5 Ways to Reconnect with your Purpose

FIRST STEP: YOU HAVE TO WANT TO BE WELL TO DO WELL.

“I had to think out of the box...” I did all the “right” things: went to college, graduate school and medical school, got married, had children. Still, when I looked at my career, things just didn’t sit well. 

I was a successful and young pediatrician working for one of the top academic medical centers in the country, and I loved my patients, but I was miserable. When I looked around, my colleagues were overworked, tired, and burnt out, too. It was the end of training: Wasn’t I supposed to have found happiness and my dream job? 

I read books like Paulo Coelho’s The Alchemist, listened to self-help podcasts like Dreams in Drive and Therapy for Black Girls, subscribed to the best blogs, you name it.

I had some serious sit-downs with my husband and friends, ones where we spoke frankly about how our happiness was our responsibility. A quote from Toni Cade Bambara’s The Salt Eaters replayed in my mind. In one scene a healer is talking to a woman with severe pain and disfigurement. She asks the woman, “Do you want to be well?” and goes on to share that there is a lot of responsibility in being well. 

I took heed and began forging my path to wellness in my career—to harmony and balance in my life—so that I could be a better me to myself, a better partner to my spouse, a better mother, and a better pediatrician. 

Here are some of the things that resonated with me on this journey:

1. COMMIT TO GREATNESS.

Reset your vision of what could have been and what should be. 

I had spent a decade thinking about what my dream job would be. But when I distilled it down to its essence, I realized I wanted to do great work with children and families. I didn’t need a big hospital system or a fancy clinic to do that—in fact, they were getting in the way of my real, authentic work. 

I now do house calls and telemedicine for children and families in my area and it feels great meeting families where they are. In order to do the work I was called to do, I had to think out of the box and get out of the suffocating systems of old-school medicine. 

2. TAP INTO YOUR NETWORK. 

I have been with Mocha Moms, a support group for mothers of color, since my oldest was born in 2011. Over the years the group has shared so many stories of how other Mochas used entrepreneurship to orchestrate the lives that they and their families needed. 

I let these stories inspire and encourage me. I reached out to other physicians in my area and nationally, and learned that my story was not unique and that I was not alone. I forged great collaborations with other house-call doctors, local midwives, and other small-business owners, and now have a thriving network that I check in with regularly. 

3. KNOW THAT FINDING HARMONY IN CAREER AND LIFE IS AN ITERATIVE PROCESS WITH MANY STARTS AND STOPS. 

I am living this now. Forging a nontraditional path means experiencing things you never imagined. Sure, I don’t have a boss breathing down my neck telling me to check off a box on the computer system, but I still have a ton of paperwork. I remind myself daily that even when doing administrative tasks, I am working toward my vision and am improving children’s lives one home at a time. 

This process also requires you to let go of many of the harmful habits that have shaped who you are. Just like the woman in The Salt Eaters who for so long had been defined by her severe pain and disfigurement—to truly be well, she had to redefine herself. 

For those of us in high-stress fields and jobs, we have to redefine ourselves in a way that doesn’t use being exploited and constantly overworked as part of our defining characteristics. For me, that required and still requires self-reflection on what it means to be in service to others. Serving others does not mean being exploited or working crazy, unsustainable hours. It means being unwavering in my commitment to a life that allows me to serve sustainably and passionately for years to come. 

4. ALWAYS KEEP A PAYING SIDE HUSTLE. 

Entrepreneurship is ever-changing, but your rent, mortgage, and bills are not. 

Even though your work is fulfilling and exciting, until you are getting a regular and sustainable paycheck, you will need to keep some side hustles in rotation. 

5. FIND ALL OF THE WAYS TO BRING JOY INTO YOUR LIFE THAT YOU CAN. 

Check in with your sisterhood circle regularly. (I do that on my parenting group’s ladies-only GroupMe.) 

Check in and make time for loving relationships with your spouse or partner and commit to prioritizing your relationship with time and attention whenever you can. Try not to talk about your stressors for too long and also don’t talk about the kids on date night if you can! 

