a heavy heart

Warning: this is a sad post involving postpartum depression and physician suicide.

I had a friend from medical school come visit this weekend with her husband, which was absolutely wonderful and much needed for all of us. They played with my kids and cheerfully put up with a quick park stop (because lord knows a 3 year old can never pass a park without stopping). Unfortunately, she also shared with me that one of our medical school classmates and a friend of ours had recently ended her life after a struggle with severe postpartum depression. She had a daughter a few years older than my son, a newborn son, and a husband. I checked her Facebook to see if there were any updates there - and all I saw was a glowing maternity photo of her husband’s arms wrapped around her, and a warm photo of her snuggling her daughter and newborn infant. I couldn’t imagine how much pain she had been in to leave these faces behind. 

It made me think back to earlier this year when I found out one of my very best friends also had postpartum depression - she posted it on Facebook that she was seeking help, and I was ashamed that I hadn’t called or texted or done anything to see if she was ok in the last few weeks. We talked on the phone afterward about how the loneliness of COVID made pregnancy and the postpartum period so difficult, and how so many people had reached out to her after that Facebook post, opening up about their own personal struggles. And of course it made me think about my own recent maternity leave. 12 weeks of maternity leave in the winter of COVID was the loneliest thing I have ever experienced. It was both lovely and awful in its monotony -  it felt like one long day of sitting on the couch with a newborn and watching a preschooler play legos. I was lucky to have my husband working from home and a support network that was open to late night zoom calls with a bouncing baby on my chest. I had to frequently remind myself that this was a time like no other, a time to shelter my children from the rising COVID trends, and I would never get this much time alone with my children again - but there was definitely more than a little relief in returning to my job and a more consistent schedule. 

This is not the first physician suicide in the medical school classes surrounding mine - and I really haven’t been out that long. Learning of my friend’s death was a harsh reminder of the terrible frequency of physician suicides and how deadly postpartum depression really can be. 

Last night, I spent the evening snuggling with family and holding my little ones a little tighter. I wanted to make some space for my friend, but really didn’t know how - so I’m sharing her story here in this community, where my fellow mothers in medicine can help remember her and hold space for her with me. So if you’re reading this, light a candle, say a prayer, close your eyes and send warmth to her family - but most importantly, check in with the moms around you, because sometimes people are just not okay.

Love to all,

Kicks

Materni-tine

It was the best of times and it was the worst of times to have a baby. 

For starters, I don’t want to be a pregnant healthcare worker in a pandemic again. No thank you.

We tried to induce Baby Girl early in November when the COVID was really hitting the fan here in the Midwest and we didn’t know if it would get worse. Didn’t matter, she didn’t budge. She ended up (as her older brother) needing a for-real induction a week after her due date. After the delivery, we struggled with a retained placenta so it seemed like the never-ending pregnancy - even though we had a baby, we still. weren’t. done.

There are definitely pros and cons to taking maternity leave during a pandemic. It has been so nice to keep my entire family at home for twelve weeks, although twelve weeks at home with a fussy baby and a three year old with minimal visitors has been trying at times. I am somewhat of a germ-a-phobe with small babies even in non-COVID times, so COVID gave us an easy out of crowded holiday family gatherings. It did get lonely. We made a grandparents-only visitation rule which worked out great until one side went south for the winter and the other actually came down with COVID so stayed away. I had to be intentional about Zooming everyone from college roommates to high school besties - and I definitely found some solidarity in their loneliness as well. It’s hard for everyone here as winter in the Midwest doesn’t really lend itself to outdoor socially distanced gatherings. My husband and I don’t feel like we’re missing out on anything by staying at home with our kids - because that’s what everyone else is doing too.

I will be ready to go back to work in the next couple weeks. I’m a little nervous about jumping back in at full speed with an extra little body to coordinate, but I’ve decided to “give myself grace” (a phrase I stole from one of my patients) and remind myself that it will be messy and it will still turn out OK. I got my second COVID vaccine which is reassuring. I did decide to vaccinate and continue breastfeeding which is consistent with AAP/ACOG/Academy of Breastfeeding Medicine guidelines. The doctor in me reviewed the evidence, weighed the risks and benefits, and made the decision to vaccinate. The mother in me called my mom immediately after my first vaccination to get reassurance I was doing the right thing. 

This is how I know I did maternity leave right: I rewarded myself with a post-COVID vaccine haircut (10+ inches gone! Hello mom cut!). My hairstylist asked what I’ve gotten done during my maternity leave and I couldn’t think of a single thing outside of snuggles and legos. And I wouldn’t have it any other way.

Kicks

Crunch Time

Sitting in my rocking chair taking a few deep breaths.

