Pay it Forward

There’s been some sadness at our house recently. To be perfectly honest, the holidays have been the last thing on my mind. Wallowing a little too much in self pity, has become a hobby over the last week or two…. but today was different.

I had a great day.

The morning office went surprisingly smooth. I escaped for lunch to meet my husband and son at Cracker Barrel. This is quite a treat, I rarely get a full lunch hour, rarer still to get to leave the hospital. We had a pleasant lunch. Boy Genius was thrilled to get pancakes for lunch (husband also ate “second breakfast”). As we finished eating, I noticed that a few tables over was a lady sitting alone. Shortly there after, she came over to our table and with a huge smile handed my son a crisp one dollar bill and said “Happy Thanksgiving.” She then proceeded to take a our check and say “I’m going to take care of your lunch, and Yall have a blessed day!”

I was quite flabbergasted. I tried to protest, but she gave me a motherly “don’t even think about it “look. So we simply said “ thanks” as she walked away.

Her random kindness invigorated my spirit. I’ve spent the whole rest of the afternoon thinking of ways I could pass on blessings to others.

This may seem like a cheesy e-mail spam story… but I promise it happened to me today. My sadness is still there, but the self pity is gone and replaced with the reminder that this is the season to be thankful of our blessings and look for every way we can to bless others.

Twisted for Twilight

As an avid reader, I pick and choose across the genres of fiction and nonfiction. I am an equal opportunity consumer of the printed page. When looking up my member card at Barnes and Nobles, the cashier says "Oh, I see you come here often." Basically I'm looking for a good story - the kind that is hard to put down, will make me schedule my lunch hour in a quiet location just to get through a couple of chapters. Now as I write blog posts and dabble in fiction, I find myself asking what makes a good story.

Can't tell you what made me pick up Twilight. Maybe it's the buzz about the movie that I've read on other blogs. Maybe it's that desire to have a reading feeding frenzy. Stephanie Meyer hooked me - through all four books and the trials of Bella and Edward. Couldn't put them down until I finished them all. Went back to Barnes and Nobles on a Sunday night to buy the third and fourth because I couldn't wait for USPS to bring my Amazon delivery. Emersed in this world of "vegetarian" vampires, I find myself having philosophical discussions about the books with my teen patients.

Now the movie is coming out this weekend, and I'm trying to figure out how to get my boys to go see it with me. Movies are a shared passion between my two sons and myself. Husband bows out graciously whenever we go because he says he can nap for free at home. Sometimes finding common ground between the three of us is tough. The oldest likes action, noise, and can follow the twists and turns of plots well. The younger (age seven) son still likes animated films, but doesn't do scary well. I like a clever plot with not too much violence. So I'm thinking that I can sell this movie to my kids as kind of action-adventure and still get my romantic, girly fix.

Trying to explain this preoccupation with high school vampires eludes me. Is it the classic girl meets boy story? Is it the element of danger in Bella's longing for a vampire boyfriend with pulsing teenage hormones? Is it the pace? In my second reading of the first book, I tried to look at the writing from the perspective of a writer. The words are not complicated, and the storyline is kind of predictable. Still, I'm hooked.

Voice

I used to have a lovely voice. I thought so, at least.

On Facebook, many friends I meet again from my high school and college days ask if I'm still singing.

Well, yes.

"What's gonna work? TEAMWORK!" (I loves me some Wonder Pets).

And let's not forget the Mail Song from Blue's Clues.

But here's the kicker. Son doesn't appreciate my musical stylings. He actually shushes me when I sing along. I'm crushed.

I thought myself brilliant once. But I'd take the role of mama over broadway star any day.

How to get a part-time job in medicine

I got married near the end of my last year of residency. When I started medical school, in fact when I started residency, I hadn't yet even met my husband, and I didn't have any of the 3 kids I now have. That's probably a good thing because I would surely have talked myself out of the specialty I really loved into something more "family-friendly". There's nothing wrong with family-friendly, mind you. I always read the classified ads in the New England Journal just out of curiosity, wondering whether there are more part-time jobs cropping up as women, who more often work part-time than men in general, represent a greater share of young doctors. So far, I don't think much has changed in the job advertising sphere.

