Better late than never. Here is my post from topic week on how medicine has changed me...
I've been trying to think of what to write about for this topic week. How has medicine changed me? I found myself at a loss. I have been on this journey for SO LONG. Medicine has grown with me more than changed me. Then I thought to the one singular occurrence in my life that has changed me the most ... hands down motherhood has palpably and incomprehensibly changed me more than I could have ever imagined. As a result, after reflecting on how medicine has changed me I really felt compelled to write about how motherhood has changed my medicine.
Here are my thoughts:
- Motherhood has given me an honest compassion that is different than the compassion I had before. I find it hard to explain, but it is simpler and more organic.
- Motherhood has given me a more zen-like patience with which to approach the craziness and chaos of medicine and residency.
- NICU nurses like moms more than surgery residents ;) I used this to my advantage and as a result, loved taking care of my NICU babies.
- My priorities have shifted. My goals are similar, but now they must fit into a different version of me.
- I can't do it all and I know it. However I will still try.
- I prioritize my time at home and at work with crazy efficiency. I definitely think the constant balancing act has helped me in being a chief.
- I love sharing my life with my daughter, therefore while at work I am even more motivated to make it count for something, to "help people" as she tells me, to heal, to learn, to affect change. She has inspired my medicine in ways that make every struggle of motherhood well worth the gain in every aspect of who I am.
Happy New Year. Here's to motherhood and medicine.
Showing posts with label how has medicine changed me topic week. Show all posts
Showing posts with label how has medicine changed me topic week. Show all posts
Saturday, December 28, 2013
Friday, December 13, 2013
Topic week: How has medicine changed you?
Welcome to MiM Topic Week on our reflections on how our chosen profession has changed us (or not). Throughout the week, we'll feature posts by some of our regular writers and readers on this topic. In the past, we've had topic weeks on everything from work life balance to metablogging (blogging about blogging) to a day in the life. See the sidebar for others.
Scroll down to see the posts. Thanks for reading!
Scroll down to see the posts. Thanks for reading!
For the better and for the worse but mostly for the better
How has medicine changed me? The honest answer is: for the better and for the worse. Let's start with the latter.
Before medicine, I inhabited time slowly. I spent a lot of time writing, a lot of time reading, and a lot of time engaged in no task in particular. I would make a salad with a friend and then eat it with her and then linger over the empty bowl talking about love and then seven hours later get up to make dinner and start over again. Before medicine, stories were as much about the how of the telling as the content. I loved words. I loved spending time with friends. I walked and sometimes even ran. I meditated. My memories from before medicine are of a particular way the light used to fall on the floor in the afternoon, of sitting at the kitchen table in the middle of the night reading a novel and crying at its beauty, of falling in love. Whatever work I was doing at a particular time was not what defined my life. It was never a day off or a day on, it was just a day.
Now I can never seem to have enough time. I am always behind on charts. There are always at least two more patients on the board waiting to see the doctor, both literally and figuratively. I am always aware of time. If I am off, I am aware of the need to take full advantage of that. Am I using my vacation time efficiently enough, I wonder? Am I relaxing enough? When I am on, there is the pressure to see patients faster, discharge them faster, order their antibiotics faster, think faster and talk faster and faster faster faster. When my formal work day is over, then there is the research work, the studying and reading, the charts to finish. I am no longer able to be at peace with time. There are too many people who need too many things! When I listen to a patient tell a story, I am waiting for the details to click into place that will allow me to identify their disease. Though I wish it were otherwise, I am not always really listening as they describe the dinner they were eating the night before the symptoms started. I am typing the things they have already said and waiting for the salient details to arrive: When did the pain start and where? How many times did the child vomit? Oh, a few days of cold symptoms and then barky cough and noisy breathing? Croup! Done! The story can be reduced to a sentence. I used to be a poet, enamored of the space between things, now I am a master of pattern recognition. I used to appreciate good novels, now I appreciate good historians, patients who can recall a sequence of events in roughly chronological order, people who have an innate sense of what is important and what is not.
Now for the better: Before medicine, I was anxious a lot of the time. Scared of public speaking. Scared of illness and death. Scared, ironically enough, of hospitals. I remember as a child seeing an elderly person in a wheelchair at the park vomiting into the bushes and feeling weak with a kind of existential nervousness about what life might bring. I took a long time to make decisions, worrying over the potential consequences of a wrong choice. I didn't like novelty. I didn't like surprises.
Now I can walk into a room with a child who is gasping for breath and it is still very scary, but my adrenaline translates into action. For me, it turns out that the drive to help a person who is suffering is stronger than fear. Medicine has organized me around a purpose, and even when that purpose feels daunting, exhausting, or completely impossible, I just do it. After presenting on rounds hundreds of times and being asked hundreds of questions publicly to which I didn't know the answer, I am able to accept that I am a work in progress. I used to worry what people would think of me if I made a mistake. Now I worry what will happen to patients if I make a mistake, and that change has been profound. I still worry a lot, mostly over the things I did or failed to do for patients, but this kind of worry makes me better at what I do. I am still afraid of illness and death, but I understand in a way I could never have understood before that these things are the way of life. When they find out I am a pediatrician, people often say, "I could never be around sick children. It would make me too sad." And I think to myself, "Someone has to be with those children." Children get sick, children die, and creating distance between ourselves and that reality does not change that reality. Medicine has taught me how to be strong for other people.
Sometimes it is hard to remember, or re-enter, the world of everything else, by which I mean the world in which things are happening that are not related to how the heart and lungs and kidneys are functioning. When I go to a performance or concert now, sometimes I have an intrusive thought about what I would do if the performer collapsed, if they were pulseless and needed compressions, if they had a seizure. In the midst of watching a person accomplish an incredible act of beauty or physical agility or creativity, I find myself mentally reviewing the ACLS guidelines for cardiac arrest or wondering if the venue has an automatic defibrillator and if so, where. I have trouble relaxing out of the life of the body and into the life of the mind. For me, beauty used to be the highest calling. Now I just want to make sure that everyone makes it through the night. I have to fight the impulse to turn to whoever is sitting next to me at the show and whisper something along the lines of, "Don't you realize our bodies could fail at any time?!" Then I have to remind myself that there is more to living than maintaining physiologic homeostasis, even if nothing would be possible without it.