We hadn’t shared it on the blog yet but we are expecting Baby #2 any day now. I can tell you that the pandemic is about 8.5 months along because I took the pregnancy test the week we started shutting things down. I had some funny experiences I had forgotten to share - for example, I found out buying a pregnancy test when you’re the small town doctor is a little more difficult than anticipated, and due to a miscommunication between the pharmacist and me, somehow I accidentally bought 6 pregnancy tests.

We have 2 weeks (give or take) until Baby Girl arrives and of course it’s been the worst of the pandemic that the Midwest has seen. I luckily have gotten approval to work remotely doing video visits and phone visits at home alongside my husband who was working from home even prepandemic. However, I still feel every day I remain pregnant is a day we are trying not to bring COVID into our house. We are just ticking down the days. We removed our 3 year old from day care for the next two weeks and convinced my retired parents to watch him at their house out of town, but the members of our already very small family circle are also reporting positive contacts one by one. It feels suffocating. I spend my mornings as a primary care provider cringing at the notifications of positive test results in my elderly and institutionalized patients. I spend meetings hearing about surge planning and watching steadily rising graphs specific to the region where I live. I talk via phone/video to my patients who are either having significantly worsened anxiety - or don’t realize that the term “quarantine” means “don’t leave your house”. I do everything I can to make sure we have minimal in-person interaction in all we do - and then I turn on the TV and the high school football team is still playing their rival team. I scratch my head and I just can’t reconcile the world I live in and the world other people seem to live in. 

I am ready for Baby Girl to get here, but not in the way I was hoping. I wanted to be eagerly awaiting her arrival, not feeling like I have to rush her along so we can barricade ourselves in our house during maternity leave. I wanted to spend time with our 3 year old and enjoy his last moments of being our only child, not ship him off to Grandpa and Grandma’s so I can finish working. We’re doing okay, and we are lucky in so many ways. We’ll continue to take it here one day at a time, and I’ll try to take advantage of this quieter time as much as I can while it lasts.

Kicks

Summer Vacation Comes to an End

It's my last night of my long awaited summer vacation. Ever since I had Toddler almost 2 years ago I have been looking forward to this summer. 

I'm so glad that Past Kicks was looking out for Future Kicks and took a shorter maternity leave to get out of residency a bit earlier. I only had 2.5 weeks to make up at the end of the year this way. There is something sad and lonely about most of your cohort leaving you behind and watching the junior residents step up and fill your roles before you're even gone, and although I love my residency, I was definitely there 2.5 weeks too long.

This summer was glorious. I took about 6 weeks off between jobs. My husband had minimal time off to help with our move, so I was glad I had plenty of time and helpful family members to get settled in our new home in our new smaller community. The weather has been wonderful and Toddler and I settled into a routine with daily adventures to parks, pools, beaches, and libraries. We've spent extended weekends with family and caught up with old friends. I had to remind myself after the first week (in which we went to 3 parks in one day) that this was a time to slow down and relax - after all, we live here now (and hopefully will for a very very very long time) and the parks aren't going anywhere. 

Tomorrow is the day I go back to work - this time as an attending physician in a brand new town in a brand new health system. I thought I would be more nervous, however I've kept myself so busy I haven't had time to be nervous (something I did subconsciously I'm sure). I think I will get more nervous the night before I see my first patients unsupervised without a preceptor for the very first time after the initial orientation wraps up. 

I originally was dreading the return to work, but this weekend has been a little trying between Dog barking at neighbors and Toddler trying out some extra sass, so I do think it is time to see some grown-ups again. I'm sure the initial daycare drop off will be a nightmare (for both of us), but we have gotten over nightmare drop offs before. 

I have one cute story to share from my time off: Toddler and I were out at my parents' favorite local coffee shop when  I learned that Toddler was actually well acquainted with all of the regulars from his times going with my parents. He was handing out fist bumps and babbling along knowingly to several older gentlemen he apparently knew. Toddler then decided (as Toddlers do), he wanted to go out the door and stand on the sidewalk to watch the goings-on outside. I followed. One of the older gentlemen held my coffee so I could follow. Standing outside lasted about 5 seconds before Toddler decided to go back in. The older gentlemen opened the door for me. I tried to explain that he didn't need to help, otherwise he would likely be up and down 10 more times. He slowly shook his head and smiled and looked at Toddler and said "The days are long but the years are short" - which is already exactly how I feel about Toddler, and am lucky to have had these long days to spend together and look back on for years to come. 

