Old Photos

I am typing this on the fourth computer I've used in the past year. When I started a work-from-home job in August, they gave me a nice new laptop just as my old warhorse was dying. When I left that job in November, I sent the nice new laptop back and starting using our old desktop. A few weeks ago I bought myself a refurbished laptop for my new business. I wanted to make sure all the important old stuff migrated from the desktop computer, which we had been using for long-term photo storage, so I upgraded our cloud storage and got everything synced. And the past started flowing onto my new hard drive.

Eve and Grandpa Jim, 2004

Eve and Ga, 2004

The child in those photos is now 17; as I write this she is sprawled on the living room floor watching videos and doing homework and stretching, all at the same time. My father died two years after that photo was taken. My mother, in the late stages of dementia, no longer knows who I am. 

Over the last few days, I have paused from my business and my busy-ness; instead of looking ahead, I've been looking back. Mommabee is not the only one doing a review. I have enjoyed the last six months of doing very little work. I have not cleaned and reorganized the entire house. I have not made scrapbooks of Eve's preschool artwork. I have not trained for a marathon. I have slept well, spent time with friends, done the things I could never do because I was on call, and been the primary parent for the first time since Eve was a toddler. I have written more and sung more and read more than I have in years. Looking back at old photos reminded me that since Eve was born in 2000, we have weathered a great deal of loss, and I worked through all of it. I don't mean I worked through it therapeutically; I mean I kept working. Got up, went to work, did my job, wrote my notes, took call. The last six months have been catch-up time.

I am ready to file away the old photos (happy to know they are safe) and move toward the new ones. There will be Eve's prom photos and dance portraits and candids of her as a lifeguard; there will be snapshots of our garden and our summer vacation (wherever that ends up being) and the college campuses we visit. 

Old photos. New times. Life, as they say, goes on.

Photo credit Amanda Lynch Morris

Me, Sam and Eve at the beach, 2016

Who Am I?

So I've been a little - scarce around here lately. My last post was in July, and that was just a link to a piece I had published on Pulse*. My last substantive post was in June, nearly nine months ago. I feel as if I don't have any material.

I still have a kid at home. Writing about her has become more challenging as she's grown older. Eve is 17 now, with her own social media presence and a keen awareness of being talked about. "Mom, you can post that on Facebook if you want to." Her story is her story, and while I have a piece of that story, it's challenging to figure out how to tell my parenting story without invading her privacy.

So I'm still a mother - but am I still "in medicine?" I left my clinical job at the end of July and since then have done a variety of different things, none of which feel much like practicing medicine. For the first time since 1986, my days are not primarily concerned with diagnosis, treatment, and notes. It's - odd. And disorienting.

I've always been determined to have an identity outside of my work, unlike some of the other docs in my family. My grandmother referred to my grandfather as The Doctor, as in "The Doctor won't be home for dinner tonight." My mother didn't do that, but she was The Doctor's Wife first and foremost, and we were The Doctor's Children. I worked fewer hours than they did, although my call still interfered with family life. I took more vacation; my dad took his first week of vacation in 1968. He started practice in 1961. I don't ask Eve's friends to call me Dr. Jay; they mostly call me by my first name. In the end, though, I still defined myself as a doctor first. Everything else is "spare time" - "In her spare time, Dr. Jay hangs out with her husband and daughter and enjoys crossword puzzles and mystery novels."

I guess now my whole life is "spare time." I'm not retired - I still need to contribute financially, and I'm figuring that out - but I know I am done with full-time clinical work. Or even significant part-time clinical work. I'm generally OK with that. I miss talking to patients, and I miss the intellectual challenge. I do not miss having to schedule my life around every third weekend call and I do not miss dragging myself out of bed after being woken up four times over night.

I hope to remain a contributor and figure out what I have to say as we prepare to help Eve launch into college, and launch ourselves into the next part of our life. Most likely, we'll all have to navigate this transition. Perhaps I can start thinking of myself as a trailblazer.

___
*I had another short piece published on Pulse during my MiM hiatus

Linky Linky

I had a piece published in the Pulse section called "More Voices." (if you read MiM and haven't yet read Pulse, stop now and go over there. I'll wait. Really. Please subscribe, and donate if you can. It's an amazing resource.)

