Should I go to medical school?

I have gotten several emails though my blog, some from people who found me through Mothers in Medicine, asking me for advice. I am so touched that people reach out to me. I used to answer these emails individually. I have not answered the last handful, for many reasons.

Most of all, these reasons are personal. Intern year is much different than fourth year as a medical student. I have had a lot more demands on my sleep schedule, my time, my emotions, and my responsibility. I haven't been blogging much in general.

I also did not match last year, and have spent most of this year questioning my dreams. I don't want to rain on anyone's parade with some sort of bitter reply. Which, I wouldn't necessary give, but I have to be honest in my answer. Being a single mother in medical school and residency isn't a piece of cake. But, being a single parent in this world isn't a piece of cake, either, and being a medical student and / or resident isn't a piece of cake. Foregoing medical school isn't necessarily the answer to any of that.

Here is some general advice I will share with parents, single or otherwise, who are facing decisions about medical school and residency. These answers cover a mishmash of frequently asked questions that come up in comments and emails. I looked it over, and I use the qualifier "very" a lot. I usually avoid that word, thanks to my father's influence. He told me to edit by replacing every "very" with "damn", and then to edit out the profanity. I have left them in, because this topic is very damn very challenging.

For single parents or parents whose partner will not be available for child care:

You will need to have a very, very flexible, very solid support system. For clinical years and residency, you will be expected to change what time you come and go on a moment's notice. The rotation you are on most likely will change every four to six weeks, and the demands, time wise, may change day to day on certain rotations. These hours can be as early as 5 am or even earlier, and you can be expected to stay way past midnight, even all night. Some of these times you can plan for, and some you can't. Living near family is very, very important for those of us who can arrange for that. It definitely can be done without family, but please keep in mind the expense and issues with screening and turnover of caregivers.

For people who are facing custody issues, possibly moving for residency, lack of familial support in their particular area:

I feel for you. Coparenting arrangements are very, very difficult. Depending on a lot of factors, you may need to be willing to move for residency, especially for certain specialties or even for some of your rotations. This may involve moving to a place your ex doesn't want you to move to, or moving to a place away from familial and / or social support. The judge may not look to kindly upon you leaving town with a child or children to a place where you know no one and will be working 80 hours a week, including nights, no matter how much you love your kids and parent well. And, there is a reason for that. Is it doable? Yes. Is it a good idea? Depends. Keep this in mind before embarking on medical school. This is one reason I wish I had done ARNP midwifery instead of medical school, occasionally. I wouldn't have to do the match for obstetrics residency. I had reasons not to go the nursing route then, and those are still valid.

For people trying to decide between nurse practitioner, midwifery, physician, and other avenues of the medical profession:

I really stumbled into medicine without a full understanding of how involved the process was, when it came to board exams, residency match, etc. I am still not fully informed on what it takes to be most of the other options available. Please research the nitty gritty, and you will still be surprised by the reality of how the sausage is made. I found studentdoctor.net. With all of its problems (and there are MANY), it is a decent place to find out practical details of many steps of medical school, from pre-med through fellowship and beyond, if you can fish through the trolling, bragging and nonsense.

As for whether or not you can handle it...sigh. I think we can all handle a lot. I think there are times at work, even at 4 am, in which I am exhilarated, and so happy that I chose my path. There are times when I am with my kids that are quality times, and everything seems to work out. There are times in which I feel completely overwhelmed, where I cry at work, and then cry at home because these kids who I wanted to desperately to spend time with when I was stuck at the hospital are bickering with me and with each other, and all I want to do is send everyone to their rooms. No matter what happens this March when I find out if I match in obstetrics or family practice, I will be happy as a physician. I will also have regrets. I think this will apply to anyone, no matter where their choices lead them.

For people who are older:

I was not the oldest person in my medical school. I am not the oldest person in my residency program. I think it is more of an issue with your peers than with your professors and attending physicians, who may be your age. They don't think they are less skilled, and may identify with you more readily than they do younger students. Some people may say it's a waste of investment of a medical school spot or residency spot that a younger person who would give more back deserves more. People say this about women in medicine, too, and that we want to go pop out babies and work part time when we are done with training. All these people can, um, stuff it.

For people who have a history in the "natural" birth community, i.e. doula, midwife, or are just crunchy types looking into medical school:

There is definitely room for us in all aspects of the medical community. I was pleasantly surprised by the diversity in my medical school and in the medical community. One of the first events I participated in for medical school was a social event at a bar, and one of my classmates, a massage therapist, was a few sheets to the wind and offering to balance my classmates' chakras in a wobbly kind of way. I sat next to a grandmother who caught her own grandchild at a home birth all of my second year.

