Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.

Health

This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?

Last Week

My little family had a tough week last week. In addition to the usual chaos of single-working-mom-with-two-kids life, which includes (but is not limited to) two morning drop offs during the week, ballet, play rehearsal, soccer, swim class, my own personal interviews for a potential promotion at work, and a snow day during the week (oh how I could do a single lengthy post on the chaos of being a doctor mom with two kids on a snow day!), three year old E got sick. And we landed in the hospital.

I should mention that my seven year old daughter, M, has immunity of steel. She had the usual colds, fevers, early childhood sicknesses until roughly 18 months old, and then she’s been rock solid since. I can’t remember a time in 5 years that she’s seen the pediatrician other than for a wellness physical.  

And then there’s E. He’s had an ongoing solidly built relationship with our pediatrician which has landed him in her office so many times we all stopped counting. Sometimes I see her so much (and I like her SO much!) I think I should take her out for coffee or something!  For a while it was bi-weekly, for a new cold, fever, cough.  Between the ages of 6 months and 16 months, this kid was hospitalized three times for respiratory problems.  The frustrating thing was he would get overtaken by a cold which would turn into brochiolitis, land in the hospital with hypoxemia, get treated with oxygen (and time) and get better, but no one could really put a name on it.  It wasn’t asthma. He got tested for CF (oh, that was a harrowing day!), amongst other things, and the pediatricians landed on a diagnosis of “tracheomalacia” and told me he’d grow out of it.  So for 2 solid years, we walked on eggshells with this little guy and his tenuous health.  And, slowly, he seemed to get better and the “colds” got less frequent, and I slowly let go of some of my anxiety about him getting sick.

Last week, he wasn’t himself on Monday and had a low grade temperature. I didn’t think much of it because he wasn’t coughing and thought he’d rest a little on our “bonus” snow day. On the morning after the snow day, he still had a low grade temp so I kept him home from school but I needed to be at work. I was precepting for three residents, two of my colleagues were away on vacation, and there was just absolutely not a single soul (believe me, I racked my brain!) who could precept those residents for me. So, I brought E to work with me -- he was psyched! He sat at my desk, drew pictures, played on the computer, got fawned all over by my colleagues, and enjoyed the bonus graham crackers and apple juice in the ‘supply’ closet! He was really acting fine, even a little energized by being at my office, but a slow, barking cough began to emerge.

We left my office midday and went to the pediatrician (it was a covering doc as our usual pediatrician was out that day! Sigh.) to find he had since spiked a fever, and his room air pulse ox was 92%.  He had a right lower lobe pneumonia [ok, this is the part where I confess I listened to his lungs when he was in my office -- which I try to NEVER do, except I did this time -- and thought I also heard a pneumonia but tried to leave that to his real doctor to decide!]. They gave him nebs in the office (I told them they never work, but they always say it’s worth a try) and his pulse ox remained at 92%.  So, we left with our amoxicillin prescription and a word of caution: “You know what to do. You are a doctor. If he gets worse overnight, don’t even call us. Just go to the ED. If you are worried tomorrow, bring him in again.”

I should have known. It always gets worse.  This kid gets sick fast.  So he got his first dose of amoxicillin, and I waited.  You know that waiting -- the kind of waiting moms do -- where we are so worried, need to be distracted so we don’t obsess, then we second guess our judgement, try to convince ourselves it will be ok, exercise some magical thinking that all will be fine as soon as the antibiotics kick in, and the time can’t pass quick enough.  I put E to bed at 6 pm because he was so tired and miserable, and the next 3 hours were unbearable. He would sleep for 5 minutes, cough uncontrollably, wake up and cry, and then be so tired he’d fall asleep again, and then do the same thing over and over. It went on like this for so long. Did I mention I also was getting my 7 year old fed, showered, ready for bed? Oh yeah, that too!

At 9:30, while holding E in my bed, trying to get him to calm so that he could get some much needed rest, he woke and cried and said “Mama, I need help. I need help.”  So, that’s it.  I sped into action: clothes on, coats, boots, hats, gloves for kids, I woke up M, I put both kids in the car (10 degrees outside!), dropped off M at a friend’s house to sleep over, and drove to the ER.  E’s dad eventually met us there -- another story.

In the ER, E’s room air pulse ox was still 92% but when he fell asleep, he got hypoxemic to the low 80s.  I’m guessing it’s why his sleep was so fitful.  So, we got admitted. And we spent 3 days in the hospital. From the gurney in the ER, I sent emails and texts to my clinic manager, medical director, and colleagues to cancel all my patients and my meetings, and the interviews for the promotion that I’ve been working toward.  The rest of the week was a wash.  In fact, all the stress and chaos of ‘everything else’ just melts away when you have a sick kid. I told myself, “I’ll catch up. It will be ok. Everything else will wait.”  And it did. Time stood still with him in my arms. All I needed was him to get better.

E is fine now. He is back to preschool, and back to his usual self. M had a few days of being bonkers because her routine was off as we figured out how to move all the pieces of the family puzzle while I stayed with E in the hospital (thank goodness for good friends!). But, she was truly a champ during it all. And, we are back to ballet and soccer and swim class and play practice and birthday parties and the crazy of morning school drop off, and I’m back to patients and meetings and interviews. And somehow we are all staying afloat. And we are making sure to do it all with lots of hugs and giggles and a few dance parties mixed in -- the chaos is there, it’s never going away, and we are trying to keep it ‘light’ for now because that’s all this doctor mama can take at the moment.