Mothers in Medicine

My perspective on being a mother in medicine is a little different than those which have been posted earlier this week. I’ve been at this now for almost two decades, but vividly recall the times when my children were much younger. I have worked 80 hour weeks and been on call 20 weeks out of the year. I have been a pregnant resident. I have been a pregnant attending. This is what I have learned through the years.

All specialties are conducive to raising a family.
No specialty is family friendly.
Wait, what?

Being a mother in medicine is a study in duality. It is the best of times. It is the worst of times.
It is the pride of juggling three, four, five – more – items in a seemingly effortless manner; it is the guilt and defeat when everything crashes around you. It is the memory of your child proudly proclaiming (to anyone who will listen) “This is my mom – she’s a brain doctor!” followed by the innocent (but cutting) comment that “There are lots of moms who stay home with their kids and don't go to work.” It is the sense of relief that you are *finally* home in time for good night stories lined up back to back with the mortification of being shaken awake by your three-year-old shouting “No, Mom! Officer Flossie doesn’t say SNRKK! Read it right!” and recognizing that you’ve fallen asleep mid-sentence. It is ticking off the “to-do” list that you carry in your head at all times and yet – despite the satisfaction of knowing that before 8AM you’ve cleaned two bathrooms, started a load of laundry, fed and dressed three children, got everyone off to school – still feeling the disgrace of arriving at the office 10 minutes late and realizing you’re already behind for the day.

Early in my career, I felt that in order to prove I was a good doctor I had to show my dedication to my job. Putting in long hours I missed more room parties than I attended. I was physically present for my children at the end of most days, but I was exhausted. And I finally recognized that exhausted me wasn’t good for anyone. So I tried to change. It was hard – hard to change the sense that I was somehow shirking if I made it home before 7P on a weekday, hard to change the assumption of my colleagues that I would always be the one who would stay late and pick up the case in the ER. But I found a position that allowed me to grow - as a physician and as a mother. I learned that it was the support of those around me that gave me the opportunity to thrive in my job and at home. I’m not alone in this recognition - it is this support system that is mentioned in almost every essay that has been posted this week. Many have already noted that it’s hard to have everything. Working moms make sacrifices to do what we feel called to do – whether we are in medicine or not. Balancing these sacrifices is the joy and love from (and for) our children, and satisfaction from knowing we have performed a job well done.

Therefore, every residency and specialty has the potential to be the best one for you as you raise a family – or the worst. Look at the support system that comes with the program and then decide. And remember that no matter how good or bad one day is, the next is likely to be the opposite.

It is the best of times. It is the worst of times. Today, I wouldn't trade my experiences for the world. Just don't ask me the same question tomorrow.
A

When Balance is Lost

What a time for a "Work-Life Balance" topic - just as I begin picking up the pieces of my life again. I thought I was doing a great job of juggling everything, and even (finally!) finding time to build some friendships - something I previously viewed as too much of a luxury to maintain.

And then, not one, but two of my family members were diagnosed with serious illnesses within a few days of each other. When Husband was initially diagnosed, I remember thinking "Wait a minute - this is the kind of thing that people read about and think Thank God that's not us" - except it WAS us, and I wasn't reading about it, but living it. And suddenly, my carefully constructed house of cards was crashing down around my ears. Scrambling to find coverage so that I could be at his side for two surgeries (one to remove a cancerous tumor, one absolutely unexpected correction of a bizarre bleeding complication) within 10 days strained not only my extended family, but my work relationships. As he was recovering and we had received the fabulous news from his surgeon that the margins were clear and no chemo or radiation therapy would be required, I dared to breathe a sigh of relief.

Barely done exhaling, the next day I received a call from my mother (yeah, I wish I was making up this timing) who lives several hours away. "Can I send you a report from a test I had done?" The report described a biopsy of an intra-abdominal mass lesion, which based on the sample received, appeared highly malignant and possibly metastatic. Um, WHAT? When did this start? You've had symptoms for how long? Back onto the patient-advocate wagon I climbed, this time trying to keep track of everything from hundreds of miles away. And now, several weeks later, Mom is beginning to recover from her surgery, with a follow-up appointment with a radiation oncologist still pending.

So what did I learn from this about balance? For one, that it was remarkably easy to jettison areas of my life that I thought were "musts". A phone call here, a brief (or not so brief) explanation there, and I was able to rearrange paperwork, lectures to residents and even days of patients. The "extra" things outside of work that I used for relaxation and ways to build friendships - gone with the blink of an eye and the click of a "send" button heralding an explanatory email. Will I restart these? Absolutely - at some point in the future. Because although it was easy to dump them now, I know I'll eventually miss doing them - and ultimately, these "extras" are part of what I use for balance.