Kicks

Residency Roast

Another academic year comes to a close this weekend. Tomorrow a fresh fleet of interns across the country will be starting their first days nervous and tremulous to be finally let loose on the wards. Although most of my classmates have walked out of the clinic for the last time, I and a number of my classmates have “mom time” to make up for maternity leave (which feels a little like a punishment for having a baby during residency, despite only taking a 5 week maternity leave....but I digress) so I’ll be around a few more weeks.

Our residency celebrates the end of each year with a large banquet to celebrate the new arrivals and to honor the graduating residents with awards, nice words, and roasts. The outgoing residents get roasted by the program director first, followed by another roast by the incoming chief residents. The outgoing chiefs roast the faculty, and everyone has a good laugh along with some good food and drinks.

As a graduate, I was able to bring a whole table full of family to the banquet this year. During cocktail hour I was able to show off Toddler as we mingled with my friends and coworkers and faculty and guests. I was honored to be able to receive an award as well as present a teaching award and was glad those close to me were able to make it. 

I awaited the roasts with some trepidation. I felt I had a lot of potential - I’m a messy eater, a loud talker, a clumsy walker. My PD went first. When it was my turn, he poked fun at my small town (as he is originally from a neighboring small town to my own), my instant apologies whenever something even mildly inappropriate escaped my filter, and my overall “church lady” nature (I used to play church piano and work at a Catholic hospital so it was fitting). He did mention how pragmatic I was, to the point I would send my child away when I was on weeks of night float to my small town (my mom and sister cheered at this point seeing as that was who Toddler spent the most time with on those nights). 

I instantly had a bit of a flashback and felt a familiar feeling in the pit of my stomach. I hated those weeks so much. I remember the first week of night float I had as a parent. I stressed Husband out so much trying to get us to cross paths for those 15 minutes before he had to leave for work and I was coming home and vice versa and losing sleep trying to spend minutes with my Baby. It was awful. It was nerve wracking and left me in tears. The next week I sent Baby to my parents. It was such a good logical solution. My Baby would get to spend time with his grandparents who lived out of town, and they coordinated things so my in-laws could see Baby too. My husband was less stressed trying to hurry home as fast as possible to I could see Baby for five minutes before heading to work. And I got to sleep. It worked so well we did it for pretty much every week I had of night float. 

Logic didn’t stop the deep pit I would feel in my stomach as I handed off Baby each of those weeks. It felt like an essential part of me was getting ripped from my gut every time. I would do those hand offs and head off to the hospital to spend overnights alone isolated in my call room or being crushed by the pager. It was absolutely awful. 

And even in the banquet hall, surrounded by those I love most and my co residents and members of my residency who I will miss dearly, surrounded by all the warm fuzzies from sharing memories and laughter together, I felt a remnant of that aching pain in the pit of my stomach. As I looked around the room and thought about all that I would miss about my program, I knew what I would be the happiest to leave behind.

I snuck into Toddler’s room that night when he was fast asleep. I watched him sleep with his face shoved against his crib mattress and his diapered butt up in the air. I thought about how grateful I am for my upcoming attending  job - outpatient with low volume OB call - and thought about all the weekends and nights we would be able to spend together from here on out. I am so happy for the bonds he has formed with his grandparents and extended families from those weeks away, but am even happier that those weeks have finally come to an end.

With love,

Kicks 

Saturday AM coffee

The golden weekend begins

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

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

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

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

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

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

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

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

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

I think I need another cup of coffee.

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

Kicks

Guilt and Determination

Quote of the week:

“Guilt is useless. Determination is important”.

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

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

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

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


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

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

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

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

Kicks

Exceptionality

I learned a beautiful new word this week - exceptionality

I am on my community health rotation. One of the best parts of being a resident are the off-service rotations, which means less time at the grindstone of patient care after learning after patient care after learning and a little more time to breathe. I got to spend a day with a public school nurse in the metro area school system. I graduated with less than 50 kids in my rural high school graduating class, so touring a public metro school system was eye opening, especially as I toured the schools where the kids were >90% free/reduced lunch. Both as a doctor and as a mother.

The school nurses I met were all so gentle, patient, and kind. I watched at the elementary school as 3 kindergarteners came together for their pre-recess albuterol inhalers and impatiently watched the clock together with their little spacers in place. We talked about the special needs kids there as well. I don't remember the issue we were talking about in particular for one of the kids, but I remember the nurse saying (instead of "part of his disability is...") "Part of his exceptionality is _______". She said it with a knowing smile and a twinkle in her eye despite what I'm sure was a frustrating and time consuming issue for her.

We never really had a schedule. We floated around an elementary school, a middle school, and a high needs school. The nurses were so proud of their schools and their kids and talked non-stop about their goals and wishes and kept pulling me aside to show me other students that had made great strides. One of the middle school nurses was one of the most reflective listeners I'd ever met, and as she told me about the difficult parent interactions she's had, I thought about how much she could teach us as doctors about how to handle difficult patient interactions.

