Friendship and Female Physicians II

Over a year ago I wrote a post about the challenges of making friends as a female physician. I cross-posted it on my own blog, and the comment boards on both blogs were pretty interesting. I'm back for a visit here because the topic has generated a lot of reflection for me lately, once again.

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven't seen her since I was in school, we're still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I'll call her Ziva (yes, I watch a lot of NCIS). Ziva is from Israel. She is smart and funny, a lover of books and movies and good music and good food, talented and competent, and above all a great and generous person I would entrust with my children's lives. Ziva and I can talk about just about anything - silly "girl stuff," deep intellectual stuff, spiritual questions, moral/ethical dilemmas, work stress, kids, comic moments from day-to-day life, worries about tough problems, faults and failings, embarrassing secrets, cultural differences, things that inspire us or bring us joy.

For some reason, her colleagues are very uncomfortable with our friendship and underhandedly persecute her for it with snide comments and not-so-veiled criticisms. One time I arrived to provide a spinal for a C-section. Ziva was already in the room counting instruments, and one of the other nurses said, "Oh, are you happy now - your friend's here." Another time she happened to mention that she and I had recently discussed the mechanics of intubation, and in front of all the other nurses one of her other colleagues made some critical remark about her being friends with me. When Ziva called her on it, saying "What's wrong with that? T. is SO nice! She's totally adorable," the other nurse said, "I have no desire to be friends with T. I have my OWN friends." Ziva found this nurse's comments and the tone in which she said them disrespectful and hurtful. Many of the other nurses can barely conceal the clouds of disapproval and resentment that darken their looks when Ziva and I greet each other cheerfully at the nurses' station.

"They feel threatened," my husband said.

"But if I were a single, tall, good-looking MALE doctor it would be FINE for a nurse to be close to me, right? Isn't that totally self-demeaning of these women? Sure, it's ok to befriend a man in a position of authority, but it's somehow wrong if it's a woman?" I was totally frustrated and irritated that the culture in this workplace wouldn't tolerate a genuine close friendship between a female doctor and a nurse.

Ziva and I do not flaunt our relationship in professional situations. I feel I am just as business-like with Ziva while delivering patient care as I am with any other team member, and conversely, just as nice with the other team members as I am with her and with the patients and with any colleague. But there's a lot going on here. Gender issues. Cultural issues. Xenophobia, or, even worse, maybe some anti-Semitism. And perhaps status issues. Maybe they think nurses and doctors can't or shouldn't be friends (unless, of course, it's a dating situation between a male doctor and a female nurse). Or maybe they feel Ziva's smarter and more highly trained and better educated than they are and they just can't stand it.

I am feeling exasperated and a little angry. This type of collective attitude is completely stupid and unnecessary. I don't know that there's much I can do about it. I'm certainly not going to change this blessed friendship for the sake of a few small-minded harpies who aren't comfortable enough in their own skin to show some tolerance, respect, and support.

-T. from Notes of an Anesthesioboist

Friendship and Female Physicians

I've noticed over the past several years that it hasn't always been easy for me to make friends.

Sometimes I wonder if I'm the reason.  Am I simply un-like-able?

When I was in grade school I constantly found myself blurting out goofy things and wincing afterward.  I'm sure my social awkwardness cost me some friendships at that age.

Then there was high school  Oy.  Recently a friend from high school whom I've always admired told me I could sometimes be intimidating back then.  ME?!  Intimidating?!  But I'm so sweet!  And shy, and awkward! And un-tall!  But I suppose my love of Renaissance history, French poetry, and molecular biology might have struck some people as off-putting...

I had a great time in college.  I found like-minded people, kindred spirits, people in different spheres who loved a lot of the same activities, subjects, books, etc.  I made some life-long friends in college, as many of us do (and a few good friends in med school and internship as well, though not as many).

I can think of a few things that can make building new friendships and maintaining existing ones hard after college.  Relocation. Marriage.  Parenthood.  Jobs.

And if your job is in medicine as a resident of some kind, you get the added challenge of sleeplessness, no time, no energy, no patience, high stress, contact with suffering on a daily basis, making lonely decisions in what can be an isolating profession, all free time spent sleeping or running errands.  Relationships of all kinds suffer during residency; friendships are no exception.

But I think there's yet an additional layer for female doctors.  I can't quite put my finger on what it's made of, but it's there.  

When people find out you're a doctor - that's if you can even get around to meeting new people in the first place - sometimes their whole vibe toward you can change.  It's almost imperceptible, but there's a turn somewhere.  It's there. A pulling back, maybe, or the inexplicable sudden presence of an invisible veil between you and the person you'd like to befriend who happens not to be a physician.

