The critical first decade

I was at a conference a few weeks ago for rising chief residents. Hilariously, my husband (who had a few days off from work) decided to take advantage of the free hotel room and come with me, bringing out 20 month old. They had a lot of fun during the day, until he got a febrile URI and became a clingy mess. (Of course, then I felt guilty being wined and dined with the program leadership while he sat in the hotel room with a sick kid, but what else is new in Mom-land?)

But this isn't about that.

During the first day, the keynote speaker gave an address about carving a career path for yourself in academia -- life "after" chief year. He talked about the historic ideal of the "triple threat," where you succeed in teaching, research, and clinical time, essentially having a contract that allows you to spend 1/3 of your time in each area, adding up to a full time job. He reminded us, not so gently, that no one ever succeeds at all of these things, not as effectively as they could if they focused on one or two areas, and encouraged us to pick one or two when envisioning our future career.

And then he described the trajectory of a career in academic medicine: "The first decade is focused on establishing yourself, making a name for you and the research or clinical area you want to be known for. The second decade is to deepen that commitment to "your thing" -- publishing extensively, traveling, teaching, and speaking. By the third decade, you're known -- being asked to contribute chapters to books, leading courses with medical students, innovating as a clinic director. The fourth decade is a time to relax, to live in the space you've carved for yourself - and if you're lucky enough to have a 5th decade, you're an emeritus, enjoying the learning and not doing very much."

And as I sat in the audience, surrounded by future chief residents, I thought about how ~50% of us are women, and women who, most likely, will only be fertile during that first decade of our careers. What does that mean for the "most critical" decade of our work, to also recognize the very real demands that daycare and illness and doctor's appointments and soccer and pickups and dropoffs have?

Years ago, I once told a mentor that I thought that, realistically, this 10 years of my career would likely be my least productive, by publishing standards. I have a small child, I was planning on having multiple others. He was totally blown away, immediately shook his head, said there's no way that would be true, that he knew me and my work ethic, that lots of women "succeed despite kids." I left that meeting embarrassed, thinking that perhaps I shouldn't admit what I knew to be true - my partner works, too, and our lives have to adjust to the very real presence of our child.

This lecture was fresh on my mind when we returned from the conference and my husband went back to work. They've had some staffing turnover among the employees, and a new boss has been hired. Two leaders who currently work part-time (for various family reasons) were instructed that they would be welcome to sign a contract for next year in their current positions, but would not be able to work part-time - leadership requires a full time commitment. If they wanted part-time they could do a similar role, but without "a seat at the leadership table." This discussion among the staff at his job has been burning my brain ever since he told me - that two of the women (and, not-coincidentally, the only two mothers) on their leadership team were told that their commitment wasn't enough, that their desire to work part-time wasn't enough, that the hours they put in at night after their kids go to bed, and on the weekends, and in-between the other parts of their lives wasn't enough. I was in tears as he explained it to me, and I don't even know this women well - they work in another department.

I remember this keynote speaker, and I imagine the first decade of these women's careers. I suppose they didn't establish themselves, their credibility, their niche as clearly or as well as their male colleagues - that when it comes down to it, their skills are dispensable. The New York Times had a great article about this very topic yesterday - in short, that in heterosexual couples with children, employed mothers get the short end of the proverbial stick - faced with the demands of parenting and the ever-increasing demands of the work force, they end up forced to cut somewhere. For these women at my husband's workplace (and, realistically, for future me) - they cut back a bit at work. But working 25% less doesn't mean making 25% less, or being valued 25% less -- it means making 200% less, being valued 200% less.

I'd love to know reflections on your first decade at work, post-residency and fellowship and training. How did you carve out a niche for yourself? Or is that overrated in the first place? And what does it look like to parent when work is "greedy"?

Saturday AM coffee

The golden weekend begins

I wake up at 7:30 before my alarm. Approx 10 seconds of quiet uninterrupted bliss ensues when I realize I’m the only one awake. I can’t wait to make Saturday morning coffee. Then Dog demands to go outside.

While dog is outside, I read the last few page stories of the mystery I’ve been working on. Toddler fusses. I think “only ten pages to go” and Toddler falls miraculously back asleep and I finish my book.

Toddler fusses again. No coffee yet. Upstairs I find Toddler covered in poo including pieces in hair and hands. Apparently letting him eat that much pizza last night was a mistake. Toddler is protesting in the tub but much much cleaner 5 minutes later. I peek out in the hall for backup, turns out Husband heard the commotion and closed the bedroom door for a little longer sleep in. Hmph.

Toddler is dried out of bath. I sit him downstairs with yogurt and all is forgiven instantly. He smears his yogurt-covered hands through his recently bathed hair as I rinse the poo off of sheets, his pajamas, my pajamas and throw in the wash. Coffeemaker is finally started. I sit down with my own yogurt, which Toddler immediately realizes is different from his own and demands some. We share a little more yogurt.

Toddler gets spot cleaned, and I finally pour my cup of coffee.

It’s a beautiful day. Toddler loves being outside. Dog, coats, boots are collected and I spill a little of my precious “mom juice” on the floor. (“Mom juice” is my explanation to Toddler for coffee, wine, diet Mountain Dew, etc.). Clean floor. I go out thinking I might sit outside a sip some coffee, watch the commotion and listen to the radio. Coffee is a little colder but still tolerable. Spill some coffee on my old white worn fleece

I drag my chair to the sunny corner of the backyard, before realizing I have nowhere to put my coffee down. Coffee sits on little mud pile.Toddler decides he wants to rock with me on the chair, then by himself.  The ball is thrown to dog. Sip. Throw. Sip. Throw. Toddler gets stuck in his plastic car. Extract Toddler. Sip. Run around yard with Toddler and Dog. Sip slightly warm coffee.

