What my toddler is teaching me about growth

In the last couple of weeks, my son has been learning to identify colors. Mama and Dada are bursting with pride that he's so verbal and learning new things so quickly (he's not quite two years old). For the first few days, he would try to identify a color and be right maybe ten percent of the time. When we'd gently correct him, his little brow would furrow for a fraction of a second, and then he'd try again. He's been persistent, and now a few weeks in, he names the colors of the flowers and the cars that we see walking around our neighborhood. And he's so excited when he gets it - just bursting with pride that he's learned something new.

I have a lot to learn from my son. He is curious and eager to learn, and he doesn't give up when he struggles. He's not embarrassed to admit that he doesn't know something, and why should he be? It's all new to him, and he's learning so much! He's having fun, even when he doesn't know the answer.

In just 7 short weeks, I'll be a brand new intern, and I will struggle. I will be wrong often. I will try my best and still fall short. Obviously, the stakes are drastically different for me than they are for him. But if I can approach the next phase of my training with half of my son's enthusiasm, joy and persistence in learning, I think I'll be ok. 

In praise of skin

Another work post from the burn unit, Kamuzu Central Hospital, Lilongwe, Malawi. I want to tell you about dressing change days, and interject a little ode to skin. I wrote a version of this for my private blog, but wanted to share with you all as well. As always, thanks for reading these ramblings!

Mondays, Wednesdays and Fridays bring dressing changes in the burn unit. This means that every patient—as many as 42, plus the many others who come in from home just to get their dressings changed--line up at the end of the hallway and wait their turn, while 3-4 intrepid nurses unwind and wind miles of bandages, slather ointments, and squirt morphine into their mouths. Except when there is no morphine. Then it’s diclofenac, which is, I imagine, the equivalent of getting a swig of ibuprofen right before you get scalped alive.

Walk with me. From the outside, down a dark hallway filled with people, toward the light at the back and up the stairs, three flights. The staircase is open to the outside and on each flight there's a big window with a view of the city--today it's hazy and hot, so the buildings are distant under a screen of red dirt and smog--but it's not airy or breezy. The stairs are worn from countless people walking up and down it for years, and on the second flight a woman wearing yellow wellington boots is mopping, with a broom that's seen better days and concrete-colored water. On the third floor we briefly bump along behind two policemen, big guns swinging freely, talking exuberantly and walking oh-so-slooooooowly—and finally we arrive on the third floor, and walk down the hallway to 3B, the burn unit.

Before you open the door, take a little deeper of a breath, for you're about to experience that smell. On a good day you manage to take 3 steps inside before it hits--the odor of maize meal cooked into grits-like porridge, or a paste, or a hard cake (nsima); of bodies, urine and boiled cabbage, dirty wounds, feet, doughnuts, and fear--and then you see the mother carrying her five year old daughter wrapped up like a mummy with an IV tube sticking out of her neck--and you feel ashamed for even noticing the smell.

There are six rooms, 4 beds each, lining the hallway to your right. Linking them is the open breezeway down which you’re walking, which opens onto a shared courtyard where people dry their laundry and family members cook their meals. On the other side of the rooms is another hallway, the khonde, or “outside,” which becomes another long communal room during the months when there are more patients in the unit than there are beds. During the cold season—June, July, August—the khonde is full.

Two boys, aged four and six, one with a bulky bandage around his leg and the other with a belly dressing, are playing with a glove balloon, and you toss it back and forth with them for a little while, their smiles lighting up the day.

Are you procrastinating? We have to keep walking down the hallway, to the room at the end, where all those people are queued up, since that’s where all the action takes place. Each mother dons a protective plastic gown and gloves and takes the child—the median age here is 3—on her lap. The mothers hold the children down. The first trial begins, that of forcing the morphine into the children's mouths. Most take it willingly, especially ones who have been here a while, but sometimes they purse their lips, or cry, or swat with their arms. It doesn't matter if the morphine trickles inside or outside of their mouths--there is no refill and the dressing change happens with or without it.

