Mindful Parenting and a Toenail Drama

It started back in May. She dropped her stainless steel sippy, and the bottom rim landed right in the middle of her big toenail. For hours, she was beside herself. All we could do was kiss and hug her and say, “Yep… it sucks to drop something on your toe.”

It was the first, but it won’t be the last. A week or two later, there was a good-sized, eggplant-colored bruise right under the nail. Welcome to the Black Toe Club. She didn’t seem to care too much about the discoloration, and we went on with life as normal.

Fast forward to a week ago, when I noticed that the nail was starting to unroof itself. It became so… flappy... that it started to catch on things, which resulted in fits of pain and crying. Being the Doctor Mom that I am, I devised a treatment plan involving an epsom salt bath followed by lidocaine ointment and a sharp pair of scissors. But after the bath, she had a freakout.

She WOULD NOT let me cut it. Would not let me even touch it. We fell into a cycle of hugging and talking and attempting, followed by pullback and more crying.

Her: “I’M SCAAAAAARRRRED!”

Me: “This is the best way to deal with this. Otherwise it’s just going to keep catching on things and eventually rip off, which will be even more painful. Trust me! I’m a doctor! You just took a bath! It’s soft right now! Let me cut it!”

Her: [uncontrollable sobs]

This went on and on, extending past bedtime. And repeated for 3 days. The toenail would catch on something, even bleed. It separated further from the nail bed until it was sticking straight up in the air. I got so frustrated… if you’re a physician, you’re likely familiar with the experience of family members not taking your medical advice. All those past memories welled up, compounded by a screaming, inconsolable child.

One night I threatened to rip it off after she went to sleep. One morning I told her we weren’t going anywhere until it was dealt with. We devised different plans, all foiled by her going into a crying fit… and when one involved her dad helping to hold her down, he looked at me with his peircing eyes and said straight up, “What are you doing?”

[long pause]

Um…. What WAS I doing?

I was trying to control the situation. I was worried for her, anticipating the great pain she might experience if the toenail ripped completely off on its own. So instead of letting things take their course, I tried to solve the problem for her. Like lots of well-meaning parents these days, I was coddling.

I was acting on my own aversion to the appearance of her toe (as a self-confessed Picker, if it were my toe I would have cut that flapping nail off immediately despite any pain pemature action might have caused). The sight of it bothered me more than it bothered her.

I was using logic to appeal to an illogical, 4 year old little human. Although I want to respect her as her own person, she’s not a little adult. Yet I sometimes talk to her like she is.

I was trying to control someone else’s body. Someone’s body that is not mine to control. And I was using threats (again) to try to get what I want.

These are all Respectful Parenting fails.

Before even having kids, we decided that respectful parenting was the kind of parenting we wanted to do. I read books like The Gift of Failure and The Conscious Parent. I listened to Janet Lansbury‘s podcast. But like so many things having to do with mindfulness, theory is different than practice. It’s easy to have a plan, but what matters is how you act in the moment of need. Sadly, this time it took me approaching the use of force to realize how far I had drifted off the path I meant to be on.

Defeated but brought back to reality, I admitted I was wrong. This was wrong. My emotional bank account depleted but not quite in default, I was able to salvage the day by taking responsibility.

She put on flip flops with her little nail sticking straight up, I tried not to look at it, and we went about our day. I dropped her off at the gym childcare center, assuming I would get a call about another episode when she caught her toe on the playground or something.

But do you know what happened? When I picked her up, the nail was gone! She hadn’t even noticed it fall off; it didn’t hurt a bit. After all that, leaving it be was probably the best thing to do anyways.

I’m so lucky to have her (and him); I’m always learning from them. Being a parent has been the greatest lesson in mindfulness.

(A version of this post first appeared on the blog practicebalance.com)

Quarantine Questions with a 4 Year Old

(Blubbering) "But WHY can't I go play with Sarah??"

The extent of our current outdoor adventures

How's everyone doing in the era of COVID and shelter-in-place? I, for one, am having a difficult time parenting my 4 year old daughter. Overall, I can't complain; we're happy together as a family, and we're all healthy. Despite changes in work volume, we're secure. Finding ways to balance our time with her needs, as well as physical exercise for all, is going alright. But explaining complex concepts to a 4 year old has been... challenging.

Being that she's 4, her world is pretty small. We've talked about the virus. Why our travel plans for the end of my sabbatical from academic anesthesia have been cancelled. Why Nana and Papa can't come visit this spring. Why we can't go to our gym or her gymnastic classes. Why only Mommy or Daddy goes to the store when we need things. But even a month into staying at home, she doesn't quite get why she can't play with other kids.

It's been easy with friends she's made through her preschool classes, since they're just not nearby. But little friends in our neighborhood are another story. We're in a condo complex, and for the most part, people are doing their best to remain active but socially distant. Dog walkers shift to the other sidewalk when passing. People wave hello, some wearing masks and some not. And as with any neighborhood, there are a few odd ducks. With kids.

Of the similar-aged children in the complex, I've seen the spectrum of parenting styles... made fully obvious now that everyone's home all the time. There's the child who's outside all the time, garage door open and toys strewn about the driveway. She's scootering up and down the roads, calling out for other children. She's wearing her pajamas and eating candy, all day. Mom is young and single, but three other men seem to be living in the home as well. Cigarette smoke wafts from the windows. On the flip side, there's the child who parts the drawn blinds and peers out the window longingly as we take our multiple daily walks. Her parents keep the house dark and quiet. Despite our previous evening chats and child exchanges, I haven't seen any of them outside for weeks - only glimpses of their silhouettes at the dining table when passing by.

My child desperately wants to play with both of these kids. The one is unavailable for even a distant hello. The other is too available. And the "family" is too tricky... When she asks why she can't see the one friend, or why I won't let her play with the other, I have a hard time coming up with what to say.

We definitely believe in authoritative vs. authoritarian parenting. I never want to say "because I said so" as a response to "why". At the same time, I want her to understand that we prescribe the boundaries. So I guess what I'm wondering is, how do I talk about these decidedly complex issues? Mamas of older kids, what have you done? What would you do differently if you could go back?

Turning down the dial

My daughter started high school this year, and I can't believe I'm old enough to have a daughter starting high school. It feels like yesterday when she started first grade in a new school and wouldn't go into her classroom out of fear and embarrassment from us arriving a couple minutes late (I know, total mom fail. Poor decision to elaborately braid her hair that morning given my remedial girl hairstyling skills).

She's in an all-girls high school, a transition from her one-class-per-grade K-8 co-ed school, and I've been both excited and anxious for her in making new friends and managing her time with 10x more homework and being on the soccer team which involves daily practice after school and weekday games. I want to know every. single. detail. And I want to help. But I'm realizing, too, that that kind of rabid-ness may not be ideal for her development and I am NOT a helicopter mom - or at least, I don't want to be a helicopter mom! (I'm definitely not a lawnmower mom.)