I'm not sure why that happens, or even if I'm making something out of nothing.  Women-doctors want to hang out and watch chick flicks as much as any group of women friends, or go to cafes to chat, or cook together.  Why the sudden barriers?

I have a friend - a drop-dead gorgeous, brilliant, super-sweet, supportive-beyond-measure, talented, couldn't-be-nicer friend, fellow-mom, and fellow-physician - who meets with a group of women on a regular basis to engage in a much-enjoyed activity.  She told me that for a long time she didn't tell the other members of the group she was a doctor.  She was concerned they might not be as relaxed, or their attitude to her might change, with the knowledge of her profession.  I have another, newer friend - also multi-talented, also a fellow-mom and physician, very nice, with lots of different interests - who has observed a shift in others when she strikes up a conversation but then reveals that she's a doctor. 

I don't think we're all just imagining this.  There's something about us female physicians that seems to make some people hesitate to get too close, which makes making friends even harder in the context of busy, demanding lives juggling work and family.  I tried googling "women doctors" and "friendship" to see if I could learn more, but no one seems to be talking about this much, or I'm not looking in the right places, or no one else thinks there's an issue.

Do male physicians experience anything similar?  Am I just being over-sensitive?  I don't know.  But I do think the whole subject of physicians and friendship in general, and women doctors in particular, is worth exploring.  

Cross-posted at Notes of an Anesthesioboist.

MiM celebrates one year: Anesthesioboist

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

Anesthesioboist joined Mothers in Medicine last fall. Since then, we've been graced with her phenomenal writing - a true aesthetic purist (hope I'm not putting too much pressure on her with that).

She writes:

I think my two favorites would have to be "Code Indigo" and "Mom's Apple Pie."

T., thank you for making us routinely swoon from the beauty of your words and insight.

Love and Wonder in a Carcass

I got out of work unexpectedly early yesterday and went for a walk with my husband around our peaceful neighborhood.  The weather was sunny and cool - glorious, really.  It's about time we started seeing days like this in New England.

Just as we were coming back around the block toward our house, my husband spotted something on a neighbor's lawn.  It was a tiny skull of some sort attached to a vertebral column with some ribs still connected to it.  The remains of a small animal picked clean of all its flesh, its dry bones curled almost into a fetal position.

I immediately went to get my camera and find my son, who was watching some of the neighborhood boys shoot hoops in a nearby driveway.

"Where are we going, Mommy?"

"I want to show you something.  It's a mystery.  The skull and spinal column of a small animal.  I'd like your opinion on what it might be."

At this, my son acquired more of a spring in his step as he followed me to the grassy area where I had first seen the bones.

"Cool."

He put his baseball cards in his pocket and knelt on the sidewalk to look at the specimen.  "It could be a chipmunk," he suggested.

"That's not a bad idea," I said.  "It's certainly about the right size.  Shape of the head seems right too."

"Or maybe a bird?"

"Possible.  I don't know enough about the skeletal anatomy of birds versus mammals to be sure, come to think of it, though I'm thinkin' mammal."

We looked at the skull from different angles, and I noticed in the concave hollow of the base of the skull a very similar architecture to what I remembered about the base of the human skull. There was even a recognizable foramen magnum leading like a secret portal to the vertebral column.  

"Hey, look at that," I whispered to myself.

"What?"  my son asked.

"Our skulls are not that different on the inside from this little animal's.  They're engineered so similarly.  Amazing."

I said I would go back to our house to find my anatomy book.  As I got to the door I heard one of the neighborhood boys ask my son why his mom had brought him down the road, then heard my son explain about the "cool" animal bones and invite them all to look. I had a brief mental picture of a group of neighborhood boys gazing intently at the little skeleton on the grass, and I smiled at the possibility.

"Honey, have you seen my Netter?" I called as I entered the house.

"I think it's at the bottom of a whole pile of your medical books upstairs."

I rummaged through various piles of books and finally found it - an old friend from medical school, still with me after all these years.  I went back outside to where the boys were shooting hoops and called my son over.  I turned to the page showing the inside of the base of the skull.

"See?  Remember how the animal's skull had these depressions in the bone, just like this, like someone scooped out part of the inside of a bowl?  Our skulls are the same."  By this time three or four other boys had gathered around to look.  I was delighted with their curiosity.