But for now, I'm focused on making sure that the pieces of my life that I hold dearest are intact before I start juggling again.
A

To Blog or Not To Blog

I've been blogging for a number of years at this point. My original blog started as a non-medical place to play with writing, but soon evolved (devolved?) into a medical-based journal. I participated in Grand Rounds and kept up with multiple individuals through their blogs. I cried with Fat Doctor when she was hospitalized for her recurrent strokes, and was appalled when one of the "name" bloggers was publicly outed during a malpractice trial. It was in the middle of this that KC approached and asked about this site - for a short time, I tried to do both. But life changes, and so did my job; I soon learned that private blogging was frowned upon in my new group, and so my blog was (reluctantly) deleted. I'm still debating whether I want to start a new blog; if I do, it would have to be public, not anonymous. And as already described by so many, the concerns about self-censorship leading to a dry (BORING!) output has held me back.

When I was blogging regularly, I thought it was "secret" - but kids (especially teens) know everything, and I'm pretty sure my sons read my blog routinely. I haven't shared my blogging with this site with too many; in part, I'm frustrated by my lack of output. Like many of the other mom-docs who share in this site, life too often gets in the way of trying to put together a post.

My goal is to discover a better way to incorporate writing (this blog, NaNoWriMo, crazy ideas like "Elena Kagan Effectively Kills the Exercise called Kegel in Early Court Decision") into my daily life - much like exercise, time for family, and everything else beyond that black hole called work. I'm happy to be a part of this group, even if my contribution remains small. But trying to figure out this whole life-in-balance-thing was part of the reason for this blog's existence, right? Let's keep figuring it out together - one post at a time.

A

July Decisions

It’s early July and newly minted interns and residents are gracing the hallowed halls of hospitals across the country. Not only do these intrepid souls have to cram every possible byte of data into their sleep-deprived craniums, maintain their patients and respond to pimping questions from attendings, they need to decide what they will call themselves at the end of their training.

General surgery is easy – when you’re done, you’re a surgeon. No one really has any questions about that. But what if you chose Orthopedic Surgery? When you’re finished, will you refer to yourself as an “Orthopod” (which brings up visions of a scary armor-plated vector to some), or an “Orthopedist” (which, strangely, some individuals seem to confuse with a Podiatrist)? Adjacent to the surgeons are the anesthesiologists – will you (should you) really tell someone you “Pass Gas” for a living?

Then there’s the pronunciation factor. If you choose to go into Obstetrics and Gynecology, will you practice O-B-JIN when you’re done, or are you going to practice O-B-GUY-nee? If you follow in our beloved Fizzy’s footsteps and specialize in Physical Medicine and Rehabilitation, will you be a fiz-EYE-a-trist or a Fizzy-AT-trist? (And when you examine the bony structure of your patients, are you looking at the SKEL-a-tal system or the ska-LEE-tal system? Perhaps it depends on whether you had any British instructors…)

Perhaps most confusing of all, those who choose general internal medicine – will you be an Internist? Will you practice Internal Medicine, I.M. or “Medicine”? Family Practitioners don’t have it much easier – too often, they’re considered Generalists or General Practitioners and the time they spent in training is ignored.

Some specialties don’t seem to have issues with confusing acronyms. The only time anyone had any questions about my field of Neurology was when he misheard my response to “What type of doctor are you?” as “An Urologist” rather than “A Neurologist”. Physicians who specialize in Pulmonology, Cardiology and even Proctology rarely receive questions about what they do – most people outside of the medical world know what those names mean. And I’m happy that some specialties maintain their formality: Would you really want to see a Hematologist/Oncologist who refers to herself as a “H-ONC”? (Is “QUACK” the logical next step if that were to occur?)

Medical school and Match Day are memories for those in training by this point, but the hard work is really just beginning. The title “Doctor” is a given – how will it be modified?

A

Two years and counting...

Two years? Already? I look at this number in the same way that I look at my age on my driver’s license – where did the time go?

But, unlike the grey hairs and fine lines that I see in the mirror, this blog has been a welcome addition to my life. I love knowing that I’m not along in my experiences. I love the varying viewpoints that we share. I love that I have been able to get to know such an array of women.

I would be remiss not to mention KC’s leadership through this time – this is her brainchild and I am grateful for the opportunity to help nurture and grow her idea into the success it has become (and grateful as well as her intermittent reminders about posting!).

My favorite recent post is actually the topic week* where we answered questions posed by women who are considering jumping aboard this road we’ve been traveling. I think these posts distill the essence of what this blog has endeavored to be since we started – a collective forum of opinions and experiences that we can all learn from, no matter where we are in our lives.

It is the blink of an eye – it is two years.
It is my history – it is our experience.
I am a mom who is a physician – we are Mothers in Medicine.