To summarize: I feel less and do more. I spend less time contemplating and more time problem solving. I am both farther away from and closer to life. I miss the person I once was and am proud of the person I am now. Maybe one day, when my own journey in a body is nearing its end, I'll return to the light on the floor in the afternoon and the spaces between things and the lunches that turn into dinners. In the meantime, I am going to work on getting better at taking care of sick children and will probably always be behind on charts and will spend my vacations trying to get as much done as possible with only minimal success.
Before medicine, I inhabited time slowly. I spent a lot of time writing, a lot of time reading, and a lot of time engaged in no task in particular. I would make a salad with a friend and then eat it with her and then linger over the empty bowl talking about love and then seven hours later get up to make dinner and start over again. Before medicine, stories were as much about the how of the telling as the content. I loved words. I loved spending time with friends. I walked and sometimes even ran. I meditated. My memories from before medicine are of a particular way the light used to fall on the floor in the afternoon, of sitting at the kitchen table in the middle of the night reading a novel and crying at its beauty, of falling in love. Whatever work I was doing at a particular time was not what defined my life. It was never a day off or a day on, it was just a day.
Now I can never seem to have enough time. I am always behind on charts. There are always at least two more patients on the board waiting to see the doctor, both literally and figuratively. I am always aware of time. If I am off, I am aware of the need to take full advantage of that. Am I using my vacation time efficiently enough, I wonder? Am I relaxing enough? When I am on, there is the pressure to see patients faster, discharge them faster, order their antibiotics faster, think faster and talk faster and faster faster faster. When my formal work day is over, then there is the research work, the studying and reading, the charts to finish. I am no longer able to be at peace with time. There are too many people who need too many things! When I listen to a patient tell a story, I am waiting for the details to click into place that will allow me to identify their disease. Though I wish it were otherwise, I am not always really listening as they describe the dinner they were eating the night before the symptoms started. I am typing the things they have already said and waiting for the salient details to arrive: When did the pain start and where? How many times did the child vomit? Oh, a few days of cold symptoms and then barky cough and noisy breathing? Croup! Done! The story can be reduced to a sentence. I used to be a poet, enamored of the space between things, now I am a master of pattern recognition. I used to appreciate good novels, now I appreciate good historians, patients who can recall a sequence of events in roughly chronological order, people who have an innate sense of what is important and what is not.
Now for the better: Before medicine, I was anxious a lot of the time. Scared of public speaking. Scared of illness and death. Scared, ironically enough, of hospitals. I remember as a child seeing an elderly person in a wheelchair at the park vomiting into the bushes and feeling weak with a kind of existential nervousness about what life might bring. I took a long time to make decisions, worrying over the potential consequences of a wrong choice. I didn't like novelty. I didn't like surprises.
Now I can walk into a room with a child who is gasping for breath and it is still very scary, but my adrenaline translates into action. For me, it turns out that the drive to help a person who is suffering is stronger than fear. Medicine has organized me around a purpose, and even when that purpose feels daunting, exhausting, or completely impossible, I just do it. After presenting on rounds hundreds of times and being asked hundreds of questions publicly to which I didn't know the answer, I am able to accept that I am a work in progress. I used to worry what people would think of me if I made a mistake. Now I worry what will happen to patients if I make a mistake, and that change has been profound. I still worry a lot, mostly over the things I did or failed to do for patients, but this kind of worry makes me better at what I do. I am still afraid of illness and death, but I understand in a way I could never have understood before that these things are the way of life. When they find out I am a pediatrician, people often say, "I could never be around sick children. It would make me too sad." And I think to myself, "Someone has to be with those children." Children get sick, children die, and creating distance between ourselves and that reality does not change that reality. Medicine has taught me how to be strong for other people.
Sometimes it is hard to remember, or re-enter, the world of everything else, by which I mean the world in which things are happening that are not related to how the heart and lungs and kidneys are functioning. When I go to a performance or concert now, sometimes I have an intrusive thought about what I would do if the performer collapsed, if they were pulseless and needed compressions, if they had a seizure. In the midst of watching a person accomplish an incredible act of beauty or physical agility or creativity, I find myself mentally reviewing the ACLS guidelines for cardiac arrest or wondering if the venue has an automatic defibrillator and if so, where. I have trouble relaxing out of the life of the body and into the life of the mind. For me, beauty used to be the highest calling. Now I just want to make sure that everyone makes it through the night. I have to fight the impulse to turn to whoever is sitting next to me at the show and whisper something along the lines of, "Don't you realize our bodies could fail at any time?!" Then I have to remind myself that there is more to living than maintaining physiologic homeostasis, even if nothing would be possible without it.
To summarize: I feel less and do more. I spend less time contemplating and more time problem solving. I am both farther away from and closer to life. I miss the person I once was and am proud of the person I am now. Maybe one day, when my own journey in a body is nearing its end, I'll return to the light on the floor in the afternoon and the spaces between things and the lunches that turn into dinners. In the meantime, I am going to work on getting better at taking care of sick children and will probably always be behind on charts and will spend my vacations trying to get as much done as possible with only minimal success.
The ways we grow
A patient recently eyed me right before a bedside procedure (I was supervising my residents) and asked with one eyebrow raised, “How long have you been a doctor?”
I thought about it for a couple of seconds, doing the math. “13 years.”
His face registered a small shock. Then, he relaxed a little. “Do you have children?”
“I have three.” His eyes widened, and he smiled.