I was pleased to hear, too, that they had been debating the identity of the animal.  A boy my son's age had suggested a mouse.  "There are some mice on B Street, so maybe there are some over there too."  I agreed it was a reasonable suggestion.  Another, older boy proudly put forward his hypothesis:  "It's probably a baby squirrel eaten by a crow.  They fall out of the trees a lot."  This sounded eminently plausible to me as well.

I closed the book and started for home again.  "I'll see you there for dinner," I said to my son.

My time with him had cast a glow inside me.  It was as if the afternoon sunlight had managed to get through even there, to places unseen, and turn what was dark into gold.  The little hollow of a dead creature's bone held our closeness like a cup.  A tiny chalice pouring out wonder.  A passage through death and mystery to blessed life.

[Cross-posted at Notes of an Anesthesioboist.]

Mom's Apple Pie

I have a confession to make - but first, a little story.

Last Friday my husband and I got to do one of our favorite things: walk our son to school, a lovely, small elementary school set amid tree-lined streets in our peaceful neighborhood.

That day we went bearing pie - home-made apple pie, to be exact, by special request, for an open house during which we would get to peruse all the kids' family history projects and enjoy culinary delights from the various cultures represented in the class.

My son had been worrying (needlessly, despite reassurance and encouragement) about this project for weeks. He was worried about getting the work done on time. Worried about messing up the illustrations. Worried about revising the final draft. Worried that I wouldn't have time to make the pie and he'd be the only little boy whose mommy was a dismal, neglectful failure.

Well, by golly, I was determined not to disappoint him, even if I had to stay up late post-call or get up early pre-call to do it. As it happened, not only was I able to make the pie at a reasonable hour, right on time for the open house, but also my call schedule was such that I didn't have to be at work till mid-afternoon on open house day, so he was able to have both parents there.

My son visited me in the kitchen while I was preparing the apples. He sometimes tries to keep me company because he's concerned I might get lonely (he hasn't quite grasped the concept of enjoying time for oneself).

"I told all my friends you make the best apple pie in the whole world," he said.

How cute is that?

"Well, that was very kind of you," I replied.

"It's the best pie ever."

"I'm so glad you like it."

Peel, peel peel.

"Is it hard to make?"

"Not especially," I said. "Once you get a feel for when to add water to the dough, and how much to add, it's not a hard recipe to follow."

Dice, dice, dice.

"Do you like making apple pie?"

Hmm. How to answer that?

"Parts of the process can be a little tedious, to be honest," I said. "But it's not bad - I don't mind," I said quickly, to reassure him.

"I love your apple pie," he said.

I never did learn in anatomy class where exactly the "cockles" of my heart might be, but they were definitely warmed.

On the day of the open house, as we approached the front lawn of the school we caught sight of other parents coming from different directions on foot with their children, carrying covered dishes and trays and plates, all heading toward the front entrance. There was something so village-like about it. A pleasing aroma of book paper and crayon drawings wafted over us as we entered the school building, making me nostalgic for my own elementary school days, when I could focus my attention, as these kids were doing, on things like "daily life in colonial times" and haiku.

The atmosphere at the open house was one of friendliness mixed with the pleased-as-punch pride of children who have done well at something. There was so much food the teacher had to set up a second table. We ate, visited the desk exhibits, mingled with parents, mingled with children; some families even visited their friends' open houses in other classrooms.

We opened our son's Family History Book and smiled as we read his tell-it-like-it-is descriptions, written in his painstaking scrawl. On the cover he had drawn a Philippine flag and a French flag, as well as maps of both countries. In the upper left corner there was a small, muffin-like item with steam rising from the top.

"That's a pie," he explained.

Several pages into the booklet it appeared again: a little pie in the margins.

My confession is this: making my husband and children happy with pie is the "accomplishment" that brings me the greatest satisfaction in life.

Even their deeply appreciative inhalations as they enter my kitchen filled with the smell of baking pie make me feel like I'm on top of the world, like I've made their day a little better. Yes, I graduated with honors from an Ivy League university. Yes, I got a medical degree. Yes, I am reasonably successful in my practice of medicine. Yes, I've had the chance to travel, learn languages, study music, get advanced degrees, receive a little recognition for things I've written, and all that. But nothing brings me greater joy than those moments when my husband and kids are eating well, savoring with relish a pie I've just made. Am I crazy? Perhaps. Crazy about them.

It's funny - cooking is, by definition, the creation of gifts that can't last. The moments we take to enjoy meals together are fleeting, as are the meals themselves. But those moments are worth the world to me. And somehow the gift does last, I think - I hope - in ways I'm sure I can't see or predict. I'm hoping that somewhere in the margins of my children's lives there will always be a little pie sketched in - an unquestioning, nourishing trust in their parents' love, a capacity for sharing and for happiness, a corner of freshness and warmth.