Next, the nurses soak the bandages in saline to help with removal. Since there are 42 patients and 3 nurses, waiting for a complete soak would take way too long. Some of the kids start screaming in the hallway; some when the mothers take them on their laps; some with the morphine; but all of them are screaming by this point. These kids are burned over 10-40% of their bodies, on average; over all possible body parts; in two main ways: they scald themselves or catch themselves on fire. It's the cold season in Malawi, no one has heat at home, and very few people have stoves; cooking happens over open fires, outdoors, and accidents happen frequently. Malawi is burnin', y'all:

 

Skin gets so much criticism. We stare at our pimples as teenagers and wish them away; at our wrinkling faces as adults, and hate their testament of the passage of time. We scrutinize moles and massage cellulite; we want elasticity and spend millions on creams and lotions that promise to keep us looking young. Even as we enjoy skin's gift of touch, in embraces, caresses, and kisses, we resent and focus on its fragility, its ability to hurt, and too often, its color. We don't appreciate scars. Skin should be blemish-less and baby-soft. Not at all like the skin I see in front of me--discolored, twisted, partially healed, in some cases with the tell-tale cheesecloth appearance of a healed skin graft. This is beautiful skin because it works in its intended way: not as pretty packaging but as a barrier to infection and pain, as the selectively permeable wrapper that allows the rest of the body’s functions to proceed uninterrupted and unthreatened, with just enough openings to allow a regulated exchange with our environment.

It's the absence of skin that exposes its absolute necessity. This six year old girl being unwrapped now has full thickness burns (what we used to call third degree) over 55% of her body: anterior and posterior thorax, both legs, both arms, a bit of face and neck, buttocks. Her big, deep brown eyes look at me with tears trickling down her cheeks as her mother’s helper raises the IV bag above her head and arranges it so the tubing is not kinked. This is a bad burn: flame generally causes deeper burns than hot water, and in this case, it looks like her clothes were on for some time, and the contact did a lot of damage. Like countless others, she was playing with her friends and tripped into a fire, where her clothes caught the flame. She cries, but not much: a bad sign. Although we teach that full thickness burns are insensate, since by definition the heat has destroyed the skin's sensory apparatus, not everything burns to the same depth, and partial thickness areas surround most full thickness burns—and those do feel pain. Her name is Chisomo, meaning Grace. She will die in 3 days.

I think about the ones we can’t save, back home, and here. I hold on to them for motivation to keep studying, keep waking up, keep leaving my family, and keep trying—and to honor their memory, although I see them usually only in a dehumanized form, although I know them usually only as bodies wrapped in dressings and not as children chasing goats, eating mangoes or diving into the lake. Knowing what makes a patient human makes me a better doctor but it also hurts more—and many times I don’t want to admit they are people because doing so makes me transiently incapable of returning to work. It’s like this in the States and it’s definitely like this here. The constant blur of activity insulates you from processing both the good and the bad, but both stay with you, and sometimes when you get a breather it all comes out, and it’s very hard to figure out what to do with all of it—so I try to just notice it and not cry, and carry on, because in the end, there are more of the ones who get to be human again than the ones who don’t, and so you keep going. As shown by the parents and patients in this burn unit, every day, with their smiles, their high fives, and their endurance, despair is a luxury. Ain’t nobody got time for that.

On Five Year Plans

This is a throw-back to a MiM post back in 2013 that really resonated with me at the time, and still does, in which T writes about someone asking her, "Do you have a five year plan?"

When asked this recently, I fumbled. Actually, I tossed back the answer, asking the asker to mentor me through getting such a plan. It wasn’t even someone who knew me well and it had been asked in a fairly casual way. Regardless, I was not able to answer the question. But if I were to answer it, the answer would be, “No I do not.”

The comments that followed included other MiMs stating that they too did not have five year plans. People cited living in the present, and checking in periodically to ensure satisfaction and fulfillment, but not necessarily a structured plan. Others did have plans, which they found informed their present-day decisions. I was on maternity leave with my first when I read this post, and was feeling very unmoored. I felt that I should have a very clear path of where I wanted to go in my career.

I remember being asked the same question by a male faculty member during my first week of medical school. I fumbled too, as I entered medical school interested in family medicine but open to possibilities. My surgeon-keener classmate piped in with his plan for surgical specialty x, making me feel even more self-conscious. In retrospect, I don't blame myself one bit. I think some people do well with a well-defined, honed-in focus. Others, like myself, find the goals harder to identify; my priorities have to emerge - they can't be easily forced out.

I have broad goals - community contribution through medicine and beyond, strong faith and family, a healthy lifestyle. I have diverse interests; one is health equity, which has led me to refugee health. Various other interests have led me to different projects over the years.