Thirteen years is a long time; many things have happened to me that undoubtedly have shaped who I’ve become since I graduated medical school. I’ve certainly changed in many ways. Which ways were due to medicine and which were due to plain old maturation? My marriage? Having children? Other life experiences?
Upon reflection, I think medicine is responsible for this: more compassion.
There is a belief that medical training may result in the opposite. That because we see so much death and suffering, we have to harden a little to get through it all and come out emotionally unscathed. I certainly don’t think that’s universal and likely some of those observations arise from the development of burnout, the dampening of resilience.
As a hospitalist, I witness suffering from illness regularly. I am, not too rarely, the bearer of bad news – the cancer we found, the poor prognosis, the decline in function that is unlikely to be gained. I see people at angry, vulnerable, hurting points in their lives. I’ve seen illness stem from poor choices. But just as often, I’ve seen illness strike with absolutely no provocation, turning someone’s life into a nightmare overnight.
Being a doctor has not made me numb to the suffering of others, despite sometimes feeling surrounded by it. On the contrary, it has made me more acutely away of what makes us human and connected. I think this has altered my approach to the universe. Probably, choosing to work in the veterans health system has something to do with that. I’m driven more by service now than when I was younger. I did community service in college, more because I felt I had to rather than because I wanted to. I do it now because it fills a need to serve and sustain.
The man who cleans my office is my favorite person at work. He is a wonderful soul, kind, generous and thoughtful. One day, after reading a column I wrote about emergency research done without consent, he said to me, “KC, I have observed that you have a deep, abiding compassion for those without a voice.”
I didn't know what to say.
Is that me? That wasn’t me before medical school, but if it is me now then I am grateful that becoming a doctor has made me so.
I thought about it for a couple of seconds, doing the math. “13 years.”
His face registered a small shock. Then, he relaxed a little. “Do you have children?”
“I have three.” His eyes widened, and he smiled.
Thirteen years is a long time; many things have happened to me that undoubtedly have shaped who I’ve become since I graduated medical school. I’ve certainly changed in many ways. Which ways were due to medicine and which were due to plain old maturation? My marriage? Having children? Other life experiences?
Upon reflection, I think medicine is responsible for this: more compassion.
There is a belief that medical training may result in the opposite. That because we see so much death and suffering, we have to harden a little to get through it all and come out emotionally unscathed. I certainly don’t think that’s universal and likely some of those observations arise from the development of burnout, the dampening of resilience.
As a hospitalist, I witness suffering from illness regularly. I am, not too rarely, the bearer of bad news – the cancer we found, the poor prognosis, the decline in function that is unlikely to be gained. I see people at angry, vulnerable, hurting points in their lives. I’ve seen illness stem from poor choices. But just as often, I’ve seen illness strike with absolutely no provocation, turning someone’s life into a nightmare overnight.
Being a doctor has not made me numb to the suffering of others, despite sometimes feeling surrounded by it. On the contrary, it has made me more acutely away of what makes us human and connected. I think this has altered my approach to the universe. Probably, choosing to work in the veterans health system has something to do with that. I’m driven more by service now than when I was younger. I did community service in college, more because I felt I had to rather than because I wanted to. I do it now because it fills a need to serve and sustain.
The man who cleans my office is my favorite person at work. He is a wonderful soul, kind, generous and thoughtful. One day, after reading a column I wrote about emergency research done without consent, he said to me, “KC, I have observed that you have a deep, abiding compassion for those without a voice.”
I didn't know what to say.
Is that me? That wasn’t me before medical school, but if it is me now then I am grateful that becoming a doctor has made me so.
Thursday, December 12, 2013
Guest post: How Medicine’s Changed Me – the Good and the Bad
After 11 years of training and going on five years of practice, there is no question that medicine has changed me in numerous ways. Some definitely for the good. Some for the not-so-good. On good days, I’m more optimistic and have a deeper faith in humanity as a result of my practice. As a pediatrician, I see patients who are often funny, are so incredibly resilient and have lives full of possibility ahead of them. I have seen and participated in miracles. I have witnessed deep compassion and graciousness, in both my coworkers and the families we serve. I have seen others make sacrifices to do their best for our patients and their families. My practice is frequently deeply rewarding.
But my practice can also be incredibly difficult. As a pediatric emergency medicine physician, I bear frequent witness to the senselessness of tragedy. I have struggled to save a life and failed. More than once. I deliver news of devastating new diagnoses - the brain tumor, leukemia, intracranial bleeds. I have been yelled at, cursed at. It is a rare shift that I don’t see a child for suspected or known abuse. I care for families who are at the end of their rope, trapped in generational cycles of poverty and violence. I see children whose physical symptoms are the result of anxiety, fear and toxic stress. At times, I feel my patients are trapped, that their lives are not filled with possibility. Currently, it is the changes brought about by this aspect of my practice that I struggle with.
I know that I’m not the same person now that I was when I slipped into my first white coat. I’m not even the same person I was when I finished my fellowship not quite five years ago. There are days when I struggle to be compassionate and gracious to my patients, their families, my coworkers and myself. Days when I feel unable to tolerate complexity. Days when I don’t tolerate the chaos of my home as well, when I feel unable to be fully present with my husband and children. There are cases that haunt me, that I feel will always haunt me. This problem goes by many names - compassion fatigue, vicarious trauma, secondary traumatic stress. Some say it is burnout; some say it contributes to burnout. Define it how you will, it is real and it is common.
There is a growing movement in the medical community to combat this dark side of our vocation. The hospital at which I work recently started a program for staff well-being that includes mindfulness seminars and meditation sessions. Even though I am in the beginning stages of a practice of mindfulness, it’s already helping me deal with this dark side of medicine. This new awareness, this mindfulness, is another way that medicine is changing me. Out of necessity, yes, to enable me to deal with some not-so-good ways that I have been changed by carrying out this calling to bear witness and to enable healing. But ultimately, learning ways in which to combat these not-so-good changes that often accompany a life in medicine will result in another good change - the ability to be more present at work and home, to live more fully and to care more compassionately. And to retain my sense of gratefulness for this vocation that I am, when it comes down to it, oh-so-thankful to be pursuing.