So, I'm working on dialing down my innate drive to interfere and letting it go a little. Not entirely, let's be realistic, but a conscious effort to allow her to find her own way. I know she'll come to me for guidance if needed. I know it's okay to fail. I know she needs to learn. I know she will do just fine.

It amazes (and horrifies) me when I hear stories of parents being weirdly involved when their kids are of grown age. Like graduate students' parents calling the school to take care of things for their adult children. Those stories inspire me to let go now. That's doing favors for no one.

I'm resisting. And turning down the dial. And taking deep breaths. So she can breathe and grow too.

Girls Day and Hurricane Dorian

Since my husband and son left town for a family event, I spent the entire past 2 days alone with my 7 year old daughter. It's been amazing. Thinking back, I think we have only had a handful, if that, of "alone time" opportunities since I started residency over 2 years ago. She is so fabulous. We did all the "girl" things that she loves; went shopping, Sephora, manicures, brunch, and pizza dinner. (How these are her favorite activities, I have no idea, since I am not particularly into fashion, makeup, or sparkles, and I  specifically chose a field where I can wear socially sanctioned glorified pajamas with my hair in a bun every day for work.)

We live in the southeast, where Hurricane warnings closed school the past 2 days, but the hurricane never did arrive in the way we feared. (But the devastation caused by Dorian is heart breaking, shattering, and completely devastating. There are many charity organizations already established and I encourage you to do your research and choose to help as you can. I have added some links below.)

This time with her made me realize the toll of the treadmill that our little family has been on the past almost decade of med school and residency. Between homework, dinner, bath, work, camp, sleep(?) and everything in between, I think that I lost sight of the down time, and effortless sense of "being together" necessary to strengthen relationships and get to experience my kids as they grow up as individuals. While initially I was sad that my call schedule didn't allow me to attend the family celebration, I am so thankful for this time at home. Staycation alone time is definitely something I want to do more of in the future.


Here are links that highlight some of the ways to help those affected by Hurricane Dorian
https://www.newschannel5.com/news/heres-how-to-help-communities-affected-by-hurricane-dorian

https://impact.publicgood.com/campaign/3267a266-ee73-4daa-b7fe-778d036c5e6a

https://www.globalgiving.org/projects/hurricane-dorian-relief-fund/

Starting Young: A Bad Thing When It Comes to Body Images Issues

The other day, my 3 year old daughter said to me, "I'm feeling fat, so I need to go take a long walk."

Is this the start of myriad negative body image thoughts I will inevitably need to address during her life? Maybe she's just being a word sponge, but I can't believe she said this at her age. Where she learned or heard it, I have no idea. I just want to make sure I don't contribute in any way to it.

I've experienced my share of body image issues like most of us. When you have any unusual feature (in my case, it's being over 6 ft tall), your body becomes a point of commentary. And it can become part of your ego, regardless of whether that feature is considered positive or negative. Fortunately, comments made to me are usually complimentary. The other day, a woman in the gym locker room said to me, "Your legs are absolutely perfect. Amazing." Of note, this woman was herself tall, thin and beautiful. All I could do was laugh. I see my legs (and body, for that matter) as far from perfect - and that's ok.

Men vs. women... Although both sexes are prone to chasing perfection.

"Perfect" is a word we should stop using for many things. None of us can have a truly perfect body, be the perfect parent, the perfect spouse, the perfect doctor. There is no such thing as a perfect home, a perfect job, or a perfect anything. Someone's idea of perfect (in the case of my example, legs) is completely different than another person's vision. Maybe you value strength and thus enjoy the look of muscular legs, while another person desires very thin legs. You can soften the P word by saying "this is perfect for me", but I even have trouble with that. We're never done learning or improving. Why do we spend so much time comparing ourselves to other people and trying to measure up to some sort of perfection endpoint? Endpoints are for fixed mindsets.

Social media, which is a powerful tool for helping us as physicians reach a broad audience with our message, is also a huge conduit for comparison and the pursuit of perfection. And it's frighteningly problematic when it comes to our young girls, who tend to deeply value social inclusion and are very sensitive to shaming. I heard an interview with psychologist Jonathan Haidt, who recently cowrote the book The Coddling of the American Mind. He pointed out an alarming trend of increased depression and suicidality among young girls, which has suspiciously spiked with the ubiquity of social media.

I do love my own body, but I didn't always as a child. I remember wishing to look like "everyone else", to be shorter, smaller, etc. As an aging adult and physician who sees very broken bodies, I appreciate that my body's gotten me through some serious health challenges. I would never trade motherhood for a flat abdomen with no signs of a pregnancy. And I believe in striking a balance between accepting ourselves in the present moment while also trying to make improvements. However, my acceptance only came with age and life experience. I know it'll be difficult to instill these ideas into a young girl's concrete thinking.

What body image issues have you come across with your daughters, and how have you dealt with them? Do you let your girls have social media accounts? I'd love some positive solutions.

Forty years and counting......

Random ponderings on turning forty........