*Please click here

and here

and here

and here

to get a taste of the week!

Coming Home...

I have mixed emotions about CME courses that take me away from home. Although I enjoy time in a new location and having a break from my typical daily grind, sometimes the toll of being away from family is high, and coming home can be an adventure:

"Mom, while you were gone I forgot to register for my AP exam. What should I do?"

Late fee (after countless calls to coordinator): $50.00

"Mom, before you left, I forgot to tell you I needed a costume for that thing at school"

Improvised costume (NOT Eeyore!): $25.00

Me, sniffing around the kitchen: "What is that smell?"

"Erg, I think I forgot to unpack the milk container from my lunch box last week."

(Husband, shrugging apologetically: "I thought the kids needed showers...")

New milk container and lunch box: $15.00

Finding two dozen chocolate cupcakes in the dining room "Just because we thought you'd like them": PRICELESS

(Cleaning chocolate frosting off of everything for the next 10 days: another post!)

How do you cope with the things that come up while you're gone?

A

Subject: How to pursue pre-med studies

NOTE: This is a very long question, and subsequently a long answer. I decided not to edit down the question, as all of the parts seem to be equally important to the questioner.


I have a B. Mus. in classical music performance from Oberlin. When I was wrapping up my degree, my desire to learn more about the human body trumped all my plans -- grad school, a performance career. For the past three years I have been employed in healthcare, first in a nursing home as a caregiver, and then as an EKG tech at my local hospital. I needed to spend this time working in the field to confirm my desire to become a physician and to develop accurate perceptions about healthcare.
My son is only eighteen months old, but I feel like I can't put off post-bac studies any longer. It makes me miserable to continue to put my education on hold, and it's becoming increasingly difficult to be enthusiastic about a job where I'm completely underutilized. I just accepted a new job working overnights in the ICU so that I can take classes during the day. My husband is a nurse and we work opposite schedules.
Meanwhile, I have been accepted to several programs as a transfer student to obtain a second bachelor's degree (in biology) and two post-baccalaureate pre-medical programs. Although I would love to attend one of the post-bac programs, they are all through private institutions and I'm just not sure if we can afford it or even secure adequate loans. Some of the B.S. programs are through state schools, and very, very affordable ($3000/year after grants), but not many of my credits from Oberlin will transfer and it would probably take 3-4 years to complete the degree.
Should I just take courses a la carte? It seems like a more direct route in some ways. I could afford to do this at a state school, but I hate that I wouldn't have an advisor, that I wouldn't have the opportunity to be involved with research, that it would be difficult to get to know my professors and that it would be hard to build the rapport that I would later need for recommendations. Some of the physicians I work with are willing to write recommendations, but I feel like I will still need someone to comment on my academic ability.
Should I try to complete a masters program instead? Could I tack on pre-med courses while completing an MPH? Are there other graduate programs that I should consider? I didn't apply to any graduate programs, but in retrospect, I sort of wish I had.
Did any of you work full-time overnights while being a full-time student? How did you do it? Did you ever sleep? If so, when? Were you scary or silly? I'm feeling desperate and crazed and I would be so grateful for some outside perspectives. -E.G.
(E.G. is a 24 year-old EKG technician living in Upstate NY.)

I’ll attempt to answer this as best I can, E.G. It sounds as though you’re already quite accomplished, and I understand your frustrations with feeling as though your life is “on hold” – but there are many things that you may not be aware of as you look toward your goal of becoming a physician. First, there’s no rule that says you need to have majored in the sciences to become a doctor, so looking at obtaining a second bachelor’s degree in biology may be overkill. What you do need to look at are the classes that you’ll need to succeed at the MCAT, as well as the pre-requisites for medical school. As such, the “a la carte” approach might be the most reasonable path to pursue. I wouldn’t be afraid of not being a full-time student in that scenario, and I wouldn’t worry about not having an advisor – I think that most professors would be willing to work with someone in your position in such a capacity. Even though you wouldn’t be a full-time student, you’ll still get to know your professors. In fact, you’ll likely have the same professor for several of your courses, and they’ll be able to easily comment on your academic abilities when needed. And why are you even considering an MPH? Is it something you think you’ll ultimately use? If not, at this stage of the game, it’s likely to be more of a burden than a benefit.

Now, let’s consider how realistic it will be to work full-time nights and attempt to be a student during the day. Something’s going to give, and it’s likely to be your sanity. For most of us, balancing a full-time job and a family is a stretch; adding a full load of college classes seems to be a recipe for disaster. Sleep deprivation will impair your memory, impact your grades, and potentially injure some of your relationships. To address the specific question you asked, most of us become very scary when we’re chronically sleep deprived.