However, medical school is long. Residency is long. It is a grueling, intensive slog. Make sure you are doing it to become a physician. If you want to be a doula, be a doula. I will not be a doula or a lay midwife if I am an obstetrician, or even if I am a family practitioner. It is not worth the effort to go through all the extra training, and the infrastructure is very inflexible and unforgiving. You potentially will be choosing battles constantly, and need to know your place as a matter of respect and experience and survival. Does that mean always stuffing it?  No. But, it means often stuffing it.


If there's anything I missed, please add it in the comments.

Cure for what ails ya

Hi, MiM folks. Long time no see.

I have a lot going on. I am a few months into my internship. I am applying for obstetrics residency again. I just submitted four abstracts to two conferences, I just presented at one conference and will be a presenter at another, and there is a lot going on, women's health wise, in politics and in the news.

So what am I so worked up about that I am going to break my blogging fast?

Facebook medical advice.

*Facepalm*

I joined Facebook when I got accepted to medical school. My incoming class started a Facebook group and used it for introductions and announcements. I'd never used MySpace. I started off Facebook with a bang, since our class had almost 250 members in it, many of whom were young whippersnappers used to this social media stuff. Now, of course, I'm a pro, and have been recently accused of being a "Facebook slut" because I have so many "friends." They come from many, many different walks of life. Definitely not all medical people, and not all mainstream.

So, one of my non medical friends (someone I know from an online mothering support group from years back) posted about some symptoms she found troubling. She was suddenly very dizzy - the room was spinning, and her vision and balance were off. Not really nauseous, no other significant symptoms, and I know she doesn't have a significant medical history and she said she wasn't on any medications. She said - anyone have any idea what could be causing this?

"Hmm, sounds like vestibular neuritis," I thought. I posted "Most likely vestibular neuritis - sorry :(" I purposely said "most likely" because hey, who knows, and I didn't want to sound like a know it all. I threw in the frowny face to seem more friendly and less know it all-y, too.

I wasn't so perturbed by the people posting guesses about low blood sugar or low blood pressure, even though those are technically more likely to cause lightheadedness than dizziness. I know that distinction can be difficult even for a trained medical professional. Or a patient describing symptoms, for that matter.

But, then there were some more productive suggestions:

"Go to the ER immediately and ask for a blood test, which will most likely show it is dietary affecting your blood preasure(sic)".
"I felt really bad recently and it turns out it was food poisoning. I poo'd and I felt better!"
"Intestinal parasites can cause this!"

I made a snarky follow up comment about how it was definitely sporns and she should drink some OJ. I didn't mention that I was a doctor and would you people just! listen! and stop making dumb suggestions for non existent blood tests or very unlikely etiologies. Especially since I had twice, nicely, suggested a likely cause that they could have googled. Maybe that would have been better than the sporns comment, I don't know.

I knew I wasn't fit for further commenting when someone posted how it was "Vertigo. OR an inner ear infection" and I wanted to write in all caps "VERTIGO IS A SYMPTOM, NOT A DIAGNOSIS! SO, NOT "OR"!! AND INNER EAR INFECTION WITH VERTIGO = VESTIBULAR NEURITIS!!"

When did I become such an insufferable know it all?

Sigh.

I should just go take a poo, and I bet I would feel better.

I can see clearly now

Today is the last anyone can say to me "You should know, you're a doctor," and I can answer "Nuh uh, not yet."

Tomorrow is graduation.

Tonight will be a dinner party at my mom's house. I am really looking forward to it. There will be people from so many segments of my life. There is someone I haven't seen since elementary school coming. My favorite cardiology fellow. My closest friends from my thirties. A friend from undergrad who knew me when I worked the graveyard shift at Denny's.

Nothing is how I thought it would be right now, but I am still relieved, happy and proud. And, I am thrilled the week of rain finally cleared up, because we are having the dinner party on the back patio.

Career day embarrassment

I am one week and three days from graduation. WOOOHOOOOOOOOO!

I am incredibly busy, which means I am also paralyzed in the face of all the crap I have to do, and procrastinating on the internet. Hello!

Yesterday I was a presenter for career day at my 7 yr old son’s school. I wore my white coat, wore scrubs, and brought my stethoscope and other tools. I presented in six classrooms (exhausting!), but started off in my own son’s first grade class. I had an apron with sort of anatomically correct removable velcro body parts, which I used to play a matching game with the kids. If a kid guessed which organ I was describing (this organ is a muscle that pumps blood to the body!) then that kid got to put that organ on the volunteer kid who was the “body” wearing the apron. It was especially fun when we got to the kidneys and the large intestine. Poop! Pee! “EWWWWWWWW!”