• There is genuine sadness and mourning when a favorite piece of makeup is discontinued.......it has taken me years to perfect the “easy, 5-minute, naked-face” look. Now I have to start that one piece over again and it genuinely hurts me..... 
• Alternatives to having a kid: 1) purchase $12,500 worth of organic produce and just pile it up in your living room. Leave to rot. Periodically stomp through it wearing Peppa Pig rain boots and a set of PJ Masks jams. Sometimes pretend to clean it up with a set of tiny wooden cleaning tools. When it starts to smell, scream at your spouse that it is his or her fault that the mess is there. Then toss in an emphatic “you hurt me, you’re not my best friend anymore!!” when he/she denies it. 2) drive to a bank on a tiny pink tricycle with streamers, rob it using only the threat of violence with your ridiculously fast-growing finger- and toenails, then take the pile of cash you claw away from the teller and just light it on fire in the middle of your living room. Repeat monthly. At least 10,000 USD should equivocate the experience of parenting. 3) buy some clothes that you really love, but get them two sizes smaller than your fit. Then look at them hanging in your closet every day while you pull on big shapeless scrubs, or Lycra yoga pants stained with unknown substances and with a forgotten mermaid sticker on the bum. Tell yourself that someday you will wear those again, but know that you won’t. In fact, you never did. Also, download an audio file of Honey Boo Boo complaining about a lack of syrup on her hot dogs and play that on an endless loop in the background. You know, just to sharpen your mind. 
• There are many trade-offs for waiting until later in life and marriage to have a kid. For example, with the presumed extra patience afforded by years of taking so much crap from the external world comes creaky, swollen and painful joints, stretching to their limits with every game of “pretend to be a floor worm with me!” or kneeling on the bathroom floor next to the bathtub, eating invisible cake slices out of bathtub toys with all of her rubber duck friends. But, when your kid makes you some fake strawberry shortcake out of a washcloth and some Paw Patrol purple body wash and hands it to you in a plastic cup with a star-shaped hole in the bottom, you eat that shit. Heck, I’m just happy to be invited to the party. 
• Alone time is the greatest gift the universe has to bestow upon me. There is never enough of it, and it nourishes my soul for when it gets people-y out there. The kid gets the majority of my energy, followed by job and hubs, mostly in equal proportions. Regeneration time is critical, and I’m learning to not feel guilty about it. 
• The more that I age, the more that I learn to stand up for myself and what I believe in a more fierce and unapologetic way. Being told how to use my voice by any number of different people with different agendas and issues is becoming harder to stomach. I genuinely appreciate differing opinions and polite discourse (the more animated, the better!), but when people try to strong-arm their issues and life views on me with tone-policing and gaslighting, well, Iam done sitting back and taking it, especially in my own personal space. I’m too old for that noise.
• Work-life balance is impossible (at least for me). It’s never balanced. One thing is always outweighing something else. It’s more about trying to keep my head above water, occasionally being really good at one thing or another, oftentimes just getting by, and hopefully not letting anybody die on my watch. There is also reminding myself that most of the time, the job I’m doing is good enough, and I’m learning to be okay with that. Being a doctor isn’t for the weak of heart. And being a mom isn’t for the weak of head. Sometimes my heart prevails in medicine and I cry. Sometimes my head prevails in parenting and I cry. It’s all so, so hard. But also pretty badass and (mostly) rewarding. And being a wife is a delicate and ever-moving target of balancing head and heart. Sometimes this is the hardest job, loving the one you’re with and nurturing that commitment. 
•  My husband and I have had an awful lot of loss in recent years, to include both of my parents, and his mother. Raising our daughter without these loved ancestors has brought on a lot of pain in such unexpected moments. She never got to meet them, and yet we see each of them in her nearly every day. Nature is a remarkable thing, perpetuating itself in this way. I wasn’t sure that I wanted to do this whole parenting thing for a myriad of reasons, but catching glimpses of my mom and dad again every now and again in my daughter’s face or voice is about as spiritual as it gets for me. I embrace this fully. 
• I’m truly happy to see forty, and I hope to have sixty more. I do love this life, including the joy, the pain, the humor, the tears, the angst, the stress, the happiness, the closeness and the love. Each new day is not guaranteed. The first forty (wow!) have been pretty damn good. Looking forward to what comes next.......

Disney, food poisoning, and a podcast

My husband took our son for his first trip to Disney for his birthday. Alas, sans me, I was working. But this post is not about any mommy guilt for missing his epic birthday Disney trip. My ideal vacation consists of laying on a beach and gazing into the blue ocean and blue skies. Minimal planning required on my part beyond transportation and lodging. I was happy to skip on the byzantine planning of Fastpasses and Mouse Hacking, and let my son make memories in the magic kingdom with daddy.

Father and son brought back lots of memories. But also food poisoning. On the drive back home, my husband was so violently ill, he didn't feel safe driving back. So instead of waiting a few hours to rest and recover, he suggested I drive several hours to meet him halfway and pick up our son. And he continue driving himself home. Because he must get to the hospital in time to get signout for his patients. Over the years of being married to him, I know better than to suggest logical alternatives to his crazy plans, especially if he is in any state of distress. Luckily that particular day was my day off. So off I was, driving in his general direction, hoping for their mutual safety.

On this drive, I tuned into an episode of one of my favorite podcasts, Hippocratic Hustle. And what a pleasant surprise to hear our very own PracticeBalance, talking about blogging in medicine as her side hustle. I very much enjoyed listening to your voice and your story, just as I enjoy reading your posts!

As a Disney ending to my absurd story, we all got home safely, everyone regained their health and lived happily ever after.

Morning Routines: Is There Such A Thing As A Mother In Medicine?

Years ago, I wrote this blog post about morning routines and how much I adored my "slow" non-workday mornings. I was in the midst of a 3-year IVF journey, but I wasn't pregnant yet. A friend of mine, who at the time had a small baby, laughingly said in response, "That sounds blissful, but wait until you have kids!"

So what's my routine like now? It's still a bimodal scenario: as a part-time anesthesiologist, the morning "routine" varies dramatically depending on whether or not I'm headed to the hospital. On a morning when I don't have to work, the old way I described of waking up to the natural dawn of the sun is a thing of the past. In contrast, many of my mornings start with my two year old daughter either crying or yelling, "Mommy!" I stumble into her room, change her diaper and make her bed/assess for any damage that might have occurred in the nighttime. I may or may not have been in there multiple times during the night prior to the actual wake up. We head out to the kitchen and immediately take our vitamins (me and her), drink a large glass of milk (her) and make a large cup of coffee (me). I tap dance around my husband in the kitchen, which despite being adequately sized, feels like we are bumping into each other constantly. Here's where the "slow" part comes in: we have a little time to chill, play, hug, talk, etc. Eventually we make a breakfast, usually eggs +/- bacon. Once the sun comes over the mountains, we take the dog for a walk to the park.

Those last steps are especially important to me, since I definitely don't make food on my workdays. In fact, on those days I have no idea what my daughter actually eats for breakfast. One thing that has really helped to smooth over my (sometimes rough, always rushed) workday mornings with a baby and a husband with his own agenda has been to hire what I call our Morning Nanny-Taxi. This person comes to our house at 6 AM, plays and takes care of our daughter, gets her ready for the day, and then drops her off at her daycare/preschool at 8 AM (she only goes on my workdays and a smattering of random other days). I've found that this is well worth the market price for 2 hours of service by a driving babysitter. Amazingly, there are people who will do this! Many of the people I've interviewed for this position have another job that is either part time or has a later start time. The few wonderful women we've hired so far were found through websites such as Sitter City and Care.com. (Note: I am in no way affiliated with these sites but have used them successfully to get good babysitters. I would also offer the opinion that Sitter City's pool of applicants seem more suited to random and part-time work as opposed to Care, which tends to have more applicants for regular or full-time nanny work.) While our household is very often awake prior to 6 AM, I don't have to leave for work on my workdays until 6:30. This little half-hour buffer gives me a small chunk of uninterrupted time to get ready, which I now relish just as much as my old pre-baby slow mornings.

You can find mommy blogs and parenting books everywhere that stress the importance of a consistent, daily routine in children's lives. Important for what? My daughter seems to be doing fine despite our undulating schedule. With complicated call schedules and specialties that rely on shift-type work structures, I'm sure I'm not the only mother failing at the routine game. And what about double-doc families? More than one child? Large age ranges? The complexity multiplies...

How do you deal with mornings?

Who blinked first?

It was a random Wednesday that I was off from work. I was thinking of the possibilities. Oh the possibilities! I could do my ever piling load of laundry. Replenish the empty fridge. Or forget all that, and keep my toddler child from daycare and spend time doing something fun with him. Since starting intern year, it feels like our time together has became ever so scarce. Today I would make up for all that missed time. We could go to the playground, do story time in the library, visit the local children's museum. Endless possibilities!