What is a Mentor, and Where Can I Find One?

I used to think that the word "mentor" was derived from mens, the Latin word for "mind," or men, the Indo-European root for "thinking," and the suffix -or, meaning "one who does or creates" the thing described by the root of the word. Thus a mentor would be one who uses the mind or forms a person's thinking.

But of course the word mentor doesn't come from such a derivation at all. Mentor was the guardian of Telemachus, son of Odysseus, and in The Odyssey the goddess of wisdom assumed Mentor's form to aid Telemachus, one of her favorites among mortals (as well as to escape notice by Penelope's suitors).

Homer's Mentor is a mere minor character, however, without all the attributes of the "experienced and trusted advisor" the Oxford English Dictionary leads us to believe such a figure should have. Where do we get the archetype of a wise teacher who cares about, nurtures, and encourages the learner - who builds up the learner's intellect rather than doing the opposite, sucking out the student's soul, as J.K. Rowling's DE-mentors do?

For that sort of character we have François Fénelon to thank, whose enormously popular book Les Aventures de Télémaque, published in 1699, was "a continuation of The Odyssey from an educational vista," according to author Andy Roberts. It brought Mentor to the forefront as a major character with tremendous influence over the story's hero. "It is Fénelon," Roberts continues, "not Homer, who endows his Mentor with the qualities, abilities, and attributes that have come to be incorporated into the action of modern day mentoring." The word mentor came into modern usage in English in 1750.

I am rambling on about these literary and historic niceties because I enjoy them. But I am also having a hard time writing about an actual mentor. From what I can gather from my own experience and from other people, finding a mentor in medicine usually happens by a great stroke of luck; it's not automatic. You'd think that in a profession supposedly built on compassion and learning, mentors would abound. The word doctor, in fact, means teacher in Latin. But it's not that easy to find good mentors. It may be harder still for those who long for a mentor who is a woman.

There were many teachers, of course, who gave me terrific lessons I carry with me to this day; but a mentor is more than a good teacher or role model. A mentor is someone with whom you have a relationship - someone who truly cares about your formation and expends energy, real work, to help you through it, and wants to do so. A mentor believes in you and communicates that faith; a mentor listens, and can be trusted with your struggles and your successes; a mentor teaches and guides without resorting to a power differential to exert influence; a mentor has a personal stake in the education of the whole learner - intellectual, moral, physical, spiritual - and, therefore, cares deeply about the learner's character and responses to the world as well as his or her knowledge.

I do have a couple of people who always come to mind whenever I hear the word mentor: my med school anatomy professor, Dr. Matthew Pravetz, who also baptized my youngest child; and from my days in pediatrics, Dr. Indira Dasgupta, a woman whose dignity, intelligence, compassion, and humor I hold in my heart to this day. There have been few people in my career who have helped me believe - as they did and as every mentor should help his or her "telemachus" believe - "You can do this. You are good. Your work will make a difference. I'll be there for you if you need me." Even the most independent-minded and confident person needs guidance at one point or another, or loses faith, or needs help. Mentors ultimately stoke the fire and help keep the faith. Happy are those who are blessed with some good ones

Code Indigo

The season's first snow is falling. It's raw and grey outside the hospital. Inside, Ella Fitzgerald croons a languid "White Christmas" from the internet radio station. We're wrapping up at the O.R. desk after an uneventful morning case.

"Attention all personnel. Attention all personnel. Code Indigo, third floor. Code Indigo, third floor."

I look at the nurses. "Indigo? Which one's that one again?"

Every hospital has coded security alerts for unusual events - emergency room on diversion, airway crisis or cardiac arrest, infant abduction, bomb threat, unruly patient or family member, etc. I don't recall having heard a Code Indigo* recently.

"Missing patient," says one of the nurses.

"Probably just went out for a smoke," says another.

I go to do post-op rounds. The all-clear sounds overhead for the Code Indigo. But when I get to the post-partum ward, a nurse there tells me as I leaf through a patient's chart, "Don't bother. You won't find that patient."

"Breast-feeding class?"

"No. Just gone. That was the Code Indigo."

"Oh! I thought I heard an all-clear a while back."

"Yeah, because the patient's definitively gone. Baby's still here, though. Wanna see?"

She lifts a swaddled bundle of warm, sleepy perfection out of a bassinette. The baby starts drinking formula from a small bottle the nurse is holding.