Kim
But my practice can also be incredibly difficult. As a pediatric emergency medicine physician, I bear frequent witness to the senselessness of tragedy. I have struggled to save a life and failed. More than once. I deliver news of devastating new diagnoses - the brain tumor, leukemia, intracranial bleeds. I have been yelled at, cursed at. It is a rare shift that I don’t see a child for suspected or known abuse. I care for families who are at the end of their rope, trapped in generational cycles of poverty and violence. I see children whose physical symptoms are the result of anxiety, fear and toxic stress. At times, I feel my patients are trapped, that their lives are not filled with possibility. Currently, it is the changes brought about by this aspect of my practice that I struggle with.
I know that I’m not the same person now that I was when I slipped into my first white coat. I’m not even the same person I was when I finished my fellowship not quite five years ago. There are days when I struggle to be compassionate and gracious to my patients, their families, my coworkers and myself. Days when I feel unable to tolerate complexity. Days when I don’t tolerate the chaos of my home as well, when I feel unable to be fully present with my husband and children. There are cases that haunt me, that I feel will always haunt me. This problem goes by many names - compassion fatigue, vicarious trauma, secondary traumatic stress. Some say it is burnout; some say it contributes to burnout. Define it how you will, it is real and it is common.
There is a growing movement in the medical community to combat this dark side of our vocation. The hospital at which I work recently started a program for staff well-being that includes mindfulness seminars and meditation sessions. Even though I am in the beginning stages of a practice of mindfulness, it’s already helping me deal with this dark side of medicine. This new awareness, this mindfulness, is another way that medicine is changing me. Out of necessity, yes, to enable me to deal with some not-so-good ways that I have been changed by carrying out this calling to bear witness and to enable healing. But ultimately, learning ways in which to combat these not-so-good changes that often accompany a life in medicine will result in another good change - the ability to be more present at work and home, to live more fully and to care more compassionately. And to retain my sense of gratefulness for this vocation that I am, when it comes down to it, oh-so-thankful to be pursuing.
Kim
5 Ways Medicine Changed Me
I like lists so let's go for it:
1. I'm more outgoing
Except in certain fields (rads, path), you just can't be as good a doctor if you're not at least somewhat outgoing. I think introverted doctors come off as cold or aloof.
2. Sleeping with a pager wrecked my sleep
I used to be able to sleep through my husband snoring. Now I can't.
3. I'm a much bigger hypochondriac
I really wish I didn't know the worst possible case scenario for every illness.
4. I'm more humble
Because I know that there's no way I can know it all.
5. I've gone from being incredibly squeamish to feeling like there's nothing so bloody or disgusting that I have to look away
Well, except maybe in the movies.
1. I'm more outgoing
Except in certain fields (rads, path), you just can't be as good a doctor if you're not at least somewhat outgoing. I think introverted doctors come off as cold or aloof.
2. Sleeping with a pager wrecked my sleep
I used to be able to sleep through my husband snoring. Now I can't.
3. I'm a much bigger hypochondriac
I really wish I didn't know the worst possible case scenario for every illness.
4. I'm more humble
Because I know that there's no way I can know it all.
5. I've gone from being incredibly squeamish to feeling like there's nothing so bloody or disgusting that I have to look away
Well, except maybe in the movies.
Wednesday, December 11, 2013
A Different Perspective
The title for this topic week is change; specifically how becoming a doctor alters one's life. There is no question of change, only how. For me, the most profound change is the perspective I have gained from training and experience, which has been both comforting and distressing. The ultimate goal is to find a balance in the enjoyment of what you do despite the inside look at inherent system and personal flaws that are revealed on that long journey.
As a pathologist in a large group practice, I work intimately with my co-workers sharing tough cases. As a fresh trainee I had a lot more defenses built up about showing a "stupid" consult. Over time, as I have become more comfortable and developed relationships with my partners, it has become easier. Some cases are diagnostically challenging, and just as a clinician doesn't always nail the patient's disease with the first test they order, a first glance at the tissue doesn't always provide clarity into the disease process. Even though we are all trained to render similar services, we each have our strengths and weaknesses based on training level and personality types, and I am thankful that I do not practice solo because we are so much better as a team. And I don't mean just us pathologists - I am also thankful that I can open the EMR and get input from radiology, pulmonology, oncology, and all the clinicians or just pick up the phone. Communication often makes a difficult case crystal clear.
Numerous recent articles are highlighting the drawbacks of our medical system, and having inside perspective makes a lot of it ring true. "You're Getting Too Much Healthcare" by Jamie Santa Cruz was published in The Atlantic this week and Elizabeth Rosenthal is doing an illuminating series in the New York Times I have been following called "Paying Till It Hurts." Sure, every system has its positives and negatives, but it's easy to become disillusioned when you get first hand experience navigating the real world and jumping through all the hoops that seem distant from your idealistic image of yourself as a pure patient advocate. One of the most challenging things I work on is finding value and purpose in the many things I do that help the patient, and not getting too frustrated over the more mundane and nonsensical aspects of medicine that I witness - many of which appear business driven. Having a rich life outside of work with children, family, relationship, friends, exercise, etc. - all of that helps round out the negatives. An alternative would be to bail on the system - something I have witnessed a handful or so of my classmates do over the last ten plus years since I have graduated. They have found happy and fulfilling lives outside of medicine. I don't think there is a wrong choice; everyone has their own path to follow. Mine is certainly in constant evolution.
