Guest Post: Has Pandemic Living Caused You Stress or True Distress?

When I turned forty, I tumbled slowly into a deep hole. While caring for a six-month-old infant, two older children, and starting a new job in a new city, I was expectedly busy, some days nearly frantic.  I had always been full of energy and drive, able to handle anything that either my NICU practice or my children hurled at me. We transferred to a new city and new jobs four months after my third child was born. Then I turned forty and everything changed.

Despite taking night call in the hospital twice a week, and pumping at work, I continued to enjoy nursing my last baby. She had been easy from the start, and I planned to cling onto nursing (and oxytocin) for as long as possible. At first, I noticed my sleep pattern changing, but assigned it to my workload, the stress of moving, and fatigue. I could not go to sleep, and when I did fall asleep, I awoke at 4:00 or 5:00am each day, ruminating over all my worries (call schedules, a new school, new teachers for the kids, a brand-new nanny). Despite running in overdrive, I rarely felt hungry, began to eat less, and lost some weight.

 

When I became grouchy and short tempered with the kids, I attributed it to stress and my workload. There was always so much to do, both at home and at work. However, sometimes I erupted in anger at my children for no good reason. They were adjusting to big changes in their little lives, too. I observed myself continually furious at my husband and resented his enjoyment of his new job (when I was not). Yet, because I continued to work full-time and take night call in the hospital, the fatigue I felt was extraordinary. Some days it felt like the typical “post-call” funk, and other times it felt much worse. I literally forced myself to drive into work for my night shifts.

 

Then one morning while in the NICU attending to sick babies, I noticed that I was unable to make the most straightforward of clinical decisions. Should we treat the patent ductus arteriosus with indomethacin or move straight to surgical ligation? My thinking had slowed until my brain felt foggy. This was noticeably different, since my pattern of practice had always been decisive, even borderline impulsive. I began to have terrible throbbing headaches, and my poor husband complained about my lack of interest in sex. I was so busy with work and the stresses of my new life, not to mention goings on with the children, that I had not noticed my lack of interest in intimacy.

 

For two months, my anger, irritability, and general unhappiness progressed until one day at lunch while whining about my situation to a colleague, also a critical care physician, she opined that I was depressed, and recommended I see a psychiatrist friend of hers. Fortunately, this physician worked me into his schedule quickly, put me on an effective medication, and over the next six months, I gradually recovered. Thank goodness I never felt hopeless or suicidal, as some women do.

 

As a neonatologist I knew plenty about postpartum depression but never considered that diagnosis for myself. It is amazing to me now that I was unable to identify what was happening. My symptoms of depression were both classic and comprehensive: fatigue, poor sleep, foggy thinking, inability to focus or concentrate, headaches, lack of interest in food, weight loss, irritability, inappropriate anger, and lack of interest in sex. I quite simply assumed that I was transitioning poorly to my new job and ruled out postpartum depression since my baby was already six months old when my mood changed.

 

During this period, my feelings of guilt and self-doubt were inexorable. I felt like the worst mother and wife ever. It is only because I saw a good psychiatrist, and because medication and psychotherapy worked for me, that I recovered. These last fourteen months - this stressful pandemic living - have been difficult for many working mothers. Our jobs and our home lives have changed dramatically.

 

If my story resonates with you, and you recognize any of these feelings or symptoms, please talk to someone – a counselor, a therapist, a social worker, a pastor. Feeling this way is not normal despite how much we may convince ourselves otherwise. These symptoms indicate a severely depressed mood, which may occur anytime within the first year after giving birth. Or you may have a major depression unrelated to childbirth.

 

You are not a bad mother if you develop depression. Mental illness is a genuine biological illness, like diabetes, or asthma. Moreover, depression is treatable. With medication and psychotherapy, you can feel better. I am living proof of that.

 

Susan Landers, MD

https://susanlandersmd.com

Her new book, “So Many Babies” can be found here. 

Guest Post: Frenemies

This isn’t the way I had wanted it to be. When I met and married my husband I had envisioned a relationship with my mother in law that would be better than those of other mothers and daughters in law. We would not become frenemies. My husband would not become the pawn or middle man in our petty disagreements. I would be patient and respectful, and eventually develop a love for the woman that bore and raised the man I loved. Most importantly, I would not become my mother, who I felt harboured a lot of resentment towards my grandmother over things that seemed trivial.

It is clear to me now that how we are and how we come across is as much of a reflection of who we are with as who we are ourselves internally. My best intentions have slowly over the course of the decade chipped away leaving me chronically agitated at the woman who I had hoped to understand and befriend.

 

She has always been a hypochondriac. Something is twitching. Is it a sign of something dangerous? Her face aches with tomatoes. She must be allergic to vitamin C, in fact she is sure of it. She can feel her blood pressure go up, so she will check it every 5 minutes until eventually it does. Her blood pressure is too low, she feels sick. She has this pain, but doesnt want to take tablets. Who knows what the side effects will do to her? We have been there for countless trips to the emergency room via ambulance, only to be sent home soon after as all is fine. I humoured all this, not only because of my commitment to the relationship, but being in the medical profession I was kind of used to dealing with strange and unreasonable people. I had developed a patience with them at work and this transcended easily over to my relationship with my mother in law. So we were doing fairly well, until the children came.

 

With the children came a loss of boundaries. I remember the extreme pain of trying to hobble over into the bedroom with the baby in one hand and breast pump in the other, barely clothed (what was the point?) and the episiotomy and high vaginal tear still very much fresh. My mother and father in law had decided to come by unannounced and were at the front door of our small apartment. Of course they wanted to see the little munchkin. Had he gained any weight? Was I breastfeeding? Were my breasts making enough? It was very important he was breastfed. My husband was breastfed until he was two, my father in law touted proudly. I excused myself, scrambling to hide the formula and baby bottles drying near the sink. Why was he crying now? Had he been changed? Maybe he was hungry. Had I fed him? At this point my mother in law would take it upon herself to soothe the crying baby. My rocking wasn’t good enough. I was failing at mothering already. She had more experience with rocking babies. She would be able to fix it, of course.

 

This only got worse over time. At outings I was instructed to give my son some more chicken, more bread perhaps, the orders from across the table never stopped. He never seemed to have enough food to her satisfaction. She never trusted me to know how much my child should be eating. Of course he didn’t sleep through the night, he was cold and he needed more layers on! (she’d never heard of SIDS). When I went back to work the pity she expressed for my son when he started daycare would make you believe I was sending him to an orphanage to be raised by drug lords. It wasn’t only parenting that my mother in law second guessed me. Here I was managing a delivery suite by day, and then having to convince my mother in law that I have enough medical knowledge to know this rash my son has is not worrying. He does not need to see a doctor as I, his mother and a doctor myself, am not worried. All of this preyed on my insecurities as a new mother. I was a doctor first, and I loved it. My time and attention was divided. This could not work any other way. Would it be enough for my son? It would have to be. Perhaps her words and actions were not as bad as the feelings of incompetence and loss of autonomy they elicited in me.

 

With the second baby came more of the same, but I was better equipped. No she isn’t breastfed, it just didn’t work for us. But I am happy to report she is fed, Sorry, I can’t let you in. I just got out of the shower and am not yet clothed. I will not be opening the front door naked. If you had called before coming I would have told you. They have had enough to eat, thank you. In my assertive and often uncomfortably direct responses to her behavior, I have resigned myself to a relationship with my mother in law that is nothing short of frenemies.

En322  is a OBGYN in London who has been a silent follower of MiM for years. She has two children who are 8 and 2.  

Guest Post from Australia

The 5th of December 2019, a beautiful sunny Thursday and a day I will never forget.

I woke up with a feeling of I-cannot-be-bothered to go to work. I was 34+1 weeks pregnant, and although the pregnancy was textbook perfect, I just felt tired that day and did not feel like seeing any patients. I was on a fantastic rotation at a medical practice attached to the private hospital. I had a few patients booked in for the day and I knew at least one of them would be a pain. But I loved being a doctor in a chilled environment with amazing supervisors. This is the rotation I had been most looking forward to.

My DH kissed me goodbye at 740am. He was off to have an amazing day on oncology ward and was savouring his last few days on a very cruisy rotation. He told me to suck it up and go to work and I would feel better once I was there. I couldnt have any sick leave because we had timed the pregnancy perfectly to finish with internship. I had to work until 38+6 weeks to be eligible for maternity leave so I did indeed "suck it up" and put on one of my favourite flattering dresses.

I sighed as I looked at where we were currently living - a granny flat with our furniture all piled up in the corner. Just a few days before, we had moved from a rental property into our own house which we were renovating and hopefully would be done before Christmas. The granny flat was old and smelly, and I couldn't wait to move into the big house which we had painstakingly considered the fine details of the renovation.

I put the leashes on my two cavoodles, who were very ready to go to doggy daycare. Doggy daycare is on the way to work and I loved sending my dogs there because they come back so happy. 

We made it around the corner when I crashed.

An elderly couple were on their way to cardiac rehab and were picking up a friend who also was going to cardiac rehab. They were slowing down and speeding up, clearly trying to locate the house they were after. We started speeding up again (we were going about 40km/h) when one of the dogs whined and I quickly looked back to check she wasnt caught up on her lead. When I looked back at the road, the car in front had stopped abruptly. It was too late but I slammed on the breaks as I rear ended them. My breath caught and the airbags went off. Smoke started to surround us. I removed my seatbelt.