There were only seven body parts, though, so I brought in my ragtag collection of toy doctor tools. Several people bought toy doctor sets for my kids when I got into medical school, so I had four plastic stethoscopes, a plastic syringe, toy otoscopes, etc. I passed those out to the kids who didn’t get to put on an organ, so they could guess what they were used for, and was one kid short. So, I gave that kid my coffee mug. I made a joke about how that was the most important doctor’s tool, since it helps keep doctors awake, and remarked on how much coffee I drink.

My son rose his hand, and offered, “She drinks beer, too!” I said “And, goooodnight everybody!” and quickly defended myself. “I didn’t drink any this morning! I didn’t have any last night!” and spent the rest of the half hour trying to convince my son’s teacher that I don’t have a drinking problem.

*facepalm*

Cross posted at Mom's Tinfoil Hat

In case you were wondering...

…I didn’t match.

There are probably many reasons why. I was geographically limited in two ways: my custody agreement limited me to the Southeast, and I only applied in cities where I knew people. I am an osteopathic student who was competing in the MD match. Obstetrics has been a very competitive match recently. I had excellent board scores, a research fellowship, and great extracurricular and leadership activities, but my grades were very middle of the road.

So, now what? I will be doing what is known as a traditional rotating internship at a local hospital, then reapplying for obstetrics residency. It will be much harder to interview as an intern with increased responsibilities. It will be harder to transition to my new residency, if I get one, with only days or weeks off at the end of the year, as opposed to the months I will have to ponder my temporary failure this year before starting as an intern.

Sigh.

I am tired of well meaning people asking me where I will be next year. I am tired of people telling me this was meant to happen. I am jealous, painfully jealous with a pit of hurt in my insides, of my classmates who are joyfully planning their futures. Of my former classmates (I graduated a year behind my original class because of my fellowship) who already have almost a year of residency under their belts. Of people in my profession who are my age and are well into their careers.

I didn’t post about it for a while because it was too raw, too painful. And, honestly, I don’t really want to talk about it. There isn’t much to say. It’s hard enough to deal with people I work with, people in my family, and people in my life who genuinely care asking me about it in a time released fashion. I know they’re asking because they want to share in what they think will be my good news. But, it forces me to rehash my pain over and over again, like someone with a new bandage being asked what happened by every new person they see. And, then I have to nod grimly and politely when they tell me that somehow, it was meant to be.

Please allow me to be self indulgently angry and defeated. This is not how my life was supposed to be at this point. I wasn’t supposed to be staring down the barrel of forty years old, not an obstetrician, just a single mom who is wondering if I can even keep my tiny 1000 sq ft house next year on an intern’s salary. Oh, and I just got diagnosed with a chronic disease that I am managing very well, but has a small chance of crippling me. I know I am extremely lucky to be (mostly) healthy and able bodied, with good support, and smart enough to have made it into medical school in the first place. I know that this is not the end of the world – I very well may match into obstetrics next year. I can also fall back on family medicine, and then do some obstetrics, eventually, in a rural area, possibly after doing an obstetrics fellowship. Or, I can finish internal medicine and then do a women’s health of family planning fellowship.

Sigh. I am not digging for reassurance. I just needed to finally get this out.

Reposted from Mom's Tinfoil Hat

Match Madness

Hello, everybody.

Long time no see.

I have been immersed in the turmoil that is the fourth year of medical school. I don't happen to go to one of those medical schools I keep hearing about where the fourth year is easy and awesome. We only get one month of vacation, which includes time spent traveling for interviews. So, with interviews, elective and non-elective rotations, my clinical skills board exam, and being a single mom, I haven't even been opening my laptop most days.

My match rank list is certified, and now I am sitting on my hands and freaking out quietly...well, mostly quietly. For the uninitiated out there, the match is a hellish roulette wheel in which about 37,000 applicants vie for about 25,000 residency positions. This year, I am one of those 37,000 applicants.

I wrote a little bit about my various pressures regarding applying for residency programs here, and that post also has a link to the Match Day topic week here at MiM.

I ended up trying to stay as close to home as possible. I would be happy at any of the programs that ended up on my rank list. I would have liked to have interviewed at more programs. I was limited by my custody agreement, and I further limited myself by only applying to programs in cities where I knew somebody.