I do find it helpful to have short-term career priorities; a necessary honing-in to avoid over-commitment and burnout. Dr. Mamta Gautam, the Canadian physician wellness expert, tells physicians that as people who have plenty of interest and enthusiasm about many things, there will always be more interesting things that we want to do, more than we could possibly have time for. So, it is a matter of choosing and narrowing down options.

Right now, I'm focusing on clinical work, local refugee health coordination efforts, and writing - both here, and on a blog aimed at patients. I supervise learners periodically, but have flexibility. There have been other tempting opportunities recently, but I have declined them in order to preserve family and self care time. Personally, I need regular downtime. I schedule a day off every month, sometimes more. I need some "empty space" on the horizon in my calendar, which can involve self care time, and sometimes catch-up work and projects. With two young kids, I've found the regular days off invaluable for recharging.

With the births of my two children, the last four years have been full of transitions. I think motherhood fits naturally with evolving priorities and goals. I look forward to more changing priorities over time. And I'm still OK with not having a five-year plan.

Don't forget they are someone's baby

Living in DC and taking the metro regularly provides me with ample fodder for social analysis and ample opportunities to be upset and amazed by humanity. For example, I get upset when able-bodied people see disabled, elderly, or pregnant people standing and sit in their seats anyway. Especially while pregnant, I spoke up very loudly (ex. As able-bodied men crowded on an elevator as I waddled to catch the door for a man in a wheelchair. I stared everyone down and said someone needs to get off so he can get on; we were obliged begrudgingly.). I am amazed when folks step in and help someone in need during an emergency.

An issue of growing contention in my neck of the woods is middle and high school students getting onto crowded trains. They are loud and there is often cursing involved. However, I have noticed that most of the adults regard them in a very unfriendly way or simply ignore them. The local listservs I am a member of are far worse; the disdain for these children is palpable and I have had to step in several times when the racism and classism became unbearable as well-to-do grown folks called children thugs, crooks, and goons. It literally hurts my heart!

I personally make it a point to acknowledge these teenagers every chance I get with a smile or a hello; sometimes I’m ignored or begrudgingly acknowledged, but oftentimes you can tell these young people relish the positive attention and are surprised to have been seen. I remind myself regularly that they are someone’s baby no matter how “hard” they are appearing to be. No matter how many tattoos they may have on their young skin. No matter how many curse words they and their friends yell. And I try to remember that someday my little Zo will be one of these students taking the train and I hope that others will treat him well knowing that he too is someone’s baby. My husband and I are well-read in the studies that show that Black boys like my Zo are seen as being older than they are by the majority and less innocent than they are by police (see FURTHER READING below). We know the sickening statistics of disproportionate violence against boys that look like him. We pray that folks will remember these children are someone’s baby and that he is ours.

To bring it back home to the DC metro, the other day on the train a handsome young man with beautifully styled locs and sagging skinny-jeans and a uniform high school shirt  entered the train with a young woman I assume was his girlfriend. His new-aged rap music (the kind old hip-hop heads like me can’t understand and abhor due to the crazy amounts of auto-tune) was blasting. Adults bristled. Some sucked their teeth. He walked on the train and I smiled at him, he was visibly surprised, smiled back sweetly and sat directly behind me. Every other word of his song was f--- this and blast that. I turned and said as gently and respectfully as I could “Sweetheart, don’t you have headphones or something? My old ears just cannot take all of that cursing.” He said quickly “Ohhhhh my bad! My headphones broke and I don’t have another pair, My bad!!!” I pulled out a set of headphones from my bag and said “here, you can have these!” He smiled and said “For real?!? You serious?!? Thank you so much!” And just like that - connection. Respect. Compassion. His mama would be happy.

It could have ended differently. Someone else could have started cursing at him. He could have rebuffed my offer and cussed me out. But it ended wonderfully. And I modeled appropriate, compassionate behavior for children and adults alike.

I exited the train at my stop and wished him and his lady a good day and he did so too.

___________________

FURTHER READING:

http://www.npr.org/2014/03/19/291405871/consequences-when-african-american-boys-are-seen-as-older

http://www.apa.org/news/press/releases/2014/03/black-boys-older.aspx

http://www.theatlantic.com/national/archive/2014/03/cops-tend-to-see-black-kids-as-less-innocent-than-white-kids/383247/

MIM Intro: Doctor Professor Mom

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

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

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

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

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

In between promise and fatigue: here's to the end of residency

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams.”

“Before a dream is realized, the Soul of the World tests everything that was learned along the way.”