I attempted to open the door but it was caught. I had to forcefully kick it open. As I stepped out of the car, I realised I had intense abdominal pain. I pulled up my dress, right there in the middle of the road, to check if I was bleeding. I wasn't.

The driver had gotten out of the car. I said "please call an ambulance, I'm pregnant". He ignored me and called out to a bystander and said "did you witness that? She hit me!" They started talking but I did not hear what they were saying. I thought, "I need my husband here".

I kneeled down onto the pathway as the pain took my breath away. "Please baby boy be okay, please baby be okay" is what I repeated to myself. A lady who was walking on the other side of the road eventually came over and I said to her "please call an ambulance, I'm 34 weeks pregnant". Thankfully she listened to me and called them. She also retrieved my phone from the car. DH was on his way.

That's when I remembered the dogs in the back. I opened the back door and they were sitting quietly, both shaking vigorously. My heart broke. Someone offered to hold them for me.

The ambos came and assessed me to be stable - yes I had pain (which they gave me panadol and the green whistle) and was nauseous, but I was stable with a little hypertension. They painfully did not have a doppler and I had no idea for half an hour how my baby was doing. We were delayed to get going to the hospital as there was another emergency somewhere else and for some reason we were unable to get going. This was the most painful half an hour of my life, while the paramedic tried to make small talk with me, and all I could think was "shut up because my baby could be dead right now".

Casey arrived and when I saw his face full of fear and worry, I felt a wave of guilt. He took the dogs to doggy daycare and we planned to meet at the hospital - me via ambulance.

When we finally got to the hospital I was wheeled through ED and I avoided all eye contact with the doctors I knew. We went straight up to the obstetric ward where they finally put the CTG on. He was alive.

DH arrived and my heart burst seeing his concern. All I felt was guilt.

My midwife came and asked me if I had pain and that's when I realised that I was contracting. The obs reg came around and said "lets watch and wait, you're anxious and your baby is too. We are concerned about placental abruption". The consultant came around and agreed. So just like that, I calmed down and the CTG improved for about an hour. They gave me a steroid and prepared for a c section "just in case".

The sonographer came around and happily declared "I don't see any obvious placental abruption here! You do have a nice muscle haematoma here though". I was again put at ease. DH and I talked about what we would do when we got out of hospital that day.

And then I started to have late decels for about 40 minutes.

The consultant came in and looked at the CTG and said "cat 1 c section, let's go". I cried again wondering what the hell I had done.

I felt like I had failed as a mother, and he wasn't even born yet.

A flurry of people came in and just like that I was getting a spinal and they started the operation. The obstetrician (who DH knows well) asked me "do you feel this?" and I knew he was pinching my skin hard with forceps. I pretended I was somewhere else while looking at DH's face and wondering what he was thinking about.

Baby boy was born flat with apgars of 1, 6 and 7. He was immediately taken away, and DH went with him even though I could see he was so torn about leaving me.

I was left with a room full of people but felt so alone. I felt empty.

The weeks after have been the hardest of my life. My son has moderate HIE and we don't know what his future will hold.

I am trying to heal and deal with my guilt. I'm not quite there yet.

S is a junior resident in Queensland, Australia. Her son is 16 days old today.

Guest post: On becoming a physician mom

While on a walk around a lake on a beautiful day with my newborn baby in the stroller, my dog, my husband, and my parents, we ran into one of my parents’ acquaintances. She congratulated me on my recent residency match, asked me where I matched to, and took a look at my baby in the stroller and congratulated me on that too. She then proceeded to tell me that through my dad, she had been hearing about my journey to and through medical school and that she too has a daughter who is in her first year of medical school at the same school I was about to graduate from. I quickly thought back to how grueling and demoralizing, at times, my first year of medical school was and I hinted at that to this woman and wished her daughter luck. She then looked at me and said something like “well it looks like it can all be done---you look great and not at all stressed!” I could feel a lump form in my throat, but of course that did not show to her. I’m not portraying my life accurately I thought.

Many people look at all of these doctor moms and think: wow they can do it all. Even as a medical student, I am frequently told by people how impressed they are with me-- that I was able to go to medical school as a “non-traditional, older, career-changer” student and have a baby during my fourth year (“perfectly timed” such that I had my baby two weeks after ending my last fourth year rotation giving me four months to stay at home before starting residency). And I suppose it is a lot to be proud of. I wish I, too, looked at it that way more often. But there is a struggle beneath the surface. To get to this point in my life, I have become a detailed oriented perfectionist and I am often driven by fear and anxiety that things won’t work out exactly how I have planned them.

The skills and traits that got me to my “perfectly planned situation” of having a baby fourth year after my Step 2s were taken and months before residency began were not helping me in motherhood. In fact, these skills and traits seem to harmful in motherhood. Crafting detailed daily schedules of when to study, what to study, what assignments to complete on rotations, and research deadlines to meet have felt necessary to me. Life schedules, when to get married (a few months before Step 1), when to conceive a baby (a couple of months before Step 2 so I was past first trimester on test day), and have the baby (a couple weeks after end of rotations) seemed to be the only way I could work things out.

As a new mother, I so badly want to make stringent schedules, check things off, and see that my hard work each day pays off. But it just doesn’t work that way here. My 10 week old baby is a wonderful baby but schedules, yeah right. Some things just don’t get done some days. And hardest of all for me, even on a day where he takes well-timed and restful naps, and I am so proud of that, he still has trouble falling asleep at night-- and that is so hard for me--seeing that all the hard work I put into the day trying to get him to do all the “things he should be doing” didn’t even pay off in terms of a timely and successful bedtime.

I am trying to teach myself how to be more flexible and go with the flow, how to not be so hard on myself, how to realize that everything really truly will be okay and that everything need not be perfect. And I luckily have so much support to achieve those things. For one, my husband is incredibly helpful, encourages me, and is much calmer and relaxed than I. And even more importantly, my child gives me the greatest smile in the morning when I first see him and sing his favorite song, regardless of how many times he awoke during the night. That is so rewarding and reinforcing that everything will be okay. However on a daily basis, I must remind myself that everything need not go as planned, I am doing an incredible job being a mom to my baby boy, I am trying my best and that is all I can do. I still have a lot of growing to do, in fact I am still meticulously keeping track of all his feeds and naps today. But I will be a physician mom. I am scared but I can do it if I let go of total control, adapt and show gratitude for all that I have.

Future PM&R Resident
Mother of 1 baby boy

Guest post: Mommy guilt - the struggle is real

One of the first things I did when I got a job that paid money was hire a cleaning lady. It was a given that I would, since I hate housework, and am no good at it. I actually suck pretty hard at it.

As time went on, I outsourced more and more stuff. Some of it was because we suddenly had things we never had before, like backyards–who’s got time to mow that? Landscaper!–and children. Oh, children. They’re outsourced more than anything else. They’ve got daycare, tutors, and a babysitter. And right now, we’re pared down, because there is only one babysitter. There was a point in time when I had two: one for drop off and one for pickup.

Apparently, getting a cleaning lady is a source of shame or guilt for some people–women, mostly–because they take it as a point of pride that they clean their own house, even if they could afford help, because it makes them a real woman. Or something. Some even insist that they [airquote] like it or even that it [airquote] relaxes them. (You should see the face I’m making right now. Hint: it’s full of skepticism) I work in a highly Portuguese area, and these women are nuts about their houses. But not me. I hate cleaning and I outsource it. And I never felt badly about it, until I was told I was supposed to, that is.

Same with being a working mommy. Everyone always worked in my family, and I never thought it was any big thing, but now that I have kids, apparently, I’m supposed to be torn apart by guilt, or so TV, BabyCenter.com, and social media tell me. And you know what, their influence is not to be ignored, because the struggle has become pretty darn real.

Any working mother knows the awful tug and pull of the mommy guilt. You’re tired and you need the help, but you also want to do things for the kids and the house because it makes you a true mom. Or something. The more you suffer, the more it shows that you’re a tough mother, so to say.

The guilt is terrible, and it has so many layers. It’s a freaking milhojas. Behold: a) you feel guilty that you’re not doing enough for and with your kids; b) you don’t want to do stuff with your kids and you feel guilty about that; c) you work and you feel guilty that you’re not home; d) you know you’d suck at being at home (because see the first paragraph. I suck really hard at all that stuff), and you feel guilty about that; e) you don’t want to stay home anyway, and… you guessed, you feel guilty about it.

And do not underestimate the power of other mommies. The good ones say, “Everyone makes the choices that are right for them and their family,” with the subtext being “the only right choice is my choice.” The mean ones straight up put you down for your choices. “Nothing like being with mommy!” vs. “Contributing nothing to society.” It’s a big deal.

Just the other day, I ran into a fellow young doc at the hospital, and via smalltalk we figured out that he had just had his third baby, and that his wife was staying home.

“And let me tell you,” he adds. “The behavior in our younger children? Huge difference.”

Now granted, I was annoyed and due to my own insecurities, so the next statement does me no credit.

“Oh,” I say. “So should I quit my job and go stay home with the kids?”

