the world to sit with my patients, to commune with them, to build with them. We see it all around us. Patients who can afford it are flocking to naturopaths and integrative medicine doctors. The overwhelming response is that those providers listen. They have the time. So I have to make the time.

I have been hustling and working, but I still felt stuck. Stuck in fear. Stuck in a laundry list of things to do. Stuck in the what ifs. Stuck. So again, I use the tools that I have and start to research solutions. I have been listening to a lot of podcasts about following your dreams and reading books about decluttering and re-envisioning your life (see the list below). I even watched Marie Kondo's Tidying on Netflix. I saw the piles of clothes folks had and thought "yuck! How could things get so bad?" And then I did this while my boys are away:

(clothes stored in my closet, attic, and drawers - don't judge me until you try it! Very eye-opening!)

It's no wonder I feel stuck. I have been holding on to so much. I still have clothes from my first attending job and from my corporate job that I know I will never wear again. Letting go of them causes so many mixed emotions. Failure. Courage. Pride. Anxiety. Commitment.

It's time to get unstuck. The piles and piles of donations, maternity clothes to pass down, and work clothes to pass on won't unseat themselves. No one is coming to save me. I am saving myself. Starting right here. In this moment, again. And I will do it again and again PRN (as needed for those who don't abbreviate on their prescriptions). One day at a time.


Above references mentioned:

Podcasts:

• Dreams in Drive
• Side Hustle Pro
• Therapy for Black Girls

Books:

• Marie Kondo's "The Life Changing Magic of Tidying Up"
• Dr. Dike Drummond's "Stop Physician Burnout: what to do when working harder isn't working?"

Blogs:

• mnmlist.com
• theafrominimalist.com
• zenhabits.com

Netflix shows:

• Tidying Up with Marie Kondo 

Breaking through the emotional barrier

We have the same birthday, she and I. We were born worlds apart, both geographically and culturally, but on the same day of the same month in the same year. I noticed her birth date, right there on the front page of her daughter’s, my patient’s, medical chart. Her daughter, who should have been a princess. In a family full of men and boys, sons and nephews, the baby was the first girl to be born in over 40 years. The family prepared for her birth, overjoyed, buying frilly dresses and pink bedspreads and dolls. But it was not to be. Mother was stricken with intrapartum hemorrhage and baby was born with anoxic brain injury, doomed to be neurologically devastated.

And that’s not even the worst part.

She tells me that she and her husband sometimes imagine what it would be like if her daughter, now turning one, were born healthy. They can almost hear her say “mama” and “dada”, can almost feel her hugs as she runs, laughing, into their arms. They wonder if she would be crawling now, walking now, what food she would like best, and if her older brother would share his toys with her. They mourn what could have been, what should have been.

That’s not the worst part either.

In their home country, they were told to leave her to die. They were told not to pursue medical care, that God would take care of “the situation.” And that’s when they packed their bags. They ravaged through bureaucratic red tape and procured visas. They left it all, their supportive family, their grand estate, and moved to a small apartment in the United States so they could get medical care for their daughter in the first world. In their home country, they were royalty. And here they work menial jobs to make ends meet. She works at a local supermarket, bagging groceries. One day, she tells me, a customer was checking out groceries with her own daughter, who was particularly rambunctious. The customer was frazzled, stressed, in a rush, and frustrated with her daughter. The customer turned to the woman, this grocery bagger, this almost-but-not-quite-bereaved immigrant mother and said to her, “She’s driving my crazy. Do you want her? Just take her.”

And that was the worst part.

Does she want her? Well, not her exactly, but yes, of course she craves a normal, healthy daughter. What a horrible thing to hear. What a horrible thing to say. It’s not even that the customer was trying to be mean; it’s not human cruelty. It’s the cruelty of the universe, the cosmic unfairness of it all, coupled with human indifference and sarcasm, that combine together to create a vortex of heartbreaking tragedy.

I take care of children like this every day. Children with chronic illness, children with neurologic devastation due to the unfortunate hand that was dealt to them: prematurity, trauma, genetic disease. In order to survive as doctors, there must be an emotional barrier. We can be empathetic, but we cannot get too close emotionally, otherwise we cannot function. But this one hit me hard. Maybe it’s the fact that we have the same birthday. Or maybe it’s because I, too, suffered intrapartum hemorrhage, but because it was expected and planned for, the baby and I did incredibly well. Or maybe it has to do with the fact that I am freshly back from maternity leave after recovering from said complicated delivery and I am physically and emotionally exhausted. This one broke through the emotional barrier and catapulted me from the land of empathy to the state of feeling.