The last school we stopped at was specifically built for high needs cognitively impaired students. We walked into the school nurse's office just as she was calling an ambulance for a child's third seizure of the day. They told me they call 911 approximately once a month. I was additionally interested in this school because I'd never heard of it before 2 weeks ago - when a new teenage patient with significant cognitive delays and no prior records showed up in my office appearing agitated and on the verge of violence. I had a 15 minute appointment with them and wasn't sure what to do. I was referring him to the appropriate specialists but was debating whether I needed to start behavioral medications in the meantime as his grandma had told me he had been on some medication in the past. I had found out through the school system that he was already getting hooked up with basic therapies and they thought they were meeting his school-based needs at that time. Now I was at that school. I met the therapists, the numerous paraprofessionals, and peeked at the kids in wheelchairs and helmets and in all manner of disarrayed behaviors. I saw my teenage guy too. He waved at me across the cafeteria and when I talked to his teacher, I learned he was a "delight" and they had no behavioral concerns - and they spent all day with him. I learned about their functional based classes and even got to sample a cookie from the morning's cookie class.

I won't be in this metro area much longer. As I've said before, I'm looking for jobs - I have had several interviews and don't have a finalized plan yet, but I probably won't be in this community. It gave me professional inspiration to connect with my future school district and learn more about my community wherever I practice, but more importantly I have a new deep and profound appreciation for all teachers, especially for kids with complex medical/social/emotional needs and even more importantly school nurses. Especially the ones that appreciate the exceptionality. And as a mother of one healthy toddler, I appreciate all those that willingly spend their time among hundreds of children and/or teenagers every day.

May this inspire you to appreciate rather than tolerate an "exceptionality" this week. :)

Kicks

Interview Season

I hate interviews. I don’t know why I hate them so intensely or get so anxious, but whenever I have a job interview I develop “functional dyspepsia” (or as my mother would call it - a nervous tummy). I’ve started looking for my first real attending job. Someday I’d like to be a residency faculty member, but my university system has zero openings. I got one job interview for a residency faculty at an outside system that met all my criteria - within a couple hours drive from our families, a community that both my husband and I would enjoy living in, and an established residency with good mentoring support. It was a long interview day - beginning at 7:30 in the morning and dinner going past 8 pm that night - and I admittedly wasn’t my best self. It was my sixth week of a stretch with only 6 days off total (2 of which were used for Baby’s first birthday with our family back home), so I was tired. I underestimated how difficult it would be to schedule interviews around a resident’s schedule, and I would have preferred a later date to have recuperated a bit, but this was the only date that lined up for both me and the program.

 I felt like I connected well with the current faculty and really felt like it was a good fit, except for one disappointing part over lunch. I was asked to give a lecture so they could evaluate my teaching style, and I was ready with flashy PowerPoint in hand with a topic I had done research on so I could actually answer a question or two. However, about 15 minutes into the lecture, I realized I was getting warm and lightheaded. The walls started closing in. I realized I was standing locking my legs in a warm suit jacket and hadn’t had much to drink for water. I started talking faster, thinking I could just get through it and no one would notice, but then one of the faculty members stood up and got me a glass of water and I noticed a bead of sweat dripping down my nose, so I finally quit faking it, apologized to the audience, and led the rest of the lecture and discussion from a seat in front of the podium. I was so embarrassed. I have had similar presyncopal vasovagal-y episodes before, but this was the first in front of a large group of people. Hopefully, I’ll get points for finishing regardless of my obvious physiologic distress...

The rest of the day went well but I still won’t hear from them for at least a month. The more I go to other interviews, the more unappealing pumping out RVUs day after day seems to be. I’ve had to stop myself numerous times from emailing the program director “Pick me! I think your program is exactly what I’ve been looking for! We want to live in your town FOREVER!”. But that probably looks bad so I haven’t.  😝 It’s my first choice for a job. I think I’m a decent candidate, but if someone swoops in with experience and/or someone from within their own system is interested, my chances probably aren’t looking too good.

I had another job interview at a community clinic within the past few days. It meets all my non-academic job wish list items except one. I’ve gotten more idealistic rather than less as medical school and residency have gone by, and I was really hoping to work in at least a somewhat underserved community - but this job is in the heart of a beautiful suburb which wasn’t what I was picturing for myself at all. The  more I think about my list of what I want in a job, the more I realize that this is probably a very good fit for me, but  there’s just a small hesitant piece of me that feels like a sell-out. Which is why I’m turning to you all for stories and advice - was there anything you had to sacrifice off your wish list to find a job you were still reasonably happy in?