First things first, we'd eat some good healthy breakfast to get the day started right. Today I was in no rush. Instead of his usual sugary cereal breakfast, I was going to make eggs and toast. Now anyone who knows my toddler child knows food is a big struggle with him. He reacted to eggs and toast like I had handed him a plate of dog-doo. He put on a whole production. Defiant "I don't wanna". Pushing the plate away. Putting a bite in his mouth followed by gagging sounds. Finally, eating his food in infinitesimally small bites that he would take an absurdly large amount of time to swallow each bite. I was already questioning my decision to keep him home from daycare. I was now fantasizing the alternative of doing laundry in peace.

Finally after an hour or so of lingering, pleading, arguing over the table, I just had it! Out came the threat, "Child, you don't like the food here, I'll take you to school where you seem to have no problem eating the food. Forget about the museum or playground".
"Noooo"
"So you want to finish your food?"
"No"
"So which one do you want, go to school or go to playground"
"Playground"
"Then you have to eat your breakfast"
"No"
"So school then?"
"No"

Round and round in circles we went. And of course there were lots of tears involved!

"Alright then, let me break this down for you. You can go to school. Or you can finish your breakfast and we can go to the playground." Lots more tears. Then he said something shocking! "I want to go to school." I was not expecting this at all. Really!! He wanted to not eat that food so bad, that he would forgo museum and playground, something he normally loves to do! Well, I may have been bluffing a little, we were both in our PJs, not daycare ready. But it was too late to turn back now. I got dressed, got him dressed. All throughout in a shock, asking him several times, "so you want to go to school, not to playground?". Each time, "yes". Alright dear child, as you wish! 'This was incredulous', I kept thinking all the way on our tense walk to the car. Just as I was strapping him into his car seat, he said in a low voice, "I want to eat the breakfast".
In my mind, I thought, "Are you for real??? After all this, after I got dressed, got you dressed, after all those tears and drama, now you want to eat breakfast!!!"
Deep breath.
Aloud I said, "Have you decided for sure?"
"Yes", he said.

We walked back to the apartment in silence. He finished his breakfast without another complaint or tear. I'm happy to report, we had a great rest of the day in the playground and museum, of course peppered with occasional meltdowns here and there, but nothing quite so epic.

I was amazed and strangely proud of my offspring's skepticism. For not just taking my word, but for calling out my bluff with his own bluff. Keeps growing up so fast, keeps me on my toes. Teaching me that,
1. I must be fully prepared to carry out any threats I issue or rewards I promise, and,
2. Conversely, I can not make threats or promise rewards I can not execute

(Credit: Images from the hilarious Hyperbole and a Half, which can now be generated into endlessly entertaining memes)

Stumbling Through The March For Our Lives With Little Kids

Genmedmom here.

As a primary care physician with strong public health and clinical research roots, and as a politically engaged mom with serious concerns about our kids' futures, it made perfect sense to take our kids to the March 24th March for Our Lives Boston.

One complication: Hubby and I have been shielding them from the news, especially school shootings news. Babyboy is extremely sensitive to the topic of death, dying, and violence. He'll have "bad memories" for weeks after hearing or witnessing something along gun violence lines. This may be a normal little kid thing rather than an autism thing; they're only seven and six years old, after all.

Given all of this, it was actually very difficult to explain why were marching.

The Women's March and the March for Science were so, so much easier! Yesterday, Hubby and I found ourselves searching for explanatory phrases that didn't include references to school shooting deaths or the words "being shot" or "being killed". We ended up stammering, stumbling, and not successfully conveying the point.

Many organizations have offered guidance on how to talk to little kids about tragic events and disasters, such as the American Academy of Pediatrics and the American Psychological Institution. Major news outlets regularly publish advice about talking to children specifically about school shootings (which is definitely a statement about the states of affairs in this country). Two recent articles on TODAY.com and Cnn.com are actually pretty helpful.

So, this is something we clearly need to work on, as the kids' school runs lockdown drills and the #GunControlNow, #Enough, #Gunsense, and #MomsDemandAction movements spur debate and action.

Regardless, their taking part in a massive live social change movement is a powerful lesson. We emphasized that in many other countries, citizens aren't allowed to gather and protest, that we are very lucky to have this privilege, and we have to use it.

Overall, I'm glad that we took them and that they got to see freedom of speech, political activism, public health awareness, and social altruism, all at once and in person.

The Little Echo

Almost a year ago, I was worried about her lack of verbal expression. Now, she talks constantly. She knows so many words, it’s amazing. But I'm starting to realize that having a highly verbal child exposes your own verbal ticks.

She adorably engages in imaginary play with lots of critters and stuffed animals. When they “take naps”, she shhhhhs them really loudly and pats them quite vigorously. Hopefully that’s not how she sees my pats and shhhhs. She scolds the dog in the same booming tone and inflection as my husband. She rattles off “thereyago” all the time. Apparently I say this a lot. Along with some choice swear words, particularly the ones that start with S and F, when I drop things or mess up in some way. Bad mama.

But most concerning is actually her use of “sorry”. I’d rather have her throwing around an occasional swear word than apologizing for everything she does. I didn’t realize it, but I do this too. It’s such an easy word to say, yet the meaning is both diluted and potentially detrimental when used to frequently. Saying sorry is apparently epidemic among women. There have been so many pieces written about this in the past few years, but I found this one most entertaining (replete with GIFs). Sasha at Brave Enough gave examples of how sorry is frequently used by women in the OR. After reading this, I'm going to think about what I say the next time there is an anesthesia delay during surgery.

What about you? What do you say that your child echoes back to you, and has it prompted you to change the way you talk?

Panic on the Highway

Genmedmom here.

I'm like many physicians: a bit of a control freak. C'mon, admit it, it usually takes a Type A personality to push through all this bulls**t: Exams, applications, more exams, more applications, brutal working hours, exhaustion, fear, abject terror, hazing, insurmountable debt.

But sometimes, we're just not in control.

My very first panic attack, I was huddled in a sleeping bag on the cold floor of a medical outpost in El Salvador. It was 2001, the January earthquake. I was one of a small band of medical misfits on a disaster relief mission. I was a student, and my job was translator.

We were housed in the same clinic where we saw patients, on the concrete floor. That night, there were several aftershocks, but no one else on my team woke up. I imagined the ceiling and walls caving in. Some large bug landed on my face. Mosquito? Reduvid bug? Was I going to get Chagas disease? I began hyperventilating, I could not get enough air. I was panting and suffocating at the same time. Nausea overwhelmed. It was pitch black, no electricity. I would have had to crawl over my snoozing colleagues, or throw up all over them....

It was the idea of vomiting (and dealing with vomitus) that broke the spell. Even in my panicked state I had an idea that it was all in my head. Damned if I was going to puke on my attending.

Maybe it's not completely unreasonable to panic whilst in a bona fide disaster zone, although it would have been utterly humiliating, as well as inconvenient...

There have been a handful of episodes like this since, and none with such a good excuse.

This weekend, for example.

It was Labor Day weekend, and I was not on call. I was solo with the kids, and we went on a little road trip, to visit relatives a couple of hours away.