When I happen to have a bad day at work, which is fortunately rare, I permit myself to back up and take a different fork in the road. In my alternate life, maybe I became a dermatologist, where "full-time" seems to be 4 days a week...but who works full-time anyway? Or infectious diseases, where every other ad seems to start "Full-time or part-time". Ah, travel clinic...seeing some healthy people and getting them ready to travel to exotic locales. Lest fear of boredom be a factor, keep in mind that the occasional traveler will come home with a fever of 40.8--is it malaria? Dengue fever? Ebola? See, that would spice things up. And clinic finishes at 3p.

But snap out of it. I became a medical oncologist, had my first baby midway through my second year of fellowship, another baby at the end of my third year, and a third baby about a year and a half into my first "real job". At some point in late second year when other fellows were beginning to do their job talks and interviews, it dawned on me that I didn't want to be away from my son and his future sibs for 60 hours a week. I didn't want to miss first steps or first words or first anythings. It didn't feel right to me that someone other than me--indeed, someone I hadn't even met yet--would be there for more of my kids' waking hours than I would, and that's exactly what working full-time meant.

I starting looking through journals, online, anywhere for part-time medical oncologist jobs. Zip. Zero. Nada. I even tried monster.com, and all I got for combining "part-time" and "oncologist" is: Busy oncologist seeks part-time front office staff. Bummer. Oh, and did I mention that I had kind of subspecialized to one particular type of cancer. And can't move out of the area because my husband is in the military, unless they tell us to move, in which case I have to pick up and leave instantly. When I told people that I wanted to work part-time, and no I didn't want to just take a hospitalist job, and no I didn't want to work in an urgent care, and no I didn't want to review charts for utilization management or do life insurance physicals for a living, and yes, I did plan to work as a doctor, and yes, I did plan to work as an oncologist, and yes, it had to be in this area, they just looked at me with some blend of pity, empathy, disbelief, disdain, and said, "Well...good luck."

Six months later, I was agonizing over my choices: one job working 3 days per week as an academic oncologist, one job in private practice oncology working 2-3 days per week, and one job in oncology public health/health policy working anywhere from 2-4 days per week. All of them were within 30 mins of my house. All of them were in the particular subspecialty of medical oncology that was my interest. None of them was advertised. None of them existed when I interviewed. So, what's the deal?

If you happen to fall in love with a specialty of medicine that doesn't bear the family-friendly label, here are your career choices at the end of your training, assuming you aren't willing to compromise on the family side:

1. Let this specialty be the one that got away and pick something that's more family-friendly.
2. Train in your specialty, but work in a more general field with your specialty as your area of expertise (e.g. take a part-time internist job with an interest in pulmonary disease--a big group private or academic practice may be glad to have one internist who likes to see all of the asthma and COPD folks, there are plenty of them, and is comfortable with critical care if patients get admitted to an ICU).
3. Move beyond the standard black or white career paths--academic or private practice--and look at jobs in the government (FDA, NIH, CDC, etc), public health, the pharmaceutical industry, hospices, and so on, many of which are more amenable to part-time employees.
4. Interview for your dream job, whether academic or private practice or whatever, and give them enough time to decide you are their dream candidate. When they start trying to recruit, play your part-time card. Most will use salary or benefits to try to sweeten the deal. What you want is flexibility or fewer hours or whatever it is that you want. Take a deep breath, picture your kids clinging to your leg as you try to leave for work in the morning, and then speak up without apology. You will surely benefit from a part-time job if that's where your heart is, but there are also benefits to the employer, and you should point them out: cost savings (part-time employees generally accomplish more on a per hour basis than full-time employees and generally cost their employers less in benefits because fewer benefits are provided), greater loyalty (from grateful doctor-moms such as yourself who are committed to making part-time work work) and therefore less employee turnover, improved staff morale, and fewer absences from work (you can schedule the kids' well-child visits and your tooth cleaning on your days off, and , if you're lucky, some of their colds and vomiting illnesses might even occur on your days off). You will likely be pleasantly surprised. I interviewed for all of the jobs I mentioned above, and they were all full-time. After I made my priorities for recruitment known, all agreed to work with me to tailor a part-time arrangement. In the end, I actually created a hybrid of 2 of the part-time jobs I had negotiated, working a total of 3 days per week, and it has been wonderful.