Good! Now you're back. "More Voices" publishes short pieces on a theme topic once a month. This month's theme is Mistakes, and the first story on the page is mine. Take a look (and subscribe! and donate!)

Diagnosis

This is a Daughters in Medicine post.

(which really does describe me - I'm a third-generation doc. And that is and isn't relevant to this post.)

When my grandmother was in the last years of her life, she fell out of bed. They took her to the ER, where she was Xrayed, pronounced intact, and sent home (where she lived with my grandfather, the retired internist, and a full-time caregiver.) The next morning my mother called me and said "Your grandfather is upset because your grandmother refuses to get out of bed." This was in the 1990s, before digital radiology and Nighthawk came along. I said "Tell him to call the hospital and ask for the radiologist's interpretation of the film. She might have a non-displaced fracture that the ED doc didn't pick up." Mom called me back several hours later and said - in a deeply suspiscious voice - "How did you know that?" I said "You sent to medical school. I learned stuff."

It's now 25 years later. My mother is the one with dementia, living at home with 24-hour care. No retired internist in sight; my father died nearly ten years ago. Last week Mom fell. The caregivers thought she was OK; a few days later, the pain was worse and she was refusing to bear weight. I said "She needs Xrays; she might have a nondiscplaced fracture." And sure enough. She sent me to medical school. I learned stuff.

Mom doesn't need surgery, thank heavens; we'll get equipment into the house and she'll stay in bed most of the time for a while. She's not having any pain.

But I know what it means when someone with moderate to advanced dementia breaks a hip. I'm a palliative care doc. I know where we're going. She sent me to medical school. I learned stuff. And some days, that stuff breaks my heart.

Gratitude

Not my gratitude. My kid's gratitude.

I will preface this by saying that Eve is almost always a delight. She's smart and funny and passionate about her friends and deeply upset about injustice; she usually does what she's asked without (too much) complaint and she is almost completely self-sufficient (laundry, room, homework, etc.)

And she's 16, and so she sometimes asks for things that she's not going to get, and when it becomes clear she's not going to get them, she has the typical adolescent reaction. This includes sighing, eye-rolling and detailing the ways in which her life is soooo harrrd. Our five-bedroom house is too small., Our backyard lacks a pool. We've only renovated one bathroom, and it's not hers. The hundreds of dollars she is given for a clothing budget is inadequate. You get the idea. She's not grateful.

I am not alone. A lot of my friends have the same experience. Our kids are incredibly privileged; they have rooms of their own, clothes with the right labels, and money to spend. At a more basic level, they have loving parents and safe homes and electricity and food and drinkable water. And we are shocked and somewhat hurt that they aren't grateful.

This reaction troubles me. I have the same impulse - tell me you appreciate all this. Tell me you recognize how lucky you are, how many children around the world have nothing, how many children in this country go to bed hungry while you're complaining that we don't have a backyard pool. I hear Eve rail against injustice and wonder why she can't make the connection to her own complaints. And then I answer myself: because she's 16. Because she still thinks she's the center of the universe. Because the terrible reality of poverty and war and famine and racism is too much to bear and she wants to look forward to being a grownup.

I wonder why it's so important that they be grateful. For some reason, this makes me think of Oliver Twist. "Please, sir, may I have some more?" Eve is not a waif on the streets, thank God. I trust she will never have to cower and beg for favors, and be grateful that someone granted them.  Eve was adopted; there's an extra layer of all the people who tell me she's so lucky to be our child, and she should be so grateful that we took her, and how we rescued her. Since I think we're the lucky ones, and I know we didn't rescue her - she has two biological parents who love her as much as we do - I shrink from that idea.

I realize that what I really want is a kid who appreciates - who appreciates her parents' efforts to make a comfortable home, and the work we do that makes the money to buy the clothes, and the thoughtful choices that mean we went to Paris and don't have a pool. I also want her to appreciate her privileged place in the world. I also want her to claim what is hers without apology; I want her to feel that she belongs so that she can use her secure base to advocate for the justice of which she speaks so passionately. She's sixteen. Sometimes her pendulum swings over into the petulant. I will try to take the long view and trust that it will land in the balanced center.