Spend time out in nature. Research shows that time spent outside improves health. 

Play outside with your kids. We try to take a family walk around the block every day and we use our local national parks for hiking as much as possible. 

As the healer in The Salt Eaters said, there is so much responsibility in being well and it ultimately rests with each one of us. Let’s be well!

Originally posted at: https://www.matermea.com/blog/5-ways-to-reconnect-with-your-purpose
* There are affiliate links in this post. If you buy something through the links, mater mea may earn a commission.

Photos courtesy of Leslie Kershaw: http://www.lesliekershaw.com/

On Quacks, and Cold Clinical Facts

Genmedmom here. 

We all have patients, friends, and family members who fervently believe that they have a diagnosis that we know doesn't exist. Or rather, for which there is no current reasonable believable scientific evidence.

I refuse to cite specific examples, because it's useless to refute someone's pet diagnosis. You may have examined a large body of research, read reams of textbook pathophysiology, spoken to respected specialists, but no matter what, if you attempt to disprove the entity they blame for all of their symptoms, and the treatment upon which they have pinned their hopes, they will hate you.

It's unfathomable to me that there are providers out there, some of them medical doctors, who blithely and blatantly practice non-evidence-based medicine on unsuspecting and vulnerable humans.

Infuriating.

And it sucks to sit there and listen to someone you care about describing quacky tests and (at best) useless and (at worst) potentially harmful charlatan treatments. Especially when they are paying dearly, and out-of-pocket.

Of course, I've tried to take down these totally false medical problems many times. It's what you do when you care about someone, right? And I've watched their faces shut down, as they mentally walk out the door. Or, saw them get red-faced and argumentative, unable to hear another word I said.

Sigh. So now, for the most part, I nod and smile and murmur something about how modern science can't answer all the questions and I hope that's working out for them.

After all, I can see why this is happening. Modern day M.D.'s are obviously missing something. Patients aren't getting what they need from us.

It used to be that folks had a local doctor who knew them well (and possibly also their families, neighbors, and friends). Office visits were longer, and paperwork was practically nonexistent. There was more listening, and less prescribing. The pace of the research world and life generally was slower, and slower to change. Hypotheses, explanations, and medications were more stable, things you could get your head around and use for a long stretch of time. The doctor-patient relationship was a real thing.

All that's a fever dream. Now, we docs are SO on the clock. Productivity numbers are in- you need to see more patients! And more! Twenty minutes to address all of your patient's medical problems and questions, examine, order, NEXT! Then, the deskwork. Administrative burden outmatches face-to-face clinical time two to one. It's a team of nurses doing callbacks, if the patient gets a call at all. Nowadays, it's mostly messaging through the "patient portal". The, the general public is fed research study after study after study. Papers and pundits contradict each other, data is manipulated, organizations release conflicting guidelines, medications get pulled. Textbooks aren't even printed anymore because they're outdated so fast. What a mess.

These are the cold clinical truths: There's no time to build trust. Our system prevents real connection. The scientific information world is fast-paced, chaotic, and confusing.

And so people are looking elsewhere.

Our medical system may or may not be headed in a better direction, what with the Patient Centered Medical Home movement and all. We'll see.

But meantime, behind the scenes, I am on a bit of a campaign. I recently wrote a patient-friendly article in support of evidence-based medicine for Harvard Health Blog that was well-received. At least, I didn't get any death threats.

Death threats, you say? Yes! Plenty of qualified critics of particularly trendy fake diagnoses suffer angry trolls throwing cyber-insults or writing letters with intent to harm, or kill.

So I'm trying to educate generally, not specifically. Trying to teach people how to tease apart the "fake news" from the safe news, how to be thoughtful, and consider several sides of a story. Their doctor sees it one way, but the internet says it another way. Okay, let's figure this out.

Doctors, we won't win the battle against the snake oil salesmen using facts and figures. We need to be gentle. Tread lightly. Nod and smile and murmur something about how modern science can't answer all the questions and you hope that's working out for them.

