Summer Vacation Comes to an End

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

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

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

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

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

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

Kicks

clocking

I have never been one to track my periods, but then life happened and now I am tracking them religiously.

I think back to when it all began. I was one of the last of my friends to get my period. Even though my mother had prepared me with books and talks, I still thought death was imminent when it started. So once they occurred regularly, I just went with it. No charting. No tracking.

Fast forward to my mid-twenties as a medical student. My husband and I decided to have a child before starting residency because it seemed like a good plan. Thankfully Little Zo established himself promptly after discontinuing my IUD. 3 weeks after. I had little knowledge of how truly a blessing that was.

And then life happened. The stories of loss and infertility began to trickle in. A cousin whose first child was conceived in our 20s using in vitro fertilization and who is still paying bills for it; she has been trying for years for baby #2. The friend and aunt who have both suffered multiple miscarriages. The friend who experienced a molar pregnancy and had to consider radiation therapy. The best friends who suffered a stillbirth that I wrote about here: http://www.mothersinmedicine.com/2013/07/life-loss-and-celebrations-of-love.html

Once settled into attendingdom, O and I decided to try again in order to give Zo that sibling he sometimes mentioned. I wrote in my post on December 29, 2016 entitled “(all is not) lost” about our miscarriage (http://www.mothersinmedicine.com/2016/12/all-is-not-lost.html). It was devastating.

And now, without even realizing it, I have begun tracking my cycles. 3 after the IUD was removed and then we were pregnant with number 2. And then the miscarriage.

My D&C surgery was in January 2017. And every month thereafter I prayed my cycle would return. Was that pinch the beginnings of my cycle? Was that the beginning of ovulation. 3 months later, my cycle returned. And each month that went by we still weren’t pregnant. And then. Last menstrual period May 17, 2017. We are overwhelmingly happy, frightened, joyful, petrified, and elated. Big brother Zo is happy. Thus begins a new clocking of days, weeks, and trimesters. Second trimester begins this week. So thankful.

You don't need me to go pee and other 4am thoughts

I am at a crossroads with my 5 year old. It’s 4 o’clock in the morning and I have just been woken up from some amazing sleep for the countless time with a scream of “mom, I have to go to the bathroom”. I grumpily yell back “go by yourself” and my husband mumbles “that’s not nice!” and said 5 year old yells at me from the bathroom. I get up and our little tyrant is perched on the toilet going to the bathroom by himself. The bathroom is lightly illuminated with a night light. He pees as I gently say “please stop waking mommy up. I’m very tired and it makes me cranky when you wake me up.” “Cranky?” he says. “Yes, cranky because I’m tired” I say. I tell him he’s a big boy and can go pee by himself. He says “okay” then walks to his room leaving the door cracked. I tell him it’s okay to leave his door cracked and he says “okay”. I lay down in bed, he says “please close the door” I don’t respond, hubby gets up and closes the door. I lay awake in bed recounting all of the things that I am doing wrong with him, the things I am worried about with professional drama, good things that are going on (woo hoo congratulations on the new professional leadership program acceptance!), but sleep eludes me and I am so tired. 

This and worse accounts (one particular evening I had a screaming match with him because I wouldn’t come back and put his covers on him just right) document our nighttime ritual. He sleeps completely through the night less than once a week. He pees on himself at least once a month. Me remaining awake for several hours after being woken up is much more common than me going peacefully back to sleep. My husband is usually not woken up, but when he is he rarely has a problem going back to sleep. 

And I am at a sleeping crossroads. Being woken up for months and months and years and years makes for an unhappy mommy and I can feel the effects of my sleep deprivation. I am cranky when he wakes me up and if the sleep is really good I am downright angry. I know he needs sleep, he goes to bed at 7:30pm and wakes up between 7 and 7:30am. If he goes to sleep after 8pm for more than a few days, things don’t go well for anyone. I on the other hand know I need more sleep, but getting in bed before 9pm is rarely an option, but if I could just sleep uninterrupted it would be so much more restful. Tonight though I was in bed watching TV by 8:30pm. 

I don’t know what to do. It’s 4:10am. My shoulders hurt, it’s cold (autumn in the mid-Atlantic in our 1938-built home mean it’s chilly literally all of the time). I want to be asleep, but I can’t go back to sleep. So here I type after sending my husband a “I can’t do this anymore” email that I’m sure will make for great breakfast conversation and texts back and forth all day. 

I know I have options, but in my 4am research I can find very little about nighttime awakenings. Lots about 5 year olds being scared of the bathroom in general, but nothing specifically about what to do when he wakes you up at night and won't go back to sleep. Should I start sleep training again; this time using the same techniques of slowly responding less to his demands each night (but it takes so long!)? Light his room up with an additional night light to illuminate the dark corners? Make my husband do it alone? Refuse to get up with the tyrant anymore? Ship him in a box to my parents? Put a small potty seat in his room as my girlfriend, also a Pediatrician recommends (this seems so gross to me though and all I can think of is tripping on it and pee flying everywhere)? 