Bottom line: If you assume it will be impossible to find a part-time doctor job in your specialty, it will be. If you assume it will be possible, then it will be.

Not old yet

Still enjoy animal crackers, mac and cheese, grapes.
Still enjoy playing the bongos.
Still enjoy seeing Grandma.
Still enjoy painting.
Still enjoy Clifford, Berenstain Bears, Mo Willems.
Still enjoy They Might Be Giants, Dan Zanes, Laurie Berkner.
Still enjoy wearing mittens.
Still enjoy going to the zoo, zoo, zoo, how about you, you, you?

Don't like too many snaps, buttons, and zippers.
Don't like wearing shoes when riding in the car.
Don't like keeping quiet.
Don't like coats.

Can't help interrupting.
Can't help staying up late.

But the jury's still out on stinky diapers, classical music, carrots, clothes with holes, tub time, hats...

I am Old

How I know I'm getting old:

1) I remember as a kid, I used to love going down slides. LOVED it. Especially those twisty slides where you go through a long tunnel. In the last year, I've had the pleasure of going through a handful of slides with Melly on my lap, and every time when I get to the bottom, something hurts. Usually my butt. Those slides are treacherous.

2) Prior to a year or two ago, I had never experienced lower back pain. Never. When I was stooped over a patient for whatever reason, the attending would often warn me, "Be careful you don't hurt your back." I would scoff. Back pain? No, I'm way too young for that! But in the last year, I've had back pain constantly. So far, it's all just been muscle strains that got better in a couple of days, but I suspect I'm on my way to a herniated disc. I try to be careful... I tell my patients to take off their own damn socks for the EMG. I'm aware of the correct way to lift an object so as not to cause back injury, but it's hard to lift with perfect form when you're lifting a quickly moving, wriggling object, if you know what I mean.

3) I used to love roller coasters. When I attempted to ride a roller coaster a few years ago, I found that I not only did not enjoy it, but when I came home, there were actual bruises all over my poor back.

4) About a year ago, I found my first gray hair. I haven't seen any more since then, but I'm clearly still traumatized.

5) I still get the standard "gosh you look way too young to be a doctor are you sure you aren't still in grade school" response from patients, which I know most of us have experienced. The only difference is that now I'm really HAPPY when they say that to me. I don't even get fake insulted, like I used to. Then I get overzealous and injure my back while examining them.

I am impressed that people have kids after age 35. I'm not even 30 yet and as you can see, I'm already falling apart.

(Yes, I'm under 30 and complaining about feeling old... go ahead and mock me.)

You know you're a physician-mother when . . .

. . . your first inclination after diagnosing your child with fifth disease is to photograph it for your private collection of pediatric exanthems:

And your next thought is gratefulness that the diagnosis does not preclude daycare attendance. Alarming though that will be to the non-medical parents.

(For the uninitiated, I posted a summary of fifth disease here.)

Topic Day: The advice we wish we had in medical school

Welcome to our third Topic Day on Mothers in Medicine! Throughout the day today, we'll be featuring posts about the advice we wish we had in medical school. What words of wisdom do we have for entering women students? For our younger selves?

Posts will be publishing at regular intervals today so be sure to check back. Feel free to add your advice in the comments section, or if you are currently a medical student, what you think of our advice!

Scroll down to see the posts...

A straggling piece of advice

I was held up yesterday so my post is late. Straggling, as it were.

People in my medical school did not talk much about life, the universe, and everything. We were concentrating on the cerebral aspects of medicine, not necessarily the humanitarian elements, and not the life outside med school.