I am terrified that I am going to have to scramble. Obstetrics and gynecology has been a really competitive match recently. The National Resident Match Program is nice enough to crunch the data from recent matches, so I have a boatload of tables and graphs to stare at as I freak out. 77.1% of ob/gyn applicants matched last year. 99.6% of program positions filled, which means only 2 positions were left for the more than 200 or so ob/gyn applicants that didn't match. I am guessing most of those applicants didn't have a custody agreement that had pretty strict boundaries.

So, if anyone has any suggestions of how I can distract myself until March 12th, the day I learn if I match, and then March 16th, the day I learn where I match, please let me know.

Boards. Tomorrow. Ack.

Sorry I have been incommunicado, but I am taking my Step II CK tomorrow.



Wish me luck.

A day in the life of a medical student on her obstetrics rotation

5:20 am Alarm goes off. Hit snooze. Was up way too late trying to figure out what is wrong with my knot tying.

5:30 am Alarm goes off again. Hit snooze again.

5:40 am Alarm goes off. Groan and drag myself out of bed.

5:40 - 6:20 am Shower and dress in scrubs.

6:20 - 6:35 am Make coffee and breakfast (cut apples and peanut butter), walk and feed dog, go through younger son Z's backpack and fill out homework sheet

6:40 am Get in car, upset because I meant to leave by 6:30.

6:30 am - 7:40 am Commute in ridiculous traffic. Make a phone call to the kids' grandmother to tell her I found Z's homework sheet on my coffee table instead of in his folder. Get informed that he didn't have his homework sheet yesterday so they didn't do his homework after school. Wonder why I wasn't told about this, but keep it to myself. She promises they will do yesterday and today's homework today after school. Realize older son, S, never emailed me his science homework to print out the night before, which was already 2 days late and he had lied about not being due. Call roommate / nanny, talk her through printing out his homework from my laptop.

7:40 am - Show up at hospital for a 7:30 am cesarean section.

7:45 am - Finally get to labor and delivery OR. Manage to scrub in before attending, who was already in the room. Curse that he is much more punctual than my general surgery attending was.

8:30 am - Get to tie a few knots in the abdomen. Attending tells me my knot technique is still "invented". Sigh.

8:40 am - 1:00 pm Clinic. Running around taking fetal heart tones, measuring fundal heights, assisting with pap smears and a LEEP. Get to do an ultrasound all by myself! See the embryo moving, and cardiac activity! Manage to print a picture for the happy couple!

1:30 pm Report to OR for adenexal mass procedure. Doctor asks me if I want to grab a sandwich. I say no. He leaves and walks out. I decide I do want to eat, but I need to get cash and my student ID in my car. By the time I get it, eat, and return to the OR pre-op area, I am locked out. My badge doesn't work at this hospital. I finally get in, and they have already wheeled the patient back. Crap. I show up in the OR, and they have already started the surgery. I scrub in, and the scrub nurse in training hands me the towel over the sterile field. I take it, even though I know it's wrong. We both get royally reprimanded by the scrub nurse for contaminating the sterile field. She throws out my gloves. I stand there with no gloves and feel like crying. I finally get gowned and gloved. The attending physician pulls off some really fancy laparoscopic maneuvering, tying off the ovarian ligament with suture and graspers as the external iliac throbs right there in the background. Cool. I GET TO CLOSE!! OK, it was just a tiny port opening, but I do it, and I do a good job. I actually feel comfortable managing the instruments and do some pretty good instrument ties. The PA tells me I did a good job. SQUEEEEEE!

2:45 pm. Back to clinic. More cafe cubano and another pastelito. I am going to gain so much weight on this rotation. More clinic. I love clinic. I manage to do some gringa histories in broken Spanish. La ultima regla? Cuantos hijos tienes?

6:00 pm. The midwife tells me we are heading to the other hospital for a birth. I call my nanny on the way and tell her to get S (Z is going to his dad's tonight). I tell her that there is a frozen steak she can try to defrost if it's not too late, and that I will be coming home if the birth isn't imminent.

6:30 pm Get to hospital. Mom is at 9 and pushy. Wait outside for baby's head to descend a bit more. Round on some postpartum patients. A nurse gives me some suture to practice with. I keep tying knots wrong, and we go in to the room for the birth.

7:29 pm Time of birth. Baby is delivered onto the mom's chest. There is a nuchal cord (cord around the neck) and a true knot in the cord. Baby has 9/9 Apgar scores.