And then, if we can, listen. Try to cut through the requisite logistical bullshit and reach out to our patients. If they are feeling heard, they may trust. And if they trust, they may listen. It will take time, and open minds on both sides. But the patient may get the expert help they need, that the doctor is able to give.

a review through the year(s)

I cannot believe it has been almost 4 months since I wrote the post about my miscarriage, 1 year since I left a toxic work environment and dove into health care leadership, 2 years since residency ended, 5 years since becoming a mommy, 12 years since graduating from college, and almost 30 years since I proclaimed that I wanted to become a doctor.

Through it all I have learned so much and I am truly indebted to the colleagues and mentors who have helped me craft this career. I am even more so indebted to my loving husband and family who constantly teach me that my happiness is worth it and at the end of the day, a job is a job, is a job and when you aren’t in your job, the job goes on, the world does not end.

Motherhood changes you. Partnership changes you. Medical training changes you. Motherhood in particular, puts a new perspective on things. And in my opinion, it makes you question things that you had never questioned before. It makes you prioritize in ways that you hadn’t before.

For example, for my whole life I’ve known that I wanted to become a doctor. I never waxed nor waned in that belief. Though it was hard at times, I knew I would achieve that goal and I did. But I also realize that it might not have happened. My heart cries for the countless young medical students who don’t match into residencies. For the countless applicants who go into super extreme debt to attend post-bacc programs or use private loans to finance medical educations in international schools (I know far too many!) and then to not match?!? I can’t fathom that. But that could have been me, could have been any of us. It has happened to some of my friends. But now as a mother as I reflect with other women physicians, so many of us question our decision. In particularly frazzled moments, we say emphatically that it was not worth and we would not do it again and we would discourage our children from pursuing medicine. What was it that shifted our beliefs? Was it aging? Was it pregnancy hormones? We may never know.  

I started residency with a newly crawling baby. I began questioning things that I had learned, that seemed so dichotomized, so absolute because caring for my snuggly little Zo taught me that everything and I mean everything is shades of grey, covered in drops of breastmilk and smeared in shea butter and kisses. There was no more black and white,no more textbook answers to lull me into a false sense of security.

And the changes continued, each moment and each role took on new meaning. Weekends off from work took new meaning. I had a baby to raise and learn and love. I had an amazingly supportive and successful husband to dote on and love. Each moment became more precious because when I was at work, I had to completely be present caring for and keeping alive someone else’s baby. Time at work took on new meaning. Every time things got rough, I would say to myself “this is someone’s baby! This is someone’s baby! Do your freaking best! Love up on this family and this baby! Do the right thing by this baby!” and it worked. I was able to care for countless patients and their families.

I started my first attending job. The one I knew was going to be my dream job. And it wasn’t. From the very beginning. The burn out was palpable among my partners, the check in staff, the medical support staff, the nurses. In my first few weeks, I was warned by various members of the staff to literally “get out” before the patients lured me into staying forever. I didn’t know how to process it. This was my “dream job” at my dream institution, a top 10 children’s health system in a highly desirable area. The one that I was supposed to stay in, rising through the ranks, being a tireless advocate for my patients and their families. But I looked around at the colleagues who had trained me as a medical student and no one was happy.

Everyone was raging against the machine of big-institution medicine without the tools they needed and without the support of the administrators. There were partners who were months behind in charting on the outdated electronic medical record. There were partners who worked hours from home each night and who spent more time charting than seeing patients. There were incompetent team members, difficult to work with management, and mountains of red-tape and bureaucracy at every level and it frustrated us to no end! We were understaffed at every level but the message from the higher ups was “do more, see more patients! You’re not meeting your numbers!” while we providers questioned the safety and quality of fitting in another patient, of overbooking overbooked slots, of opening earlier and closing later. This scenario isn’t unique. I hear countless stories from other physicians in private and academic medicine, from friends working for nonprofits, I could go on. And when you hear it from so many people in so many industries, you realize that we are all workers. We all struggle with the same things, but it is up to us to find our niche, our space where we can deal with the “particular brand of crazy” of an organization.