More Important Than Your Marriage, or Lessons from Old TV Shows

I've been re-watching The West Wing lately - my Netflix version of re-reading a favorite novel, which I also do frequently. In the episode Five Votes Down, early in the first season, Leo (the Chief of Staff to President Josiah Bartlet) forgets his anniversary and comes home at 2:00 AM in the midst of a crisis with Congress. The next day he sends his wife a pearl choker and plans a catered dinner, but it's too late. His wife has packed her bags and has a taxi waiting.

Jenny: I can't do this anymore. This is crazy. I don't want to live like this. I just can't.
Leo: I'm sorry about the anniversary. I just...
Jenny: It's not the anniversary. It's everything. It's the whole thing.
Leo: This is the most important thing I'll ever do, Jenny. I have to do it well.
Jenny: It's not more important than your marriage.

We all know what the right answer is here, don't we? We do. Leo knows, too - but instead he gives her the honest answer.

Leo: [emphatically] It is more important than my marriage right now. These few years, while I'm doing this, yes, it's more important than my marriage. 

Every time I watch it, this scene brings me to tears. This time, though, I watched it while I was doing the dishes at 10:30 at night on a day when I'd missed dinner with my family because I was at work until nearly 8:00 PM. That's not unprecedented; I'm lucky that it doesn't happen very often. One of the reasons we put off having kids was that I knew I would have a hard time leaving work at work during residency to be fully present for a small child. Sam was in graduate school at the same time and it was even more difficult for him. For many years, I was Jenny in that scene - I was afraid to ask Sam if his work was more important than our marriage. I was afraid he would say it was.

And now? Now I am almost always home for dinner, but I know I'm preoccupied with stress about work and thoughts about patients. I have to say "no" to my kid every third Saturday because I'm on call and I can't commit to whatever it is she wants me to do. There are a lot of mornings when I don't hear what's said to me because I'm in a fog from multiple overnight calls. Am I behaving as if my work is more important than my marriage? If I were answering honestly, how would I answer that question?

Overall, of course I would say my marriage is more important. Sam and Eve are the center of my life; I adore them and I want to be with them. I want them to be able to depend on me. In any one moment, though, I make choices that clearly put my work first, and those moments add up.

There's an episode of M*A*S*H in which the members of the 4077th invite their families to a party in NYC. Hawkeye assumes his dad won't leave, because he won't want to leave his patients. The elder Dr. Pierce writes back that of course he will go; "Yes, I'm attached to the patients I've brought into this world, but I'm more attached to the son I brought into this world." Hawkeye, brushing away tears, says "Funny, I always thought they came first."

I don't want my daughter to grow up thinking my patients come first. I want to show Sam and Eve now, in the moment, that they are important to me. And I want - I need - to keep the sense of myself that is only satisfied when I'm doing my work the way I know it needs to be done. Is my work more important than my marriage? No...and yes.

Being On Call

When I was a kid, my dad was on call all the time. I am not exaggerating. He was in practice with my grandfather (his father-in-law.) Nat (my Popop) had been in solo practice for years and so when Dad joined him, Dad took over call. Nat was always willing to cover if my parents had plans; mostly Dad was just - on call. 24 hours a day. Seven days a week. My mother finally forced him to take an actual vacation after eight years.

Now, Dad would be the first person to remind me that this was in the 1960s. No ICU. No CCU. No tPA. No push to get patients out of the hospital - people with uncomplicated MIs (if they survived) stayed inpatient for at least ten days. You could admit people for evaluation of new diabetes. No urgent calls on abnormal labs in the  middle of the night. And he genuinely loved his work and his patients, and he didn't need all that much sleep, and of course he had no responsibilities at home because my mother did everything. But still - on call EVERY SINGLE NIGHT. I can't even imagine it.

I'm thinking about it now because last night was One Of Those Nights. I was exhausted after a long and difficult week and I went to bed at 10:00 PM. The beeper went off at 11:00 PM, 1:00 AM, 2:30 AM, 4;00 AM and 5:30 AM. The 5:30 call was from the ED about a patient who needed urgent admission to the inpatient hospice unit, which meant three more phone calls, so I had to get out of bed. I tried to go back to sleep - and then my daughter's alarm went off at 6:10. She's away for the weekend. She didn't turn her alarm off before she went.