Please help! I’m so over this. It’s now 4:25am and I’m going to see if I’m tired enough to fall back asleep.

How Do You Do It All? (i.e. The Art of Being Imperfectly Perfect)

Genmedmom here. 

Let’s face it: working moms have alot on their plate. A patient recently complained to me how guilty she felt because she couldn’t be a perfect mother, wife, accountant, and friend, all at the same time. If she felt really good and strong in one area, she was slipping in another. “No matter how much I try, I’m a failure!” she declared. 

Okay, look, despite the expectations on us, no one can achieve perfection 100% of the time. No one is going to excel in all of the areas of their life always. But we can manage. We can do our myriad jobs well enough. And we can be happy. 

On a weekly basis, I usually manage: four clinic sessions a week (approximately twenty hours seeing patients), one morning precepting in the firstyear medical students’ interviewing and communications course, co-parenting our two school-aged kids (with lots of family help), regular blogging on three separate blogs, kids’ dinner/ bathtime/ bedtime virtually every night, about three good workouts per week, church and big family dinner on Sundays. 

Is it all done perfectly? Hell, no. I wish I could get to all the patient phone calls, emails and lab results every week. It would be great if I could do the reading before the medical school course. Our kids are late with homework probably at least once per week. We never seem to know what's going on at school until the last minute. My blog posts often have typos, and could have used a little more editing. My workouts are sometimes really short. We don't get to church or have family dinner every Sunday.

But I can say this: We fit in what we need to fit in. We do what we feel needs to be done. It's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

I am often asked “Geez, how do you do it all?” 

Well, if what you're aiming for is happiness rather than perfection, then I’ve thought about this. It will be different for everyone, but generally, I suggest: 

Identify your time-wasters and eliminate them. What time-consuming things in your life do not help you to achieve your goals, and do not serve a healthy purpose? For me, that’s television. I do not watch television unless there is a really good reason. I’ll watch a Disney movie with the kids once in awhile, all snuggled on the couch. And, of course, once a week our whole family watches my husband’s football team play. Other than that? No sitcoms, no news, no movies. Social media can also easily become a time-sucker, so I limit that to my train commute.

Hire cleaners, if you can. Yes, we all know that we are capable of cleaning. But how much is your time worth? You are an M.D., and if you were paid by the hour, you would earn $100, at minimum. Multiply that by a thousand- no, a million- and that’s how much your hour is worth to your kids. Though we couldn’t afford it when we just started out, as soon as we could, we hired a cleaning service. They are worth every penny.

Order anything online that can be ordered online. We have groceries, pet supplies, clothes, shoes, furniture, books, et cetera delivered right to our front door. 

Stay local. Need to run an errand? If possible, avoid driving time, and support local businesses to boot. 

Schedule carefully. There are so many options for kids’ activities around us. It would be very easy to slip into driving-everyone-all-over-the-place-for-this-or-that-thing. We were forced to hold back quite a bit, as our son with autism doesn’t handle a busy schedule very well, and doesn’t do drop-off events at all. So, we have a music teacher who meets them in my mom’s home after school one day. And we choose family activities like hikes, trips to the farmer’s market, and scouting (Boy Scouts), rather than kids-only classes like dance and tae kwon do. We’ve realized that this quieter, easier, more familiar approach results in less hustle and bustle, and doubles as “family time”. 

Identify toxic relationships and avoid them. Okay, I'm wandering into therapeutic territory here, but the truth is, people who make us feel bad are a real drain on our precious time and energy. Conflict and negativity are distracting. We can't be our best selves now if we're re-living an argument or re-thinking that weird conversation from yesterday. If there's a person around who consistently brings conflict and negativity into my day, I avoid them as much as possible. Likewise, if there are good, psychologically solid people who support me and boost my mood, then hey, I want to spend more time with them.

Keep reasonable goals. I’m not striving for crazy achievements in any area. I’d like to take good care of my patients, be a solid teacher for my students, raise emotionally well-adjusted kids, keep on writing until it goes somewhere, stay as healthy as possible, and be actively engaged in our community. Like I said, it's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

What about other mom-docs? How do you "do it all?" What do you do to save time? How do you keep you and your families happy?

Summer Book Recommendations

Ah, summer. There's nothing like the joy of sitting with an iced tea and a book on the deck... or waiting in the dentist's waiting room reading tiny print from a reading app on your phone.

1. Vaccinated by Paul Offit. It was completely fascinating to learn about the early days of immunization. Even if you've learned the science before, reading about the social context is so interesting.