My mama heart made me extra courageous, extra fierce. I began to network and met a group of other outstanding physicians many of whom were mamas who had experiences just like. They found the strength and courage to craft professional lives that were more in line with their beliefs and their experiences gave me strength and I began to let go of the made up dream as I began to develop a new dream.

If it weren’t for my husband and my family, I never would have had the courage to leave. But I did. I spent countless time and even significant money on legal fees fighting and it’s not even over yet (always, I repeat, always consult with an employment lawyer early when you first begin to worry about retaliation or have safety concerns, just do it! Human Resources works for your employer and unfortunately not really for you). But you know what - MY HAPPINESS IS WORTH IT! I trained too long and too hard to not be valued, to be underappreciated and you did too! We are worth it. We must advocate for ourselves and our happiness as a matter of survival. Physician burnout is on the rise and unfortunately so is physician suicide. Your life is worth it! You should not be miserable in your job! Being a mama made me more courageous. What would I tell Zo if he was going through this? I would tell him find a new job, it’ll be okay! You’re worth it! I know they tell us it’s our calling and although that may be true - a job, is a job, is a job!

This last year in part-time health care leadership coupled with part-time direct pediatric primary care has been a whirlwind. Scary and beautiful, overwhelming and exhilarating. Exhausting and empowering. I have been getting my lean-in on! And the view from my first big girl office is the bomb!

And because I have been courageous enough to sit myself down at the big-kids’ table I realize that we really do have expertise when allow ourselves to do what we are good at. Working with a major managed care organization, I understand why providers are asked to check off certain boxes in our patient assessments and I realize that this information must get back to the providers.  I realize how essential physicians such as myself are in re-envisioning health care.

Everyone has a boss, every organization has a parent organization and auditors to respond to. The system is such that major revision is needed to truly improve outcomes. Though my overall happiness has increased tremendously, the job is still a job. And I don’t think enough physicians, especially those in training, fully grapple with that. You still have people who are burned out; though honestly, much less here in my new office. You still have issues with incompetent people and I had to terminate my first staff member a few months ago. But “this particular brand of crazy” is one that I can deal with and is one I am thriving in. It’s one that my family can deal with.

Thank you for sharing in my self reflection.

Have you done your own personal review lately? If so, please share. What have you learned? How have you changed?

Living Your Questions

I’m sure you’ve heard Sheryl Sandberg's advice to women, "Don't Leave Before You Leave". Well, several years ago, I faced some choices. I had finished Family Medicine Residency the year prior. As planned, I did a series of temporary positions filling in for other doctors - the usual course of action for new grads in my field and location. These experiences were crucial in showing me the kind of practice style and environment I desired. After a year, though, I longed for "my" patients - to be able to get to know people, and follow them over time, both personally and clinically. It was unsatisfying to frequently step into a new clinic environment, never knowing how complete (or legible) the patients' charts would be, and never being able to follow a patient for very long.

Then, I filled in for a colleague's vacation at a great clinic and I didn't want to leave. Another doctor there asked for maternity leave coverage and I happily obliged. It was so refreshing: the clinic physicians were collegial, the staff was efficient and professional, and the electronic medical records system worked like a dream. The great news was that they had room for me to start a practice there. 

This idea daunted me: was I ready to commit to a practice? I wasn't sure, actually, because Family Medicine has its challenges and those that concerned me most were dealing with patients whose expectations greatly conflicted with what treatment I was comfortable providing, as well as assessments of disability for which I felt woefully untrained and unqualified.  I also had interests beyond clinical medicine - in academics, including medical education and research. Wouldn’t it be great not to be tied down? Many of my colleagues continue doing locums for years, and have great freedom and flexibility. Finally, my husband and I wanted to start our family: wasn't it foolish to start a practice when planning a pregnancy? I had uncertainties, and wasn't sure what was the best next step. 