8:00 pm Ask midwife to watch me tie a few knots. She shows me what I am doing wrong. Lightbulb! I remember how to do it right now! Muscle memory is a cool thing. Get in car to drive home. Call roommate / nanny, get an earful about S's attitude about not doing his homework. Also find out they were unable to print his assignment this morning, and he got an F on it. Call his dad, and we discuss ways to handle this. Taking away his birthday party at the end of the month is on the table.

8:40 pm. Get home. Read S the riot act about his homework and attitude. Eat delicious dinner roommate / nanny left for me in microwave. Tell her she is the best wife ever.

9:00 pm. Walk dog. Change kitty litter. Sweep floor. Realize it's too late to call Z and say goodnight. Write blog post. Avoid other obligations.

When a patient is not a board question

I am really enjoying my Geriatrics rotation. Although my attending preceptor is primarily a geriatrician, he also sees some patients who are younger. I took a history on a patient who was younger than me today, in her early thirties.

She started off complaining about insomnia and headaches, and then said she had some sort of an "attack" earlier this week. She quickly added that her husband died suddenly three weeks ago, and her therapist recommended that she come to see her doctor. I immediately offered her my condolences.

My mind quickly flipped to a frequent practice board question as I gently asked her about other symptoms. A 40 year old man presents to an outpatient clinic complaining of insomnia, poor appetite, and feeling helpless and lonely. He frequently thinks of dying to join his wife. He lost his wife of 18 years five weeks before. Was she suffering from loss of appetite? Was she able to return to work? Had she thought about hurting herself? What did she mean by an "attack"?

Telling the difference between Bereavement-Related Depression (BRD) and Major Depressive Disorder (MDD) is a frequent sample board question that I have come across in various forms as I have been doing patchwork board review. Bereavement is an exemption from a MDD diagnosis for two months after the death of a loved one, while the duration of depressive symptoms only needs to be for two weeks otherwise. Board review questions often dance around this time period. This BRD exemption (and the duration of symptoms for MDD diagnosis in general) is also the subject of some controversy as experts are constructing the new Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-V), which is the guide to diagnosing mental illness.

I snapped out of my board review musings and continued to question and console the new widow. When I got up to leave the room, I strongly considered asking the patient if I could hug her. Since it was only my third day on the rotation and I was in the room with the physician's assistant, I decided against it. I think if this would be my own patient in my own practice in the future, I would not hesitate to ask. When I left the room and told the other student about it, I teared up.

I guess my empathy toggle switch is still operating just fine.

Cross posted at Mom's Tinfoil Hat

The month I almost switched specialties

I am finishing up a really great month on outpatient pediatrics. I thought I wouldn't love it. I was scared in the beginning how much I really love it. I had a moment in the first week or two that made me waver, ever so briefly, from wanting to do obstetrics.

I love the babies, even when they are screaming. I especially love the girl ones, since I don't have one of those at home. I love the variety. Sure, there is an awful lot cough, runny nose and fever X 2 days on top of the chart. But, I have been pleasantly surprised by the variety.

I have done everything from a one month well baby visit to STD counseling on a young man. I have seen children living with autism, a child with Fragile X syndrome, one with mosaic Klinefelter syndrome, and a few with insulin pumps. I have seen congenital and developmental variations.

My main fear was becoming too upset by seeing a serious ill child. I cried more than once during my preclinical years during films and lectures about terminal developmental disorders and abuse. I still have to do a month in Peds ER, but my rotation site doesn't do pediatric trauma. I hope I don't end up too emotionally overwhelmed by anything I see. I don't have to do PICU or NICU. I think I would have been fine if I wasn't a mother. Now, I identify with every parent and associate all the kids with my kids.

I think one way we end up picking a specialty is by what we can't handle. Some people can't handle the idea of treating someone who is pregnant. I have an internal attending that always jokes that treating someone under eighteen makes him diaphoretic. I know another who can't face pus. There's a student who dreads the ER.

I still haven't done my ob/gyn rotation yet. I am pretty sure I'll love it, since I trained as a midwife. If not, I suppose I can switch everything over to pediatrics. I really doubt I'll be doing it, though.

Starting my internal medicine rotation

I started my clinical rotations in July of this year. (These traditionally occur during the third year of medical school. For me, it's my fourth year, since I did a fellowship year.) I have been able to ease in - my first two months were surgery, which is normally a difficult rotation, but is a fairly mellow one at my rotation site. This past month I have been on my psychiatry rotation, which has also been a low demand rotation, time wise. I have still been able to cook dinner most nights, and have been (mostly) keeping up with the cleaning and the laundry. I was even able to pull off a birthday party for my newly six year old younger son this weekend.