So if I did medical school again (and, yes, I absolutely would), I would take this advice back with me: have a human perspective on all things. During my training, we all tried so hard to be professional, but I think that, in the process, we started to ignore or even invalidate our own feelings. Our emotions and reactions may not always need to be open and visible, but it's okay to feel the burden of your patients' experience and not be closed off to it. I think too many people have the fear that allowing themselves to feel too much will cripple their medical ability. I don't think so.

In my years since medical school, I have seen many of the best and brightest doctors from various disciplines getting their hands and their hearts dirty (so to speak). They have an intimate knowledge of their patients, and I see how they are invested in their patient's care. These professionals have taken down the wall that is supposed to exist between the medical brain and the feeling person underneath. I have immense respect for them and the care that they provide. They manage to be involved, yet they don't make inappropriate recommendations or have nervous breakdowns. They just see the patients (and themselves) as the human beings that they are.

These are my role models, from my unique spot from behind the microscope. But if I were a medical student again, I think I would allow myself to feel a little more sadness, frustration, helplessness, and love.

My Two Cent’s Worth about General Pediatrics

A new doctor on the medical staff of my hospital parks his Rolls Royce in the MD parking lot. It sticks out among the Mercedes, Suburban’s,and Hondas that other doctors park there. It gives me pause to fantasize about the life this physician has and how different it must be from mine – no school loans, kids grown and out of college, retirement nearing with a nice nest egg (or at least decent after the recent downturn of last month’s market.) As a Pediatrician, I know this will not be my life, and I’m absolutely fine with it. As Nancy Snyderman, MD, told Matt Lauer recently on the Today show, “Pediatricians don’t go into medicine to get rich. They go into medicine because they love children.” Lesson #1: Think about another specialty in medicine or another career altogether if money is high on your life priority list. Don’t get me wrong. My family and I are comfortable, but there’s a reason (which is best left to a future post) pediatrics winds up on the bottom of the pay scale every year.

Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.

Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.

Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.

Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.

Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.

What My Medical School Acceptance Letter Didn't Say (but maybe it should have)

Congratulations! You've made it to medical school. All of your hard work, community service, pretending to be interested in anesthesiology in order to be able to shadow a physician (any physician), over-involvement in extra-curricular activities, long nights spent studying whilst your English major roommate goes out and enjoys the college experience, and never, ever getting to schedule all your classes on only Tuesdays and Thursdays (so the better to enjoy a 4 day weekend) has finally paid off. Well, sort of. We'll get to that "payment" issue in a minute.

Right now you are, no doubt, a very "big fish" in a little pond. You are probably known as the smartest, most ambitious, and most masochistic, ahem, of all your friends. In medical school, you'll be surrounded by 100 + of people just as smart, ambitious, and masochistic (if not more so) than you. You will probably be, maybe for the very first time in your life, average. And as much as that may give you angina right now, you need to know that "average" is actually ok! No, really!

You thought you studied hard in college, but you are in for a surprise. You *did* study harder, relatively, than anyone else you knew. You also routinely got paid off in As. In medical school, you will sit in the same position for 8-9 hours a day, pausing only for bathroom breaks and pasta, reading, re-writing notes, and reading again, only to score an 80% on your exam. You need to go to lecture, but if you don't go to lecture, then you need a good note service, and, unless you are a hell of a good transcriptionist, if your medical school employs a lot of professors with thick accents, then you will probably need to ante up the cash for someone else to transcribe "your share" of note service lectures. Take some time to go "off campus" for lunches with your friends, and allow yourself to skip a lecture for a mental health hour every now and then. It will be worth it.

The first two years of medical school, you will work, and study, and take tests, and drink copious amounts after tests, and wonder why in the world you ever wanted to go to medical school. Keep the faith. The MD/PhD candidate that sits next you in the third row and your gross anatomy lab group will likely form the core of your best friends throughout your four years together, even though at times you want to throttle all of them. Familiarity breeds contempt, but you are all going through the same hellacious experience. You will value these memories, even if you don't believe it now.