I went for it anyway. I read and reflected on a couple of things: one, that I owe it to myself and potential patients to try practicing "real" Family Medicine. I knew it was the only way I'd find out whether I liked it. After all, having your own patients and directing their clinical care is so different than covering for another physician -- you set the tone of your practice. Further, I came across this powerful statement during that time - "if your next step doesn't scare you a bit, you're not pushing yourself hard enough”, which further reinforced my decision. This, I might add, is quite uncharacteristic for me - I am a very careful decision-maker. And the truth is, for the first few months, I still wasn’t sure that I had made the right decision.

Nearly six years later, I love having my own practice.  I get to establish a rapport with my patients, and partner with them on their journey to improve their health. I have been able to really delve into the problem-solving that makes medicine so engaging. I was also able to serendipitously find and develop an interest in refugee health.  Skill-building in this fairly new, actively growing field added another dimension to my practice, and allowed me to incorporate teaching with medical students and residents and involvement in community initiatives. 

As it turned out, it took my husband and I longer than anticipated to conceive. We are now grateful to have two young children, and I’m grateful that after each maternity leave I looked forward to returning to my practice. The experience of being completely unsure of my decision brings to mind these lovely words by Rainer Maria Rilke, which I first encountered several years before, during another period of uncertainty:

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”

In praise of skin

Another work post from the burn unit, Kamuzu Central Hospital, Lilongwe, Malawi. I want to tell you about dressing change days, and interject a little ode to skin. I wrote a version of this for my private blog, but wanted to share with you all as well. As always, thanks for reading these ramblings!

Mondays, Wednesdays and Fridays bring dressing changes in the burn unit. This means that every patient—as many as 42, plus the many others who come in from home just to get their dressings changed--line up at the end of the hallway and wait their turn, while 3-4 intrepid nurses unwind and wind miles of bandages, slather ointments, and squirt morphine into their mouths. Except when there is no morphine. Then it’s diclofenac, which is, I imagine, the equivalent of getting a swig of ibuprofen right before you get scalped alive.

Walk with me. From the outside, down a dark hallway filled with people, toward the light at the back and up the stairs, three flights. The staircase is open to the outside and on each flight there's a big window with a view of the city--today it's hazy and hot, so the buildings are distant under a screen of red dirt and smog--but it's not airy or breezy. The stairs are worn from countless people walking up and down it for years, and on the second flight a woman wearing yellow wellington boots is mopping, with a broom that's seen better days and concrete-colored water. On the third floor we briefly bump along behind two policemen, big guns swinging freely, talking exuberantly and walking oh-so-slooooooowly—and finally we arrive on the third floor, and walk down the hallway to 3B, the burn unit.

Before you open the door, take a little deeper of a breath, for you're about to experience that smell. On a good day you manage to take 3 steps inside before it hits--the odor of maize meal cooked into grits-like porridge, or a paste, or a hard cake (nsima); of bodies, urine and boiled cabbage, dirty wounds, feet, doughnuts, and fear--and then you see the mother carrying her five year old daughter wrapped up like a mummy with an IV tube sticking out of her neck--and you feel ashamed for even noticing the smell.

There are six rooms, 4 beds each, lining the hallway to your right. Linking them is the open breezeway down which you’re walking, which opens onto a shared courtyard where people dry their laundry and family members cook their meals. On the other side of the rooms is another hallway, the khonde, or “outside,” which becomes another long communal room during the months when there are more patients in the unit than there are beds. During the cold season—June, July, August—the khonde is full.

Two boys, aged four and six, one with a bulky bandage around his leg and the other with a belly dressing, are playing with a glove balloon, and you toss it back and forth with them for a little while, their smiles lighting up the day.

Are you procrastinating? We have to keep walking down the hallway, to the room at the end, where all those people are queued up, since that’s where all the action takes place. Each mother dons a protective plastic gown and gloves and takes the child—the median age here is 3—on her lap. The mothers hold the children down. The first trial begins, that of forcing the morphine into the children's mouths. Most take it willingly, especially ones who have been here a while, but sometimes they purse their lips, or cry, or swat with their arms. It doesn't matter if the morphine trickles inside or outside of their mouths--there is no refill and the dressing change happens with or without it.