“Every search begins with beginner’s luck. And every search ends with the victor’s being severely tested.”

I can see the end of residency. My schedule is set. I know that June 23 is my last official day of my pediatric residency. I am standing on the edge: the edge of my time as a “trainee” and the beginning of my time as an Attending Pediatric Physician. As one of my closest mentors says, “Medicine is about delayed gratification,” and she is so right because I can feel the end of training, it’s palpable. It stands looming in the distance. I see the promise - the chance to continue to create the career that I have envisioned for so long. One committed to the underserved, adolescents, and new families. One committed to medical student education and helping to forge a path in medicine where the marginalized student feels less alone. One committed to enhancing trainees understanding of health literacy, compassionate care, holistic care. One committed to clinical excellence and rigor.

I can feel the promise of creating a career where I can share more of the child-rearing responsibility with my husband. We have had the chance this year to experience up to 2 consecutive months of me having a “regular” or non-Ward schedule and it has been amazing (family dinners, weekend outings, dates, sleeping in). My Attending friends tell me that this is how life can be post-residency and that I have to work hard to get a schedule that allows us to feel more like a regular family. Interviews have been going very well, but none has felt quite like “the one.” I can feel “the one” coming though and am giving myself until April to keep searching and networking.

But I can also feel my fatigue. It also stands looming and sometimes sneaks in for a jab or two. The tight pull of my neck as I continue to type into our electronic medical record. The beginnings of a tension headache as I work on licensing applications during Zo’s nap time. I can feel my strain and my friends’ strain as we begin conversations about our final residency rotations with “I am soo over this!” Invariably all of our texts, phone calls, and in person conversations include our “being over” being on call, covering in the wards, and Interns doing crazy things. Then we laugh and talk about how a friend who is a new Attending has told us something wonderful about his or her life.

As my Residency Director said, “You’re not supposed to love residency” because it’s not a permanent job, it’s just a big hulking stepping stone.

As I always do when I am straddling a new transition, I have begun to re-read selections of "The Alchemist." This book has been with me since the first time I read it in 2004 as a fourth year undergraduate awaiting medical school acceptances. This road has had its share of suffering. Times where I felt failure was imminent. I fought on. In spite of a few very low points, I have experienced joy beyond what I ever could have imagined. Providing excellent patient care, figuring out diagnoses, being hugged and hugging amazing families and assisting them during their lives’ lowest points. I have experienced the joy of getting married to an amazing man that I now call my own and together we welcomed to the world an outgoing, rambunctious little boy that amazes us every day. There isn't a day that we don't pause, smile or laugh out loud and shake our heads at his silliness and love for life.

As I stand on the edge of my most recent life’s transition, I foresee some suffering, some testing, and a whole lot of joy. While I welcome luck, I also know that I have been fortified by life’s challenges and know that you can experience fatigue and promise simultaneously and it still bring so much joy.

Here’s to the end of residency!!!

Quotes above are from Paulo Coehlo's "The Alchemist," 1993.

That way you talk

I was in the office speaking with a parent and her kids at some point in the past year (how's that for sufficiently anonymized).  The mother was gazing at me for just a little too long.  She could have been pondering my most recent question, or may have been lost in thought, but at that moment I opted to ask her gently if she was okay.  And she simply said, "I'm sorry, I just love the way that you talk with my kids."

Oh how that made me feel that I'm right where I should be and doing what I should be doing.  She saw the way I really ask, really listen, and aim to motivate. It's working, at least in this case. 

You've probably heard similar positive comments from time to time about how you communicate with your patients.  And yet, if I could only do so at home!  I can be ever so calm and motivating, building partnerships, and serving as a measured and informed voice of reason at work.  And while I want to consistently do the same at home, I CAN'T HELP YELLING. AT MY KIDS. SOMETIMES. GOT TO WORK ON THAT.  You?

What's your idea of fun?

Our health centers are “medical homes” now, so I have to come to accept (but not necessarily embrace) my allotted turn or assignment to work, i.e. see pediatric patients, on an occasional Saturday. Periodically, I am able to trade these away, so they end up being few and far between. After a full day of patient care on a recent Saturday on a recent 3-day holiday weekend, my family (me included) were out to dinner and a colleague happened to be picking up dinner at the restaurant where we were dining. She came over to make small talk, and I mentioned I'd just come from working the whole day.

My young son then chimes in with, “But mom, for you, work is fun, so it’s not so bad.”