I haven’t even begun to discuss the economic impact that this will have on you and your family. There’s no getting around it - medical school is expensive. It will be very difficult to work through your first few years due to the course load, so to be practical, you’ll want to have as little debt as possible prior to entering med school.

Lastly, your son is only eighteen months old. While it seems like he’ll be tiny forever, wait another three seconds and see how old he’s suddenly become. Don’t miss out on your time with him in your desire to finish your schooling. What about other children? Two kids are exponentially more difficult than one, especially if you’re working – let alone going to school.

Ultimately, although it seems that you must complete everything now, in reality you’ve got lots of time. You’re way off the path of being a traditional student at this point, so revel in your non-traditional status. Enjoy your job – use it to hone your bedside manner with the patients you see on a daily basis. Share your ambitions with the physicians you work with – you may find that they go out of their way to share some interesting findings with you. Do the best you can in the classes you take, even if it’s only one per term – professors are much more likely to write letters for students who have genuinely enjoyed and subsequently succeeded in their classes. And realize that there’s no reason to be desperate and crazed now – save those emotions for later (like when you’re post-call, your husband is out of town and your son won’t stop barfing….).

I hope this helps –
A

Would I have done anything differently?

QUESTION: Is there anything you wish you had done, or done differently (fellowship, 6-month trip to India, get married before rather than after school, etc.) over the course of your training, starting in college?
FROM: GradStudent, child-less, unmarried 20-something aspiring science researcher and medical school instructor

Oh, the “woulda-shoulda-coulda” question! Isn’t it human nature to question what we’ve done and what might have been if we had taken a different course of action at some point?

That said, there are some things that I wish I would have known when I was at your stage of the game. Specifically, I wish that someone had told me that taking a little extra time to complete my schooling would not impact my future adversely. When we’re in undergraduate (and even high school!), there’s a pressure to complete everything ASAP. However, most of us need a little time to percolate (OK, mature) before we reach our full potential. Additionally, learning to savor time away from a job (or books) can help make our productive time that much more productive.

I’m happy that I delayed marriage until after my formal schooling was done – I didn’t have to worry about spending extra time in the library prior to exams, nor did I have to worry that my husband didn’t really understand why a lab finished at 3P one day but not until after 6 on another. I didn’t have children until the end of residency, and I wouldn’t change that – I think I needed the extra time to sow my wild oats!

But, even with these items in mind, as I look back on my experience in college and med school there are a few things that I wish I would have done differently. The college I attended for my undergraduate education had (has) a terrific overseas study program. At the time, I felt that I needed to concentrate on my science courses rather than spend time on additional language classes, and so I didn’t think twice about ignoring the information about the program that crossed my path. In retrospect, I think that to have had an experience of being completely immersed in another culture would have been good for me – personally, to have shaken me out of my cocoon of comfort, and professionally, so that I’d have some empathy for those patients I see who are new to our way of life. In a similar vein, perhaps I should have gone on the “backpacking in Europe” summer trip that I was too afraid to pursue at age 22. I wouldn’t have worried as much about majoring in a science, but would have spent more time in classes that I really enjoyed. I would have learned earlier that just because something comes easily to me doesn’t mean it’s not worthwhile for me to pursue. I would have recognized sooner that life is a journey, not a destination.

So, dear GradStudent, I hope this answered your question. As you look ahead to your career in research, or teaching (or whatever you ultimately decide on), don’t be afraid to take a detour – it might be one of the best decisions you’ll make!

A

Another Day: The Life of a Clinical Neurologist

What a week this has been! I was going to post about a really lousy day I had earlier in the week (arising at 4:30A after having been kept up until after 11:30P the night before was the start of it all). In my sleep-deprived state I was feeling really bad for myself - and then I read GCS15's post. I've been there in the past; I remember coming home (too many times!) well after the kids were in bed, realizing that I was too tired to eat the great dinner that Husband had saved for me and making do with a bowl of Cheerios, and then falling into bed - only to do the same thing the next day (with a few stolen moments of sticky hugs and kisses prior to starting, which served only minimally to tide me over). After doing this for too many years, missing too many class events, too many birthday parties, too many competitions that I had promised to attend, I realized that I needed to make a change. It took a long time to find the right fit, but now I am fortunate enough to work only 4 days per week; while I have an occasional day that stretches beyond its boundaries, I've managed to limit my practice to mostly office work - which is far more predictable than hospital coverage. Less lucrative? Without question. But ultimately far more satisfying due to the time I can spend with my family. I admire any female physician who can routinely execute the rigors of a surgical career - and challenge those chauvinists who throw any derogatory phrases at their female colleagues to keep up with the double duty that the majority of working mothers perform on a regular basis - but I know that I cannot be successful at such a life at this point. So here's my day:

4:30A Fall out of bed (yes, really - I got caught in the covers after turning off the alarm. At least that doesn't happen daily); awaken Eldest for breakfast before [sports] practice - he's got to be there and ready to go at 5:15A. While he's eating, pack a second breakfast for him; pack lunches for Eldest and Youngest.