Next, the nurses soak the bandages in saline to help with removal. Since there are 42 patients and 3 nurses, waiting for a complete soak would take way too long. Some of the kids start screaming in the hallway; some when the mothers take them on their laps; some with the morphine; but all of them are screaming by this point. These kids are burned over 10-40% of their bodies, on average; over all possible body parts; in two main ways: they scald themselves or catch themselves on fire. It's the cold season in Malawi, no one has heat at home, and very few people have stoves; cooking happens over open fires, outdoors, and accidents happen frequently. Malawi is burnin', y'all:

 

Skin gets so much criticism. We stare at our pimples as teenagers and wish them away; at our wrinkling faces as adults, and hate their testament of the passage of time. We scrutinize moles and massage cellulite; we want elasticity and spend millions on creams and lotions that promise to keep us looking young. Even as we enjoy skin's gift of touch, in embraces, caresses, and kisses, we resent and focus on its fragility, its ability to hurt, and too often, its color. We don't appreciate scars. Skin should be blemish-less and baby-soft. Not at all like the skin I see in front of me--discolored, twisted, partially healed, in some cases with the tell-tale cheesecloth appearance of a healed skin graft. This is beautiful skin because it works in its intended way: not as pretty packaging but as a barrier to infection and pain, as the selectively permeable wrapper that allows the rest of the body’s functions to proceed uninterrupted and unthreatened, with just enough openings to allow a regulated exchange with our environment.

It's the absence of skin that exposes its absolute necessity. This six year old girl being unwrapped now has full thickness burns (what we used to call third degree) over 55% of her body: anterior and posterior thorax, both legs, both arms, a bit of face and neck, buttocks. Her big, deep brown eyes look at me with tears trickling down her cheeks as her mother’s helper raises the IV bag above her head and arranges it so the tubing is not kinked. This is a bad burn: flame generally causes deeper burns than hot water, and in this case, it looks like her clothes were on for some time, and the contact did a lot of damage. Like countless others, she was playing with her friends and tripped into a fire, where her clothes caught the flame. She cries, but not much: a bad sign. Although we teach that full thickness burns are insensate, since by definition the heat has destroyed the skin's sensory apparatus, not everything burns to the same depth, and partial thickness areas surround most full thickness burns—and those do feel pain. Her name is Chisomo, meaning Grace. She will die in 3 days.

I think about the ones we can’t save, back home, and here. I hold on to them for motivation to keep studying, keep waking up, keep leaving my family, and keep trying—and to honor their memory, although I see them usually only in a dehumanized form, although I know them usually only as bodies wrapped in dressings and not as children chasing goats, eating mangoes or diving into the lake. Knowing what makes a patient human makes me a better doctor but it also hurts more—and many times I don’t want to admit they are people because doing so makes me transiently incapable of returning to work. It’s like this in the States and it’s definitely like this here. The constant blur of activity insulates you from processing both the good and the bad, but both stay with you, and sometimes when you get a breather it all comes out, and it’s very hard to figure out what to do with all of it—so I try to just notice it and not cry, and carry on, because in the end, there are more of the ones who get to be human again than the ones who don’t, and so you keep going. As shown by the parents and patients in this burn unit, every day, with their smiles, their high fives, and their endurance, despair is a luxury. Ain’t nobody got time for that.

The Zuckerberg: Space Does Matter

Hello everybody!  I am one new to the group and just wanted to introduce myself.  I'm originally from Massachusetts, currently a Bay Area Internal Medicine Hospitalist with a 2 year old daughter, siberian husky (mini) and techie hubbie.  Hope to contribute some entertaining stories.  The following is something I wrote last month after we moved into our new hospital. 

            The ‘space’ can make a difference.   I had already spent two years working as a physician/hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges.  Fast forward to the end of May 2016 to one my first shift working in the new building … Zuckerberg San Francisco General (ZSFG/The Zuck); change had never felt so good.