I start to think of another baby, a patient I had had to discharge to a foster parent during my internship. The baby had been hospitalized with bilateral spiral femur fractures. Yet every time I approached his crib to examine him, his face would light up with a bright smile that held nothing but joy. After I turned him over to foster care, I went into the call room, called my husband, and sobbed on the phone to him, utterly disconsolate.

My mind starts churning around my current situation, trying to figure out if there's some way we could take care of this baby ourselves. But of course we're not at all prepared for a decision like that right now; all I can do is call the social worker and make sure she's on top of what needs to be done to get this child into a suitable pre-adoptive home. It seems like such a small, ineffective measure to take.

The snow has turned into something a little wetter and clumpier. It's dark by midafternoon on days like this. I've turned on a mix of Christmas music - a little Nutcracker, some Kathleen Battle, a little Boston Pops and Leroy Anderson. I go back up to the nursery to hold the baby. The nurses welcome the break.

"Here, Dr. T - have a seat right here."

The baby sleeps in my arms. His cheeks bulge out like rosy little fruits. He is totally at peace. He has no idea that either nobody loves him at all, or someone loves him so much that she felt she had to set him free. He is blissfully unaware that he is alone in the world. Abandoned.

"At least she didn't try to flush him down the toilet, like the kid we got last week."

Thank heaven for small blessings.

Advent starts today: the liturgical prelude to the Christmas season, and the new beginning of the liturgical year. There's something in the baby's given name that conjures up images of light. Light, on this grey, darkening day.

"The people who walked in darkness have seen a great light." I wish, I wish, I wish.

I start humming the baby a lullaby. My favorite song of the season, half ancient chant, half carol for a newborn.

O Come, O Come Emmanuel
and ransom captive Israel
that mourns in lonely exile here
until the Son of God appear.
Rejoice! Rejoice -
Emmanuel shall come to thee,
O Israel.

I hope this baby gets his Christmas wish, the wish all babies are born with: a wish for love, for a life that matters, and for a world of hope to be cradled in.


*(Not the actual alert used.)
Cross-posted at Notes of an Anesthesioboist.

Mommy Awards

"You did it! CONGRATULATIONS! World's Best Cup of Coffee! Great job everybody! It's great to be here." -Will Ferrell as Buddy the Elf in Elf


One thing's certain: I won't be getting any "World's Best Mom" awards any time soon. "World's Most Embarrassing Mom," maybe - we're getting to that age.

Some people might even wonder - ESPECIALLY if you scour the American Academy of Pediatrics recommendations, or talk to parenting-book authors/readers - how conscientious I could possibly be as a physician when one considers that I have, at various times in the past,

-occasionally co-slept with my kids when they were babies (right in line, I must interject, with, like, 90% of the rest of the world's cultures)
-used Disney's Fantasia and the like as a babysitter when I had to cook dinner
-let my kids jump on backyard trampolines
-let my kids eat raw cookie dough
-skipped back-to-school night
-let them eat apple pie for breakfast (just once - and it was homemade and yummy and we all did it)
-made them memorize their times tables BEFORE explaining multiplication conceptually
-been physically and emotionally unavailable to them due to an excess of call
-let their father take them through a carnival house-of-horrors when they were WAY too little to laugh it off
-been way too permissive about TV-watching and video games/Wii playing
-missed some performances / special days
-failed to nurse at least one of them for the recommended period of time
-used phrases like "Because I said so" and "Don't do that"
-taken them out of school for trips
-required them to stick with certain academic or extracurricular activities against their wishes
-been impatient and snappish when tired or preoccupied
-let them eat a sickening amount of Halloween candy all at once.

Then I think, all those nitpicky little recommendations in the books and guidelines are nice, but they're not gonna make or break our parenting "success." I was sitting around comparing notes on the subject with some colleagues once when I was a resident.

"I watched TV all the time when I was a kid, " said one. "Violent stuff, too - martial arts movies and everything."

"We didn't even own a TV," said another

"We only ate food from local growers."

"We subsisted on chips and soda."

"I read TONS when I was younger."

"I barely read anything before college."

"And look - we all ended up in the same place, with 'M.D.' after our names, being fairly good people, for the most part, right?" someone finally pointed out.

That one conversation enabled me to avoid beating myself up too hard for all my faults and failings. Here's my bottom line: my kids are happy. They are healthy. They are curious. They have a sense of wonder. In general, they are kind. They read lots. They ask lots of questions. They know we expect them to work hard for their learning, to do not just "good enough" work but their best work always, and to accept the fact that they can't have every material thing they want. They have an abundance of what they need, and much more besides.