I think I'm too old for this. And then I think of Dad and feel like a wimp. And then I remember that he was 20 years younger than I am now, so perhaps I should let myself off the hook.

Am I the only one who has grown to loathe being on call overnight?

Money Talks

I've been reading The Grumpy Rumblings of the (Formerly) Untenured blog lately. Their personal finance posts make me kind of uncomfortable because I don't think we've done a good job of planning or saving. We're not frugal and we haven't paid down our mortgage (although we did refinance to shorten our term) and we won't be able to retire early. Which mostly I think is fine...except when I read their posts.

But anyway, I read this post about how we communicate about money and I commented. Sam and I communicate fairly easily about money; we discuss major decisions, we have similar values, we have enough money so that we can each buy the things we want. I'm not surprised to read that money is a source of conflict for a lot of couples, or that one member of the couple manages the money. I was astonished to see how many commenters say that they give their partner an "allowance". 

I give my daughter an allowance. I had an allowance when I was a child. I don't give my husband an allowance and he doesn't give me one. I understand the value of having money you can spend without accounting to your partner for every penny, and I can see the reasons for deciding ahead of time how much that will be each month. But an allowance? As an adult? That just rubs me the wrong way.

Is it just me? Do you have an allowance? Do you give your partner an allowance (if you have a partner)? Am I completely over-reacting to a perfectly reasonable word?

Conversations With My Daughter

A keeps telling me what to do. She's so mean. It's like she's my mother.

Hey. I'm not mean.

True. It's like she's the mean mother I never had. Why is she so mean, anyway?

Well, honey, you know her better than I do. It sounds to me as if she's really insecure and also pretty envious of you and C.

Why?

You both have a lot more money than A and her family. You two get to travel and buy pretty much anything you want. A doesn't.

I know. And I don't know why she's so mean to her mom. Her mom works really hard. I think she's nice.

She is nice, and she is working really hard. I can't imagine how painful it must be to have to tell your kids you can't afford things they need. And, at the same time, she seems to tolerate B being mean to her. You said once that you knew I'd never let you talk that way, and you're right. I wouldn't.

It would never even occur to me to talk you like that. Or to yell at you that way.

I know. And a lot of that is just the way you are - the way you're wired. Some of it, though, is that Daddy and I have been clear about what the limits are. And we've also treated you like a human being. We've listened to you and explained why we make our decisions and we respect you and your point of view, so you trust us to be reasonable.

Yeah. And then I expect everybody to be like that, and they're not! Other people are NOT reasonable. Like, I keep thinking people will apologize when they've done something wrong, the way you and Daddy do. And they don't!

I Wish I'd Said Thanks

One of my mother's cousins died yesterday.

I hadn't seen in her a long time - there's a fair amount of distance in my family, literally and figuratively. Miriam was married to my mother's first cousin. He's an internist (that runs in my family) and she initially trained as a pediatrician and then did a psych residency so she could practice pediatric psych. Which she did; she was still working part-time when she took ill, just a month or so ago.

According to her obituary, Miriam graduated from medical school in 1971, shortly before I turned 11. I didn't remember the exact dates. I do remember - quite clearly - that she was the first woman physician I'd known. There were lots and lots of doctors in my family. They were all men. At that age, I planned to be a nurse. It had never occurred to me that I could be a doctor. And then I met Miriam.

I made up my mind when I was 14 - I was going to medical school. Miriam started sending me occasional articles from JAMA about women in medicine. It was one of those articles that I learned that there was a first wave of women in medicine in the early 20th century; I asked my grandfather and he told me that his med school class was about 30% women (he graduated in 1927). The Great Depression, the rampant discrimination that made it impossible for women to join hospital staffs and the post-WWII pressure for women to leave the workplace changed all that. My father graduated from the same medical school in 1958 and there were six women in his class. Miriam was part of the second wave, the women who went to med school when the OR changing rooms still said "Doctors" and "Nurses" instead of "Men" and "Women" and when women were still routinely asked why they were taking a spot away from a man, since they were just going to quit and have babies anyway. Miriam had babies - two of them - and never quit. She was the first Mother in Medicine in my life.