4:50A Eldest is safely on his way. In an Ideal World, I'd have been to bed by 9:30 and be rested enough to head out to the gym myself. Not today. Climb back into bed; try not to awaken Husband with my feet (which have turned into blocks of ice despite my slippers). Reset the alarm for 5:45.

5:45A Turn off alarm for second time; manage to get out of bed safely this time around. Ignore slippers at this point and head into kitchen to put on coffee. Realize that we only have enough left in our canister for about 3 cups - not the 8 that the pot is set up for. Figure out a way to get most of the water out of the coffee brewer so that I can have at least a sip of needed caffeine prior.

5:50A Start a load of laundry.

6:50A Showered, dressed, ready to go. Awaken Husband and remind him that I'm leaving early because I'm scheduled to give a lecture to the residents. Check on Youngest - remind him of his school obligations for the day. He wants to know why I'm leaving so early (usually I'm not out the door until he's left for school).

6:55A Reawaken Husband.

7:00A Get out the door and on the road. Realize that I've forgotten to pack the cord for my laptop and hope that the battery will last through my lecture. Further realize I've forgotten my watch. Stop at a local coffee shop and grab a large cup to go. Would love to get a pound to go, but don't have time to wait for it.

9:10A Finish lecture - 30 minutes later than expected, but it was a really good group with a lot of questions. Start drive to office - remember the coffee situation and pull into a Target. Run into the coffee aisle and realize that there are about 900 varieties of coffee - where's the one we like? Finally find it and grab three bags. Do I have time to buy drain cleaner for the slow drain in the upstairs bathroom, too? I'm here now, so I decide I'd better get it.

9:35A Get into the office. The 9AM patient showed up despite his phone call two days prior stating he had the flu and wouldn't be in. He's only a little grumpy, and his mood elevates when I mention that I was giving a lecture to a group of residents. "Teaching, eh? Good for you!"

11:30A Meet with a patient that hasn't been to the office in more than a year. She's in with her family; she's not doing well. Son is with her, as are other family members. Long discussion about transition to hospice care. End up spending more than an hour with patient and family.

12:40P "Lunch break" - optimistically penciled into the schedule as a 60 minute time without patients; due to add-ins, unexpected lengthy visits, and phone calls, this rarely happens as scheduled.

1P Start the afternoon schedule. Remind MA that I want to be out the door early for Youngest's sporting event. I missed his competition last week and still feel bad about it.

3:30P The gods are smiling on me; the last patient of the day didn't show, so not only am I done with physically seeing scheduled patients, I managed to get my paperwork done, too!

3:40P Out the door (this is usually 5:30 or 6)

3:43P Office manager calls to discuss a few issues that she didn't have a chance to speak with me about - our conversation lasts the entire drive time, as well as some time in the parking lot.

4:10P Find a seat in the stands. Another working mom sees me and moves to sit closer. "I don't know how you manage to do everything you do." I'll take this as a compliment.

4:25P Cell phone rings; RN from office with questions about patients. Answer as best I can despite noise from stands.

4:45P Cell phone rings again; RN from office with more questions about patients.

5:15P Look at cell phone to check time; realize I've missed another (!) call from office. Call back to address issues.

6:00P Sporting event over; have given permission for Youngest to be driven home (so he doesn't have to take bus) and wait for him to appear in the hallway. Take a call from a physician that I've been trying to reach for two days; the call lasts most of the drive home. I pout a little - this is usually the time I can really catch up with my child's life.

6:3oP Finish a really quick dinner so that Youngest doesn't start eating his own hand. Husband runs out the door to Eldest's sporting event; we've previously decided that we would not make Youngest attend all of Eldest's competitions, so we knew that one of us would stay at home.

6:45P Youngest reminds me that his science fair project proposal is due. I question him about the project, and he tells me that his partner was going to write it up. He calls the partner to have the proposal emailed over - only to find out that the partner has been unexpectedly kept after school and is just getting home. Nothing has been done.

6:55P Put laundry from AM into dryer.

7 - 8P Help Youngest and Science Fair Partner through the requirements of the project proposal; remind Youngest about other homework due the next day.

8P Realize that an early bedtime isn't going to happen....but am content in the fact that I'm at least at home.

9:30P Get Eldest and Youngest tucked into bed. Snuggle them an extra long time.

10P Crawl into bed. Find a crossword puzzle (I used to do them nightly - this one is from last week); fill in about six responses and

11:30P ...wake up to a line trailing across the puzzle. Finally turn off light and end day.