No sooner were the words out of my mouth, and Fellow Young Doc didn’t even have the chance to utter some PC comment, a random nurse, whose name I don’t know and who was not a part of the conversation, sticks her nose, literally, between the two of us, and says, emphatically:

“YES!” I kind of looked at her, open mouthed. She then elaborated, in case I didn’t get the point: “Yes! I stayed home with my kids, and let me tell you, it’s always better when mommy is around!”

She said it a couple of more times too.

Fellow Young Doc removed himself politely from the conversation, and I was left to pout and seethe.

Here’s a paradox, catch 22, predicament for the modern woman today. We’re supposed to have all this choice, but what happens when we make the choice? If we choose motherhood and family – we’re wasting female brainpower and negating years of the feminist movement. Don’t you want more for yourself? If, on the other hand, we choose career and work – we are a failed unfulfilled woman. What is a woman without a child? If we do both – we are doing a half assed job at both. What’s the point of having kids if someone else raises them? (which, by the way, is something I have heard multiple times as well from random judgmental people). And if you’re working part time, do you have the best or the worst of both worlds? Or are you just doing a half assed job half of the time?

So, here I am feeling guilty about the fact that yes, I work, but I don’t work that hard, and I still have a nanny, a cleaning service, a landscaper, and now we’ve even found a service that will deliver delicious home cooked meals twice a week. And I’m all, Oh boo hoo, I only see my kids for an hour each day….

Then, I picked up Mary Poppins to read to my son. By the way, have you ever read the actual book?? Julie Andrews has it all wrong in the movie with her sunny disposition. The real Mary Poppins from the book is very unpleasant, and I really don’t understand why the kids were so smitten with her because she’s kind of mean to them, and she’s always sniffing and paying herself compliments, and looking down her nose at everyone.

Anyway, the book starts with the old nanny leaving, and Mrs. Banks being incredibly stressed about that. Meanwhile, remember, Mr. Banks had told her that to have 4 kids they’d have to live in a shabby house because they aren’t rich. So they’re living in a shabby house with 4 kids, a nanny, a cook, a maid, a lady who does, and a gardner. And the mom presumably doesn’t work, because people didn’t back then. And she’s so stressed out about having lost one of her 5 staff, and having to spend time with her children. And not an ounce of guilt.

Yeah, so now, I feel guilty about feeling guilty. I really seriously cannot win. Can’t we all just give ourselves a break? I have no helpful advice. I just wanted to point out the struggle because I know I’m not the only one.

-Sasha Retana, MD.

Guest post - 7 going on 37: my baby boy gets surgery

“Mommy,” my six-year-old says to me as he stands over the toilet. “There is a big bubble on my penis.”

“Heh?” I say. “A big what on your what now?”

“A bubble. On my penis”

So I go over to take a look, and am astounded to find what looks like an adult sized left testicle – kudos to my kid for saying “penis,” and not, like, wee wee (though I thought it was awesome when he came up with “pointer” all by himself at age 2ish, and I mourn “pointer’s” passing to be replaced by anatomically correct terms), but he actually meant testicle. It’s a double mom fail: 1) I failed to teach him the difference between penis and testicles; and 2) I’ve been giving him regular baths right along and never noticed that his left one has apparently been exponentially increasing in size.

After a brief talk, we determine that it doesn’t hurt and that sometimes, it’s bigger than others. I’m thinking I know what this is, even though my experience with penises and testicles, especially six-year-old ones, is limited. I have a friend who’s a pediatrician, so I text her asking if she’d mind a penis pic being sent (that’s actually not the term I used, but I feel funny putting the term I did use out there in relation to my kid because I feel like it might be inappropriate and possibly frowned upon), and she actually says she doesn’t mind (she must be used to crazy parents), and when she looks at it, she confirms what I had been thinking: Munchkin has a hernia.

I tell hubby that we gotta take Munchkin to the doctor to check on the lump, and unfortunately, Munchkin overhears me. He’s a very conscientious child, and that is not to say anxious. No, you know what, I’m gonna say it, he’s an anxious child, and at the time this all was happening, he was going through a phase where he was very concerned with death and dismemberment, and other forms of bodily harm and injury.

Like, we had gone on vacation that year, and there was a man who didn’t have an arm staying at the same hotel. Oh. My. Goodness. My son was so affected. “Why doesn’t that man have an arm?” “What happened to his arm?” “Where did he lose his arm?” “Can kids lose their arms?” “I don’t think I want to be a policeman because I might lose an arm…” I tried to tell him that clearly, the man without the arm is doing well, because he looks happy, and he’s here with his beautiful family, but it was to no avail, we could not stop talking about it all week. And wouldn’t you believe it, on our last night we went out to a nice dinner, and guess who they sat next to us? Yup. I was basically using my body as a shield to keep Munchkin from seeing the man and saying something stupid. It was quite the ordeal.

So, when he overheard that I was concerned with his “bubble,” and that he had to go to the doctor, he was immediately all wound up about the possibility of something bad happening to his nether-region. “Why do I need a doctor? Is it because something bad is going to happen? What is going to happen?” And every day he’d ask me when his doctor’s appointment would be, and if I think the “bubble” can kill him.

The day of the doctor’s visit arrives. It’s a female pediatric surgeon, and I love her immediately, because she talks to my kid the way I talk to him: like a grownup, with big words.

“We’ve got a bubble on our testicle,” I tell her.

“I see,” she says with a straight face.

“It’s not always out,” Munchkin says. “It’s only sometimes out.”

“Well, let’s see if it’s out now,” she says.

She confirms that this is a hernia, and that he will need surgery to correct the situation. She explains the operation to me in medical terms (I told her that I’m a doctor. Why do I always feel like such as asshole saying that?).

Then, she turns to him, sitting up on that examination table, and says, “Do you have any questions?”

Munchkin very seriously says, “What bad things can happen during the surgery?”

The surgeon explains that it’s very unlikely, but there could be some bleeding or infection, or a reaction to anesthesia.

Munchkin nods, and then says, again, very seriously, “What bad things can happen if I don’t have the surgery?”

The surgeon explains that probably nothing, but the “bubble” could get stuck and hurt a lot, and it could get progressively more uncomfortable to walk around.

I’m sitting there thinking, this kid is asking more intelligent questions than some of my grown up patients! And I don’t even know whether to be proud or scared or what, since he’s clearly probably smarter than I.

Satisfied with the explanation, Munchkin says, “Ok, I’m ready, let’s book the surgery.”

Well, he probably didn’t say “book the surgery,” but he might as well have, because he did hop off the examination table, and briskly lead the team out to the scheduler’s desk. I’m still gathering my things and frantically stuffing papers in my purse, and he’s already seated in front of the secretary, and I could have sworn that he was signing consents. Even the surgeon’s trainee, who up until then had maintained perfect decorum, had to laugh.

The offer us a few dates, and he picks the closest one, next Thursday, and I say to him, “Are you sure you want that day? That weekend, you have a birthday party, and graduation from karate, and you’ll probably have to miss those things if you have the surgery. Are you sure you don’t want to postpone it?”

He says, “Oh, please, let’s not postpone it, I want to have the surgery because I don’t want anything bad to happen.”

Like, seriously? Who is this kid?

And it’s not the first time he leaves me somewhat speechless. Most recently, when he found out we were moving, and he’d have to switch schools, I was agonizing about how he’d be upset, but he said, “Okay. It’s time for a change.” Who says that?

Unbelievable.

And then, just like that, he’s a kid again. After eating a giant bag of ketttle corn, he bounces off walls for about an hour and the passes out in the middle of his Spanish lesson that afternoon, head down on the table. Whattayagonnado.

The surgery went fine, by the way; I think it was worse for me. Watching my little old man’s face as he was put out with a mask was distressing, I realized as I walked out of the OR on rubbery legs, and watching him wake up and crying “ouchie, ouchie” in the PACU was really upsetting, even though he didn’t remember it after being properly medicated.

I feel like it’s always harder on the mom… When Munchkin was a baby, and I had just gone back to work, I accidentally caught a glimpse of a baby of the same age in the OR, and almost fainted. One of our techs saw me, and said, “Funny how things change when you’re a mom, eh?” I never thought I’d turn into such a delicate flower.

Munchkin, though, he did fine. He marched in, got rolled out, and the next day was out on the playground already, showing off his battle scars and refusing to skip a beat. Mommy got a talking to by daddy though, for allowing this and not being firm enough. But I figure, kids know what they’re doing. If he were in pain, he wouldn’t have wanted to go to the playground.

How about that kid, though?? He’s 7 going on 37, I swear to God. How did I get so lucky? (poo poo poo, spit three times and knock on wood)


-Sasha Retana, MD. Originally posted at  https://andwhynotshesaid.com/

Guest post: Our scars are our torches

Women are mothers, teachers, healers, and crusaders. We are slowly entering a revolution for women where sexual assault and abuse are a topic of national conversation now more than ever before.