I don't know what my life's path would have been if I hadn't watched Miriam walk hers. Even from a distance, she was an inspiration to me, and in many ways my first mentor. I just sent a condolence note to her husband telling him that. I will always regret that I never told her.

When we are touched by death, we often want to hold our loved ones closer, and I will do that. I will also think about the other mentors who have touched my life, and start thanking them today, while I have time.

Conversations with My Daughter

This morning as she read the newspaper report of yet another shooting death.

Why does this keep happening, Mom?

It's complicated.

After all those kids were killed in Newtown, you'd think someone would do something. And black kids get killed all the time - way more often than white kids.

Yes.

Can't the President do something to fix this? To stop this? Can he make guns illegal?

You learned about checks and balances in the Constitution, right? The President can't act on his own.

So Congress needs to make a law?

Yes. And the National Rifle Association spends a lot of money to make sure they don't pass laws limiting access to guns.

Do you think we should do something?

Yes. Your dad and I do what we can to support politicians who would pass reasonable controls - to treat a gun like a car. Before you can get a driver's license, you'll need to pass two tests and practice for at least 65 hours, and we need to have insurance.

I guess criminals will always be able to get guns. They can steal them.

Yes. I don't think we'll completely stop gun-related crime. I do think we can reduce the number of accidental shootings and suicides by gun, though, and I think we should.

Well, the way it is just isn't right.

Comfort

I used to think that I was drawn to hospice practice because I wasn't one of those doctors that had to fix everything. I'm comfortable with the incurable, the insoluble, the chronic and unremitting. I don't see death as a failure of my medical skills. Nope, not me. I'm not like that. I don't have a personal need to cure.

Except....I do still have a need to fix things. I don't feel compelled to cure; I feel compelled to relieve suffering. I need to make pain go away, ease shortness of breath, make the nausea stop. I need the furrowed brow and the tense muscles to relax. I need to make things better. And most of the time we can. We have morphine and humor and steroids and Haldol and ice packs and Ativan and massage therapy and music and pets and chaplains and social workers and aromatherapy and our own presence. When our patients are suffering, we can bring comfort.

It's more challenging to bring comfort to the families. Pain goes away. Grief must be borne. We can provide some companionship and support; in the end, though, grief is a solitary journey. A husband's tears or a daughter's anxiety leave me feeling powerless in a way that the patient's pain and shortness of breath do not. I want to do something, and I know I just need to stand there.

Today was a little different. Today, oddly enough, two different family members needed something I could give them. Something simple and available and entirely over-the-counter. They needed water. Twice this afternoon, I walked down the hall to our ice machine and filled a cup with ice and water, carefully placed a lid on top and collected a straw. I brought the cups back to the quiet rooms and placed them in the waiting hands. And I felt much better.

Introducing Myself

Hello! I'm Jay. I've been hanging out here and commenting for a long time. I used to blog on Two Women Blogging (don't go looking - you won't find it) which shut down about three years ago. I've written under my real name for HuffPo and NYT's Motherlode. Last June, my essay about my father appeared in Pulse (do you read Pulse? You should!).

These days I mostly write narratives for hospice patients. I was a primary care doc for 20 years; for the past six years I've worked full-time as a hospice medical director. That means I see patients in our 10-bed inpatient unit, do a lot of home visits, attend three IDG* meetings weekly and take weekend call with our palliative care group. We have fellows and residents and med students so I do a fair amount of teaching, too.

My daughter, Eve**, will be 16 in January - she could tell you precisely how many days it is until that momentous occasion. I love having a teenager. I'm sure you'll hear more about that. I've been married nearly 31 years to Sam** and you'll hear more about him, too.

Thanks to KC for founding and maintaining this great site and especially for inviting me to join. I'm delighted to be here. Now if I only had something to say....***
____

* IDG = Interdisciplinary group, also called IDT (interdisciplinary team). The IDT is the core of hospice work and consists of nurses, social workers, chaplains, aides and doctors.
**The names have been changed to protect the mother.
***I'm really not worried about that. It's more likely I won't be able to shut up.