And that got me thinking about whether or not it is fun. Of course, there are all kinds of fun. Family fun is our recent amusement/water park trip, swimming in any lake, ocean, or gorge together, and family movie night. My individual "fun" is going on a long run, doing the Sunday NY Times crossword puzzle, or simply sleeping late.

But the perception that work is fun has got me thinking. Indeed, a lot of pediatrics and teaching is, when my patients giggle and the toddlers talk and my students are inspired and inspiring. And my work is gratifying. It feels meaningful. But at times it is heart-wrenching. I’m intrigued that “fun” is how I portray my work to my children, or that this is how they perceive my orientation towards what takes me from them day to day. That this one word (fun) has encapsulated their mom’s chosen career path.

Self advocacy - why is it so hard?

It’s funny how a few things collide, to suddenly make life crystal clear. It’s job application time for me, and I was lucky enough to receive three offers, strangely enough covering the gamut of work life balance from no after hours to full on subspecialty. After much deliberation, I chose the job that would best complement all my roles – mother, wife, doctor, furry friends owner, health advocate wannabe – you all know the list. I recognised I was burnt out, and at risk of leaving medicine altogether if I didn’t make an active decision to change my hours and where I was headed. Both my husband and I are in high level, full time roles, something I never felt comfortable with for the children. Here was my opportunity to make a change more in line with what I wanted for my family. I’m a firm believer in if-something-isn’t-right-fix-it, don’t just wish or whinge! Fast forward one week - past all the happiness at finally making a decision, the peace that the decision was right for me and mine, excitement of starting a new job, the daydreams and plans to incorporate fitness, walk the furry friends, spend more time with hubby and children - to today. I’m catapulted from a state of contented decision-making bliss into Guilt – guilt I now know is ‘doctor guilt’ (thank you Emily). It deserves a capital G, don’t you think, for the central place it often plays in women’s lives? So what happened?

Well a couple of things. Firstly, taking this new, wonderful job involves resigning from my current job, something that I’ve never had to do before (I’m yet to do this, because I’m waiting on a formal contract). It also means leaving a path I’d always thought I’d follow, and jumping into a reasonably unknown area for me. After making my decision, I had a conversation with the boss of the subspecialty I’d originally planned to follow, creating doubt in my mind that I’d made the correct choice. She wanted me to take her job offer, and I felt like I was letting her down in choosing not to. It was also ‘known’. After the ‘doctor guilt’ came self recrimination – in resigning, I am jumping ship, baling out, leaving colleagues in the lurch. In reality, my position is actually supernumerary at present, so in actual fact, no-one is left in the lurch, but my soon to be old hospital won’t remember that. I’m now the person I never thought I’d be – the one who leaves a post early.

This really forced me to choose what was important to me. I sat down and thought long and hard about my values, what I considered ethical, the life I wanted for my family, the sort of mother I wanted to be, and whether that married with my current workload (no surprises the answer is no). I pictured myself in each of the three jobs, and tried to see how I felt, what my reactions were. I read widely, trying to build a picture of my future career options. I came across an article about women failing to speak up when sexually harassed and why we are all so ingrained to be ‘good girls’, to not create waves, keep everyone else happy. I had many long chats with close medical friends, trusted senior colleagues, and my husband, who all agreed I should take this job. People who, like me, would never ordinarily leave a post early. I was told leaving a post early is common, people do it all the time. Not me though. Never me. In an ideal world, I would ask to start the new job when this one finishes, in five months time. That’s the path of least resistance.

But spending another week, let alone another month, in my current position is too long. My family needs to make a change now. As well as that, moving now saves me time at the end – possibly nearly a year of time (due to retrospectively counting some of this year, something that probably won’t happen if I don’t move until next year). The next five months in my current job is surplus to my training needs. So, for the first time in my life, I’ve chosen to do what is right for me. I’m going to take the community based, no after hours or on call job, and I’m going to start in 4 weeks. All I have to do now, is tell them. Resign. Although I’ve decided, I still question it, and probably will, until my contract arrives, and I have to make the decision final.

So I guess two questions. Has anyone else ever left a post early? Taken a leap of faith? Any advice on whether it turned out ok in the end? Fingers crossed.