Most important, when they see our faces greeting theirs, they see us light up at the sight of them. They know they are immeasurably loved. They know we intend to be there for them no matter what.

And despite all those years of medical training, we have family memories to cherish. A brass band concert heard from a picnic blanket one balmy July night. Making s'mores in the wood stove one New Year's Eve. Dressing up as a medieval family with a Power Ranger to trick-or-treat one Halloween. Stolen moments, when I was either post-call or, miracle of miracles, actually off duty. Precious, warm, treasured moments.

So when the kids run to the door exclaiming "Mommy!" and throw their arms around me in big bear hugs every time I arrive home from work, or come home after a long night of call, I take heart. I may not be the world's best mom, or the world's best doc, for that matter, but I've had more than my share of the world's best moments.

Tugged

"Can you write an order for that?"

"How long will the epidural take to put in?"

"Mommy! There's a bug in my shoe!"

"What's for dinner, honey?"

"Attention all personnel, Code Blue, CCU..."

I am a tugged person. That can be stressful.

Last week while I was brushing my daughter's hair I started thinking of generations of women who have been brushing their daughters' hair for hundreds of years before me. The brush almost tugs her closer to me with each stroke - a wistful rhythm. It's an act that seems to expresses this tender, almost plaintive thought: stop a moment, my lovely girl; don't grow up too fast; enjoy this time to yourself, this untroubled time without complications or worries or major responsibilities, this fledgling time to be you and be entirely lovable and free.

I talked to her of our good fortune: we are women in a society in which we are free to choose to be wives or not, mothers or not, with opportunities to educate ourselves, vote for our leaders, work at professions of our own choosing.

Yet centuries of disregard for women don't fade all that fast. Just days ago I had to draw a thoughtless nurse aside for speaking to me in front of a patient in a way I truly believe she wouldn't have with a male physician.

Then I had to let it go, fast. I had a patient who was afraid to the point of tears. With her I was gentle, I hope, and reassuring. She nodded as I described things, showed relief when I explained things, clung to my hand when I rested it on her arm.

I was pulled away again for some other unpleasant business, and I had to put the harder face on, the one that has to take charge and get things done right. Then back to the patient, and more reassuring murmurings, more of what I hoped were kind words that built trust, and soothing moments.

Then the procedure began, and again, there was a need for firmness - my more business-like side, as I tried to convey important directives and elicit competent, efficient work from the team I was working with.

Then it was time: the patient awoke, surprised it was all over, refreshed. Again a hand on the shoulder. Everything's all right. You're just waking up. Procedure's all done. You did great. Tears of relief. A smile. A squeeze of my hand.

Hard. Soft. Hard. Soft. So it goes all day, every day. Compassion in the interstices, between moments where I have to take a stand, or take charge of something, or direct someone, or all the above.

Tugged.

We're tugged in so many directions. I think of trees pulled about by storm winds or rain. How can I teach my daughter to stand firm in this whirlwind world, to bend but not to break, to be firmly rooted but pliant, and most important of all, to use her health and her gifts to bear good fruit? I want her to be happy and safe. I want her to stay energetic and free. I want her to feel satisfied with her work but not to get too physically and emotionally exhausted. All day at work as I travel from patient to patient, task to task, she is in my thoughts, like a song in the background of everything I do and try to be.

What can I teach her about how to cope with wave after wave of demands on her attention, her time, her energy?

It comes to me: I will have to teach her, by example if not by word, to reach for stillness, again and again. When I return to it, sometimes it's for just a millisecond. A pause before inserting an I.V. A putting aside of annoyance at a fellow-doctor's lack of consideration or a nurse's thoughtlessness, in order to lay a hand on a patient and hold still for a second. I hold still. My daughter and me brushing hair during a weekend retreat: another moment of stillness. It's a rhythm, a habit, but one that takes practice, one easily forgotten.

I flutter around, busy, sometimes frenetic. But I have to go back to that stillness, even draw other people into it if I can, or I absolutely cannot cope with all the tugging.

Stillness. Young people so often underestimate the value of that, the gift of that. Everything now has to be high-stim, instant gratification, always on-the-move. My kids are no different. They are sucked in along with all their friends, into the maelstrom of entertainment and activity that their generation craves. But there is something in mindful stillness that none of those delights can match.

Somehow I will have to teach my children this if I can, and hope that it's of use to them as they grow (too fast!) and discover (wonderfully!) who they are.

[Cross-posted in slightly different form here.]

"Doctors Wanted - No Women Need Apply" - NOT!

