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

Refining

So this is my introduction to you! I’m excited to be a regular contributor to Mothers in Medicine. I practice family medicine by day and wrangle my brood of three small children by night. My oldest just finished kindergarten and my youngest just turned one. I’m approaching my ninth year in a busy primary care practice in the Pacific Northwest. I enjoy the privilege and challenge of caring for a variety of patients, from newborns to nonagenarians. I used to practice obstetrics as well, but haven’t since having my own babies. I miss it sometimes.

After finishing residency, I studied tropical medicine in London and have worked at a rural teaching hospital in Kenya. My teacher husband and I dream of living and working abroad with our young family; maybe when the majority of them are out of diapers.

I began writing in earnest after I had my first child in 2011. I did write throughout medical training but it took the refining aspects of motherhood to get me to take my writing seriously. Nothing like even less time and an unveiling of your faults for some forced self-introspection! I’m curious if any of you have found motherhood to be similarly clarifying? I’ve studied narrative medicine and bioethics and have taught narrative medicine workshops. Particular interests include medical ethics, global health, motherhood as vocation and the intersection of religion and science. I blog regularly on these topics, among others, and I’m currently working on my first book. I still always cringe a little when I hit “publish” or “send.” I imagine it will always be hard, as a type A introvert, to put myself out there.

My third, and presumably last, baby just turned one and I finally feel like I can breathe again. It feels like a milestone, reaching this point, after having three children in five years, settling into my primary care practice, letting myself take my passion for writing seriously and expand into that vocation.

My life has been disrupted many times in the past year with unexpected challenges and writing and community have pulled me through. I think much in medicine and in motherhood is refining: the pressures of medical school and residency, the intensity of caring for babies and children who need so much.

I’m excited to join you all in this journey; to learn from your wisdom and laugh alongside you. If medicine and motherhood have taught me one thing, it’s that we all need each other desperately - for kindness, for encouragement, for understanding. These are the things to cling to and to provide for each other in this world. Thanks so much for having me.

On Family Medicine

I wondered during undergrad if I could do medicine and "have a life". I didn't have a lot of first-hand contact with physicians, and had just started to consider a career in medicine, so I really didn't know what a medical lifestyle was like. I knew it could be incredibly demanding and busy, but I wasn't sure how much flexibility there would be. In the end I suppose I still didn't really know, but I figured if others did it, I could figure it out too.

We had the chance to get early clinical exposure at my medical school. I had always planned to do family medicine, so every Wednesday afternoon in my first year, I would take the bus to the family medicine clinic of Dr. B. Dr. B's patients adored her. She truly listened to them, and was clinically excellent too. Seeing patients -- real people with real problems! -- was thrilling. I get a reminder of this from time to time in my office when I have early medical students join me. Looking at a tympanic membrane is exciting to them! It's a great boost. 

During medical school, I went through the "cardiology! neurology! infectious diseases!" rotation in my mind, until it was clear that being a generalist was what I wanted. Internal medicine was tempting, as I actually enjoy learning minutiae, but I loved women's health, pediatrics, and doing preventative care. The flexibility of a career in family medicine was unmatched in my eyes. So from clerkship onward, I continued to feel that family medicine was the right fit for me. 

I now have a family practice of about 1200 patients in a small group practice, and see patients for about 30 hours per week.  Charting, results and other paperwork takes about 8-10 hours a week.  I block one day off every month for self-care or catch-up time - with young kids, if I have to cancel a clinic due to their or my illness, it’s nice to have a day available to re-book patients. I can book off in advance for appointments for the kids or myself, or fit in local CMEs or meetings related to some community health work I do. The demands of my practice - and of home - fluctuate from week to week, but generally it feels like a good balance. 

I ran into a lovely, well-meaning non-medical friend a little while ago. "How's work going?" she asked. "Ah, it's been a long week." I said. "Lots of coughs and colds?" she mused. "If only!" I thought. I tell this to students a lot: family medicine can be very challenging, medically, and very draining, emotionally. So rather than things like a chest cold or plantar wart being boring and mundane, they can be a very welcome break from the challenging things we see at times.  The medically complex cases are invigorating, and the emotionally draining cases, highly meaningful; the "mundane" cases act as a much-needed foil. And above all, when you know your patients like you do in family medicine, it becomes much more about caring for the person in front of you than about the particulars of their issues. 

Reverberations

March 20, 2003. I stand with other students, staring at a television in my university's student union building, watching Baghdad being bombed. Explosions light up the screen. "Shock and awe". I'd spent many hours in the preceding months organizing, marching, due to the pressing need I felt to do whatever my small part was to stop the impending attack on Iraq. In the end, not surprisingly, it went ahead. I was grateful that Canada wasn't a part of it, but still, here it was. I stand watching war on television. 

In the strange happenstance of life, I now spend my days in family practice, seeing Iraqi refugees resettled in my city, still reeling from the effects of the war. Crippling PTSD pervades some of their lives. Yes, they have built new lives in Canada and many are thriving, but the ones who aren’t take up most of my attention. Layers upon layers of trauma. And for all of them, the sense of loss remains. I think of these effects as the reverberations of those initial explosions - rippling out across the world and the Iraqi diaspora, for years. 

This is, of course, not unique — the longstanding, multi-generational effects of trauma are felt within many communities.  But it’s one that’s close at hand to me, almost every day. During the student and community campaigns that I worked with to urge non-violence, I strove to think of the individual men, women and children who would be affected on the ground in Baghdad. Today, I know some by name.

  

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.”