Let me tell you a story about myself. When I was 14 years old, I had my first chaste kiss at a summer camp where I was volunteering. When I was 15 – I was a junior in high school that year, moved ahead for academic reasons - I was asked to a Christmas formal by a 17-year old boy who had just transferred to my school from another state. I was shy and introverted and hadn’t dated much so was thrilled; he was very handsome. We went to a party after the dance where there were no parents and alcohol was in abundance, but I wasn’t very experienced with it so I only had a few sips. Any slight head change was immediately extinguished by excitement when he asked me to go to a park with him in his car and make out. I hardly knew him but was heady with youth and the clear starry night and the possibility of fun.

In the car on the way to the park – a park that happened to be across the street from my house, we had the windows down and the wind was whipping through my hair. He put Bad Company in the tape deck and I was pleased because I knew the words to a lot of the songs and I have a decent singing voice I was proud to show off. We pulled into the parking lot and awkwardly started to do what a million 15 year olds do every day and it felt wonderful.

Then something happened; it took a turn for the worse. He got rough, and I wasn’t prepared for that – what to do, what to say. I don’t even think I knew there was a name for it at that age. I tried to push him away. My clothes were torn. He became violent. I remember staring off into the trees, trees I had run and played under when I was younger, trees that had sheltered me from the sun at the adjacent swimming pool for many years, trees that still shelter me now from the memories of that experience. I disappeared into the moonlight as it shone through the trees. As an adult I know this is dissociation. As a teenager it allowed me to go on.

When it was over he offered me a ride home but I opened the door of the car and ran. I hid behind some bushes and stared at the front door of my parent’s house until it was light enough outside to go knock on the door, pretending that a friend had dropped me off after a sleepover. I have no idea how long I waited, but it must have been hours in retrospect. I remember aching with pain and dripping blood on the ground as I leaned against a fence and peered through the leaves, still frightened since I was alone in the dark. I finally gathered the courage to knock and when someone opened the door, I hid the areas of my torn clothes with my hands as I rushed up the stairs to my room. I cleaned myself up in the bathroom with the door locked. I called a friend from another school in another town and told her that all men were brutes, and that I would never trust them again. I was too ashamed to tell my parents.

I convinced myself that it was my fault; that I had asked for it. I wore turtlenecks to school for weeks until the bruises healed – luckily it was winter so it was easy to hide them. I managed to make his presence, one that persisted until graduation, invisible to me. I beat myself up inside my head for singing “Feel Like Making Love” on the way to the park – I still cannot listen to that song and have to change the station or remove myself from the situation if it starts playing on the radio or at a restaurant or bar. My singing that song felt like giving permission for what had happened, even though the words were in no way a description for what occurred.

I beat myself up even worse when a six-foot tall confident blond tennis player asked me how my date with him went – he had asked her out. I told her it was fine, didn’t meet her eyes, shrugged my shoulders underneath my turtleneck, then turned around and walked away. She angrily sought me out the next week because he had tried to lock her in a room and assault her and she had to kick and scream and fight and forcibly push him away and run through a door to escape. “Did that happen to you?” She asked angrily. I shook my head no and burned with shame. She got away, I thought. She is stronger than me. I’m a failure.

Predictably, my mental health deteriorated. I became so thin and pale I looked like a ghost of myself. I became a career bulimic. I started having suicidal thoughts. A teacher was worried about something she saw in my private journal for writing class and alerted me that she was going to talk to my parents. This was my breaking point. One of my parents walked in on me trying to slit my wrists with a steak knife that morning. I didn’t want to end my life, they were just chicken scratches; a cry for help. It was a necessary turn of events to get me into counseling.

I finished my senior year of high school and graduated at 16 as Valedictorian. I went to a month of inpatient rehab for bulimia and learned that I was raped and was able to tell my parents. I still carried the shame, but started to gain some weight back. I found the courage to go to the police station and report the incident with my mother by my side, and was happy that the statute of limitations was up so I could not prosecute; that would have been too painful just as I was starting to heal. I felt I owed my statement to other women: to the tennis player I wasn’t able to protect from his violent advances, to any future woman he might assault. I was proud.

I started college close to home; I wasn’t strong enough to move away. I learned by word of mouth about two other women my perpetrator had sexually assaulted. I watched the Clarence Thomas/Anita Hill trials and patted myself on the back internally about not speaking out. I walked on the sidewalk the morning after a No Means No demonstration – they had painted it in colorful sidewalk chalk all over campus. A group had snuck out in the middle of the night and wrote “unless she’s drunk” after half of the statements, and I patted myself on the back for keeping silent and not going to those demonstrations.

Once I learned that my perpetrator had come to a college party I was attending and my normally passive self physically fought my college boyfriend to keep him from going to beat him up. “Take me home now,” I screamed at him while pulling his arm. I didn’t want a scene I wanted out of the situation. It took four of his friends to help me hold him back. He finally took me home and I cried in a closet.

After graduating Magna Cum Laude, I had a brief stint as a psychiatric counselor at an inpatient child and adolescent ward before starting medical school. I read the files of 5 and 6 year old children who were being used for child pornography by family and friends and then went to tuck them in for bedtime. I remember one little boy grabbing my head and forcibly kissing me on the lips and trying to put his tongue in my mouth. I tried to hide my shock not to hurt his feelings, teaching him gently with my actions how to give a proper good night hug and peck on the cheek. Two days later I held him in a basket hold in the safe room for over an hour so he wouldn’t hurt himself or another child. My relief was palpable when he finally fell asleep in my lap.

On the adolescent side, I met a girl who was 13 and pregnant. This young girl the same age as my daughter is now was so proud of the pregnancy because she had been “sexed” into the gang. I learned this meant she was gang raped, and that because she got pregnant during the gang rape that the child was a child of the entire gang, and her status was elevated above other women in the gang.

I went to medical school. I listened to a friend talk about being sexually harassed by a surgeon, all the nurses around rolling their eyes as if to say “that’s just him we put up with it,” and decide not to report to protect her future career. I watched her decision reinforced when a student reported a notorious sexually harassing doctor, one that I intentionally stayed away from, only to become the butt of every joke on campus. I became a doctor. I listened to a friend share in residency about an attending who was sexually harassing her in a creepy way and the department’s solution was to keep her away from him – to not put her on any rotations with him. I later learned the creepy attending was transferred to another academic institution after a surgeon learned from his tween daughter that he harassed her at a school bus stop. So this is how they take care of this, I thought. This is so crazy.

I became a wife. I became a mother. I got divorced. I went to therapy, again as an adult. I’ve never asked or heard what happened to my perpetrator. Thankfully he has not attended any class reunions.

After a few years of dating my current boyfriend, we became engaged. I’ll never forget the first time I told my fiancé about the rape. We had been dating about 6 months and things were getting serious. I was terrified of his reaction; terrified he wouldn’t love me. It was the middle of the night; we were on a long weekend away. I went to the porch of the bed and breakfast and stared into the trees watching the moonlight. I drank a glass of wine and gathered the courage. I crawled back in bed with him, woke him up, and we started a conversation where he told me he loved me. I awkwardly confessed that I had been raped. He looked into my eyes and said something no one has ever said. “I’m so sorry that happened to you. Want to tell me about it? I’d love to listen whenever you feel like it.” Tell my story instead of sweep it under the rug, or awkwardly dismiss it? I felt like I had been doused with a bucket of cold water. I found the courage to tell him I loved him back, and shared a truncated version of this story.

It’s not men’s fault that they don’t always find the right words when hearing about sexual assault, or women for that matter. It is hidden in a cult of guilt and shame, passed down generation after generation. Women are speaking out now more than ever before: carrying their mattresses across campuses, trying and more often succeeding in prosecution. Every time I read a story about a woman with a successful prosecution, I cheer silently on the sidelines as a member of her team. Every time I read about a woman who is penniless and suffering from mental health disorders after being kicked out of the military, her bright and promising future doused by rape, I cry silently on the sidelines as a member of her team.

In therapy I mourned my lost innocence. In solitude I forgave the little boy who grew up in a house where the possibility to do what he did to me was transformed into a reality. My therapist told me that my empathy did not need to extend to my rapist, but I couldn’t help it. And in some small way, it helped me heal.

We need to remind men and boys that the porn they can so easily google as a teenager at a sleepover is not reality. We need to tell them if they are in a gamer chat room online and a girl walks in they cannot verbally assault her just because everyone is anonymous. They cannot rape her at a college party, even if she drinks too much. They cannot call her bad names and treat her with disrespect, even if they witness it growing up in their own house.

This is a cultural ill. We need to change the fact that women on Indian reservations are so easily raped by men who know they can escape prosecution. We need to change the fact that sports institutions objectify women and value the achievement of their college and professional athletes over disciplining those that have no boundaries with women. We need to change military culture around women. We need to stop human trafficking. It’s a worldwide disease, and our country may be healthier than some, but it is still very sick.

Last week the election of a president that boasts of sexual assault and promotes intolerance and hate struck my core as a human being, but also hit me on a much more personal note. I woke up at 5am and the confirmation of what I dreaded was happening at midnight spun me into outer orbit. I sat on the back porch, had a glass of wine, and sobbed. It felt like decades of achieving and therapy and reaffirming my worth in society was erased by half of America.

A few days later I sat in a Sunday school class with a group of strong, mostly single mothers and was reassured. The current leader (we all take turns – well, them anyway I’m a slowly reforming atheist looking for faith who does not yet feel qualified to lead in this arena) spoke of a Saturday spent in a prayer house. She, a Methodist, said that she was reminded by an Episcopal leader that all lives have value, and that we spend too much time, especially in America, measuring our value by our achievements and our wealth.