Well, the easy street is merging into the internal medicine superhighway. I have three months of internal medicine starting October 1st. I am really nervous about it. I have back up to help me with the kids, but I am still dreading it. I am especially concerned since my stint stretches over October, November, and December, and all of the holidays associated with these months.

So, coffee? Check. Comfortable shoes? Check. Penlight? Fresh batteries. Big fat pocket book that promises to have all the information on all of the diagnoses, drugs and lab results that I may see in the units? Ordered and on its way.

Sigh. Any other recommendations for surviving these next three months?

To all who have gone that way before

I am staring down the barrel of the residency match. Yes, I still have a year and a half until my match day, but there is a lot of planning that goes into the process ahead of time. I know it was a topic day here once. (Covered beautifully, I might add!) But, I have a specific concern, and a specific question.

The concern: I already have kids. I am a single mom.

The question: What is more important, what is inside the walls of the hospital, or outside?

Before I got separated, I was looking at programs based on certain factors: geographical location - was it a cool city where I've always wanted to live? (Like Portland, Oregon). Was the program a progressive program that seemed woman centered? (Like OHSU in Portland, Oregon.) Was it an academic program? (Like OHSU in Portland, Oregon...see where I am going with this?) Was it a program that had a reputation for being a happy place to work with reasonable attention paid to resident work/life balance? (OHSU again).

But, Portland is across the country from my family and my support base. About as far as you can get and still be in the continental US. Yes, I have friends there. A lot, actually. Some of them are mothers. But, my kids' dads and grandmas and friends and schools are all here.

I was OK with moving the kids out of the area when my younger son's dad was going to be moving with us. Now that we're separated, I am having serious second thoughts. Not only would there be legal wrangling and custody issues, but I would be starting a residency in a new city as a single mom. It was hard enough arranging child care and new schools for both of them here in Miami. I can't imagine trying to do it in a new, unfamiliar city without two grandmas helping me out. I also don't know if I can justify moving to a new place and then disappearing, for up to 80 hours a week.

Peers in medical school have told me to go for the residency of my dreams, and if mama's happy, the kids will be happy, and it will all fall into place. I am not so sure that is the case. My kids are happy and well adjusted, but there is only so much even happy and well adjusted kids can take.

Throw in the uncertainty of whether I can even get into the local program, the recent uber-competitiveness of ob/gyn and whether I can get into any program at all...sigh. And, if a closer program that I do get into is malignant, and I am stuck there for four years, am I really better off?

Any thoughts?

The empathy toggle switch

In our clinical years, our medical school has instituted a program in which we do learning modules along with our in hospital experience and didactics. I was happy to see a module on empathy for my second month of surgery. The last question to be answered in this module was: "Although the studies on empathy are very consistent other authors have indicated that medical students are really not losing cognitive empathy, rather they are learning to engage in a “toggle switch” approach to patients where one side of the switch is “associated with the patient” and the other is “disassociated from the patient” which is necessary in order to perform medical procedures. Please discuss this and use example which you have seen or in which you have been involved."

Here is my answer:

I am not sure if I agree with this. Yes, there is a certain amount of disassociation that may have to happen in order to get through the day, and I guess I felt a “toggle switch” moment when I was first in the OR, and the patient was not a patient but more of a sterile field surrounded by drapes. But, I think there are complex layers of desensitization, not just an on/off switch situation that happens.

I participated in a dilation and curettage on a woman who was experiencing an incomplete abortion. I was in the room before the procedure and the OR nurse offered to let me do a pelvic exam on her, since the patient was already anesthetized. Although I was fascinated by the opportunity, and initially was tempted by the learning experience, I didn’t want to do it without her permission, and made myself consider her as a patient and a person, not as a pathology or anatomy in front of me. Yes, I knew she was going to have a pelvic procedure that she already consented to, and I even had the opportunity to introduce myself to her before she was anesthetized, but I knew it wasn’t diagnostic for me to do a pelvic on her in this situation, wouldn’t change the course of her treatment, and questioned the ethics of it. I knew I would have plenty of opportunities to do pelvic exams on awake and aware patients whose humanity I would face directly and whose informed consent I would be able to directly assess, and I was willing to wait for that opportunity.

I did promptly forget about the patient and what she was going through when I was observing the procedure with the physician. I was more fascinated by the tools I had seen used in other applications and in workshops, but never used in a real D & C. I was eager to listen to the physician and thrilled that he was a willing and excellent instructor, and wanted to explain everything he was doing in great detail. I suppose there must have been some sort of toggle-switch moment where the patient was no longer a patient, and I was only cognitively aware of dilators and an os, and the integrity of a previously scarred uterine wall that was attached to a nameless, faceless body.