“Pumped” in JAMA

I was at our block education the other day when one of my male co residents asked me, “Did you read the JAMA reflection piece from Sept 11?” (answer to this is always no, my JAMA sits on my kitchen table where it’s main purpose in life is to be an excellent spider squisher). When I said I hadn’t, he took his issue out of his backpack and gave it to me.

If you haven’t seen it, the article is called Pumped by Dr. Charlotte Grinberg. (Article here). It is a fantastic reflection on pumping during intern year and like most reflections on pumping I identified with it so much. I almost cried when *spoiler alert* her freezer broke and she lost her stash. And cheered at the final couple of paragraphs.

I am so happy to see this in JAMA. My coresident told me - “I read it and thought of you guys”. I’d lately been fielding comments like “I wish I got a twenty minute break in my clinic schedule!” so it was great to hear something more affirming. I suppose my male coresidents are less likely to be reading blog posts on mothersinmedicine.com so I’m hopeful this will bring more discussion and more advocacy to pumping residents among the non pumpers among us.

Re: my own pumping journey - baby is 11 months and we have almost made it to a full year of exclusive breast milk due to the combination of ridiculous pumping sessions, learning to advocate for myself, a lot a lot of luck, and a pretty supportive work environment. Cant wait to celebrate his one year journey by temporarily retiring the Spectra. 

Bipolar

There is a patient that has been on my mind this year.

I was fired as her doctor.

I have had two patients fire me. The first was a sweet little old lady with mild cognitive impairment that wasn’t too cognitively impaired to realize I was moving in on her drivers license and switched to another clinic. She sent me a card though letting me know she switched clinics, wishing me the best and left me a teddy bear for my baby. The second one was much tougher. It was definitely the toughest initial OB visit I’ve ever had. I was in there over an hour. She was a mom with 9 kids at home and a partner who was controlling and emotionally abusive. She was late onset to prenatal care and came in maxing out the anxiety and depressive scales in the office. She was basically the sole caretaker of her kids, and worried constantly about things like if she passed out in the tub, who would take care of her kids? We talked a lot and luckily I had a no show following her. I thought we were developing a good rapport when she told me she had worked for 3 days straight without sleeping at a huge event downtown. On further discussion, I found she screened positive for possible bipolar disorder. I patted myself on the back for being a good primary care doc and sent her to psychiatry for further evaluation.

She missed her psychiatry appointment, but occasionally made it back to see me.

We left a lot of our appointments frustrated - most of her problems were so complex I wanted to refer her out multiple times, but she had trouble with transportation to our specialists and finding someone to watch the kids at those times, so they never happened. Every time she came into the office and we tried to fix one problem, three more would pop up. She was taking illicit prescription medications for chronic back pain and smoking marijuana, and was frustrated I wouldn’t prescribe her buprenorphine without a referral (our clinic wasn’t doing buprenorphine at the time) and I was frustrated she wouldn’t consider psychiatric medications for her fear of harming her baby, yet continued to smoke cigarettes, marijuana, and use the pain pills. She was frustrated at me because all I could offer was Tylenol and more referrals.

I bent over backwards for her. Our OB coordinator pulled strings so we could have 40 minute appointments together - which is something I have never done for any other patient. When she wouldn’t go to specialists, I would call them on the phone for recommendations. I was prepared to put her on lithium at one point with the guidance of a perinatal psychiatrist over the phone.

She fired me because she didn’t think I was doing anything for her chronic pain, and because I was always kicking her partner out of the room to ask if she was safe. She told our OB coordinator she didn’t care who delivered her baby as long as it wasn’t me. I found out later that she delivered at a different hospital system, and as far as our OB coordinator knew everything went well.

I was her doctor before I had my baby. Since then, I think of her every once in a while when I am overwhelmed by working and taking care of one little peanut with a supportive partner in the house. I think about our discussions of her working days on end without sleep - although that might go along  with a diagnosis of bipolar disorder, I also wonder if I was pathologizing her motherhood and what she had to do to support her family. I think about her inability to make appointments and her worries about what would happen to her children if she was gone. I think about what it must be like to have to choose to stay with a nasty partner who will provide at least some financial stability and a house for all your children versus turning to a system that will assuredly break your family apart in an attempt to provide safety and security.

I think of her often, and wish her the best.

Kicks

Ode to my couch

Sometimes I think the most definitive memories I will have from this time period will come from my couch.

This is not my couch’s first life. It is secondhand from one of my aunts. We bought a house (our first house) after medical school and didn’t have a lot of time/money/interest to put toward new furniture, so we adopted this one. Her kids are now in high school and college, and give my aunt a lot of crap about selling the softest comfiest couch they’ve known for a better looking fancier one.