She spoke to my 15 year old soul. That girl had promise and value – no different from the doctor I am today. That incident no longer defines me, but it does shape my future actions. I vow to revolt against hatred, not with anger or blame, but with love and action. I vow to value every human being I encounter no matter their origin or political inclination. I vow to use my scars to help heal others.

-Anonymous

Guest post: Tampon Travesty

Another cycle. It's here. The anxious two week wait is over, and it's time for tampons. I got my period.

There are many blog posts and stories about struggling with conception. But these people aren't in medicine, they aren't in sync with the uterus, right?? They didn't have to memorize hormones and fun facts?? Right? Apparently not.

Well, we started struggling, and the foreign stories became relatable. Our trials have been so much more confusing in light of our son who grows older with every month we are unable to provide him the brother or sister I have longed for since the moment he was born. I guess they call this secondary infertility - I call it a giant, expensive, heart-breaking pain in the ass, which makes me cry on a regular basis, well by regular basis I guess I mean... approximately every 28 days.

We have been trying since our son was first born. We both want a big family, and that requires trying to have children, even during our simultaneous medical training, and what some would say are not ideal times. So, I gave up breastfeeding my son cold turkey (with ample frozen milk) to expedite my cycles returning. Well, they returned... and have been returning for close to a year now. I could have had my baby by now. I could be back to breastfeeding and snuggling, but instead I'm changing my own maxi-pads. I'm a strong woman, but this was not my plan, and I cannot will it away, or rely on our shared medical knowledge to fix the problem.

I know you're supposed to wait to see a reproductive specialist until a year, but waiting is not my strong point. We went a few months early, and are actively seeking care. It is hard to seek care as medicine folk. We are knowledgeable, but vulnerable. We want that second child so badly. So, we shall let the medicated IUIs begin.

I'm not sure why I'm writing this, but it sure feels wonderful. Partially, for my own sake and partially to break the silence of infertility. Here's a shout out to all my medical mommas trying to grow their family. A wish of wellness and fertility to all those trying and especially those struggling.

May the second pink line be with you.


MD/PhD Student Mom + Anesthesiologist Husband + One Son

Guest post: Jury Duty

I have a confession to make: I'm currently on day 2 of 5 weeks of grand jury duty. Yes, 5 whole weeks.

I write it in those terms because I feel embarrassed and ashamed every time I tell people this. When my family, friends, or coworkers hear that I am serving 5 weeks of jury duty, or when I mention to my fellow jurors that I am a Veterans Affairs physician, they respond with shock, "I can't believe they picked you!" or they make some sort of twisted, disgusted looking face. The impression that I get from them is outrage that I'm abandoning my patients and -- though this may simply be projection of my own feelings -- that I should have tried harder to get out of this responsibility.

I received my court summons 2 months ago and right away, I notified my supervisor to ask for guidance. He replied that I should just close out my clinic so no patients could be scheduled. My colleagues assured me that they would cover. I thanked them, but reassured them that I likely wouldn't be selected. I admit that part of me was ambivalent; wouldn't 5 weeks of jury duty be a welcome "break" from the grind of clinical medicine?

Fast forward to earlier this week. I sat in a crowded court room and soon realized that I had been called for grand jury, not petit jury, and that the two are very different. Petit jury, I have now learned, is a trial jury that determines a person's guilt or innocence. I had been summoned for petit jury some years ago and after sitting in a large room for several hours, I was dismissed without ever being called for "voir dire," which is when the trial lawyers question prospective jurors about their backgrounds and potential biases in order to select or reject that potential juror. Unlike petit jury, the purpose of the grand jury is to determine whether there is enough evidence to indict a person of a crime. Also unlike petit jury, there is no voir dire for grand jury (although I did not know that going in!).

Anyway, during the initial process of grand jury, the clerk asked for anyone who believed they couldn't serve to step forward. She explicitly stated, "Occupation is not a reason why you cannot serve. You can be a lawyer, police officer, law clerk, married to a lawyer, etc and still have to serve." So when I heard that, I stayed in my seat. She went on to list several valid examples of why a person might not be able to serve: medical or mental health issues, financial hardship (if a job wouldn't pay during jury duty), illiteracy. I thought, "No, no, no" and stayed in my seat with my nose in my laptop. But soon I noticed that the crowd had dwindled, and I became nervous. There was a break, and when we returned, the clerk asked if anyone would have an issue hearing cases related to sexual or domestic violence. I am a psychiatrist at the VA and care for a large number of female veterans who have experienced "MST" or military sexual trauma, but I thought, "Hey, I can be unbiased." I honestly felt that the question was directed more towards people who had been victims themselves.

So the next thing I know, I'm being sworn into grand jury duty with 22 other people! I couldn't believe it. I kept waiting for the voir dire, but at that point learned that grand jury doesn't have a voir dire process, and by then it was too late. I spoke to the clerk later that day, and she basically said as much: "Too late, you're sworn in now and you can't get out. Why didn't you speak up before?"

So that's the question I've been asking myself the last 2 days. Why didn't I speak up? As a psychiatrist, I've been trained to wonder about unspoken desires and ambivalence. I think part of me did see jury duty as a break. Yes, it's an inconvenience to my routine, but the day starts an hour later than my clinical day and often gets out early. It's nowhere near as mentally or emotionally exhausting as patient care. There is also a lot of downtime between cases when I can study for my upcoming board exams. And the courthouse is in a part of downtown that I don't normally frequent with lots of shops and restaurants.

So for all those reasons, I'm feeling guilty -- guilty that I put my own interests before my patients' needs. Yes, I had notified most of my patients that I may be out for the month of July. I don't do therapy, and I see most patients every 1-3 months, so I didn't have to disrupt weekly sessions. Yes, no patient appointments were actually cancelled. Yes, I have amazing colleagues who told me not to worry, that they would cover any emergencies that came up and see new patients during my absence. But I still feel like I am shirking my professional responsibilities.

I know jury duty is a civic duty. And just by being on jury duty the past few days, I can certainly say that I am contributing to the group diversity in terms of race, age, socioeconomic class, and education level. It is actually quite eye-opening and frightening to think that probably most highly educated and professional citizens get out of jury duty, which leaves important legal decisions to be made by people you might not want to be making important legal decisions. Thinking in economic terms, what's the opportunity cost of a good juror vs. of a physician, lawyer, or other educated professional? What's lost when a doctor is out of clinic vs. when an uneducated person is chosen for jury duty? I guess you could say, "Well, a doctor went through 7-9 years of post-college education to get here and is helping sick people, so their time is worth more than any Joe-Shmoe who could serve as a juror," but then is that fair to the defendant? Would you want a Joe-Shmoe to serve on a jury if it were your case? Can you really say that someone's health is more important than whether an innocent person goes to jail or a guilty person goes free?

I'm seeing that there is no clear answer, but all I can say is that I am still feeling pretty lousy about being on jury duty. The cases have been interesting, but I feel guilty being here and inconveniencing my patients and my colleagues and for getting this "break."