After the procedure, I happened to come across the patient in the holding room immediately post op. She was not doing well. She was feeling incredibly nauseous, and felt like the room was spinning. I was saddened that she was alone. I summoned the nurse, and the nurse tended to her needs medically by getting some anti-emetics on board. Still, I stayed with her and talked to her about how she felt, emotionally, about what she was going through. It is hard enough to feel nauseous and dizzy, but it has to be even harder when one just definitively ended a much desired pregnancy. Also, her family was not with her in this recovery area, and I felt bad for her for being so alone. I guess if I was ever switched off, I was definitely empathetically switched back on at this point.

I hope that if I do get my career in ob/gyn, I do continue to consider my patients as patients. I know there is a crisis in ob/gyn in which obstetrics is turning more into a game of avoiding liability and “moving meat”, and I hope my switch won’t get flipped to the point where my nameless, faceless patient is just a medicolegal liability or a long labor to be avoided by an unnecessary surgery.

Cross posted at Mom's Tinfoil Hat

Putting it in perspective

I had a rough week, to say the least. My tumor board presentation went fairly well, but I was called out by my attending for a mistake on my epidemiology slide. It was a minor point about the prevalence of a less common type of thyroid cancer than the type I was talking about, but it still wasn't fun being corrected at the podium.

Earlier this week, I found out that a Friday night social event at a good friend's house is not open to me anymore if I have my kids with me. I understand the concept of wanting a childfree space, especially since many of the regular attendants are childless, but it still really stung, especially after the week I've had.

The status conference over the custody of my younger son went better in some ways than I expected, and worse in some ways than I expected. I got to sit with my soon-to-be-exhusband in a waiting room for an eternity, and he spent the entire time doing the Dr. Jeckyll / Mr. Hyde routine that made my life miserable when I was with him. "I hope you're enjoying your rotations...Being a medical student means you're a bad mother...I hope you find happiness...Have fun at residency when you'll never get to see your children...I just want us both to be able to spend time with Z...You never loved me, and just used me as someone to watch your kids when you went to school...(Sorry, can't come up with another positive quote)...My next wife will make lunches for me to take to work; you didn't and that means you didn't love me..." and it went on, up and down (mostly down) the roller coaster while we waited for our paperwork. I left and sobbed in my car, and considered dropping out.

I drove hundreds of miles this week in my car (and my piriformis and sciatic nerve are not forgiving me for that, yet). My rotation site is about 30 miles from my house on the highway, which is fine with me, and I put my older son in a camp at which I was a former counselor. It is near his dad's work and my mom's house, which is even farther from my house, and on ground roads (ugh). I also had to pick up Z from my ex's house, which is even farther away. Yesterday, after picking up Z at the ex's, then driving the opposite direction to S's camp, I turned around again and drove 70 miles from my house to go to the viewing for my classmate who died recently.

My sons came with me to the viewing. She is being buried in her white coat, and we were asked to wear ours. The kids were very understanding about going. We only stayed for a short while, and sat in the back of the room. I briefly paid my respects at the coffin and to her family up front. Z crawled into my lap when I came back to our seats, and I held him and kissed his head. As I sat there and listened to my classmate's mother wail with pain, and thought of her baby in the NICU, I thought how lucky I really am. Danielle wanted nothing more than to be a mother, to hold and nurse her baby, and to be a doctor. She never even got to meet her baby, and now her family is reeling from the sudden, heartbreakingly unfair loss.

In a few years, this shitty week will be a distant memory. I can still hold my sons and kiss their soft hair. I am still (so far) going to achieve my dream of becoming a physician. I still have a strong social support system with loving friends, even though, sometimes, it can be more piecemeal than I would like. I am trying to keep it all in perspective.

(Cross posted at Mom's Tinfoil Hat)

Happy birthday to us!

Happy 2nd birthday, Mothers in Medicine! I actually didn't find the twos to be so terrible for my kids. I thought the ones were more difficult, since my boys were much better at being mobile and into trouble than comprehending and obeying at 18 months. You can bribe a two year old.

I think my favorite post of mine at Mothers in Medicine is my advice to a mom starting her pre-med. I like that I was pleasantly surprised how much I like being a mother in medical school, most of the time.

I have a lot of favorite posts by other contributors, but if I had to pick one, it would be the alternative career post by fizzy, and its comment thread. I love playing dream backup career, and everyone else's answers, contributors and commenters, were hilarious.