            I walked across the bridge connecting our old building to the new ZSFG which consisted of expansive windows and white beams that outlined the hall. It was a sunny day in San Francisco, and I was able to witness it for once.  At the entrance there was a quote etched into the wall  “Be the person who touches the lives and hearts of people. Be a positive light to others as you put a smile on their faces”.  I found myself taking a brief pause and a smile was taking form and there was no stopping it. 

            Onwards I trudged, only to be greeted by a security officer who looked at my badge, and then said ‘Good Morning Doctor’.  As I stepped off the large steel elevator onto the 6^th floor, different routes presented themselves; I was warned about this and the likely confusion that would ensue. Nonetheless, the room numbers were highlighted with San Franscisco themed unit names like “Mission Dolores” and I walked to the zone I needed to get to.  The heavy blue doors which were often manually opened were now beige and badge activated, opened by a mere hand wave.   This might sound trivial given that its 2016, but let me emphasize that it is not.  The design of the building was doing work for me instead of me pushing my way through everything.  

            Now came the real test…how were the actual work floors and units.  What struck me immediately was the lack of noise; it was completely quiet! A brief instance of panic set in and I thought, ‘ Oh my god, I’m on the wrong floor…. Is this the morgue’ but no, I was exactly where I needed to be.  As I walked further around, there was a spacious work station with an lcd screen showing patient room information and nursing assignments with call numbers. 

            The time had come to finally enter my patients’ rooms.  I knocked and then with ease opened the door only to find my patient sitting in bed comfortably with the most spectacular backdrop of the city I had ever seen. The room had ceiling to floor windows that beautifully displayed San Francisco at its finest, and the sunlight poured in.  I sat down at his bedside, and began to go through my assessment and learn about his concerns.  Usually at this point I would be raising my voice to overcome my patient’s neighbor who was either watching television, or talking to others in the old building.  The rooms had no natural light, so lights always had to be turned on, which was of course bothersome for many as some patients were sleeping, and others were not.  The rooms were also filled with walkers, trays, and other medical equipment that were strewn about as there was minimal space, and it became an obstacle course for staff, patients, and family whenever anyone moved about in the room.    Now with this all gone, feng shui was in full effect.  I reviewed the plan with the patient, and calmly exited the room.  As I entered the next patient’s room, similar exchanges and observations happened.  With my mind unburdened by the environment, I just focused on the subject at hand.  My patients too were not being set off by surrounding stimuli; they now had peace and quiet.

            I finally ended that morning with some downtime in one of the new provider rooms to start the lovely exercise of completing my documentation, and again I was struck by the silence.  It was like a library where I actually had the space and time to think about what I was doing.

            Noise and chaos was often the defining feature of our intense environment, and as faculty and staff, we perfected our ability to deliver high quality care to our troubled and sick patients despite our surroundings.  Now with ZSFG, San Franciscans along with our many generous donors have contributed to a building that has shifted the mileu of our work environment.   My patients now have a space that truly honors them in tough times and gives them the space within which to heal.  As a provider, I now have the space to work more seamlessly and to think and reflect on my work.  Of course our space is not perfect, but you have to start somewhere right? So let the healing begin…

On Five Year Plans

This is a throw-back to a MiM post back in 2013 that really resonated with me at the time, and still does, in which T writes about someone asking her, "Do you have a five year plan?"

When asked this recently, I fumbled. Actually, I tossed back the answer, asking the asker to mentor me through getting such a plan. It wasn’t even someone who knew me well and it had been asked in a fairly casual way. Regardless, I was not able to answer the question. But if I were to answer it, the answer would be, “No I do not.”

The comments that followed included other MiMs stating that they too did not have five year plans. People cited living in the present, and checking in periodically to ensure satisfaction and fulfillment, but not necessarily a structured plan. Others did have plans, which they found informed their present-day decisions. I was on maternity leave with my first when I read this post, and was feeling very unmoored. I felt that I should have a very clear path of where I wanted to go in my career.