A

Halloween

Halloween is fast approaching - what are you going to do with the mountains of candy that the kids bring home? (I guess that if you're Tempeh, you're smart enough to put it into the candy box.)

As health professionals, a part of our job is to counsel our patients regarding proper nutrition. So how do you translate this into something you can take home, specifically to deal with the giant pile of sugar that your kids collect on Halloween?

For right or wrong, we've settled on this approach: On Halloween night, we check the candy (ever vigilant!) that the kids have collected. We then set a kitchen timer for 10 minutes and let them eat whatever they want until the time is up. The candy is then put away, to be brought out only if asked for. Subsequent visits to the candy bag are limited to "one big or two small" pieces. I've found that my kids tend to relish the hunt of Halloween night and often forget about the goodies within a few days - over the years, I've given/thrown away pounds of the stuff a few months later.

Would love to hear how other MiMs deal with this issue!
A

photo credit: I wish I knew - this was sent to me in an email. Anyone? Bueller?

Our Nanny - a true gift

When Eldest was born, I was still a resident. Our first attempt at day care was, in short, a disaster.

Despairing at our choices in traditional day care, we decided to look for a nanny. I signed on with a "nanny agency", praying that we would find someone suitable - and quickly. I still remember the first day we met Nanny. We had already gone through several interviews, and hadn't found anyone that we thought would work. Then Nanny walked in. She was obviously a little shy and self-conscious. She teared up when discussing the children she had cared for in her previous job, mentioning how much she missed them. Then, when Eldest toddled over for a closer look at her, SHE GOT DOWN ON THE FLOOR WITH HIM AS SHE WAS SPEAKING TO US. Her rapport with Eldest was immediate and obvious. For us, the decision was made at that moment. Was it the correct decision? I like to think so, as she was with us for more than 10 years. She was available if I had to work late and Husband was on a business trip. She was available on the rare weekend that we didn't have a parent or in-law to sit with the kids and we wanted to go out on one of our infrequent "dates". Although she didn't live with us, she probably knew my house better than I ever will. She still keeps in contact with my children. She was (and is) a phenomenal person. I fear that despite my attempts to thank her my gratitude has fallen far short of what it should have been. So Nanny, if you happen to be reading this, THANK YOU THANK YOU THANK YOU.

A

Time flies

We measure time in seconds and minutes, hours and days, weeks and months, years and decades. Sometimes seconds drag. Sometimes days and weeks fly by.

I see patients with chronic conditions, so my relationships with them are typically measured in chunks of three to six months. It’s often a surprise to me to see a certain name on my patient list – is there a problem? Why is she back so soon? Then I check the chart – there’s nothing wrong, just a routine six month evaluation. Where has the time gone?

In my home life, too, I frequently feel like I’ve been in autopilot mode: Get up. Make lunches. Go to work. Get the laundry done. Then, like a submarine which has been submerged for too long, I have a hard time adjusting to my surroundings when I finally surface. How did Eldest get so tall? When did Youngest grow those shoulders? Is that a mustache? Two mustaches?

If I were a stay-at-home mom, would I see these changes while they were occurring? Or does every mother experience the sudden realization that her children have been quietly, efficiently, growing up? Perhaps the daily changes are so gradual that we can’t see them. Like the movement of the hour hand on the last analogue clock in the house, after a certain amount of time has passed the change becomes obvious to even the most casual observer.

I want to stop time. No, I want to be more aware of time. Any ideas how to make this happen?

A

MiM celebrates one year: Artemis

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.

Artemis, a neurologist in a private practice and mother of two teenaged boys, has written with us from the launch. She writes with honesty, insight and wiseness. Her posts make us reflect on our many roles as physician-mothers.

Artemis writes:
I like both the very first post I did (June 6, 2008), and the March 29, 2009 post.


I remember the June 6 post well, called "Moms in Medicine." Her post really solidified for me why we were coming together: to share stories like this, to support one another, and to celebrate being mothers in medicine.

The March 29, post, "No, Mom, Billy does NOT want to stay for dinner" was a humorous anecdote of a dinnertime conversation that could easily occur in any of our homes.

It's been wondeful getting to know Artemis through her posts this past year. Thank you, Artemis. We are lucky to have you writing with us.

No, Mom, Billy DOESN'T want to stay for dinner

While sitting at the dinner table, someone brought up maggots (I know! – but such is life with two boys of a certain age; disgusting subjects at dinner are the usual fare alongside the main course). Eldest quickly mentioned how skeeved he would be if a maggot were to touch him. Of course, I had to jump in with all of the medical uses for maggots, especially when used to treat decubitus ulcers or other poorly healing wounds. I casually discussed the role the maggots played in debriding the dead tissue and how most patients would likely consider maggot therapy rather than dismissing it out of hand, especially if faced with a potential amputation. I buttered a slice of bread as I chatted about how maggots stayed away from healthy flesh; concentrating on my broccoli, I failed to recognize how quiet my dinner companions had become. As I started in on the medical uses of leeches, I looked up from my plate to see three faces staring at me in horror. Mouths agape, eyes wide, silverware down; my family finally burst out as one: “That’s revolting!”