Sneak inside to top off cup with warm coffee and grab Kleenex for Toddler.

Back inside. Laundry gets  done, clothes are packed and bathroom gets cleaned. Toddler finds the Swiffer cloths very interesting.. Now off to our parents for a weekend away.

I think I need another cup of coffee.

I can’t wait until I start my attending primary care clinic job this fall (yay!) and this becomes more of a typical than atypical Saturday (minus the poo).

Kicks

I went to a concert and it was okay

For Christmas, we gave our 13-year old daughter tickets to a concert for her favorite band. She's played us songs ("Can I play you this song? It is sooooo good! *insert look on my face during song that looks like a shot from The Office when a character smiles uncomfortably into the camera*)

Let's just say that I feel too old to enjoy this kind of young boy band music. 

But nevertheless, we gifted her tickets (#4) for her and her two friends and one very lucky parent chaperone (me). Please note my deep love and devotion for my husband to not even try to do rock-paper-scissors for the pleasure. Because I knew that he might die if he were exposed to that environment. He's more introverted and has somewhat elitist views on music. 

I did establish some expectations with all parties to protect my sanity. Since it would be a school/work night (!), I declared that we would get there early and leave early, like before it ended. There's no way I'd be stuck in concert exit traffic late into the evening by leaving when everyone else did. No. Way.

So, on a recent Thursday night, I drove my daughter and her best friends through 1.5 hours of rush hour traffic to the concert venue.  They were ridiculously excited, playing the band's songs and flipping through a coffee table book of said band the entire time. By the time we got to the garage, they were downright Giddy with excitement. I have to say that seeing them united in Giddiness gave me serious feels.

We walked a couple of blocks towards the arena, realizing that there was a huge parking lot right there and that we unnecessarily parked in a remote garage. Oh well (I followed the signs!). We were almost at the arena when I ran through the exit procedures with the girls. I would leave before them, get the car, then text them to meet up, before the concert ended. 

We made it to our seats, and I noted that the median age of the audience was 14 and 90% female. Parents were on their phones.  At one point, one of the two opening acts gave a shout out to the parents in the audience. That's when you know you're old and at a concert for a much different demographic.

There was a whole lot of screaming that night. Jumping. Glee. I loved seeing my daughter and her friends enjoy the moment so much. That made bearing the screaming and jumping and loud music I didn't care for, bearable. On the plus side, I could go get them food without feeling like I missed anything unlike most of my previous concert experiences. And the music, well, I had very low expectations and it exceeded them. (ears weren't bleeding; I refused to stand though)

After looking at my watch for the 100th time, I decided that it was time for me to make the trek to the remote parking garage ahead of time, trying to project what time the concert might start winding down and how long it would take to get everyone home. I left them there with the concert going strong and, on the way out, took advantage of zero merch lines to buy them all concert shirts as a surprise. Lots of parents out there, sitting in chairs on their phones. 

By the time I came back around with the car, it was at exactly my pre-planned pick-up with them and they were out to meet me within a couple of minutes. The concert was just wrapping up and we made a hasty get away with zero exit traffic! It was a surgical strike! On the way home, the girls basked in their happy exhaustion. 

"That was the best 2 hours of my life!" said one friend.

I dropped each one off at home and presented them with the surprise shirt. They were thrilled! We hugged (more feels). And I felt very good for helping to make that experience happen for them. I might even do it again.

It just looks like that girl has a hook for a hand. Also, that girl stood like the entire time.

Getting down the mountain with Pizza turns.

A few weeks ago we took my kids on their first ski trip. Actually, it was the first time my younger one has ever seen snow!

The first 2 days, the kids were in ski school and my husband and I got to go ski the "fun stuff." We are both pretty advanced skiers so it was great going down the mountain, together, without kids,  like we were dating again. I love anything outdoors and active, so this was the perfect antidote to the recent run of a lot of ED shifts.

But on the last day of our little trip, the kids revolted. They were exhausted from learning this new skill, in this new environment, in a new climate. No one wanted to go to ski school, and the only way we convinced them to get up the mountain was if we promised "family day." So, to the bunny hill we went.

The 4 year old rode the gondola down to town with me after 2 runs, but my 6 yo was still ready to show off her new skills. So she and my husband decided to try to ski down the longest run to the base of the mountain.

The look of sheer disbelief, awe and pride she wore when they walked off the slope 40 minutes later mirrored my own. She had "pizza turned"* the whole way down. Slipped and slid across parts of it, tumbled in others, but she did it. All 3 miles of snowy slope. Some of it way harder than her 2 day total skill level. All of it an entirely new experience.

I felt that way after running my first code. A mix of "what just happened" and "wow, I look like someone who knows what they are doing." Disbelief and gratitude and pride and fear. As this academic year starts to wind down and senior year is approaching, I look forward to having more of those moments. Medicine is humbling. The human body and whatever otherworldly spirit that accompanies it, is capable of incredible, unpredictable, and inspiring things. Our capacity to learn, study, and train in order to impact the course of the life of another person, or use our skills to intervene and directly affect their future, the future of their family, their destiny, is uniquely motivating.

I hope to keep motivating my children to push their limits and challenge themselves. Parenting my children gives me a window to parent myself. Motivate myself. As lifelong learning is a huge tenement of our field, I hope that lesson of small, slow, pizza turns, sticks with me.

* For those who don't ski, "pizza turns" refers to the wedge shape you make with your skis to slow down and control your speed.