I remember being asked the same question by a male faculty member during my first week of medical school. I fumbled too, as I entered medical school interested in family medicine but open to possibilities. My surgeon-keener classmate piped in with his plan for surgical specialty x, making me feel even more self-conscious. In retrospect, I don't blame myself one bit. I think some people do well with a well-defined, honed-in focus. Others, like myself, find the goals harder to identify; my priorities have to emerge - they can't be easily forced out.

I have broad goals - community contribution through medicine and beyond, strong faith and family, a healthy lifestyle. I have diverse interests; one is health equity, which has led me to refugee health. Various other interests have led me to different projects over the years.

I do find it helpful to have short-term career priorities; a necessary honing-in to avoid over-commitment and burnout. Dr. Mamta Gautam, the Canadian physician wellness expert, tells physicians that as people who have plenty of interest and enthusiasm about many things, there will always be more interesting things that we want to do, more than we could possibly have time for. So, it is a matter of choosing and narrowing down options.

Right now, I'm focusing on clinical work, local refugee health coordination efforts, and writing - both here, and on a blog aimed at patients. I supervise learners periodically, but have flexibility. There have been other tempting opportunities recently, but I have declined them in order to preserve family and self care time. Personally, I need regular downtime. I schedule a day off every month, sometimes more. I need some "empty space" on the horizon in my calendar, which can involve self care time, and sometimes catch-up work and projects. With two young kids, I've found the regular days off invaluable for recharging.

With the births of my two children, the last four years have been full of transitions. I think motherhood fits naturally with evolving priorities and goals. I look forward to more changing priorities over time. And I'm still OK with not having a five-year plan.

What does it really mean to be a mother in medicine?

As in, in real life, day-to-day, down and dirty?

Genmedmom here.

I'm working on a writing project about being a mother in medicine in practice. This is going to be the everyday stuff: the logistics, the scheduling, the practical aspects, the balancing, the conflict. Funny stories, lessons learned, suggestions, and mistakes.

As I was thinking about this project, I realized that my experience in clinical practice is drastically different from women in other specialties. There's no way I can write this without input from moms in every area of medicine!

Things I was wondering about:

When I was pregnant, it never occurred to me not to tell people. I can't keep a secret to save my life. But I have colleagues who kept their bumps hidden for as long as humanly possible, for many different reasons: worries about discrimination; fears of being passed over for promotion; superstition. What did folks out there do? If you felt like you had to hide your pregnancy, how did you, and for how long? Looking back, what do you think, was it necessary?

What about those specialities where there is risky occupational exposure, I'm thinking radiology, surgical subspecialties… How did you manage that in pregnancy? If you needed to step out of the room, how did your colleagues react?

A lot of doctor-moms don't take a full three months of maternity leave. Some take more. Does this vary a lot by specialty? Did folks feel pressured to take less than three months? Did anyone have to fight for three months?

I never pumped at work. (Long story.) For the moms that did, can you share some of the good and the bad? Were offices and hospitals supportive or not? Were facilities acceptable or not? What were your worst pumping experiences? Would you do it again?

As a general internist with no inpatient duties, my call weekends involve, well, phone calls. What is it like for doctor-moms who have to go in? For the surgeons and anesthesiologists out there, is it better to be on call from the hospital or from home?

My office clinic is low-key enough that if I need to, I can step out and answer a phone call from my kids' teachers or the school nurse. But what about for moms working in the operating room or the ICU or on a busy inpatient floor? If you need to step away to take care of your family, are you supported?

My husband travels, and occasionally, I've had to cancel a clinic day to stay home with the kids: blizzard closed the schools, kids throwing up… Have others needed to cancel their workdays for childcare? Did colleagues make you feel bad, or did they step up? For those who haven't or can't, how do you manage those unforeseen events, the school cancellations and nasty illnesses?

I am eternally grateful that I can work part-time. I know that not all physicians approve of that. For those working full-time, how do you make that work? What supports and systems need to be in place for you?

And of course there are more questions, more scenarios… We can all learn from each other!
All specialties should have representation. I would love to hear what you have to say.

Don't feel comfortable commenting here? Email me: mauroratello2@gmail.com