Reading, commenting, contributing, and just being part of the experience of Mothers in Medicine is such a wonderful and rewarding experience. Thanks, KC! Pass the cake!

Freaking out about away rotations

Hi, I’m MomTFH (from Mom’s Tinfoil Hat and Foodie Loves Picky). I have written three guest posts here at Mothers in Medicine, and participated in the last topic week, but this is my first post as a (squeal!) contributor. I love this site and its contributors, and I am so honored that they want me as a mom medical student voice.

I am a medical student at an osteopathic medical school in Florida, and a mom of two boys, currently 11 and 5 1/2. I am just about to finish a year long pre-doctoral research fellowship. I will resume my medical education as a third year student starting clinical rotations in July.

I was planning on writing a touching, self-actualizing first post, based on the recent birth of my cousin Susan, weaving in reflections on the birth of my first child, my journey to obstetrics, and the joy of observing a practitioner who is an incredible example of how to combine evidence based medicine with woman centered obstetrics. That post still may come.

But, for right now, I’m freaking out about away rotations.

The fourth year of medical students consists mostly of elective rotations. Those rotations usually involve “audition rotations” in your specialty(ies) of choice at your location(s) of choice. These are usually month long commitments, in which you are supposed to work your little tail off, so this potential residency site wants you to be part of their incoming team of residents.

There is only one residency site in my immediate vicinity. All of the other sites of interest to me are at least a half day drive, if not a several hour flight. If I could combine this into a summer vacation for my family, we would possibly be able to work something out with them coming with me to one or more of these locations. But, these elective rotations usually happen in the fall and winter, when the kids, S (11) and Z (5) and my husband, Coach Stu, are in school. There are months of elective rotations for most of the year, but interviews occur in November, December and January, so your audition interviews should occur just prior to or during those months. Let's not even get into the fact that a lot of huge, family oriented holidays occur during October, November and December.

How can I just disappear for several months? Many programs end up selecting many residents who don’t do an elective rotation at their site. But, most sites do choose many new residents who did a rotation there. I have no affiliation or connection with many of these sites, otherwise. I am a pretty good student with pretty good test scores, but I am also an osteopathic student competing to get into an MD system. Not to mention I am going to be forty my first year of residency, and have two kids and a husband in tow. I need any edge I can get in applying.

Is there any way I can put my kids, husband and pets in deep freeze hibernation (Alien style) for a year? I can fly around, do away rotations, fly to interviews in several cities, and not worry about abandoning my family. Then, I’ll get my match results, hopefully in some fabulous, progressive, friendly city with seasons at a wonderful, academics and research-heavy focused residency program with night float, while still being family friendly, in a place I happen to know some moms already (hey, I can dream, can’t I?). Then, I can thaw them out, and we can all move there together.

Ugh.

Med school with kids

I am a pre-med student (planning to apply in 2011). I am married and I already have two children, who will be no younger than 3 and 5 when I start medical school. I see that most people waited until residency or after to have children, but obviously that's not an option for me. Did anyone else go through medical school and residency with children? Do you regret it? Are you glad you did it the way you did? Do you have any advice!


Thanks,
Hannah

Hannah,

Good luck and good for you. I am just finishing up a research fellowship, and I will be returning to join the class of 2012 at my medical school. I was originally in the class of 2011, the year I hope you get in!

When my classmates ask me when I think they should have kids, I tell them all "Before you get into medical school, and then wait until they're potty trained and sleep through the night." Of course, most of them don't have that option. I am mostly kidding when I say that, but it worked for me, and I hope it works for you.

I actually wrote a guest post with advice for parents in pre-med, recently (I am squeaky brand new as an official contributor! Whee!) I especially like #4 Don’t overestimate or underestimate the understanding of your classmates, professors or administrators when it comes to your kids and #5 Don’t put your education last in your house.

I was less alone than I thought I would be. There were at least half a dozen fathers in my class, and more than a few mothers. We have three single moms in our class. I sat next to a grandmother for my whole second year. We all make it work in different ways.

This research fellowship has been a blessing. It gives me an extra year to spend time with the kids, and I can learn from my classmates who are now a year ahead of me about the logistics of rotations, so I can plan as much as possible. Mornings are going to be rough.

I felt very grounded by my family and children the first year of medical school. I saw many of my childless classmates struggle with loneliness in the beginning. It can be a grueling transition, especially if you have to move to a new place. Having home and children to go home to can be a blessing, not a weakness, sometimes. It does make applying to programs, both for medical school and residency, a bit of a challenge. My first official post (coming soon) will be on having children while looking into away rotations and the residency match.