Up to this point in my journey, I have shed a lot of the insecurities of youth but gained insecurities of experience; the latter being much more tolerable and rationally tackled through knowledge and resources. I have been elated by success and ravaged by missteps. I have been buoyed by support from this community of women and also retreated from it to nurture myself and my kids. Change is inevitable when you choose this road. Although some of it feels reactionary, which can yield cynicism and doubt, the most important changes are those gained from knowledge and experience - lifelong processes - the kind of glacial change that affects your core being. This kind of change brings a sense of control, purpose, maturity, and peace into your daily challenges and decision making, both inside and outside of the hospital.
As a pathologist in a large group practice, I work intimately with my co-workers sharing tough cases. As a fresh trainee I had a lot more defenses built up about showing a "stupid" consult. Over time, as I have become more comfortable and developed relationships with my partners, it has become easier. Some cases are diagnostically challenging, and just as a clinician doesn't always nail the patient's disease with the first test they order, a first glance at the tissue doesn't always provide clarity into the disease process. Even though we are all trained to render similar services, we each have our strengths and weaknesses based on training level and personality types, and I am thankful that I do not practice solo because we are so much better as a team. And I don't mean just us pathologists - I am also thankful that I can open the EMR and get input from radiology, pulmonology, oncology, and all the clinicians or just pick up the phone. Communication often makes a difficult case crystal clear.
Numerous recent articles are highlighting the drawbacks of our medical system, and having inside perspective makes a lot of it ring true. "You're Getting Too Much Healthcare" by Jamie Santa Cruz was published in The Atlantic this week and Elizabeth Rosenthal is doing an illuminating series in the New York Times I have been following called "Paying Till It Hurts." Sure, every system has its positives and negatives, but it's easy to become disillusioned when you get first hand experience navigating the real world and jumping through all the hoops that seem distant from your idealistic image of yourself as a pure patient advocate. One of the most challenging things I work on is finding value and purpose in the many things I do that help the patient, and not getting too frustrated over the more mundane and nonsensical aspects of medicine that I witness - many of which appear business driven. Having a rich life outside of work with children, family, relationship, friends, exercise, etc. - all of that helps round out the negatives. An alternative would be to bail on the system - something I have witnessed a handful or so of my classmates do over the last ten plus years since I have graduated. They have found happy and fulfilling lives outside of medicine. I don't think there is a wrong choice; everyone has their own path to follow. Mine is certainly in constant evolution.
Up to this point in my journey, I have shed a lot of the insecurities of youth but gained insecurities of experience; the latter being much more tolerable and rationally tackled through knowledge and resources. I have been elated by success and ravaged by missteps. I have been buoyed by support from this community of women and also retreated from it to nurture myself and my kids. Change is inevitable when you choose this road. Although some of it feels reactionary, which can yield cynicism and doubt, the most important changes are those gained from knowledge and experience - lifelong processes - the kind of glacial change that affects your core being. This kind of change brings a sense of control, purpose, maturity, and peace into your daily challenges and decision making, both inside and outside of the hospital.
as an extrovert without good answers
Though I am loath to admit it, I am, by nature, an introvert. And despite the recent torrent of articles espousing the benefits of being an introvert (also see here, here, and here with funny retort here), it's the part of my personality I like the least. I wish I was better at small talk, better at making friends, more relaxed in a crowd, not so ready to leave a party, and not so frequently told to "smile".
Medicine made me into an extrovert. Or maybe an introvert who can affect the persona of an extrovert with an enthusiasm that actually is genuine. I do smile, a lot actually, and frequently when I don't feel like it. In my white coat I am animated and chatty and quick to introduce myself. Perhaps not surprisingly, I like myself as the extrovert - it's like pretending to be the cool kid I never was. And, again painful to admit, I think patients also prefer Extrovert Me.
On a less frivolous note, I was very much looking forward to this Topic Week, and so am now surprised by how difficult I've found writing on the subject matter. It's hard to collect all the ways medicine, with its messy contacts and daily pressures, changes its practitioners, then analyze and distill that change into a theme confinable to a blog post. I think, after many hours staring at my computer screen, that I can't be complete in the assessment. I will have to focus my thoughts more than I'd planned.
Please excuse the generalization, but I think oncology, perhaps more than primary care and medicine subspecialties, treats patients whose disease cannot be clearly linked to poor lifestyle choices. Yes there are associations between obesity and breast cancer, smoking and (amongst others) cancers of the head and neck, lung, and bladder, and the various HPV-associated malignancies, but the majority of patients had no reason to think they were at risk for cancer. In plain terms, they never saw it coming. These patients, and particularly the young ones, will spend a significant portion of our initial visit asking and re-asking the question "how did this happen?", for which an abbreviated synopsis of cancer genomics is often emotionally unsatisfactory and scientifically insufficient.
I am just beginning to understand how frequently life lacks good answers to some very good questions. Terrible things happen to people undeserving of an early death or a near lifetime without their spouse. We do not all get what's coming to us.
I used the fumble the question "Do you like what you do?" because, although the answer is yes, there are times when it's truly horrible. I can't cure a substantial number of people who walk through the door and my job can involve making people understand something they don't want to understand. But there is meaning to what I do, there is meaning to palliation and prolongation of life, even when the situation itself seems meaningless. Medicine has taught me to find meaning where it isn't apparent and, in doing so, helped me to enjoy this short life that happens to us all.
Tuesday, December 10, 2013
How medicine changed me during the snow and ice
I am in medicine, where I must get out of bed and leave home on a “snow day” after arranging care for
my own kids, to de-ice my car, commute through snow, sleet, and freezing
rain, so that I can be available in person for my patients. Before medicine, I would have probably lounged around, woken up late, and
perhaps taken a walk just to enjoy the snow.
As a medical professional, I have responsibilities rain or shine. Just like a post officer, "neither snow, nor rain, nor heat, nor gloom of night stays these couriers [read: medical professionals] from the swift [read: caring and comprehensive] completion of their appointed rounds." The mother portion of me as a mother in medicine feels particularly bad leaving my family on a snow day. The medicine portion of me as a mother in medicine feels good, to be in a service profession, indeed.