Play dates: Mothers in Medicine Style

Most of the Mothers in Medicine contributors, including myself, write anonymously. I write about my husband O and my son Zo knowing that folks who know me can figure out pretty quickly who I am. I write as if my boss is reading my posts, though I have never actually told her, but just in case, I write as if she may read them, nothing too embarrassing. I write to share and get feedback from folks near and far who understand my struggles and my triumphs in ways that my non-physician family never truly will. I have been writing for MiM since I was a Medical Student and over the years I have started telling folks beyond my family to check out my posts including some trusted work colleagues.

Over the years, I have felt like I have come to personally know many of our regular contributors and even a few of our regular commenters. I hope that someday there will be a big Mothers in Medicine Conference or maybe just a gathering at a bigger annual professional conference. When I read Cutter’s posts I said, hmmmm, I think we work in the same hospital! Flash forward to several months later (and many thanks to KC) and Cutter and I had our first MiM meet up at a local museum. Her daughter is super duper cute and Zo was smitten at first glance. He quickly followed her to the slide and then he began chasing her around the exhibits.

Play dates are always good times to reflect on the joys and vent about the struggles of motherhood, but when the other parent is a MiM, it is especially cathartic. Cutter is amazing. Chief Resident, Super Mom/Wife, super hair braider (from Youtube videos nonetheless). We spent hours talking and it was so nice to have someone who understands the doctoring and the mothering because it makes for a really unique life.

I have had a few other play dates with women Doctors including several with a beloved Attending who has young children. These times are equally amazing. She has the wisdom of being several years out of residency and fellowship. The first time I asked her and her kids out for a play date, she gladly accepted. We met up at another local museum and the next time at a park. Each time there was a lot of her being a cheerleader, saying “You’ll get through this.”

Play dates with stay-at-home mothers usually involve looks of pity and many exclamations of “I can’t believe you work that much.” Play dates with 9 to 5 working non-physician mothers usually involve less pity, but still many “I can’t believe you work that much” looks. There was none of that at our MiM playdate and I liked it!



Here’s to many future play dates, MiM style!

Homeschooling options for the busy parent

My husband and I are products of public school education. Don’t get me wrong, we are both extremely motivated and successful but we both believe that our education was lacking in very significant ways. My husband now teaches college students who have only been taught under “No Child Left Behind” and we are both very concerned about the results of this method of learning. As the parents of an extremely bright and energetic 2.5 year old, many of our conversations revolve around preparing him for a future that requires tools that traditional education will not provide him with.

One of my best friends from college who is an innovative teacher and curriculum developer attended Montessori schools for her early education. The methods she used to remain organized during college amazed me. She color-coded and charted and organized in ways that I did not even know existed. Studying for me was always about picking up my book, reading, taking notes in the margins, and more reading. It wasn’t until medical school that I learned how I most effectively studied. I began drawing funny caricatures (nothing close to Netter’s) and charting and mapping things out so that I could better process the material and retain it later. As a second year Resident I still use this method. I can’t even imagine how much stress could have been relieved and how much better I could have learned if I studied better earlier.

Back to Zo, my little genius in the making. He amazes us. He is more than a sponge. Every day he comes home and does and says something new; something that makes us pause, smile, and say "how/when did he learn that?!?" My husband and I are exposing him to as many good things as we can. We listen to music (kiddie things like the Dino V, adult things like soul, jazz, rap, classical) and dance all of the time. He helps us cook (he mixes), plays outside, goes to museums. He attends an amazing Spanish-immersion daycare and knows more Spanish than both of us. We got rid of our TV when he was an infant, though he does watch a few hours of Netflix Dinosaur Train and Turtle Tales on the weekends while we straighten up and prepare breakfast. Every 2 weeks we get a new book kit from the library that contains 15 books on a toddler-friendly subject.

But he’s learning so fast and I know he can learn more, I just don’t know how. I read Amy Chua’s Tiger Mom and I’m not a fan of her parenting philosophy, but I will incorporate some of the things that I agree with and like. I want Zo to learn the best way he can, I want him to learn a martial art, to be fluent in another language (Spanish), and play an instrument (kind of got this from Chua and Fifty Shades of Grey, LOL!). I belonged to an amazing mommy-group in the mid-Atlantic before starting residency where many mothers home-schooled and their children were so inquisitive and learned; it was inspiring. I love being a doctor and homeschooling full-time is just not an option for us. 

I have begun researching “homeschooling” options for working parents and am looking for more resources. If you have done modified homeschooling or know anyone who does, please send them my way. I promise to keep you all updated on our progress. Things will be kept very simple since we only have a toddler, but I’m sure as he ages, I will find other fun, innovative ways to supplement what he learns at school. 