Er, yes, I guess some might view it as such. Apparently it’s time to brush up on my sense of acceptable dinner conversation, which has at this point been warped by too much discussion around the themes of farts, boogers, loogies and the occasion poop.

Baseball, anyone?

Now, it's just another day

I debated with myself for a long while about whether I wanted to post my recollections of matching. I've realized while looking back my memories of this time have become far hazier than I would have ever imagined possible. I'm sure that circumstances at the time might have had something to do with it - I was recently engaged (the prior November) with a wedding planned for early summer (when I conveniently had a few weeks off following graduation). In the midst of dress fittings and cake tastings, I waited to hear what would occur. I recall vividly who I interviewed with, and still recall the vaguely funky smell in an outer office as I waited to meet with one of the administrator/physicians who would potentially determine my fate. As it turned out, when it was time to decide, I limited my choices of where I wanted to train due to my upcoming marriage; when faced with what seemed to be starting a career versus starting a life, I chose the latter.

Now, many (many, many!) years later, I have had few (if any) regrets. OK, I wish I would have traveled more and if I knew then what I know now, would probably have structured some of my early experiences differently. But I received a very good education in my little community-based program and have never felt limited in what I could strive for.

So dear students, although today emotions run high and nerves are shot, in the long run this day will become just one of several pinnacles you'll scale. Looking back, memories of my wedding, the birth of my sons, and numerous career highlights are crowding out any recollection of the anxiety I'm sure I felt when Match Day rolled around for me. And I think that's as it should be.

A

Advice from a mentor

I've been fortunate to have worked with many individuals who have sheparded me through various stages from medical school to the present; limitation of time and space doesn't allow me to describe how each of them contributed to making me the person I am today.

But as I was pondering what to share, one memory kept pushing to the front of my brain: This was a statement from a woman who I admired greatly during the early years of my career and am pleased to share a working relationship with today. At the time she told me this, she had three school-age children and a nicely balanced life. I had two very young boys and felt like every day was a struggle. I vented one afternoon about my frustrations with my morning schedule; I knew it was my choice to take my son to preschool, but when I did this (seemingly) straightforward task I was invariably late to the clinic to see patients and ran behind for the day. Her response to me was so elegant in its simplicity that even today I admire it. What were those words of wisdom? "Start your clinic day fifteen minutes later." An invisible solution until it was pointed out to me, and with those seven words my outlook changed dramatically. Yes, I could put my family first and still be an effective physician. Yes, I did have some control over my days. Yes, even I could find some balance.

Today, as young women rotate through my office I try and discuss with them how being a mother has changed me as a physician (only for the better!), and I try to emphasize that they, too, will likely be able to find the balance they need. Sometimes its just a matter of letting someone show you the simple solution that you can't see on your own.

A

Obligation or not?

As physicians, we’re all aware of the frustrating “medical mystery.” These are the cases that initially look straight-forward, but then veer from the expected path when laboratory and/or imaging results fail to show the anticipated results. We do more digging, we sort through our text books, we perform internet searches. We reassess the patient; we comb through the history for something we’ve missed. Often, with diligence, we’ll find a piece of the puzzle that points us in the direction of a solution.

But what happens when that piece of the puzzle remains elusive? Where do we go? Most of us have a game plan for those cases that don’t seem to have any answers no matter where we turn. And often, our patients are satisfied with our attempts - even if no answer is found.

But what about the medical mystery that isn’t our patient – but the child of a friend or an acquaintance? What’s the best response when that friend asks for advice or an opinion? How much effort have you (or would you) expend in such a circumstance? I think that we’ve all expended some informal efforts regarding kids – an otoscopic evaluation here (a neighbor calls on a Sunday afternoon and wonders if a trip to the ER is warranted), a concussion assessment there (you’re at the playground and watch a child fall off the slide) – but what’s your comfort level regarding something that doesn’t seem to have an answer?

As with the mysteries mentioned above there many not be one specific answer (and certainly not a “right” or “wrong” response!), but I am interested in knowing your opinions when faced with this issue.
A

Resolved:

We're coming up to the new year, traditionally a time for resolutions to be made - in jest (I resolve to never drink so much spiked eggnog ever again) or in a real effort to better ourselves (I will keep up with all of my paperwork in the office every day). What are some of the resolutions you've made in the past, or are planning to make now?