(And maybe we'll get out early, in time for some twilight sledding.)
As a medical professional, I have responsibilities rain or shine. Just like a post officer, "neither snow, nor rain, nor heat, nor gloom of night stays these couriers [read: medical professionals] from the swift [read: caring and comprehensive] completion of their appointed rounds." The mother portion of me as a mother in medicine feels particularly bad leaving my family on a snow day. The medicine portion of me as a mother in medicine feels good, to be in a service profession, indeed.
(And maybe we'll get out early, in time for some twilight sledding.)
Medicine Made Me the Person I Am
As someone who went directly from college to medical school, I have spent most of my life in medicine. Medical training morphed all the areas of my life. I have no idea what I would be like if I wasn't a doctor, but I know medicine has made me a stronger, more appreciative person.
Medicine made me stronger. Its 3 a.m. and the baby's heart beat drops into the 60's. It's my patient's third baby. I check her cervix and she's a good 8 cm. The nurses and I give her oxygen and change her position but nothing helps. As the bradycardia approaches 5 minutes the tension in the room begins to rise. I am the doctor. Likely the only one at the hospital, at this hour. It's a tough decision, but this is my call. My pulse starts to rise, but I take a deep breath to calm myself down. I'm bone tired, but that really doesn't matter because I've done this so many times; I know I am strong enough to push through the fatigue, the stress and pressure. I have to be. This team needs be to be a calm, confident leader. As the bradycardia passes 10 minutes, I communicate the seriousness of the situation to the patient but not try not to scare her. We must proceed with an emergency C-section. A chaotic symphony of orders, instruments and bed pushing ensues. A healthy baby is born moments later.
Moments like these have given me some wrinkles and grey hair over the years, but have also given me nerves of steel.
After surviving residency, two kids and private OB practice not too much scares me. I know that I can tackle most any challenge whether emergency surgery, bodily fluids or board meetings. I am afraid at times, but neither fatigue nor feces make me flinch.
Medicine taught me to appreciate the little things. Life contains so much sadness; too much cancer, drugs abuse and loss. Beauty and miracles abound, but around the next corner you find stupidly ridiculous tragedies. Life in medicine becomes a daily decision not to become jaded. I'm stronger and little rougher around the edges but I refuse to be jaded.
One small way I do this is to purposefully enjoy the happy moments of my day. When I deliver a baby, assuming mom and baby are happy and healthy, I take a moment to soak in the moment. I simply observe the mother's face light up as I place her baby in her arms for the first time. I watch the expressions of astonished love and the happy tears rolling down dad's face. I remind myself that THIS IS WHY I do it. All the late nights,emergency c-section and all the sadness ARE worth it. I get to make a difference in this family's life. I get to play a small but integral part in helping make their family.
This goes to my home as well. I appreciate my own children's health. The little moments of hugs, giggles and homemade cookies are stored away in my memory for safe keeping. Many bedtime stories are missed but the ones I'm there for are cherished.
Medicine made me a scientist. Medicine teaches you to reason. I look to randomized controlled studies to help make decisions for my patients. I follow the standard of care for my specialty. I know my strengths and limitations. I find these principles spilling over into other areas of my life as well. I have consumer reports and google ratings to help decide on appliances or any other purchase. I rarely make a decision without research to back it up. If only there was a published standard of care for parenting toddlers.
As a premed college student, I was nearly bursting with enthusiasm over my chosen profession. I could rarely wait for the point in an introduction when I would get to declare my plans to "be a doctor." But medicine is more than a profession, it's really become a large part of who I am. Medicine has made me a stronger, smarter, better person and I'm thankful for the privilege of being a physician.
Medicine made me stronger. Its 3 a.m. and the baby's heart beat drops into the 60's. It's my patient's third baby. I check her cervix and she's a good 8 cm. The nurses and I give her oxygen and change her position but nothing helps. As the bradycardia approaches 5 minutes the tension in the room begins to rise. I am the doctor. Likely the only one at the hospital, at this hour. It's a tough decision, but this is my call. My pulse starts to rise, but I take a deep breath to calm myself down. I'm bone tired, but that really doesn't matter because I've done this so many times; I know I am strong enough to push through the fatigue, the stress and pressure. I have to be. This team needs be to be a calm, confident leader. As the bradycardia passes 10 minutes, I communicate the seriousness of the situation to the patient but not try not to scare her. We must proceed with an emergency C-section. A chaotic symphony of orders, instruments and bed pushing ensues. A healthy baby is born moments later.
Moments like these have given me some wrinkles and grey hair over the years, but have also given me nerves of steel.
After surviving residency, two kids and private OB practice not too much scares me. I know that I can tackle most any challenge whether emergency surgery, bodily fluids or board meetings. I am afraid at times, but neither fatigue nor feces make me flinch.
Medicine taught me to appreciate the little things. Life contains so much sadness; too much cancer, drugs abuse and loss. Beauty and miracles abound, but around the next corner you find stupidly ridiculous tragedies. Life in medicine becomes a daily decision not to become jaded. I'm stronger and little rougher around the edges but I refuse to be jaded.
One small way I do this is to purposefully enjoy the happy moments of my day. When I deliver a baby, assuming mom and baby are happy and healthy, I take a moment to soak in the moment. I simply observe the mother's face light up as I place her baby in her arms for the first time. I watch the expressions of astonished love and the happy tears rolling down dad's face. I remind myself that THIS IS WHY I do it. All the late nights,emergency c-section and all the sadness ARE worth it. I get to make a difference in this family's life. I get to play a small but integral part in helping make their family.
This goes to my home as well. I appreciate my own children's health. The little moments of hugs, giggles and homemade cookies are stored away in my memory for safe keeping. Many bedtime stories are missed but the ones I'm there for are cherished.