So for this week’s "Homeschooling for the Busy Parent" activity:

- lots of fun time and play, dancing, riding our bikes outside, and time at the playground
- nightly reading of our colors books
- I will make some simple flash cards and we will focus on primary colors and then secondary colors using a concept called “isolation” that I learned on YouTube from a video-blog called “Preschool Homeschool”

Guest Post: Why It’s All Worthwhile (or What Keeps Me Going)

(I am posting this as a followup to Gizabeth’s excellent, thought-provoking “Disillusionment” post. I wrote this anecdote awhile back but decided to post it now, since it illustrates so perfectly what “keeps me going” and why I’m not disillusioned despite all the difficulties we face. - gcs15)

“Make a Joyful Noise unto the Lord”

In October 2007, the ER called me for yet another emergency. A thin, elderly man lay on the stretcher with his anxious wife at his side. “He’s been more and more confused, Doctor. This is just not like him!” she said. Sure enough, on examination, he had no focal deficits, but he was clearly disoriented. No history of trauma, no blood thinners, just chronic treatment for myelodysplasia (which was stable). His CT scan showed the reason for his confusion: a large subdural hematoma extending over the entire right hemisphere of his brain. Yet another elderly patient with a subdural.

I took him to the OR emergently that night. I removed a large window of bone from his skull and opened the tense, bluish dura. A large blood clot lay on top of his angry-looking cortex; once the hemorrhage had been removed, his brain began to gently reexpand. Successful surgery, but how would things go over the next few days? So many irritated, elderly brains begin to seize postop. The mortality rate for subdural hematoma is 50%. This is one reason many budding physicians avoid neurosurgery; we see a lot of terribly sick patients, and a lot of them don’t get back to a functional life.

Back in the ICU, the nurses told me, “We’ve been getting a lot of phone calls about this patient! How did he do?” Evidently, he was a Ph.D., a professor emeritus of fine arts at Bob Jones University, beloved by hundreds of students and alumni around the country. He conducted their orchestra and had been composing all kinds of opera and classical music for more than 50 years. His children was all bright and successful, some of them accomplished vocalists. In short, my patient was a brilliant, artistic man.

His first 2 days postop were encouraging. He began to eat and joke a little. I transferred him to the floor and gave a sigh of relief. That evening, however, the nurses called me. “He’s not looking so good.” When I arrived at the bedside, he was minimally responsive, pale and diaphoretic. A workup, including a CT head, was suggestive of infection. I transferred him back to the ICU and aspirated fluid from his wound; clearly he had developed meningitis. I started him on IV antibiotics and began to really worry.

He was very sick for a long time, but he recovered and actually did very well. I got to know him and his family a little during his illness. They were delightful, cultured people with a great sense of humor. The first time I saw him stand up, I realized he was at least 6’6”! We talked about his passion for music and his love of God, among other things. I told him, “When you are completely recovered, and you are ready to conduct again, let me know. I want to come.” He laughed and promised. Privately, I wasn’t sure that would ever happen, after what his brain had been through.

About 2 months after he left the hospital, he came back to my office. “What do you think about this spot?” he asked, pointing to his head. The wound was infected again. Over the next few weeks, he had 2 more surgeries and IV antibiotics to remove the bone flap, clear the recurrent infection, and implant an artificial custom-made bone flap in the defect. Finally, finally, he was better, this time for good.

The months went by, then a year; no news from him. I thought of him every so often, hoping that his cognitive function was still improving. By this time, he was 78 or 79 years old.

Just before Christmas 2009, my phone rang at home. “Hello, Doctor! Remember me?” Of course I did! “Remember my promise? I am conducting Samson et Dalila in March, and I want to know how many tickets you need.” What a wonderful Christmas present!

So my husband and I took my 12-year-old son with us to my friend’s opera that weekend in March. I can’t remember ever enjoying opera so much. It was stunning. A cast of 200, including 3 nationally acclaimed guest performers, and a wonderful orchestra took a simple Bible story and cast a spell that lasted 3 hours. As the stars of the show escorted my patient onto the stage at the end for a long standing ovation, the supertitle proclaimed, “This will be the final major performance of his career.” I stood with his family in the audience, hoping my eyes wouldn’t overflow.

I could feel in the thunder of applause the impact he had made on so many of his students, and the love and respect they have for him. I could feel the force of his personality and the persistence that brought him back to his baton at almost 80 years old. And I could hear clearly the Almighty whispering to him, “Well done, good and faithful servant.”