The ride home was ugly storming, the remnants of Hurricane Harvey. My kids are in this sibling rivalry phase, where rivalry means drawing blood by any means necessary. So I had the car VCR on for maximal distraction.

Still, they fought, and I fought to keep my full attention on the road as they yelled: "You wear poopy diapers on your head!" "Oh yeah, you smell like poopy and pee pee AND cat food!" "AAAUGH! MOM he kicked me!" "WAAAGH! MOM she pinched me!"

I was into a long sort of barren highway stretch when I realized that the gas tank was low. Really low. Sixteen miles of gas left low.

Hmmm. Miffed at myself that I hadn't noticed that earlier when we passed several rest stops, I paused the DVD and asked Siri "Where is the closet gas station?"

Siri paused and then ever-so-unhelpfully directed me to a gas station ten miles BEHIND us.

Okay. I kept driving South, looking for any evidence of a gas station at any of the very few exits coming up. They were all for major routes, not towns. No signs indicating restaurants, hotels, or gas stations.

The range dwindled. When the gauge read nine miles, I started to really freak out.

"Okay guys, I need to pause the show."

The kids actually quieted down. I explained that if we didn't find a gas station soon, we may need to pull over and call for help.

But I really, really did not want to do that, in the middle of a heavy late summer rainstorm and on a holiday weekend.

So I just kept driving-- like Dory, Just.. keep.. driving...

With SIX miles left, a lonely exit had a lone sign: "Gas: Mobil"

"Hallelujah!" I called, and gleefully flicked the blinkers on, aiming right, to salvation.

But: the signs then directed me to cut left, OVER the highway, towards the ramp going in the opposite direction. This required me to veer left. The car behind me honked loudly: They were going straight, and I had almost clipped them when I veered left.

Face burning (did I just almost cause an accident?) and heart pounding, I tried to sort out where the hell the goddamned gas station was. It looked like there was a small access road on the other side of the highway, but I would have to cut across two lanes of traffic getting on the highway going in the opposite direction to get there, with literally no wiggle room, just straight across.

There were so many cars! I couldn't make it! I was funneled back onto the interstate: going BACK from where we came.

I yelled, something unprintable, multiple times, banging the steering wheel, then "OH MY GOD WE ARE LITERALLY GOING TO RUN OUT OF GAS ON THE HIGHWAY IN THE RAIN! S--t S--t S---t F---k F---k..." I felt that familiar catch in my breath, that quick succession of gasps that means panic is beginning to overwhelm, except I was DRIVING on the HIGHWAY with my KIDS in the CAR.

The logical M.D. brain kicked in. Should I pull over now? But the shoulder isn't that wide, and the ground is soggy. Pulling over on the interstate could be really dangerous, and if I pull over onto the grass I might get stuck in the mud...

Hey, I can ask Siri! "Siri, where is the closest gas station?"

A Citgo twelve miles away popped up. What??? The Mobil we had tried to reach wasn't on Siri's radar. Maybe it had closed?


So there I was, speeding along the interstate, with five, then four miles left, not sure if there were any options... Crying. The kids were silent.

The next exit was coming up, for a busy route, no buildings, no towns anywhere nearby.

Deep breaths: "Okay, guys, I'm going to try to turn around and get back to the gas station that's supposed to be there that we just missed."

Blinking away tears, I managed to turn around, thinking Okay, at least if we have to pull over now, we're heading in the right direction, and I won't look like such an idiot.

Just.. keep.. driving... Three miles. Two.

I made it back to the same exit and the same veer left and over the highway and across those two lanes of traffic feeding onto the interstate... It was a miracle, there was a break in the cars, we zoomed across, and into the Mobil. With less than two miles of gas left.

As I pumped the gas, my legs shook. We took a little bathroom break. I splashed water on my face, and then felt silly for having had a truly unnecessary freakout in front of my kids.

I've since reviewed this whole incident with my husband, and we have some rules: ALWAYS gas up to the max before a long drive, and never freak out while driving. Pulling over and calling for help is way, way better than getting into an accident.

Still, another reminder that we are not always in control. (And neither is Siri, apparently.)

Photo credit Holly Mandarich: https://unsplash.com/photos/0317cop-0Ug

Charlottesville

I've been watching the events unfold in Charlottesville, VA, over the past two days. I was already sad; now I am scared and angry as well. I wrote about it on Medium.

None of us is safe. Hate touches us all. Hate threatens us all. If you are white and your first thought is “that’s not me,” then you are not listening. You are not listening to my voice. You are not listening to the voices of people of color. They are telling you we are being murdered. We are being systematically eliminated. We can’t breathe. If it’s not you, then you must work to stop it. We all must work to stop it.

We must. Our children lives depend on it. Our lives depend on it.

(Helicopter) Doctor Moms

As my toddler becomes more and more active, I've been grappling with an internal conflict: how do I balance my desire to let her experience life and take chances within the reality of my risk-averse, medical background? The other day, my mother almost had a stroke in the park, watching my 20 month old girl teeter along on the edge of a three foot tall retaining wall while she laughed with glee at her cousins. Below was grass on one side and a stone tile on the other. "Get her down from there!" she cried. I hadn't thought anything of it: if she had fallen on the grass side of the wall, she would have been fine. She would have learned a lesson on how to place her feet to balance. If she had fallen on the tile side, things might have been fine... or they might have resulted in a broken ankle, or a broken head. Flashes of my baby intubated with a head injury in the ICU swirl through my head, and I have to slap myself to break loose.

So much potential badness and goodness in this picture

I don't want to be one of those helicopter parents. I want my child to learn problem solving, to take chances and learn consequences, and to feel the exhiliration of meeting physical challenges. And yet, as an anesthesiologist, I've seen the worst. I've seen the pediatric traumas and the burn unit cases. I've heard the PICU stories ("How did this happen?"), and I'll admit that I absorb these details differently now that I'm a mother. The information is clouded by a background wonder of what I would do if I were in the parents' situation. Sometimes I see my own child's face in that hospital bed or on the OR table.

As a teenager, I had some friends whose fathers were policemen. They always had lots of restrictions, and because their dads had similarly clouded lenses through which they saw everything, I now understand why. But overbearing parenting has been associated with what Jessica Lahey, author of The Gift of Failure, describes as "emotionally, intellectually, and socially handicapped children." How do we as parents allow our children to grow up with freedom, autonomy, and challenge while still appropriately protecting them from physical harm? If anyone has some good insights on this, I'd love to hear them!

Tell the truth, as soon as you know it

It was a Thursday evening and I had just gotten off from back to back shifts, first a full day in private practice and then a hospital training for my new gig. Zo was riding his bike up and down the street. My husband O catches me on the porch and says, “have a seat, I need to tell you something”. My heart sank, I knew this wasn’t going to be a good conversation. He proceeds to tell me about how Zo had stabbed another student in the neck at school. This is one of those students who is always crying, always dramatic, always asking for a hug. The student had cried and gotten a band-aid and Zo had gotten in big trouble.