I could browse this site for hours: the N.I.H./National Library of Medicine website called Changing the Face of Medicine, which celebrates the lives of women physicians in America.

Any time I get a little discouraged or feel a little fatigued about working my two jobs - nine or more hours in the O.R., followed by a commute home directly into the next task, food preparation for the evening meal and after-dinner homework/music/general kid-help - I look up stories of women who had it MUCH HARDER than I do and try to give myself a little wake-up call. I stop whining right away.

Here are just a few of the many amazing stories that have inspired me:

Dr. Susan La Fleche Picotte, born in 1865, was the first Native American woman in the United States to receive a medical degree. She was 24 years old. She was also the first person to receive federal aid for professional education. The M.D. program at the Women's Medical College of Pennsylvania was a three-year program; she graduated after two years at the top of her class. She had been inspired as a child to study medicine by the death of a Native American woman after the local white doctor refused to provide care for her. In 1894 she married Henry Picotte; they had two sons. She had a busy general practice serving both white and non-white patients. Two years before her death in 1913 she opened a hospital in the reservation town of Walthill, Nebraska, achieving a lifelong dream.

Dr. Elizabeth D. A. Magnus Cohen was the first woman licensed to practice medicine in Louisiana. The NLM site relates, "While she was still in medical school, a New Orleans Bee editorial on July 3, 1853, had labeled the idea of a female physician treating male patients as incongruous and improper. In 1898, an editorial in the Journal of the American Medical Association blamed women physicians for the declines in salaries and prestige of the medical profession. Eventually, medical schools began refusing to admit women." Dr. Cohen recounts that as a surgeon she was called at least once or twice every single night before dawn during her thirty-year practice from 1857-1887. Other doctors apparently referred to her as a "lucky hand" in tough cases. She was married and had five children, though only one lived to adulthood.

Dr. Sarah Read Adamson Dolley was the first woman to complete a hospital intership, in 1852. Her interest in medicine was sparked by a physiology book given to her by her teacher, Graceanna Lewis, to read at home. She practiced OB/gyn and ran a medical practice with her husband, with whom she had two children, one of whom died in childhood. "Her vivid correspondence documents her success in creating a solo practice after the death of her practice partner—her husband. They also reveal her anguish over how to support her son, pay for his education (he, too, became a physician), and how to overcome the resistance of her male colleagues. But her letters reveal that in her rise to success, nothing was easy, especially without a role model to guide her."


Dr. Halle Tanner Dillon Johnson was the first woman of any ethnicity to be a board-certified physician in the state of Alabama. She was already married and a mother when she began her medical studies and in 1891 earned her medical degree from the Women's Medical College of Pennsylvania with honors. While "southern newspapers had scoffed at the idea of a black woman even applying to take the [board] exam," in that same year the New York Times took note of her success in passing the grueling ten-day Alabama State Medical Examination. Alas, her career was brief. She died of childbirth complications on April 26, 1901.


Finally, though I don't think she was a mother as well as a physician, I want to honor Dr. Elizabeth Ann Grier, the first African-American woman licensed to practice medicine in Georgia. She was an emancipated slave who alternated every year of her medical education with a year of picking cotton in order to pay for her training. "When I saw colored women doing all the work in cases of accouchement [childbirth]," she said, "and all the fee going to some white doctor who merely looked on, I asked myself why should I not get the fee myself. For this purpose I have qualified. I went to Philadelphia, studied medicine hard, procured my degree, and have come back to Atlanta, where I have lived all my life, to practice my profession." Sadly, she died in 1902 after practicing for only a few years.

It's stories like these that let help keep me going, putting one foot in front the other and telling myself, "You can do this. You totally can." I think we have to keep passing on stories like these - to our students, our colleagues, our children, ourselves.

Girl Bonding 101: Moving Beyond Netter

I am in a state of slow, silent, ever-evolving panic.

I just looked over at my 10-year-old daughter (soon to be 11), and for a second I saw a young woman sitting in the armchair. Or at least, a young pre-woman. Ack.

She has shot up several inches and a couple of shoe sizes this year. I feel like she goes up one Tanner stage every week or so. Her face has gradually acquired subtle, more mature angles, and let’s not even talk about the rest…

She builds sand castles at the beach and sleeps with her teddy bear. But she also notices attractive young actors or singers, and her comprehension of the nuances of flirtation is accelerating at an alarming rate. She is bubbly and all smiles and hugs one moment, irate and scowling the next, at the slightest provocation. She can still enjoy Sponge Bob, but she can also start to discuss American politics and social issues. I am amazed and thrilled and in awe and totally distressed.