Professor, I was blessed to have played a tiny supporting role. Bravo, and bravo!


About my patient: Dr. Dwight Gustafson was the longest-serving Academic Dean in the history of Bob Jones University. Samson et Dalila took 2 years of intensive preparation and rehearsal; it was the biggest such production done at BJU in the last 20 years. Dr. Gus says of his illness and recovery, “Through it all, I kept saying to everyone, ‘God is good at all times.’” I continue to be inspired by his faith and his example. This is printed with his permission.

"Doctors Wanted - No Women Need Apply" - NOT!

I could browse this site for hours: the N.I.H./National Library of Medicine website called Changing the Face of Medicine, which celebrates the lives of women physicians in America.

Any time I get a little discouraged or feel a little fatigued about working my two jobs - nine or more hours in the O.R., followed by a commute home directly into the next task, food preparation for the evening meal and after-dinner homework/music/general kid-help - I look up stories of women who had it MUCH HARDER than I do and try to give myself a little wake-up call. I stop whining right away.

Here are just a few of the many amazing stories that have inspired me:

Dr. Susan La Fleche Picotte, born in 1865, was the first Native American woman in the United States to receive a medical degree. She was 24 years old. She was also the first person to receive federal aid for professional education. The M.D. program at the Women's Medical College of Pennsylvania was a three-year program; she graduated after two years at the top of her class. She had been inspired as a child to study medicine by the death of a Native American woman after the local white doctor refused to provide care for her. In 1894 she married Henry Picotte; they had two sons. She had a busy general practice serving both white and non-white patients. Two years before her death in 1913 she opened a hospital in the reservation town of Walthill, Nebraska, achieving a lifelong dream.

Dr. Elizabeth D. A. Magnus Cohen was the first woman licensed to practice medicine in Louisiana. The NLM site relates, "While she was still in medical school, a New Orleans Bee editorial on July 3, 1853, had labeled the idea of a female physician treating male patients as incongruous and improper. In 1898, an editorial in the Journal of the American Medical Association blamed women physicians for the declines in salaries and prestige of the medical profession. Eventually, medical schools began refusing to admit women." Dr. Cohen recounts that as a surgeon she was called at least once or twice every single night before dawn during her thirty-year practice from 1857-1887. Other doctors apparently referred to her as a "lucky hand" in tough cases. She was married and had five children, though only one lived to adulthood.

Dr. Sarah Read Adamson Dolley was the first woman to complete a hospital intership, in 1852. Her interest in medicine was sparked by a physiology book given to her by her teacher, Graceanna Lewis, to read at home. She practiced OB/gyn and ran a medical practice with her husband, with whom she had two children, one of whom died in childhood. "Her vivid correspondence documents her success in creating a solo practice after the death of her practice partner—her husband. They also reveal her anguish over how to support her son, pay for his education (he, too, became a physician), and how to overcome the resistance of her male colleagues. But her letters reveal that in her rise to success, nothing was easy, especially without a role model to guide her."


Dr. Halle Tanner Dillon Johnson was the first woman of any ethnicity to be a board-certified physician in the state of Alabama. She was already married and a mother when she began her medical studies and in 1891 earned her medical degree from the Women's Medical College of Pennsylvania with honors. While "southern newspapers had scoffed at the idea of a black woman even applying to take the [board] exam," in that same year the New York Times took note of her success in passing the grueling ten-day Alabama State Medical Examination. Alas, her career was brief. She died of childbirth complications on April 26, 1901.


Finally, though I don't think she was a mother as well as a physician, I want to honor Dr. Elizabeth Ann Grier, the first African-American woman licensed to practice medicine in Georgia. She was an emancipated slave who alternated every year of her medical education with a year of picking cotton in order to pay for her training. "When I saw colored women doing all the work in cases of accouchement [childbirth]," she said, "and all the fee going to some white doctor who merely looked on, I asked myself why should I not get the fee myself. For this purpose I have qualified. I went to Philadelphia, studied medicine hard, procured my degree, and have come back to Atlanta, where I have lived all my life, to practice my profession." Sadly, she died in 1902 after practicing for only a few years.

It's stories like these that let help keep me going, putting one foot in front the other and telling myself, "You can do this. You totally can." I think we have to keep passing on stories like these - to our students, our colleagues, our children, ourselves.