I began crying. Ashamed. Scared. Worried. More shame. Guilt. Fear. I had flashbacks of when I had gotten into a fight in high school and the look of worry and concern on my parents’ faces. I didn’t understand then, but in that moment, I fully understood. You work so hard to raise well-rounded, empathetic, gentle humans and then they go and do something so utterly stupid that you lose your breath, you lose all sense, you feel like a failure.

O proceeded to explain to me how he had managed it. He decided to handle it while I was at work between the men-folks. He had picked Zo up early. He had talked to him first and then he even met with the the School Psychologist, Assistant Principal, his Teacher, and the Teacher’s Aide. My husband had cried once they returned home due to fear, shame, guilt, and an outpouring of emotions. He called one of our friends who has an 8 year old son and they walked through an appropriate discipline plan. O talked to Zo a lot and explained how we have to have “gentle hands” all of the time. By the time I got home things were smoothed over. I was saddened that yet again I was at work, but I was proud of my husband for the way he handled things. O is the more calm and collected parent and I begrudgingly admitted that it was good that he was the one who had picked Azola up.

Zo finally came down the street and saw me on the porch. He came to give me a hug and then put his head down and said “did you hear about my behavior?” and then we talked about how he had hurt his friend at school. I explained that I was very disappointed. He promised never to do it again.

I texted the other parent, a stepmother, who had been a little flighty in the past. I asked if we could talk about what happened and we set up a time. That time came and went. I reached out again. Same thing. Apologies. The weekend went by. We continued to talk to Zo about being gentle and that it was important never to hurt others.

Then on Monday I get a text from Zo’s teacher asking had I heard what really happened. I quickly texted back and learned that Zo HAD NOT stabbed another child in the neck, but that on Friday they had learned from the stepmother and father of the little boy ON FRIDAY AFTER SCHOOL that Zo had been dared to break a plastic fork and that a tooth of the fork had popped up and hit the other boy in the neck. The kids had thought this meant that Zo had stabbed him.

So after an agonizing weekend feeling like failures of parents, all the stepmother had to do was text me and say something like “hey, you know Zo didn’t really stab my son, right?” and that would have changed things considerably. Zo wouldn’t have been disciplined. Why didn’t the family tell the truth as soon as they learned it? I would have! Why schedule a time to talk and then miss it and not say anything?

I wish those parents had told the truth as soon as they’d known it.

We lost our s--t with the stranger who criticized our kid

Genmedmom here.

Hubby and I are not proud of our behavior. As a matter of fact, if anyone at the suburban quick- service restaurant managed to videotape us losing our sh-t, we'll be mortified.

Saturday was Earth Day as well as the March for Science, so we took our kids downtown to meet up with friends for breakfast and then show our support for our planet. Of course it was lovely and inspiring and all, so when we had to cut out early for a birthday party, we were a little bummed. On the other hand, the day was raw and rainy, so we were also a little relieved.

At the train station, a balloon man made a blue balloon sword for Babyboy and a pink poodle for Babygirl. Halfway home, rather predictably, Babyboy's sword popped. He wailed, then pouted, as Babygirl "helpfully" reminded him that HER balloon toy was still like new.

We didn't quite realize how upset he was about the balloon. And also, perhaps, how exhausted from our packed day thus far, dealing with new people at breakfast, trekking all over the downtown area, managing myriad sights and sounds and general chaos, then keeping it together on the train. Though he has autism, he handled it all incredibly well.

So we were probably pushing it when we decided to swing by a takeout salad place for a healthy late lunch just before the birthday party.

The restaurant was pretty crowded, and there were only a few tables open. Babyboy found a small table in one quiet corner, while Babygirl found a bigger table in the middle of the larger sitting room. Both refused to relocate.

Hubby ran to the men's room while I tried to resolve the table situation. Babyboy's table only fit two, while Babygirl's was for four, so, pretty straightforward: "Let's go over there where your sister is, honey, so we can all have a seat."

But Babyboy was done. Just DONE. He had draped himself over the tinier table, hugging it, not budging.

I gently touched his shoulder and leaned down, whispered in his ear: "Honey, we need four seats, or we won't all fit, okay? Let's go to that bigger table, okay?"

He whined: "I want to sit HERE! Why does SHE get to pick where we sit when MY balloon popped and I'm sad? I should pick because I'm SAD. I want to sit HERE."

I tried reasoning, then gentle tugging. While he did release the tabletop and shuffle grudgingly towards the larger space, he did so while whining VERY loudly:

"It's not FAIR! It's not FAIR! Why does SHE get to pick where we sit? Why does SHE get to pick? I'm the one who is sad! MY balloon popped, not HERS!"

Meantime I whispered reassuringly, soothingly: "Okay, okay, I understand, here, you can watch a show on my phone. Want to watch a show? Here, let's pick a show.." I was practically begging, but, to no avail.

The more I whispered/ begged, the more he whined, and loudly. People were watching us, with curiosity and annoyance, and I was acutely aware.

When offering SpongeBob on my iPhone didn't work, I knew we would have to leave, so I announced:

"Okay, this isn't going to work. Let's go home, guys, let's go outside, c'mon. We're leaving, right now." I said this out loud, as much for the other diners' benefit, as I herded our kids out the doors.

The kids were just ahead of me, already in the glass foyer, when I noticed a loud banging and clattering sound.

It was like a fist hammering on a table so hard, that it was making the silverware clatter.

Which is what it was.

An elderly man seated near the open door was bringing his closed fist down heavily on his table, again and again, HARD, so that his food and utensils jumped and rang out with every beat.

Only when I finally looked, did he stop. He then gestured angrily towards Babyboy, raised his finger to his lips, and made an exaggerated, furious, spitting SHHHHHH sound at me.

I froze, eyes locked with this angry old man who didn't seem to speak English.

The kids were already pushing at the outer set of doors.

Only a second passed, but this is what went through my head:

Are you kidding me, asshole?  My kid's autistic and exhausted and fixated on his silly balloon and I cannot do anything about that besides leave. Can't you see that we're leaving? We've only been here about three minutes total and we're LEAVING and you have to pull this shit? 

And then I did was something I don't think I have ever done in my entire life.

I leaned towards him from the doorway, leveled my middle finger right in his face, and said, as clearly and calmly as I could:

"FUCK YOU."

Then I followed my kids into the foyer and out the doors to the parking lot. Babygirl tripped and fell and I lifted her up, pulling Babyboy along with me as I made a beeline for the car.

Meantime, Hubby had just exited the men's room. He had heard Babyboy's whining and then the banging/ clattering ruckus. He had seen the old man pointing at Babyboy and shushing us. Somehow, he didn't catch my reaction, and thought that I had just fled.

So when he passed by that guy's table, he threw out:

"Have a nice day, sir, God bless you, and by the way, FUCK YOU!" and he ran to catch up with us in the parking lot.