In our childless days, this is where my husband and I sat to play Nintendo games together with a dog in between us. We watched movies and ate Chinese food back before we had an active 9 month old who could reach  everything on the coffee table.

It is a perfect couch for post call naps with a dog at your feet. It is covered in soft fuzzy blankets thought to protect the couch from the dog but moreso add extra snuggle factor.

We brought baby home from the hospital at the first snowfall of the year. Our extended family was sick during Thanksgiving and as I was very hesitant to bring my baby near any germs under 2 months of age, so this is where our small little family sat with plates of takeout turkey and potatoes from a local cafe pretending to watch football but really all of us  intermittently napping. It is one of the favorite Thanksgivings I ever had because it was cozy and all about my own little family.

I spent the majority of my maternity leave on the couch with baby snuggles sleeping on my tummy. I either had a coffee or a book or would play my Nintendo switch over his head. The only time in my entire life I have ever completed a video game was the week I was post term pregnancy waiting for induction and they wouldn’t let me work and during my maternity leave. It is the snuggliest I have ever felt in my whole life with the snow falling outside and all the warmth inside.

Fast forwarding - baby is now 9 months old and more of a little boy than a baby each day. He is a great explorer and crawls and scoots himself around non stop. Our living room is our biggest room so it seems like all my free time is spent on this couch, watching him bang two toys together, only to find two different toys to start banging them together.

I’m post overnight call today. We have crawled and played. And Baby is napping in his crib and I am back on my couch. Time for a nap. The dog and blankets and couch are calling.

Kicks

Pink eye

Sick days are hard.

I'm on a tough couple of rotations coming up - I have 2 weeks of 24 hour shifts of my own, a week of nights, and another 2 weeks of 24 hour shifts I picked up for another resident's maternity leave, not to mention some 12 hour shifts in between all that. Future Kicks is going to be happy - less 24 hour shifts for next year - but presently I'm looking at the upcoming calendar and thinking....blegh.

We've been pretty lucky when it comes to Baby's health though. We've walked through the day care door for the past 4 months despite the warning signs of RSV, pneumonia, and strep and come out with multiple runny noses but nothing else. 

Yesterday he was a bit crabby but hadn't slept much and was. not. having. the peas we were trying to introduce. I thought he had a booger in his eye, but didn't think much of it as he pretty much has boogers everywhere all the time. However, this morning one of his eyes was matted shut and it took multiple wipes to get the goo off. Was it pink? I thought so, but the lighting in our house isn't great so I couldn't be sure. I just kept staring at him for a few minutes trying to decide. It definitely wasn't clear cut pinkeye but I wasn't sure. 

I took a minute to evaluate the week's schedule. It was about 6:15. I had a meeting at 7:30 with my PD, I was the walk in clinic resident this AM, and I had block ed this afternoon. Nothing that couldn't be rescheduled or easy to fill. Tomorrow and the next day were 12 hour shifts at the hospital that could be much harder to fill and impossible to leave mid-shift. I knew I had two options and I had to make the choice quick.

1) Take him to daycare and roll the dice that it wouldn't get more pink. 

2) Call in sick today even though it was a soft call on pink eye with the hope of nipping it in the bud today and having a doctor's note to return to daycare tomorrow

I opted for #2 because it's much more difficult to leave mid-clinic shift than to not go in at all. Took him in right away this AM. Of course under the bright lights of the office, those eyes looked clean and white. The FP there recommended I stay home with him today and gave me a note saying safe to go back to daycare tomorrow. 

Now I'm home. I feel really guilty about calling into work, but trying not to. The meeting will be easy to reschedule, it's generally easy to fill walk in clinic, and the only one who loses if I miss out on block education is me. I still think I made the right choice and I am going to finish out the day at home (doctor's orders as above :)) 

I'm reflecting today on how utterly hopeless it is to try and schedule a sick day. 

I also feel somewhat stupid for bringing him in to clinic. After all, I am a family doctor who diagnoses pink eye in kids all the time. As soon as I brought him in, I knew that his eyes would be clean. I remember looking at him on the table early this morning thinking "I am a mother-effing doctor. How am I not able to tell if it's pink eye or not?". I've read about the fallacies of trying to diagnose your own kid and the scary stories of doctor parents never bringing their kids in, so I'm probably overcompensating the other way. 

How do you guys feel about bringing your kiddos into the doctor? Do you think you do it too much or not enough?

In the end - I'm going to enjoy our day off together, put the guilt aside, and rejoice that it's not pinkeye (yet). 

Adventures in Pumping II: The rotating resident

Here is my past few months in pumping chronicled by rotation. As the weeks went by, I turned from a shy awkward pumper to a frank “I’ll do it wherever just get me a plug in” resident.