2. Overdiagnosed by H. Gilbert Welch. This book changed the way I look at my practice, every day. Welch is an epidemiologist and explains the principles in a very accessible way.

3. Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters. A must-read, especially if you work in mental health. I see a lot of refugee and newcomer patients, and do some element of cross-cultural mental health most every day. It's challenging because our entire mental health assessment is rooted in the culture in which it was created, and the very definitions of mental illness vary so widely in different contexts.

4. When Breath Becomes Air by Paul Kalanithi. I know you are hearing about it everywhere. It is beautifully written and helped me reflect on medicine in a different way. "But if I did not know what I wanted, I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician's duty is not to stave off death or to return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence."

I was on a female memoir kick last year, and thoroughly enjoyed the following:

5. Julia Child's My Life in France. Transport yourself to France and witness the early days of her love affair with French cuisine.

6. Nora Ephron's books of essays, I Feel Bad About My Neck and I Remember Nothing were, of course, hilarious.

7. Laughing All the Way to the Mosque by Zarqa Nawaz. Zarqa Nawaz is the creator of the TV show Little Mosque on the Prairie. She diverted from her parents' expectation for her of a career in medicine and found her way to journalism and the arts instead. As a fellow Canadian Muslim woman, I loved hearing her always-funny perspective on issues she faced along the way.

8. I Was a Really Good Mom Before I Had Kids by Trisha Ashworth and Amy Nobile. A down-to-earth book about the real issues we face every day as mothers, I found it totally affirming to read.

Fiction:

9. On Beauty by Zadie Smith. "And so it happened again, the daily miracle whereby interiority opens out and brings to bloom the million-petalled flower of being here, in the world, with other people. Neither as hard as she had thought it might be nor as easy as it appeared". Filled with breathtaking passages but also dry humour and wit, On Beauty was captivating.

10. Everybody Has Everything by Katrina Onstad. Following years of infertility, a young professional couple takes guardianship of a young child when their friends suffer a terrible accident. The struggles of being thrust into parenthood of a unique sort; with the same truth that we all live with - the uncertain future.

What books would you recommend?

MIM Intro: Doctor Professor Mom

Hello, I am Doctor Professor Mom.  No, that’s not my real name but it’s a name that makes me really proud.  My oldest son coined it a few months ago when he learned that I am not only a doctor but I am also a professor and I am also a mom.  He seemed genuinely proud when he coined the name and, of course, I was equally proud both at his creativity and at some of my accomplishments.

Even as a Doctor Professor Mom, it’s hard to feel accomplished.  Maybe it’s something about academic medicine where I feel pulled in a million different directions. I teach; I do research; I see patients – it’s easy to feel like a jack of all trades and master of none.  Add on a busy family life and mastery is not in my cards.  But academic medicine has given me incredible flexibility, variety, and satisfaction.  Plus, I get to proudly say I am a doctor and a professor.

Of course my proudest accomplishment is not that I am a doctor or a professor but that I am a mom to three boisterous, energetic, and absolutely wonderful sons.  They are ten, eight, and six (gasp - how did they get so old).  After ten years of motherhood I have a lot to reflect on in managing a household with two equally ambitious working parents and ever changing challenges of parenting. 

I became interested in writing about my experience as a doctor and mother after my first son was born.  I spent 18 months crying every day when I went to work and decided (with the incredible support of my husband) to leave my job and stay home.  Then I struggled trying to find my identity as a stay-at-home mom (I wrote about this experience in an essay called Dr. Mom).  I returned to work and decided to focus on research and a career in academic medicine.  For me, it was an excellent choice.  That being said, the struggles of being a working mom, finding meaning and satisfaction in your work, and all the other challenges of life never go away even when you feel like you’ve found the perfect job.

When I wrote Dr. Mom in 2007, so many women contacted me and thanked me for sharing my story.  I promised myself I would write more, but, not surprisingly, life got busy.  I’m thrilled to have a place to write, to be a part of a community of women in medicine and hope that something I write will resonate with someone else. 

Answer to lingering questions...

I know you always wondered how preceptors graded you on the rotations. And you always wondered why your grade was less than what you thought it should be for the work and energy and time that you put in. Now as an attending I understand - those that clearly like the rotation, get jazzed about it, do the work in a way that you can trust them and not have to repeat the work, or just do it themselves to get it done right - those are the med students that do well during rotations. BUT SO WHAT!! you did everything you needed to do, studied the way you needed to to pass, slugged out a horrible internship year which made you question going into medicine at all. Then you saw the anesthesia light at the end of the tunnel and you're life only continues to get better from there. You chose the ABSOLUTE right profession. Yes, if someone said I could not continue to practice unless I go through med school again - I NEVER would do it. But now being at the other end, I'd NEVER give it up! My advice? If you've started - get through it and enjoy as much as you can without killing yourself... the results are worth it. If you haven't started DON'T unless you're ABSOLUTELY SURE!! And of all the people in my med school class, those that came with kids, those that had them during med school, residency etc, and those that went straight through - we are ALL satisfied about where we ended up!!