In the car, I was shaking, almost crying. Hubby turned to me and shared that he'd given that guy a piece of him mind. I admitted that I had, as well.

We both smirked.

Now, Hubby and I are both well-educated working folks with professional reputations to protect. As such, neither of us uses the F-bomb, or any profanities, very often. And neither of us is in the habit of losing it with compete strangers. But we did both, and if given the chance for a do-over, I'm not sure that we would have done it any differently.

Of course, we didn't do much to advance the cause. Our classless behavior didn't help anyone to understand autism, empathize with struggling parents, or tolerate tantruming children.

I'm not sure if any of that would have even been possible, but we could have acted with more grace. So, we both feel ashamed.

We did end up going to the birthday party, where we shared our story with many very sympathetic parents. People shared their own experiences of child-behavior-shaming in public spaces, and how they reacted. It was therapeutic.

Still, I know for a fact that neither Hubby nor I will ever venture into that takeout restaurant again!

Documentation

Do you keep a lot of mementoes related to your kids? What about other aspects of your life?

I tend toward the less-stuff end of the spectrum, but I want to keep the special stuff. At home, I prefer calming spaces that are cozy but aren’t teeming with trinkets - it gives me sensory overload. It’s been said that we shouldn’t document our experiences too much, and that with time the most salient features of an experience stay with us, while the lesser details or perhaps the aspects we’d rather forget dissolve with time. I tend to think this is the best approach to take with the past. That’s not to say I never document, but I don’t get caught up in cataloguing everything. And with smartphones, I find my phone pictures act as a diary themselves. 

At work, of course, we document EVERYTHING and often in great detail. As a family physician, my notes range from a sparse, simple visit to a long and detailed assessment. It’s no surprise, then, that with the amount of documentation I do daily, I feel exhausted at the thought of further documenting. 

Long ago I accepted that I didn’t feel the need to journal on a regular basis, as much as I admired those who did. Writing was often what I turned to during challenging times. It still fills that role, and has also become a way to process different kinds of experiences. Recently I did an online writing course that reflected on motherhood that I would highly recommend. But the constant recording of exactly what I’ve done, when — no, that’s too much.

I recently went through old papers at home and found a card from one of my closest friends, written just three months after we’d met back in university over fifteen years ago. Just seeing her handwriting was such a treat, with most of our current communication occurring in fonts. 

With my young kids I’m saving special artwork in binders with page protectors - it’s quick and easy to slip them in and to look through them that way. I let a stack build up then put them in, in my best attempt at chronological order. Overall, though, I'm trying to focus more on the moments.  

Itty bitty ones and screen time

Screens! There are so many. And they are everywhere. Even AAP relaxed their screen time recommendations in recognition of the ubiquity of screens. I remember when my little one was born, AAP recommended no screens for children under 2. Current recommendations relaxed the no-screen age from 2 years to 18 months. Like many other things related to parenting, I have been flying by the seat of pants, and experimenting as I go along. Here are some observations from our ongoing screen time adventures.

Under 18 months? No screens for you: We did not adhere to that. Part of it has to do with very different approaches that me and my husband take to screens (and parenting in general). I was the stickler in the beginning, determined that my child would view no screen until 2 years. Husband is several notches more laissez faire than me, felt screens were fine birth onwards. After several battles, a compromise was reached. I don't recall the exact age, but it was somewhere between 12 and 18 months.

So many screens and so little time: At first, I didn't distinguish between different kinds of screens and let the toddler do as he wanted. TV? Sure! iPhone? Why not! Laptop? Here ya go! But then I dialed it back quickly after seeing him flip from one video to another at a dizzying pace on the touchscreen phone. My toddler has pretty good attention span for doing tasks, but watching him with that level of stimulation gave me future ADHD nightmares. For now, I have stuck to less interactive screens like TV. Watch a show. Finish viewing. Turn it off.

Screen as a pacifier: Kids and restaurants don't mix well together. "Twenty minutes in a high chair is about all you can reasonably expect from a toddler... Little bodies need to move" When he was having a meltdown, initially a smartphone seemed like a very effective pacifier. Avoid the angry stares from other patrons. Enjoy our meals in peace for a little bit. But then our child became Pavlov, and we were his little rats. When every meltdown was rewarded with a phone, they just became more frequent. Eating out is an important social skill. Sowing seeds for that ineptitude so early didn't quite sit right with me. So I stopped caring about strangers stares. If the meltdown was too intense, one of us walked out with him until he calmed down. Now instead of playing with a phone at a restaurant, he plays with his food. Baby steps!

Screen as babysitter: AAP recommends against using screens like electronic babysitters. Easier said than done! As I discussed some of my childcare challenges with limited financial resources in a previous post, this is the rule I feel guiltiest about breaking, but I continue to break it anyway. In AAP's ideal world, "parents should co-view media with children to help them understand what they are seeing". In my real world, while my child is glued to the front of a TV, that is some precious time to hastily get stuff done. However I did find a workaround through a loophole for that AAP recommendation. Toddlers love to view the same thing over and over. We cut the cord and watch most of our TV via Netflix/Amazon Prime etc. I watch a few episodes of some shows with him, and then play the same ones over and over for him.

All programming is not created equal: I have found PBS to be the highest quality, though even with PBS, not all shows are equally good. By far my favorites are Sesame Street, Daniel Tiger and Peg+Cat. There was a even a study showing correlation between Daniel Tiger viewing and children's emotional intelligence. Adding anecdotal evidence, I have taught my son to apologize using the episode where Daniel Tiger learns to apologize. And to clean up after himself using Daniel Tiger's jingles "Clean up, pick up, put away. Clean up, everyday".


Practicing the preaching: All this fussing about my toddler and his screen habits have made me rethink my own screen time. Excluding unavoidable screen time (work/school related), I tried to take an inventory of the my avoidable screen time. I am not much of a regular TV watcher, my biggest avoidable time sink was checking social media on my smart phone. A strategy that I have had moderate success with involved creating extra hurdles to view social media. You can read about it in greater detail at my blog here. Less time with my face in a screen meant more time being present (actually present) for my munchkin.

It's been a bumpy ride but I feel like we have reached somewhat of a steady state with our relationship with screens... for now. But these pesky children keep growing up, ensuring that the steady state will not stay so for long. Screen time for kiddos has been in recent news, with stories of links between increased screen time and diabetes risk and teens replacing drugs with smartphones. Even without those scary stories, I am dreading navigating the whole wild world of smart phones, video games, internet and social media when my itty bitty one is no longer so little and outgrows PBS Kids. Mothers in Medicine with children of all ages, share your own screen time adventures. What has guided your approach to your children and screens? What screen related rules do you use in your house? Did you have it all figured out or do you fumble around like me?

In the dark quiet of the last day of 2016

Oh, no. Not a New Year's Resolution post. Who needs another "Live healthier, Be a better doctor, Be a better mom" post?

Well, I do.

Genmedmom here.