What would you do? How do you handle jury duty summons? Have you ever served? Do you think physicians should be exempt or always try to "get out of it?"


~~~~~
Bio: I am a new attending psychiatrist at the VA in a Mid-Atlantic city, studying for my board exams in September and mothering 2 young sons.

Guest post: Have baby, will travel

I had my first baby during medical residency, where we were allowed 6 weeks off (including all the year's vacation) without extending leave. My daughter was, ahem, rather "colicky" (read that as "screams for no reason unless being walked on your shoulder for hours a day, or possibly asleep on mom"). I love her but after 6 weeks I was sick of watching Law-and-Order by myself at home (boo hiss lack of US paternity leave support), and starting back into a relaxing research rotation was a relief. Even if it was hard to find a private place to pump. With number two I vowed not to isolate myself so much. To go out and about more with baby, even if it meant breastfeeding in public a bit. (I was just too self-conscious to do it with number one, even with a sheet) So, while pregnant with number 2 during my first year of Oncology fellowship, I realized ASCO (the big annual oncology conference), which I very much wanted to go to, would occur about a month and a half after he was due. Should I go for it?

Being a mom in medicine feels like a mixture of wanting to have my cake and eat it too. I want to work, I LIKE work. I want to have babies, I LOVE my babies. I want to breastfeed exclusively. I hate pumping. I'm going stir crazy after a few weeks of being a stay at home mom. I'm incredibly anxious about the prospect of leaving my baby. It's so nice to be among adults and using other parts of my brain again. Etc.

So, should I plan to go to ASCO?
With a one month old?
While breastfeeding?

First I did a Google search. I found a few articles on graduate students going to conferences, and that people were generally supportive. But nothing specific on ASCO. OK.

Could I keep the baby on me with a sling? Run out if he starts to fuss?

Sadly the answer to that is very much NO. ASCO does not allow any children under 16 in the conference, for "safety reasons." No exception for pre-mobile and breastfeeding babies.

So, I would say it's mostly impossible to attend ASCO if you don't have some kind of secondary childcare arrangement.

However I am incredibly lucky in that my parents are in Chicago, close to where ASCO is held. I was planning to stay with them anyway. My father no longer works and is very supportive. So, I did go with my baby to ASCO, and it was a good experience. Here's how I made it work.

1) Knowing my priorities. For me, my baby and establishing breastfeeding was my number one priority, so if there was a conflict I would choose that. Anything I got out of the conference would be gravy - some conference would be better than no conference, I reasoned. Especially since given the timing of my baby's birth, I was actually still on my 6 weeks of maternity leave while at the conference.

2) Having on-site childcare. In my case, my parents. What we ended up doing was, I went to the conference center with my father and my baby with a stroller full of supplies; there were a lot of common areas we could all go to. I would go to sessions, my dad has a book (did I mention he's tremendously supportive??!). When the baby got hungry and fussy, my father would text me and I would dash out to feed him. There was a first aid station where I could go nurse in privacy. I had my nursing pillow stashed with the diaper bag in the stroller.

3) Only go in-person to the in-person stuff: At ASCO at least, the talks are streamed online! So I could watch those in the luxury of a living room with some water and nursing a baby any time after the talk happened. There's really not much interaction at the talks, in fact sometimes the sessions are so full you end up running from room to room to watch it streamed. The poster sessions, on the other hand, I could read online beforehand then go and talk to the presenter one on one. Bonus, I could run in and out without any issue! I identified which sessions would be most valuable to me and went to those, running out for a half hour here and there when I got a text.

-- I did miss out on the "fellows lounge" as I did not know about it, apparently a good spot to be. Maybe next year!

Things that wouldn't work:
-- not having on-site childcare
-- pumping. Unfortunately the first aid station did not have a breast pump, you have to bring your own. And the site is HUGE. I did try to go one day on my own with a pump, and hauling all the supplies around was just obnoxious. They don't even let you stash them at the first aid station. So I can't recommend that.

Overall, I got to visit my parents, they got to see my new baby, I still breastfed and was with my son constantly, AND I was able to make a few connections and learn about some of the latest data on immunotherapy in different cancer types. I would definitely recommend it if you can find the support.

-Proliferating Oncologist, a first year hematology-oncology fellow.

Guest post: The Wandering Mind

The way my mind works as of late is akin to that of the ‘Tasmanian Devil’. I am constantly shifting focus. As a hospitalist, and probably like a lot of other types of physicians, I find myself switching my train of thought often every minute. Triggers of course are the barrage of pages, cell phone texts, acute patient care issues and the list goes on. Honestly, I was fine with this pattern because it has been going on since the beginning of my residency years, but now that I have a child….the rules to my crazy game of life have changed.

My baby girl who is now two years old is at this incredible age where every moment is of significance. She’s discovering her mind and the world that she is in. I realized I must focus and ‘be in the moment’ during the limited time that I have with her throughout the day.

So these past few weeks I’ve dived into the field of focusing. Strangely enough, after scouring the Internet and stumbling upon a TED talk about ‘happiness’, one main finding that I thought was intriguing is that the mere lack of focus or shifting of the mind can lead to unhappiness. The other activity that I’ve started are guided daily ten to fifteen minute meditations. It’s helping to drown the noise in my mind, and practice being aware of what is now.

I’m starting to see the effects of some of this and I’d love to hear what the rest of you brilliant moms out there are doing to hone your focus and truly be in the moment.



I'm an academic hospitalist at SFGH/UCSF. I have a 2 year old daughter. You can follow me on twitter @psanyaldey.

Guest post: Why I can’t be Mom and Doctor to my own kids

A few years ago, my eleven year-old came down with something. He felt horrible, and after a long day in the clinic, I dosed him with ibuprofen and tucked him into bed. I reassured him that he would feel better soon. I’ve got this, I thought. I’m a doctor. I wasn’t going to panic about a day of fever and malaise. I pulled out the Gatorade and chicken soup and enforced naps. My quarantine was effective, and no one else got sick.

Four days later, he was still vomiting. He stopped drinking. He had no interest in his favorite ice cream. Soon, he was barely making urine. Kicking myself, I imagined simultaneous appendicitis and rhabdomyolysis, Occam’s razor be damned. Or instead, rashless HSP. My quarantine mocked me: no one else had caught it because it wasn’t contagious. I called my pediatrician and showed up in the office with a child whose moaning broke my heart and accused me of neglect. Had I waited so long his appendix had burst? What good was all my training if I couldn’t even trust my own abdominal exam?

I shared my broad and crazy differential diagnosis with our pediatrician, who gave my son one dose of ondansetron and sent urine, blood and a rapid flu to the lab. While we waited, the magically dissolving tablet did its job, and my son sat up, asking for a drink. When our doctor came back in with the lab results, the patient was begging for apple juice and Dairy Queen. I hung my head in shame. Ready to do an appendectomy for Influenza B, I had become the hysterical mother I routinely saw in my own office.

Once the sting of fear wore off, I realized that while being a mom has made me a better doctor, being a doctor hasn’t necessarily made me a better mother. I have yet to locate the elusive sweet spot between the extremes of doctor and mother. I cannot be objective when it comes to my own children. Which is why I keep my pediatrician on speed dial and a supply of ondansetron in my cupboard.



--Ann Dominguez, mom to four children, writer and Family Practice attending. I have been in community health for 16 years. My novel, The Match, came out in November, and is available on Amazon, iTunes and Kindle.

Guest post: My Valentine

This year both my children have their own Valentines to congratulate. I was eating breakfast at  a hotel when one lady approached and asked to share a Valentine story for her anonymous site. It did not have to be a romantic Valentine. Just anybody who you feel special love for. I immediately thought of one person. My grandmother.

About 40 years ago she was working full time and caring for her elderly parents when she took me in. Initially it was about a better school district and starting me on my first year at school. Then she ended up raising me, giving me the best upbringing ever, guiding me, stressing work habits, taking me to movies, theater, and concerts with her. Her life as a professional and community member will always be what I strive for. She grew up in a village, poor and hungry, in a country where authorities took basic posessions from their citizens for all to share. Her family of 8 children had to give up their only cow to the collective farm.The cow would cry passing their house in the evening on the way from pastures to the collective farm. My grandmother and her siblings would gather at the window to see their beloved cow ("feeder") pass by and would cry silently too. The family was allowed to keep the hens, but they had to give away eggs to the collective farm, so that eggs were a special meal on certain holidays only. My grandmother helped her parents at the farm since age 8. When she complained that she was too small for the labor, her mother would reply, "If you only could pick up one thing from the ground, it would be one less thing for me to pick up." So, grandma kept going. Then World War II came. All the food went to the fighting soldiers. There was so little to eat, many days my grandma's family members had one potato a day per person to eat. Life afte war was desperately poor as well. Nonetheless, my grandmother as a university student exchanged her bread allowance for concert tickets and went hungry to be able to see opera, ballet, and theater performances to educate herself about the higher culture, city life. She ended up running financial affairs of a company employing 16,000 people, exporting goods to 35 different countries. She was always proud of helping people and aiding lowest workers in their hardships and pursuit of better life. Many of her coworkers came to wish her happy 90th birthday last year, it made her so happy they remembered her.

My grandmother was the one who pointed me in medicine direction for a career, advised me on my marriage, came to see my children when they were born, remained my soulmate who I can talk to every day. She tells me her only regret now is she cannot visit her great grandchildren due to age. But she is happy she got to see America, the best country in the world. Turns out visiting America was her dearest dream back then, on the farm. She always wondered why Americans lived better and wanted to see for herself. She did, and she was happy her great grandchildren were growing up here. I will be sure to pass grandma's lessons to them - nothing is impossible if you work hard, help others when you can, what you are is more important than where you are from. I will be forever grateful that I was shaped by such a person as my grandmother. Instead of feeling resentful she embraced life as it was and made the best of it.

Elena

Guest post: No longer twenty-two and thankful

This has been a reflective week for me. My two-year old, the fourth and last of our kid posse, ditched the diapers. My husband and I are on the verge of making the decision to repatriate our family to the US after five years of living in South America. And I received my first-ever acceptance to medical school.