Ortho: show up to clinic struggling with clinic bag in one hand and pump in the other. Young ortho PA that I am scheduled with has kids, gets it, and finds me a private office for the day.

Cardiology: lots of older male physicians, and scheduled with a new one every half day. Rather than explain the pumping every single half day, I pump on the way to and from work and simply say I need to leave half an hour early to make my q4h schedule. I don’t say why, they shrug and say sure. I tell the younger female cardiologists I need to pump and they “remember those days” and are full of support.

Hospice: in a car with my wheelie backpack going to multiple hospice sites. At one point, I am stuck far from my pump as I misjudged how long the trip would take me and as my mentor for the day is sharing a deeply emotional story as we are ending or day together, all I can think is “gottapumpgottapunpgottapump”. Also had a mentor that went to NP school in the pre-double electric breast pump days and not-so-fondly remembers hand expressing during breaks. I’m so glad we’ve come far from that.

Night float: Sitting in my call room calling specialists with the little “whirr whirr” in the background. Eye the pagers carefully, just daring them to go off with a Code Blue while I am plugged in.

In between, check Facebook. That Willow pump that keeps haunting my news feed with ads looks wayyyy too good to be true. But cheering on the days to an better breast pump.

Psych: checking into an attending’s office for a half day. He has a no show, so I casually mention I need to pump sometime in the next two hours. Ten minute tour through the offices ensues, ending with me pumping in his private office and him waiting outside in his own lobby.

Clinic: having much more in depth conversations with my patients about pumping, supplementing, etc. Run downstairs every 3-4 hours past all the patients in the lobby past  to the pump room, stopping to briefly complain to the care coordinator about how pumping sucks literally and figuratively as we both have babies within a few weeks of each other. She made it a year with her first so we are cheering each other on.

Conference: presenting a poster at a conference at a large office building. Find the pump room of dreams including sink, long counter, multiuser pump, fridge, large comfy chair. Immediately send an email to my office manager outlining this in case we ever have extra money lying around when we design our next clinic. The pump room is in use when I need it in the afternoon, so I am directed to a Breastfeeding Pod (called a Mamava) that looks like one of those party photo booths. Crawled inside, feeling slightly seasick but very private and secluded in my little cocoon.

OB: I pick up an OB shift for a resident out sick. I sit in the pump room in peace wishing I could figure out how my Spectra parts could attach to the multi user hospital Medea  pump. I get to work with the nurses who helped deliver Baby, show them pictures, and they let me eat from their potluck spread.

I mainly wanted to write this all down so I can remember both the ridiculousness and support when we’re finally ready to shelve the pump. Hopefully someday I can say “I remember when I had to haul my pump around with lots of parts from place to place in a huuuuuuge bag! You have it so much easier now!” Until then, pump and I will continue to hit the road.

Kicks

Adventures in Pumping

Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

To OB or not to OB...that is the question

Career advice wanted

I’m having a mid-residency crisis. I’m halfway into my three year family medicine residency, which means in a year and half there will be much more independence but also much less of a safety net below me.   I want to practice in primary care - so I know that it won’t be hard to find a job, however will be much more difficult to find the right one. I’d like to continue doing underserved medicine of some variety - but not sure if that means staying in the city as I am now or moving to a rural area, possibly closer to family now that Baby is here. I’m currently ruminating on whether I’d like to continue practicing OB or not.

It was a surprise to me how much I liked practicing OB as a resident. I liked it as a med student enough (although I will forever hate ORs - I’m too clumsy with too little body spatial awareness) but doing deliveries of my own clinic patients has been so rewarding and energizing. When I find that precious time to devote to independent learning, I find myself reading OB literature (and staying awake through it) more than any other kind.

Today was the first call for a delivery I’ve had since our own Baby was born. As timing goes, it was perfect for me. I was called at 6 am, ran to the hospital, and was back after a beautiful delivery by 9 am. It was great for me - but maybe not so much for Husband. When I left at 6, Baby was just starting to wake up and Husband had stayed up late working the night before, was already awake and was very much looking forward to a morning nap. He didn’t say anything negative, but his expression was less than pleased.

...and this is a best case scenario when I got called in. Our residents are continuously on call for our own patients with lots of back up as with residency schedule we may be working nights or a hospital shift elsewhere that we may not be able to leave. My husband didn’t realize it was a possibility that I would be going in today, but the reality is it’s pretty much always a possibility as I’m usually within 2 weeks of a patient’s due date and babies don’t always come on schedule. And I think as an attending, I’ll likely be much more responsible for my own patients’ deliveries - although having adequate back up is something I am definitely evaluating as part of my future job.