It's 6:30 in the morning on Saturday, December 31st, 2016, and I'm sitting typing in the quiet dark of our house. No one is stirring except for our two big spoiled cats, who relentlessly knocked things off of my nightstand until I got up.

You know how you get really busy, barely any downtime to even answer the texts from old friends, never mind call them, and all the very small spaces in your life are stuffed with overflow tasks, like making shopping lists on your phone on the train, and never going up or down your stairs without having something in your arms that needs to go up or down, like dirty laundry down and folded clean stuff up, empty tea mugs down and toilet paper rolls from the basement up, wrapped gifts down and unwrapped stuff up, so many goddamned toys and factory-new clothes and the boxes, tissue and gift bags that you can't bear to toss that will clutter your home until next year too, and even with your superior physician multitasking skills you realize you're screwing up, like forgetting to RSVP for that thing and being late paying that bill and getting lame last-minute crap for the important staff member you totally spaced out, and then even the doctor stuff starts slipping (which is always last to go, right?) like that you promised to personally get back to your longtime dear patient on a result that wasn't critical but it was important to HER and you totally intended to check that on the holiday weekend and simply send her a quick message through the online portal and you just did not do it.

Then the kids get sick, and you get sick, and any delusion of control you had goes down the toilet with the first bowl of vomit. Your Christmas agenda: poof.

Barf.

But life marches on and there's still things to do and when everyone is (mostly) better you try to keep going, get yourself and the family to rescheduled gatherings and pick up where you left off with the gifts and the cards and the outings for school vacation. Maybe you start losing track of what's really important and what's just life and lose your cool, show your frustration, yell at your kids when the situation just doesn't merit a freakout. No one is running towards a busy street or about to drink drain cleaner, they're just jumping on the couch and throwing pillows and wrestling and, well, not listening to you when you order them to get their shoes on because you're late or pick up that banana peel and take it to the trash or SETTLE DOWN already. And when they react to your red-faced temper with sass and disrespect, maybe you throw the remote control across the living room and when it lands on the hardwood with an unexpected clatter, your kids stare at you with a sad, silent combination of shock and wonder and fear that you hope you never see again.

You know you're out of balance and that this is not right and this is not you.

So in the dark quiet of a holiday weekend morning when, miraculously, there is no event planned nor pressing task nor other thing of perceived great import, you sit and breathe and resolve:

This year, I will live healthier, be a better doctor, be a better mom. I will do this by uncluttering my headspace. I will leave the little breathing spaces empty. For breathing. I will remain thoughtfully committed to my medical practice and remember the high standards I hold for myself. I will love my family, my children,  always reflecting on how blessed we are, how much we have and enjoy in this very difficult modern world. I will pray for those who are struggling and suffering, every day, I will not forget them.

Happy New Year and God Bless.

Money and mothers in medical training

Children are expensive. So is medical school. Children take up a lot of time. So does medical school. Unfortunately time and money are two things in considerable shortage during medical training. Mixing children and medical school can be an unhappy combination. We had our baby halfway through medical school (me) and residency (the Mister). There has been lots of discussion regarding the timing of procreation in medicine (eg here and here and on this blog). My general takeaway can best be summarized with this license plate.

I have found some serious life wisdom on vehicle license plates.

My general takeaway 1.1 regarding the subject of timing babies in medical training is that there is no perfect time. Each time is good in some respect and not so great in others. Having spent my 20s in pursuits of other advanced degrees, I didn't want to wait until I had a "real doctor job". But that meant that financially it was not such a great decision. Residents stipend is not enough for supporting a family, especially when one member of said family is incurring expenses of medical school. More than a third of our income goes to childcare expenses, and that's not even including food, diapers, and a multitude of other child related expenses. We are always worried if we'll be able to pay all our bills at the end of each month. I am in debt up to my eyeballs. Financial worries are always lurking in the background of my thoughts, and money has been on my mind even more as I am looking into taking out more loans for upcoming residency interviews.

A friend offered me wisdom from her interview experiences, telling me about some common interview questions, one of them being "Tell me about a difficult experience you had in medical school". I said (almost half jokingly), urrmm pretty much the entirety of medical school since having a baby has been one incredibly difficult experience. It is difficult to separate the experience of being a parent from that of being a medical student, and money has been one of the connecting threads between the two.

Daycare was the only affordable childcare option for us, and we are lucky to have hospital subsidized daycare. It was amusing (not really) when one of my classmates thought that "hospital subsidized" meant that all costs were covered by the hospital and it was free of charge. No, it just means there is a small discount. Though it is a "hospital affiliated daycare", but like most other daycares, it is not a 24/7 facility. Having both spouses in medical training means that both of us have very little control over our schedules. There are plenty of times that we are both working outside of daycare hours. And trainees may have an 80 hour a week work limit, but a child requires care 168 hours a week.

This same classmate who thought that daycare was free, was also surprised to learn that I hired baby sitters to study for medical school exams. "Wait, so every time you have to study, you have to pay someone to watch your kid? Can't you just put him in a playpen and do your studying?" Before I had a baby, I envisioned this picture of getting home from the hospital and spending daily finite hours of "quality time" with the little one and then he would, I don't know, put himself to bed or maybe I'd read him a little bedtime story at the end of which he'd dutifully doze off and sleep through the night, and I'd get more hours of "quality time" studying. Or just like my classmate I assumed that I would be studying while the baby/toddler would be happily playing by himself on the side with his toys, of course, without interrupting me. Those fantasies/assumptions disappeared pretty fast when a real baby (who is now a toddler) showed up.

Talking to other people in our situation (two medical trainees with no family close by) most options I heard of were not financially viable alternatives for us. I have heard people say to not worry about money and keep taking out loans because when I have a "real doctor job", I'll be able to pay it all off. Maybe there is truth to that. But when I look at the enormous amount of debt that I have already accumulated, and when I think about the uncertainty with future physician compensations, I don't feel comfortable taking out loans to whatever amount.

Things haven't always worked out great with this whole arrangement. I have less than perfect grades in medical school. I feel like if it was just the hours in the hospital and then I could come home and eat, pray, love or something, it would be fine. But because work just gets started after getting back home from work, is what makes it so hard. After a particularly rough rotation that had lots of nights and weekend shifts (read: "when daycare is not open" shifts) and an end of rotation exam, I bombed the exam. The course master told me that he was really surprised about my exam performance because the clinical portion of my grade was stellar and there was such a discrepancy between the clinical grade and the exam grade. I didn't know how to explain that for me studying for exams cost money. Whatever little savings we had, had recently disappeared after a family emergency, and as interview expenses had drawn closer, I had scrimped on getting sitters to study for tests.

As a minority it is sometimes difficult to explain or convince people even in the face of overwhelming evidence that social factors control how you experience your life and the color of your skin can change the opportunities and travails you encounter. At some point it is tiring to keep going through the explanations over and over and knowing that unless someone has actually been there, they really won't know what you are talking about. I feel that way about the experience of being a mother in medicine too. I could go blue in the face with my explanations but it is exhausting.