I want to say to her: I feel you. I feel your pain and your heartbreak and you are not alone. Let me bear some of it for you so you can take a breath. Right now, as the discharge papers are being printed and you are collecting your things, let me shoulder some of this pain for you. I don’t say it. Maybe I should but I don’t. I squeeze her hand and wish her well and tell her that her daughter is lucky to have her. I thank her for the opportunity to take care of her daughter, and I say goodbye.

New Year Goals

2018 was intense, harried, and a blur. There were highlights, like our first international trip to Italy in June (amazing, loved every minute, especially hiking through Cinque Terre and going on a timed family scavenger hunt through the streets of Florence), but there were also times that were just so busy that we were just trying to get through the week and not forget anything big (like that First Communion parents' night meeting that I totally forgot).

The busyness was entirely self-inflicted, a combination of too many kid activities, daughter applying to high schools (yes, it's a thing - a very stressful and energy-sucking thing), did I mention too many kid activities? There's three of them and we try to make sure they all get enriching experiences that they are interested in, but it's reached a comic/insane level if I do say so myself. Soccer alone.

Upon reflection during this sedate winter break, I've decided that I'd like to work on some life goals for 2019 for our family and home.

• More time with friends. We once tried to have friends over once a month which was awesome until it petered out. I think this is important for all of us and also important to our house in terms of general upkeep. We are resurrecting Guests of the Month and thinking of our first invites!
• De-cluttering. Our next door neighbors have the same exact house as we do but the mirror image. They had a holiday party which we attended last week and each time I'm in there, I marvel at their lack of clutter. They have NONE. Now I know it's a party and I'm sure they got it party-ready, but they are naturally immaculate (have 2 older kids) and spare. I came home from the party ready to donate 1/3 of the items in our house. We started with the Great Clean Out by having a family organization event of our basement storage room. The storage room has items like Rollerblades circa 1992, a small couch, and 5,395 other items strewn about in no particular order. It's level 2 Hoarders, Buried Alive. All 5 of us were down there, throwing things out, cleaning up, organizing, donating, and it looks amazing! No longer an embarrassment when the plumber needs to go in there! It felt good and didn't take too long. We also unearthed some forgotten treasures like my medical school commencement program and a birthday letter from a college friend. 
• Developing kid grit. Husband and I have decided that at least some of our kids lack grit and tend to give up easily. While watching our two boys, 7 and 10, on an unseasonably beautiful day during this break, I decided we needed to go on a Mom and Sons Run to enjoy the day and get some exercise. After the complaining and realization that I was set about this plan, we all ventured out to do a neighborhood run - just 1 mile! Now, we've all run a mile before- they've all run a 5K - so a mile is nothing right? Well, during that 1 mile, there were 40 stops, crying (someone fell), pushing (in play but still), a side cramp, and so much walking--I had to pause my activity tracker twice until we could continue. It was like the Bad News Bears Go On a Short Run. I told Husband and we decided there would be a repeat Family Run the next day as part of Grit Bootcamp. It was actually pretty fun. The 5 of us ran 1.25 miles with minimal stops and the 7 year old said, "We ran faster, longer, and it wasn't as bad!" We want to teach them they can get through discomfort and to be mentally tough too. More Family Runs to come!
• Mangeable kid activities. I want to include a question mark here since I'm half-hearted about this goal. I think 7 soccer teams was definitely over the top last fall, but I also want them to have time to pursue their interests, develop themselves, etc etc. I guess my goal is to be more conscious of our whole family schedule and to make sure everyone has some down time. Spring means only 4 soccer teams so that's a start! 
• Be more connected to others. Beyond having guests over, I want to reconnect more with friends and make time for that. I want to carve out more time to be connected with my husband. And continue to have great family unit time. I think this means committing to the bullet point above because connecting takes time and time is of short order around here.

Any one else have goals they hope to tackle in 2019? I figure writing them down makes us more accountable so feel free to share in a public declaration. :)