WAKE UP CALL

Okay, I'll just come right out and say it: I was T-boned by a bus on Tuesday and have a type III odontoid fracture. I am now in a neck brace for 6 months but lucky to be alive and not paralyzed. I cannot even begin to explain all the thoughts and emotions that one goes through - from the coldly rational (wow, this is what it's like on a backboard, in a collar, in MRI) to the wildly emotional (DAMN DAMN DAMN, there goes the concert I was going to give, there goes the clinical study that was going to make JAMA, there goes the dressage show I'm ready for, and there goes vacation with the kids in the Carribean). But the one thing that is the MOST heartbreaking: not being able to scoop my kids up into a big bear hug.

Trying to be the optimist I'm struggling with what to do with months of non-physicality. Go ahead I think, perfect that Spanish, read all the library books, type up my diaries, catch up on all the movies - but somehow it pales in comparison to the dreams I was already embarking upon and achieving. And although I'll be home (always), I'll see the kids less because I won't be taking them to piano and swim and school and birthday parties like I usually do. But it's early yet - perhaps as a result, the kids and I will have more bonding time with the hubbie and our nuclear and extended family as well as friends may become closer still.

The weirdest thing is (harkening back to psych) that my schema of myself is slow to change. I keep having to remind myself that IF I move my neck the wrong way, or trip and fall, it could be disastrous. But it still doesn't seem real until in moments of sobbing I realize it is. Now excuse me while I go cry.

EXERCISE AT 4AM??

Okay, I think I finally figured it out. Last year I remember talking to a colleague who told me he exercised at 4 in the morning before work. I looked at him like he was crazy. Turns out he wasn't so crazy after all. I discovered if it's something you love to do (dressage horseback riding) AND you don't want to take time away from the kids and the husband, it's a PERFECT time to do it. Not only that but you get there quicker since there's no traffic - and no one is there so you get the whole place to yourself!! It has completely eliminated the guilt I felt when I rode post call because I was either missing picking the kids up from school, or missing eating lunch with my hubbie. Not only that, the post call days weren't even that predictable and progress with riding was haphazard. This way it's 4 days a week guaranteed (Thursday is staff conference at 6:20). PLUS there's the extra added benefit that I come to work completely happy and relaxed, so no matter how bad the day goes I just remember my ride in the morning and I automatically get that meditative wash of "yah, but I got to RIDE this morning!"

kid bodies

I think one of the most amazing things in medicine is having the privilege of seeing ALL of kids' bodies - all of it - inside and outside. I'm always amazed at their little tiny livers, kidneys, wormy moving intestines, beating hearts, and my favorite - those always expanding lungs. So when I go home and I watch my kids play, or snuggle with them I often just look at them in awe and imagine their insides too and how it all incredibly fits together, continues to grow and works! When they're tired or snugly and not running around like madmen, I hold their rib cages in my hands and feel their breathing and beating hearts, and I trace out their internal organs with my fingers for them (of course they like to concentrate on the food in and poop out part). If I think too long on it I almost always feel like squeezing them, crying and thanking the universe that they are healthy and whole and ALIVE.

NOT SO FUNNY MOMDOC

Okay, you guys are all so FUNNY!! I am not. I'm a very serious but very very very happy momdoc. I just wish I could split myself in 7. One for each of two kids, one for hubby, one for violin, one for dressage horseback riding, one for work, and one for friends. Well, and maybe one for fun. Then I could be doc oc!! Instead I intensely devote each waking moment to dividing up what little time there is in a day. The trick I found is being in the moment. When at work enjoy work and forget about home and kids. When with family, forget about work and revel in the family. And the violin and riding - well you have to concentrate only on that to do it - it's my meditation, release, and my source of renewable energy and happiness. The problem I have is how to shift the time - and how to deal with that overriding sense of guilt that the others are not getting enough. So, I tell myself (and it's true), that if I gave up any one of these things I wouldn't be so happy and able to deal with the every day frustrations and problems. But there are ever looming questions: do I take more time to write papers and go for the promotion? Do I forget the promotion and watch everyone else get it but know that I have more time for the other 7 things? Do I do less riding (my only exercise) and spend more time with family but be a lot grumpier? Do I play less violin to have more hubby time and cut myself off from my only social network? I feel like I'm very happy where I'm at right now, but need to decide from here to continue as is, or shift time one way or the 7 others...