So my question is... can we do this? Or more accurately, will it be worth the effort to do this? We don’t have family close. We don’t really have an emergency contact nearby who can watch Baby if plans change quick. I think I can handle the lack of sleep and unpredictable hours, but is it fair to ask my family to do the same? What about when we want to leave town and spend time with our family? Husband and I have had several conversations and will continue to do so over the next 6 months as my patients continue to deliver and we’ll see how it goes.

 I just really wanted the advice of some moms who have been practicing outside of residency for awhile. Spoiler alert: this likely won’t be my last post asking for career advice. Are you doing what you want in your careers despite a somewhat demanding call schedule? Or did you find that giving up a bit of call was worth it for a little more overall family stability?

Surprises

Hello everyone! Kicks here, and happy to announce the arrival of Baby! He is doing great and we are so in love. I am sitting in my rocking chair where he fell asleep in my arms contemplating how things have gone so far

I was surprised...

L&D:
...that after signing up for an induction, my water broke in the hospital with no pitocin needed!
...that I was such a puker. I have delivered about 40 babies thus far and I haven’t seen anyone puke like I did.
...how much I HATED the nurse who wouldn’t give me an epidural at 3 cm
...how much I liked her after getting me through early active labor and getting me to 8 centimeters before my epidural
...after how nervous I was to deliver at the hospital I will soon be working at, how much I am going to enjoy working with those fabulous nurses. I always seemed to have the right nurse at the right stage of the process, and we bought them all chocolates for the nursing station on day of discharge
...how well my husband did. He feels lightheaded at the sight of blood, but stayed by my side through each yucky moment. And even watched baby be born (we had a mirror at the end of the bed) which surprised us both
...how wonderful that first hour of skin to skin was. I always counsel my mommies that we will try to get them that moment but no guarantees, as many times something happens where we’re not able to make that safely work - however it was AWESOME. Baby and I cooed at each other for so long we completely lost track of time.
..how little I have learned about breastfeeding and breast pumping despite being interested in newborn care and OB. All I knew was breastfeeding is best for baby and Mom - but the mechanics were completely new. And that pump was so intimidating. I brought it out of its box a month before delivery just to stare at the pieces. And I had no idea what people were talking about “flanges” and “membranes”. Yish.
...how many interruptions we got during our hospital stay. I wasn’t completely clueless since I am frequently one  of those interruptions myself. So I expected baby’s doctor, and my doctor, and frequent nursing checks. But then early childhood stopped by to invite us to a new parents group. The discharge planner (who said she didn’t mind that I was nursing even though I was trying to make it clear I was new at this and I happened to mind at that time). Being  offered essential oils so many times I started to think the hospital was getting  kickbacks from Big Lavender (one nurse even taped a cotton ball to my little table while I was eating breakfast so I had a lavender flavored omelette). It got to the point that my last visitor on my second day was an adorable little old lady who goes around offering blessings to the baby - I was very short with her in my declining and trying to scoot her out of the room - even though later I felt bad and really wished I would have let her as she seemed so sweet and nice and I just snapped at her to get out.
...how ready we were to go home (see above)
...how hard it is to put babies in car seats

Home:
...how natural it was to slip into the role of Mom
...how hard it is to find good advice on the internet at 3 am
...how other moms survived before internet delivery services like amazon
...how defensive I was at Baby’s first doctors appointment despite the constant praise from Baby’s doctor. Must remember to try and do that for my own patients.
..how much I question everything I do with baby. Am I holding him not enough or too much? Am I giving him enough attention or should I get out of his face for a bit? Etc.
...how much Baby sleeps. And how deep Baby sleeps, where it’s still hard to resist the urge to poke him and make sure he’s still alive.
...how much Baby grunts or makes weird noises. Seemingly all the time
...how lucky I am to have family med docs and pediatricians one text away.

Work
...how fast maternity leave went. I thought I would be itching to leave the house but I really really didn’t want to go. I cried the whole way in my car to my first day back at work.
...how much I both enjoy being back and enjoy the people I work with - but also can’t wait to get home
...how much my patients asked about Baby and how things were going. And how much I missed some of my frequent patients.
...how happy I am to go back 2 days a week only for the next month. Jumping back to full time would have been overwhelming no matter how many weeks of leave I had.
...how much more like “myself” I feel after putting real pants on and using my brain a bit more. I didn’t feel “not myself” at home with Baby, but feel a little more normal now somehow.
...how much it is going to suck to try and fit things in between work and bedtime especially once I go back full time
...how awesome my family is at stepping in to take care of Baby when I go back part time and going to extra mile to help clean and cook us dinners.
...how much I love coming home to my little peanut!

Cheers!