To get started, my resolutions are the same ol' boring resolutions I make every year: 1) get the home office cleaned out and usable! 2) be a better [enter one, pending day and mood: wife, mother, doctor, friend...]. 3) Exercise regularly.

NOTE: If you're worried about being held to your resolution ('cause I'm going to follow up in August!), leave a comment anonymously...

A

image credit: www.buycostumes.com

A Lesson for Youngest - and his mom

I'm often asked to speak at support group meetings for the various conditions I see in my practice. I try to go to as many of these as I can; it's a great way to meet with individuals on an informal basis. Many of these patients don't have much insight or knowledge about their condition (or worse, have a skewed picture of the future based on misinformation), and I hope I can change some of that in the time I spend with them. As could be expected, in my attempts to balance work and home, I occasionally run across some problems with time constraints. This happened a few months ago. I had promised a group that I would meet with them, but the week became filled with mandatory department conferences and other events which kept me away from home, so on the evening I was scheduled with the support group I was greeted with a chorus of "You're going where? Why can't you stay here for a night?" In a desperate attempt to spend some time with my boys, I asked them if they wanted to come with me. Eldest declined with a bit of a sneer, but Youngest jumped up with enthusiasm. His question, though, gave me a bit of cause for concern: "Can I bring my GameBoy?"

As we pulled into the parking lot of the church where the meeting was being held we could see a steady stream of cars pulling up to the entrance. We parked in a far corner of the parking lot and while we walked to the building we watched people in wheelchairs and using walkers approaching the doorway and struggling to get through. As we got closer, I suggested that Youngest might want to hold the door for some of the people we saw. He looked at me sideways, but then ran ahead. I could hear him talking to a couple wrestling with the door (which didn't have any modifications for people with disabilities); then with a smile, he opened the door as wide as he could so that the husband could push his wife through. After he assisted a few more individuals it was time for the meeting to start.

Before I knew it, Youngest was talking with the facilitator of the group and passing around cookies and punch to the members there. He sat quietly while I spoke to the group and answered questions without bringing out his electronic toy once. As the evening was winding down, I was approached by a woman who had been sitting quietly in the back. It was obviously difficult for her to move forward, even with the rolling walker she was using. Watching Youngest's face, it was apparent that he felt removed from this group. I could almost read his thoughts, "Poor folks; too bad they contracted this disease. Thank God it will never happen to me." The woman thanked me for the information I had provided, and the enthusiasm and encouragement she felt I had brought to the group. And then she said, "You know, I've been battling this since I was 16 years old. I never thought I'd be around this long." Youngest's mouth dropped wide open at this point - with just a few words, this woman had made him realize that none of us are immune to whatever it is that our futures hold. Before I could say anything, Youngest had moved next to the woman and said, "I'm so sorry to hear that. May I give you a hug?" While I answered questions for another person in the group, I could see Youngest speaking softly with the woman.

Afterwards, he and I helped the facilitator clean up the napkins and cups. Youngest didn't say anything while he gathered up debris and placed it in the trash can. As we began to walk through the now-quiet parking lot toward our car I said, "I'm proud of you. I think you did a very nice thing tonight."

His response was typical pre-teen. "WhatEVER, Mom. Race you to the car!"

I wasn't sure how much of that evening Youngest retained, or what an impact it had made upon him until recently. As we were talking about the upcoming Thanksgiving holiday, Youngest suddenly blurted out, "I guess we can all be thankful that we're healthy, right?"

Right, son. And I'm thankful for lessons that are learned without trying.

And to all of you - I wish you a healthy, happy Thanksgiving (and quick healing to you, Happy Mom).

A

Things I wish I knew in medical school

Things I wish I knew in medical school (and beyond):

-When starting, I wish someone would have told me that the daily grind of medical school would be the hardest thing that I’d ever done to that point.

-The smell of the anatomy lab will eventually fade. With luck, everything you learned there won’t.

-It’s OK to not know what you want to do with your life; spend your time during rotations and clerkships learning as much as you can. Likewise, it’s OK to be completely grossed out by sputum samples.

-Learn to listen to your gut regarding patients and yourself. It’s part of the art of our profession.


-Every once in a while stop to thank your support systems: parents, siblings, friends, significant others, spouses. Med school is a tough row to hoe (so to speak), and they’ve got your back while you’re cramming for yet another exam. Don’t get crazy - you haven’t got that kind of time.

-You’ll never know it all, so don’t panic when you realize you don’t. This profession is built upon learning regularly, so learn to learn quickly and efficiently. And teach what you’ve learned – it’s the best way to reinforce your knowledge and pay back those who you feel were good teachers.

-Above all, remember that you're never alone. Don't be afraid to ask for help.

A