Medicine made me a scientist. Medicine teaches you to reason. I look to randomized controlled studies to help make decisions for my patients. I follow the standard of care for my specialty. I know my strengths and limitations. I find these principles spilling over into other areas of my life as well. I have consumer reports and google ratings to help decide on appliances or any other purchase. I rarely make a decision without research to back it up. If only there was a published standard of care for parenting toddlers.
As a premed college student, I was nearly bursting with enthusiasm over my chosen profession. I could rarely wait for the point in an introduction when I would get to declare my plans to "be a doctor." But medicine is more than a profession, it's really become a large part of who I am. Medicine has made me a stronger, smarter, better person and I'm thankful for the privilege of being a physician.
Guest post: How has medicine changed me
Since the age of 22 I have been entrenched in medicine-went right from college to medical school and residency. The formative years of my 20s have been busy dissecting bodies, studying dense medical textbooks, giving case presentations, rounding, taking call, eating bad cafeteria food, searching Up To Date, and learning how to adapt to different classes/teams/attendings/colleagues every month. I also took A LOT of tests. Looking back now 4 years post-residency, I am simply not sure how I did it!
Medicine has changed me in ways that could be viewed as “good” and “bad.” Medicine has given me more empathy; it has showed me the importance of compassion and hope; it has made me a better listener; it has given me confidence and the strength to be vocal; it has given me a career to be proud of. Medicine has also given me my husband! (We met, married, and couples matched in medical school.) It has shown me the value of wonderful friends and family, which many people do not have. It is a privilege to help people in their times of need and share intimate details of their lives. I trained in emergency medicine and have a valuable breadth of medical knowledge from excellent training. The knowledge helps me daily both on the job and off.
On the flip side, medicine has changed me in some negative ways. I am more judgmental-there is a need for quick (instantaneous) decisions when talking to a patient in the ER. I am cynical-while practicing medicine is considered a privilege, it is also a burden, and we usually see people at their worst. I take frustration out on my family because I know they will always be there (I hope). Medicine has been consuming and I have missed out on a lot of experiences….like family birthdays, funerals, weddings, parties, leisure, travel, holidays, and such. These missed experiences have caused me to be resentful and bitter at times.
I am not sure about you, but I feel like one of the most important things medicine has done is make me a better mom! I have 2 young kids and am grateful everyday for my medical knowledge. I know how to observe, study and treat my kids. I also know where to look for the answers I need for them. This medical knowledge helped immeasurably with my son’s near-death from kidney failure when he was 2 weeks old and all the subsequent care he has needed. Some mommy physicians complain that they “just know too much”....but I would never trade in that knowledge for ignorance.
No field or career can only have positive impacts on a person, and overall, I am proud and grateful to be a physician. Being a ‘mommy’ physician is an even bigger badge of honor in my mind. There have been a lot of challenges/walls/ceilings to break through….and a huge inner struggle to conquer the mommy guilt and “just keep swimming….” (Thanks, Dory.) Time out of training has brought more clarity with this issue and the compromises needed to make work and life, work. I wish all of you luck with making medicine work, as well.
AW
Medicine has changed me in ways that could be viewed as “good” and “bad.” Medicine has given me more empathy; it has showed me the importance of compassion and hope; it has made me a better listener; it has given me confidence and the strength to be vocal; it has given me a career to be proud of. Medicine has also given me my husband! (We met, married, and couples matched in medical school.) It has shown me the value of wonderful friends and family, which many people do not have. It is a privilege to help people in their times of need and share intimate details of their lives. I trained in emergency medicine and have a valuable breadth of medical knowledge from excellent training. The knowledge helps me daily both on the job and off.
On the flip side, medicine has changed me in some negative ways. I am more judgmental-there is a need for quick (instantaneous) decisions when talking to a patient in the ER. I am cynical-while practicing medicine is considered a privilege, it is also a burden, and we usually see people at their worst. I take frustration out on my family because I know they will always be there (I hope). Medicine has been consuming and I have missed out on a lot of experiences….like family birthdays, funerals, weddings, parties, leisure, travel, holidays, and such. These missed experiences have caused me to be resentful and bitter at times.
I am not sure about you, but I feel like one of the most important things medicine has done is make me a better mom! I have 2 young kids and am grateful everyday for my medical knowledge. I know how to observe, study and treat my kids. I also know where to look for the answers I need for them. This medical knowledge helped immeasurably with my son’s near-death from kidney failure when he was 2 weeks old and all the subsequent care he has needed. Some mommy physicians complain that they “just know too much”....but I would never trade in that knowledge for ignorance.
No field or career can only have positive impacts on a person, and overall, I am proud and grateful to be a physician. Being a ‘mommy’ physician is an even bigger badge of honor in my mind. There have been a lot of challenges/walls/ceilings to break through….and a huge inner struggle to conquer the mommy guilt and “just keep swimming….” (Thanks, Dory.) Time out of training has brought more clarity with this issue and the compromises needed to make work and life, work. I wish all of you luck with making medicine work, as well.
AW
Monday, December 9, 2013
How Has Medicine Changed Me?
KC suggested this topic, and I have had to think and think about it. How HAS medicine changed me?
As an uber-idealistic practically socialist gunner med student, I had a vision of myself in the future as a doctor completely devoted to the poor and disenfranchised of the world. I was going to work for Doctors Without Borders or something like that. I was going to deliver skilled medical care with aplomb, to the suffering and forgotten. My vision was pretty vague, but definitely included basic field hospitals, palm trees and grateful patients.
I held onto this vision well into residency, shrugging off questions about how I would finance my dream, seeing as I paid for med school with loans, and would end up about $120,000 in the hole, before interest.I shrugged off those questions, figuring where there was a will, there was a way. I did every international elective I could. I ended up in crazy places (and I have many crazy stories) from Guatemala, Nicaragua, Peru, Ecuador, Sri Lanka...