It's been a long and non-traditional road. When my husband and I met in organic chemistry many years ago, he had already switched his major to English and I was an enthusiastic pre-medical student. After college he took a job that required him to stay in our alma mater's location. I had a track injury that kept me in school for a fifth year. After my graduation, we decided I would take a deep breath from the hamster wheel of school, athletics, research, thesis, more school, and the insular world of which a 22-year-old college student is the center.

As often happens when one takes the opportunity to step back, my horizons broadened. A Masters degree. Marriage. My first year teaching high school with 153 teenagers. A surprise pregnancy. My mother-in-law with terminal cancer. And I hadn't yet reached my twenty-fifth birthday. Sometimes I felt like taking the deep breath was more like having the wind knocked out of me.

Fast forward a few years. My husband's parents have both passed away. We have four lively, enthusiastic children. Our career paths have been eclectic, and we are considering returning to the States, where we will find ourselves at another life junction.

"What do you want to do?" my husband had asked me a couple years ago.

"Well, the same thing I've wanted to do for a long time. Go to medical school."

He smiled, chuckling at the roundabout trajectory we had taken to get to this point from our chemistry classes way back in the day. "Well, let's go for it and see what happens."

I flew back to the States and took the MCAT seven months pregnant. I asked my thesis advisor if she could dig up the letter of recommendation she wrote for me over a decade ago. I finally filled out the tedious AMCAS application. I went to my first interview wearing a green suit (slate green at least!), and quickly realized that everyone else was wearing black, with a dark navy or two thrown into the group. But I am okay with being non-traditional.

I am no longer twenty-two, and I am thankful. Thankful for the crazy road of life, that has left me with unexpected joys, scars of sorrow, and varicose veins. Thankful for a family that has encouraged me through multiple moves and international transitions with uncertain futures. Thankful for the medical admissions committee members who decided to give me a shot.

And thankful for all the Mothers in Medicine, who have shared their stories and their journeys. Many blessings to you as we finish another year celebrating all the lives with which we are intertwined.

A soon-to-be MS1

Guest post: Unexpected gratitude

I love Raymond Carver's poem "What the Doctor Said." The doctor tells the poet he has widespread metastatic lung cancer. The poem ends with this:

I jumped up and shook hands with this man who'd just given me
Something no one else on earth had ever given me
I may have even thanked him habit being so strong

I may even have thanked him. 

I don't have to tell people they are dying. I'm a hospice doc. My patients know they are dying before they meet me. Everyone knows they are dying. They may not want to say it out loud, and they may use a variety of euphemisms, but everyone knows. I don't have to say it. I do have to find a way to answer the question "How long?" I always start and finish my answer by saying "I don't know." We never know for sure. I am frequently surprised - I am surprised how quickly some people die and how long some others linger. I am surprised by so much about this work. I am surprised by the peace that I feel at the bedsides of the dying, and how comfortable it can be in our inpatient hospice unit. I am surprised at the laughter I find when I make home visits. I am surprised by the capacity of family members to do the hard, dirty, physical work of caring for their loved ones.

And I am surprised when they thank me.

Patients thank me for coming to their homes. "A doctor who makes house calls! In this day and age"! Caregivers thank me for the medication that eases the symptoms and makes their job easier (even though it's the nurse who tells me what they need). Family members thank me for clear explanations of the medical system and for signing forms (although most of that credit should go to the social workers who do all the actual work). All of that makes sense. I have done something, given them something, provided an answer or solved a problem.

Then there's the question no on ever wants to ask: "How much longer, Doc?" It's often asked in the hallway of our inpatient hospice unit. Someone is usually crying. Sometimes the someone is me. I am as honest as I can be when I don't really know. I say "I don't see anything that suggests it will be the next few hours...", but I know the patient might be gone when we walk back into the room. I ask what the family needs - what decisions are they wrestling with? Who needs to come in from out of state? Who are they trying to protect? And at the end of the conversation, they say "Thank you." I am always surprised.

I don't really know why they are thanking me. Perhaps it's for some clarity and honesty after the muddle of modern medical care. Perhaps it's for the moment of connection and the respect I hope I'm communicating. And perhaps it's what Raymond Carver wrote about - that I have given them something no one else ever has.

Those moments will continue to confound and humble and amaze me, and for that, I am thankful.


Jay is an internist working full-time in hospice and palliative care and mom to a 15-year-old daughter.

Guest post: How hard things can get

I am a more than full-time family doctor. I manage my own office and do extra urgent care shifts on weeknights and weekends. I have a very busy, demanding and wonderful two year old son. I am paying off my mortgage and helping my husband get started with a farming business. I am struggling to keep up all my medical skills, applying for continuing education grants and trying to stay healthy and balanced...

I thought my life was chaotic enough... then...

I find myself pregnant with my second baby. 8 months of a very difficult pregnancy follow, forcing me to eliminate night and extra shifts. I don't sleep and suffer from severe heartburn later found to be due to polyhydramnios.

My baby is born a month early and at 24 hours, I find out he has a major birth defect, undiagnosed through the pregnancy, an extra connection between his trachea and esophagus with no connection to his stomach.

I am discharged in the middle of the night, sleep deprived for 48 hours and severely anemic with my son to a children's hospital. I have to drive myself, and it is heartbreaking to leave the hospital with your flowers and gifts but not your newborn baby after giving birth.

We survive intubation, days on a ventilator, swelling, emergency surgery, jaundice, phototherapy, catheters, central lines, ng tubes, countless needles and tests to look for other problems. He still can't swallow and is aspirating. At a family meeting I learn his vocal cord was paralyzed at some point during all his testing and procedures. It should heal but over weeks or months. Otherwise he may need a gastrostomy tube for the next year.

As I drive in daily to visit him in the NICU, nearing his 1 month birthday, I cry. I blame myself even though his doctors tell me it is not known why this defect happens. I blame a sinus infection, not enough nutrition, exposure to farm pesticides I might have had on a hike...the list goes on. I can't let it go.

I sit in the NICU and hold him, wondering what the future holds. Nobody can predict how things will progress with him. All we can do is take it day by day, waiting to see if he stops aspirating and starts swallowing on his own- then his TPN and NG tube can be removed.

As I sit in the NICU, every little thing scares me- an increased heart rate, no weight gain, a rise in temperature, I usually get so worked up within an hour that I have to leave and let my husband sit with him. Normally I am calm in this environment, but that is with other babies, not my own.

And the stress of the situation is affecting everyone around me. My office staff don't know how to book my office, when day by day, I need to be in the NICU and I don't know how long it will last. One staff is billing me for hours she hasn't been at work, another is demanding a raise (could she have picked a worse time)?

My husband is snapping at me for asking questions and his parents are telling him to give up on his farming business for now to devote himself to the care of his two sons. I am the breadwinner for the family, so if we need to bring home a high-needs baby, he needs to be the one to give up work opportunities for now. I feel guilty about this too.

My intent had been to have the baby and return to work the next week, as I had done with my first. I never thought to make a plan B. So I post ads for a locum and a babysitter for my older son, but as of now, no replies to either. And my patients don't understand why the office is closed down-they just want their doctor back.

I look back to all the times I thought I had so much stress in my life, school and residency especially, and they don't compare to this.

Today the first good news in a long time came. I have won two awards for continuing medical education courses. I will also have a chance to work as a locum in a place that I have wanted to work for a long time. This hint at my past organized life as an FP is so reassuring when the rest of my life is so chaotic and the future so uncertain.

I tell myself to focus on the positive and not worry about what can't be changed. This is what I have told past patients and this is what I do. I am learning a lot just sitting with my son in the NICU. I am donating milk to other babies. I am spending more time with family. I am learning empathy and how it feels to be a patient's mom. I have some of the best night-time babysitters around- the NICU nurses. Most of all, I know that in another time or place, my son would have died from this now corrected birth defect.

If this is how hard things can get, I hope that eventually things will swing back just as far in the other direction. Once they do, I will have to write again.

Guest post: Miscarriage

I thought I was over my miscarriage, but I’m not. It started when I wishfully wasted a home pregnancy test a few days ago (negative.) This past weekend I’ve been taking the Advanced Life Support in Obstetrics course, delivering rubber babies with shoulder dystocia and fighting back tears the whole way.

Let me start from the beginning. I’m 35 and just starting a family medicine residency. I’m newly married to a wonderful man; he will be joining me when he finds a job in the far away city where I moved for residency. I found out I was pregnant in May. It was my first pregnancy and we were overjoyed.

One month ago, I had my first prenatal visit at an OB/GYN practice in my new city. I went alone. I wore my favorite blue dress. I was happy and confident and looking forward to taking home images of my 8-week future baby.

The appointment started with an ultrasound. I wasn’t alarmed when Monica, the sonographer, asked to switch from a transabdominal to transvaginal view. No problem, I thought. When the imaging resumed, I asked Monica if she could calculate my due date. She paused for a second, and then said, “Well, I’m seeing some concerning things here.” The floodgates opened and I started crying. In the nicest way possible, Monica described the enlarged yolk sac and absent heartbeat. The embryo had died ten days earlier.

Through my tears I met the nurse practitioner who explained my options: since I was starting residency in just over a week, I chose surgery. I spoke with the physician, who booked my D&E the following day. Everyone asked me: where is your husband? (Florida.) Do you know anyone here? (No.) Who will be with you for the surgery? (I don’t know.)

OB/GYN offices are filled with pregnant women and their spouses, best friends, mothers and sisters. It hit me hard when I waited alone for my pre-op bloodwork, then for my Rhogam shot, surrounded by women who still had their babies. I felt their eyes on me, felt their pity. An hour earlier, I too had been smugly pregnant, thinking how elated my parents would be when I told them about their first grandchild.