I want to tell her pituitary axis: whoa! Slow down! Childhood’s short enough! But it’s useless.

It’s time to have THE TALK.

No, not that talk. We had that talk when she was eight, because the kids at school were already disseminating all sorts of sketchy information about reproduction and childbirth. I told her I was okay with her discussing reproduction and childbirth but I wanted her to have the right information – and who better than her doctor-mom to provide it, right?

Now, I am sure there are lots of people out there who can describe the “right way” and “wrong way” to handle sex education. I myself got “educated” in a bit of an unusual way. I was in a book store when I was five and saw a book entitled Where Babies Come From, or something like that, illustrated with some cartoon-like illustrations. I had been reading for about a year. I picked up the book, learned the facts of life, and, bored out of my mind, put the book back on the shelf. My mom was a little surprised, I think, when, after she expressed doubt that I actually knew about intercourse, I explained the process to her fairly accurately. It was only later that the more abstract concepts came within reach.

When my daughter asked me where babies come from, I said, “Cells, of course. Remember how I told you all our bodies are made of little, tiny things called cells? Babies start out as little clumps of cells inside their mothers and grow bigger and bigger with time. The parts of the body develop as our cells make more cells.”

That explanation satisfied her for a while, but then the inevitable came: “How do the cells get inside the mommy? And is it true that mommies push the baby out through where they pee?” That was the part the kids at school were talking about.

That was the part that made me thankful I'd hung on to my Netter Atlas of Anatomy from medical school. I sat my daughter down between my husband and me and we explained the relevant mechanics of reproduction step by step. I explained a little bit about menstrual cycles. I drew simple diagrams of female internal organs and used Netter as a supplement. Last but not least, my husband and I both expressed our personal values regarding the place of sexuality in the context of human relationships. As our daughter listened I felt proud, because she seemed to be listening so thoughtfully.

Lately, though, now that she’s a little older, she has acquired a kind of embarrassed reluctance to discuss “woman stuff.” When she was eight we could almost sense a certain pride in her at being entrusted with these more “adult” concepts. Today, however, she’d really rather not talk about them. But I feel I have to get us talking about them, not only to reinforce the idea that it’s okay for us to talk and for her to have questions, but also to make sure she doesn’t feel anxious or uncertain or ill-informed. Sometimes it seems like it's almost easier to get patients to open up about personal things.

I wanted to have the talk about menarche. I think it’s imminent at this point. But how to create a level of comfort about the subject? And to make sure we’re prepared, together, before the moment arrives? I want her to feel good about growing up, to celebrate each milestone instead of dreading or being unpleasantly surprised by it.

The other night an opportunity arose. I don’t quite remember how. But the subject came up, and I asked her if she had any questions about periods.

“No,” she answered emphatically, casting her eyes down. I could almost hear her mortified mental voice asking me, Please don’t give me an awkward, long-winded lecture; please don’t start looking for “ins;” and please, whatever you do, don’t ask me if I’m sure about not having any questions.
“Are you sure?” I asked, stupidly. So predictable.

Then I started to babble. I told her she could always come to me if she felt unsure or worried about something. I told her it wasn’t at all scary to get a period if you knew what to expect. I told her I would go with her to the drug store when the time came to look at the options in terms of supplies.

Then it happened. I got my “in.”

“Actually, that’s the part I wasn’t sure about,” she said, looking up again.

“What’s that, honey?”

“The supplies part. I don’t exactly understand how they work.”

Relief! She had given me a concrete way to nurture and support her! Hallelujah! I launched into an enthused discussion - not, I hoped, an awkward, long-winded lecture - about the pros and cons of various types of supplies, demystifying the “anatomy” and mechanics of each with appropriate exhibits. I explained what I liked and didn’t like about each option.

Sometimes, whether it’s a patient or a beloved child, it can be so tough to talk about so-called “sensitive” issues. And somehow it can be much easier to be direct with total strangers. “Are you sexually active?” we ask during a comprehensive medical history. “With one partner or more than one? Male or female?” I can do all that "doctor stuff" without batting an eyelash, but somehow when it comes to the mother-stuff of making sure my daughter’s emotionally okay, or figuring out if I’m asking too much or too little, saying too much or too little, I feel much less certain that I’m doing an adequate job. There’s no Netter Atlas of Parenting, after all.

I guess I just have to take my cues from her.

Photo: reusable menstrual pad with Kokopelli motif from Wikipedia article on the history of sanitary napkins

Link of interest, for the historically inclined: Museum of Menstruation