As the end of residency approached, along with those ever-increasing loan statements, I started looking for a job in my dream field, which was, in my head, basically "International Health". Of course most medical jobs in this area don't pay much; and though many allow loan payback deferment, the interest still mounts... I considered going for an infectious diseases fellowship, but I had signed on for Primary Care loans, and would take a penalty if I broke my commitment to primary care.
I tried some things; I did work in HIV research and thought about pushing that work into something more... international. I struggled. I got kind of depressed, trying to reconcile my vision with the reality of life, and finances.
But then, something else was happening. I was in my mid-thirties, and I was starting to have other visions... Visions of family. Of settling down, raising kids, of community, of stability.
There was a transition, a positive one, and I ended up here, in a very nice suburban home, with my wonderful rock-stable husband and two healthy kids, working in a small practice at a respected academic institution, providing primary care to decidedly American patients. I'm really very happy.
A lovely patient of mine, someone who has faced many medical adversities, told me once that "it's the kindness of caregivers that gives a person courage." I do try to remember that, even when faced with an angry patient... Be kind. It matters, whether it's with first-world or third-world patients.
So, I try to be kind. And it's all good. What's so funny is that I feel like I'm a nicer person now than I was when I was supposedly devoted to saving the world...I seriously think that's how medicine has changed me. It's made me a nicer person, though not in the way I anticipated it would.
As an uber-idealistic practically socialist gunner med student, I had a vision of myself in the future as a doctor completely devoted to the poor and disenfranchised of the world. I was going to work for Doctors Without Borders or something like that. I was going to deliver skilled medical care with aplomb, to the suffering and forgotten. My vision was pretty vague, but definitely included basic field hospitals, palm trees and grateful patients.
I held onto this vision well into residency, shrugging off questions about how I would finance my dream, seeing as I paid for med school with loans, and would end up about $120,000 in the hole, before interest.I shrugged off those questions, figuring where there was a will, there was a way. I did every international elective I could. I ended up in crazy places (and I have many crazy stories) from Guatemala, Nicaragua, Peru, Ecuador, Sri Lanka...
As the end of residency approached, along with those ever-increasing loan statements, I started looking for a job in my dream field, which was, in my head, basically "International Health". Of course most medical jobs in this area don't pay much; and though many allow loan payback deferment, the interest still mounts... I considered going for an infectious diseases fellowship, but I had signed on for Primary Care loans, and would take a penalty if I broke my commitment to primary care.
I tried some things; I did work in HIV research and thought about pushing that work into something more... international. I struggled. I got kind of depressed, trying to reconcile my vision with the reality of life, and finances.
But then, something else was happening. I was in my mid-thirties, and I was starting to have other visions... Visions of family. Of settling down, raising kids, of community, of stability.
There was a transition, a positive one, and I ended up here, in a very nice suburban home, with my wonderful rock-stable husband and two healthy kids, working in a small practice at a respected academic institution, providing primary care to decidedly American patients. I'm really very happy.
A lovely patient of mine, someone who has faced many medical adversities, told me once that "it's the kindness of caregivers that gives a person courage." I do try to remember that, even when faced with an angry patient... Be kind. It matters, whether it's with first-world or third-world patients.
So, I try to be kind. And it's all good. What's so funny is that I feel like I'm a nicer person now than I was when I was supposedly devoted to saving the world...I seriously think that's how medicine has changed me. It's made me a nicer person, though not in the way I anticipated it would.
Friday, November 22, 2013
Next MiM topic week: How has medicine changed you?
Our next MiM topic week will take place the week of December 9. The topic: How has medicine changed you? Not medicine as in drugs, but medicine as in Our Chosen Profession. During the week, we'll feature posts written by our writers and hopefully you, on the process of becoming a doctor and how we feel that has changed us (if at all). We're excited about this one and hope you'll join in on the fun and reflection by submitting a guest post. If you'd like your piece to be included, please send it as a Word document to mothersinmedicine(at)gmail.com by Sunday, December 8.
As always, thank you for reading and for being part of this community.
As always, thank you for reading and for being part of this community.
Thursday, August 21, 2008
Backfired
Years ago, I heard my sister tell her then 2-year-old son that she was 'so excited' to go to work. I questioned her motive behind that statement, as I knew she would rather spend time with him.
"I don't want him to think I would ever leave him to do something I don't like," she said. "If he believes I love going to the hospital, it won't hurt him as much when I walk out the door."
Now that I, too, am a mother, I see the logic in her little white lie.
A few days ago, Son was quite upset when I left him at preschool to go across the street to my own hospital. I stooped down so I was at his level and explained to him that going to work was fun for mommy, that sometimes I need to have fun like he needs to have fun.
Today, we are staying home. I told Son our plan to meet our friends (a nurse I work with and her son, who is in Son's preschool class) for a picnic in the park. I suggested it would be fun for us both.
"No, Mama," he said sternly. "You go to work to have fun," he explained. "The park is not fun for you."
Sigh.
I guess I need to rethink that line.
"I don't want him to think I would ever leave him to do something I don't like," she said. "If he believes I love going to the hospital, it won't hurt him as much when I walk out the door."
Now that I, too, am a mother, I see the logic in her little white lie.
A few days ago, Son was quite upset when I left him at preschool to go across the street to my own hospital. I stooped down so I was at his level and explained to him that going to work was fun for mommy, that sometimes I need to have fun like he needs to have fun.
Today, we are staying home. I told Son our plan to meet our friends (a nurse I work with and her son, who is in Son's preschool class) for a picnic in the park. I suggested it would be fun for us both.
"No, Mama," he said sternly. "You go to work to have fun," he explained. "The park is not fun for you."
Sigh.
I guess I need to rethink that line.
Subscribe to:
Posts (Atom)