My husband flew in the same day (I have never asked him how much his flight cost.) The D&E was uneventful; I had no pain after the surgery. We went out for steak that night; I had red wine and blue cheese, because I could. Because I was not pregnant anymore.

The past month has been a whirlwind of excitement, of new long white coats and responsibilities and stresses. Amongst the distractions, I haven’t grieved. But I remember something my physician said before the surgery. She said: “Miscarriages are very common. They’re the norm. But in our society, we don’t talk about them. I wish women talked about their experiences with miscarriage instead of grieving in secret.” And so that’s what I’m doing here. I want to tell you that I’m sad, that I’m angry, and that I’m not okay with what happened. I hope it helps me move on.

Guest post: Gender equality?

I generally LOVE my job. I work part time as an anesthesiologist at an academic medical center in the Midwest. There are several other part-time faculty in my department, both male and female, which has created an atmosphere where the commitment of part-time workers to their careers is not typically questioned. My department recently scheduled an all day seminar on an upcoming Saturday, geared for and limited to our own department's clinical faculty, with educational topics ranging from reviews of clinical care, giving feedback to residents, and research resources. I decide not to go, as Saturdays that I'm not on call (I'm typically on call one weekend/month) are generally reserved for family time, my kids have some new activities starting this Saturday, the weather is (finally) getting nice, and with the exception of about a 2 hour period, I'm not that interested in the agenda. So I have a discussion with my husband (who is generally wonderful and supportive of my career) about our upcoming weekend plans and I mention that I may go to the 2 hr period of the seminar that I'm actually interested in, depending on what else he has planned/would like to do with the family. It turns out he is not at all in favor of me going to only the 2 hours of interest to me- he thinks I'm making a big mistake by not going to the entire seminar- commenting that I will likely miss out on networking opportunities, face time with higher leadership, etc. The discussion continues, and he comments, "3 out of the 4 women who directly report to me behave just as you're doing, not taking after work hours events seriously...and it is negatively impacting their opportunities for advancement." Side note: he works as an upper-level manager at a major business and typically spends at least 2 evenings/week out of the house attending either work related activities or board of director activities for local non-profits. At this point, I was pretty angry, reminding him that the 3 women in question all have young children (as do we), and I ended the conversation telling him, don't take it for granted that you are able to spend multiple nights/week away from home for various purposes- it's only because I am at home caring for the family that you get this opportunity- these women that you work with that don't make it to all the evening activities- who is caring for their families?- that's why they're not there.

As one may surmise, working at an academic center means that there are frequently lectures, town halls, discussions, seminars, etc to which faculty are invited to attend. Once in a while these sound interesting to me and actually don't conflict with my clinical responsibilities. However, I usually feel stressed when I decide to go as it means either arranging evening childcare or childcare on what would normally be my day off with our nanny (she is great and very flexible but out of respect for her I do my best to minimize requests for super early mornings, evenings, and significant schedule changes to what is truly necessary) or trying to explain the importance of it to my husband so that he will be home at a reasonable time (it is not uncommon that his evening activities come with only a day or two of warning). In the end, I usually just don't go- it's much easier that way. I am long past the "Mommy guilt" that I felt for working at all when my first child was born; I truly love what I do, am proud of my work, feel reasonably respected at work, and feel like I honestly do have a good work-life balance. I am able to make some time for myself without guilt- I go to the gym semi-regularly and spend time with girlfriends about once/month. However, I admit I continue to struggle with guilt in situations such as the one I mentioned.

So, I'm interested in the opinions of others- how much should our attendance be expected at after hours work activities? How much guilt do you feel about going (or not going) to these types of events? Do you even feel like you really have a choice to go given family responsibilities? If you regularly go to these types of events, how do you manage to get there?

Guest post: Oral boards anxiety

Tonight I ran a Google search "thoughts about the oral OB-GYN boards" and your site came up. I read all your comments in the hope I will find some relief of my anxiety. I did not.

You see, I passed my oral OB-GYN boards 6 years ago. I can't remember being this petrified prior to taking them and I felt ok after the examination has ended. Now, it's time for round two: my oral subspecialty Boards. I can't figure out why, but this time around I am mortified. Everything about it, the clinical part - am I thinking like a subspecialist? am I dissecting this disorder process in 10 different way for analysis? The research part (the scariest of all) - am I going to survive the probing questions regarding the study design and power, the statistical significance of my results, is my data "worthy" and my results "meaningful" to their scientific expectations? An then, the genetics - will I remember what findings fit the puzzle of what disorder, how well am I counseling my patients? I wish I could find my answers before I walk into that room to go through it all for yet again, the second longest three hours of my life.

I hope I will survive them next week and not have to repeat this ever. Although I am as prepared for it as much as I will ever be, I still feel "On a wing and a prayer."

Speaking about a prayer, I think I could use one in just a few short days.



A little bio about me:
IronGirl practices Maternal-Fetal Medicine in Midtown America, mother of two beautiful children Jek 13, and Lui 10, wife to Mr. Bold, non-MD guy that likes to play with fire and ice for a living, awesome hubby, caring partner, and multitasked oriented sports-dad.

IronGirl likes to spend her free time (is there any time that's free, hmm...) running, biking, swimming, racing, and sometimes just chilling by a bonfire listening to Flamenco music. And now, getting initiated into blogging.

Guest post: ADHD or ASD?

My oldest child is eight years old. He is funny, super-smart, and charming. He once made up a song about how much he loves me.

He has also recently been diagnosed with ADHD.

You see, ever since he was very young, I knew there was something different about him. I was just finishing my second year of medical school, and he was my first child. But I knew. In infancy, he stared at objects of interest with an intensity of focus that was mesmerizing. When he began to speak, he spoke eloquently (seriously!) and argued his points with logic well before the age of 2. He never joined in group activities, but observed them solemnly and seriously. He slept poorly. He had explosive, long-lasting, inconsolable tantrums about everything from transitions to meals to seams in his socks. He had severe separation anxiety at school drop-off, which lasts to this day. He had (has) exquisite sensory sensitivities. He remains a slave to routine and ritual (and reacts poorly indeed when things change). He can talk for hours about black holes and superheroes. He clearly loves his siblings and his parents, but all interactions must be on his terms.

I thought – I still think – that he has an ASD. Asperger's. It's him to a T.

I could write for pages and pages about my son and his symptoms and his birth and neonatal course and December birthday and GI problems and build my case to you – fellow physicians and mothers – as to why I am so sure that ADHD is the wrong diagnosis. But at the end of the day, in my mind, the letters don't really matter. All I want is someone out there to help us better parent our child. The way he relates with the world is not "neurotypical", that is for certain. But how can I help him, who he is, grow and thrive and make his way in peace and confidence in this world? My husband and I have done a lot which I think has been very good for our son. But we were at an impasse. We took him to the pediatrician because we were looking for help. Guidance.

So now we have this diagnosis. Maybe it is accurate, maybe not. I am truly not writing this as an argument one way or another for his actual diagnosis. The essence of my post relates to my own reaction to hearing the diagnosis. I just thought: no. Not that. NO. I would have accepted "ASD" – I suspected it. I may have accepted some kind of anxiety disorder. Or – no diagnosis! That's just who he is, and here's how we can help you. That would have worked. But ADHD… I absolutely balked. Why?

I feel that in popular media, ASD is portrayed as a diagnosis which is blameless. Autism support groups, parent groups, blogs, articles, and fundraising abound. There are supports for parents, and children can receive evidence-based treatment (at least in my province). We have specific screening tools in Ontario, for use at the 18 month well child visit, specifically to screen for ASD. And don't get me wrong – rightfully so. Early intervention works and should be promoted. Also, I'm NOT saying parents of children with ASD have it easy. Not at all.

Now I contrast with ADHD. I feel that ADHD is portrayed more as blame-able (i.e. on the parents) and less "real." ADHD is often the butt of jokes or widely derided as an "excuse" for poor behaviour. I do not know of any screening for ADHD that is done in routine well-child visits. I do not see articles or blogs about parenting a child with ADHD. I don't hear about ADHD research fundraising activities. I'm not saying they don't exist. But I do not think that they are as "out there" in popular media.

I am not a pediatrician, nor a psychiatrist, but I understand that both ASD and ADHD are considered neurodevelopmental disorders which arise through an interplay between genetics and "environment" (that lovely catchall for everything from prenatal exposure to substance X to pollutants to diet and so on). I do not think the medical community considers one or the other of these diagnoses to be the parents "fault." But I do think, that deep down (and I am ashamed to say this), I am afraid of my son being diagnosed with ADHD. Afraid of the looks. The blame. The rolled eyes. The label. Afraid of the consequences of starting him on medication – or not doing so. Afraid of possible misdiagnosis and its consequences. Afraid of grandparents finding out and having to deal with the inevitable questioning and doubt. Afraid that I will feel less sympathetic, more frustrated, less supported, more alone. Simply afraid.

I know that my child is who he is, despite any diagnosis or lack thereof. I know that one diagnosis is not "better" than any other. Diagnosis won't change who he is. I want to be clear that I am not saying I want or favour a certain diagnosis for my child. Nor am I implying any judgement of any of your children with these diagnoses, or you! Rather, I write to explore my own reaction to this situation, and to consider the reasons behind it, even though in doing so, I seem to have uncovered my own fears and biases.

What do you think of when you meet a child with ADHD? The child might be a patient, a niece or nephew, a classmate or friend of your child. How does that differ from your feelings when you meet a child with ASD? Are you more or less sympathetic? Understanding? Willing to forgive / accept / work with the child's behaviours?

I want to parent my child as best as I can. I want what we all want – I want him to feel loved, confident, and secure. I want him to thrive. I know that the letters won't change who he is. Despite my fears, I also know that the letters won't change who I see, as his mother: a very unique and special child with some incredible talents and some special challenges to work with. The question is: will the letters change what others see?