You will have a med school fling. It will be fun, but won't last (and you'll be totally ok with that.) You will make mistakes. You will fail (yes, I said FAIL) a test. You will cry, a lot. You will feel like everyone else smarter than you. You will wonder, more than once, if you have chosen the wrong path. You haven't. You will eat too much, drink too much, and exercise too little. Try to take better care of yourself, that extra hour of studying probably won't make a difference, but that hour of exercise could mean a healthier you four years from now. Don't forget about your family and friends. Try to stay in touch with the people that mean the most to you. Their support is important. Life is going on outside your little microcosm, and you'll be sorry that you lost touch with the friends that knew you before you became a med bot.

Once you start clerkships, you will remember why you started doing all of this in the first place. Taking care of patients! You will *like* what you are doing again, and, all of the sudden, some of the lectures that seemed like absolute nonsense will actually begin to become more clear. No matter what you think you may want to do, clerkships will change your perspective on everything.

Be a good student. Know your patients. Have the patient seen and the notes written before your (overworked) intern hits the floor. Keep a running list of scut that needs to be done on *all* patients on your service (not just *your* patients, remember, you are working as a team) and be sure it is done before you leave the hospital. Check in with your resident/intern often, they are too busy to page you, but you may get to see (and do) some cool stuff if you stay visible. Learn how to write orders and practice whenever you can. Do everything you can to make your resident's life easier. Write prescriptions, skeletonize discharge orders ahead of time, and offer to get them food if you notice they haven't eaten. Stick close to your resident on call, but *go to bed* if they tell you to go! Don't try to show off how much you know, it is obnoxious and will likely come back to bite you. One of your patients will likely die, and you will never forget it.

Once you find out what it is that you want to do when you "grow up," be sure to make yourself known to the residents and attendings in that specialty. Ask lots of questions. Find a resident that needs help with research and offer your data gathering skillz. If it is a surgical specialty, make an effort to scrub in on as many cases as you possibly can. Center your fourth year electives around the specialty early in the year, so you can make the proper connections for letters of recommendation. Make yourself invaluable to your team. It will serve you well no matter what specialty you choose.

Even if you have met the love of your life, and think that January is a wonderful time to get married, think twice about planning a wedding in January of your fourth year. That is right in the height of interview season, and you will cause yourself undue stress trying to plan interviews around your wedding! The good news is, it is quite possible to nurture a fledgling relationship through the stresses of medical school (and it will prepare your spouse to be twice as awesome as he supports you through the worse stresses of residency!)

When you finally finish medical school (it is a marathon, not a sprint!), you will not be the same person that you were. You will be in debt up to your eyeballs, literally. It will take you years (some as an indentured servant) to pay off hundreds of thousands of dollars just for the privilege of being tortured, erm, learning for these last four years. You will realize that you will never be "rich," like your classmate that quit second year because he was making more money day trading stocks than the average family medicine attending. However, you will be a physician...fallible, over-educated, and under socialized, and you are going to help patients in ways you never even considered when you first sent in your application.

All the best of luck (you could use a little of that, as well),



Future Dr. Whoo

If I were a first year med student right now, I would...

As a third year med student, I was involved in some sort of group discussion session with first year med students. All of us older, wiser third years were offering advice to the first years in the form of "If I were a first year med student right now, I would..."

I had just finished a particularly grueling internal medicine rotation and I was feeling fairly disenchanted. When it came to be my turn, I said, "If I were a first year med student right now, I WOULD QUIT."

Everyone kind of stared at me in shocked awkward silence, then quickly went on to the next person.

But you didn't come here to read that kind of advice, so I'll give you some revised sagely advice from an even older and even wiser me: I wish I had taken a year or two after college to see what else was out there, instead of going straight through to med school.

It seems like the happiest people in med school were the ones who were in their mid-20s when they started out, instead of 22 like I was. They had taken a few years to see what else was out there and realize that it wasn't for them. Oddly enough, some of the people who were significantly older seemed to be just as disgusted as us young'uns, possibly because many of them had families that med school was taking them away from.

This is my graphic representation*:



I wish I had taken a couple of years off. At least then I could stop romanticizing all the stuff I didn't end up doing. Maybe I would have realized that being an actuary (i.e. calculating insurance rates for companies) isn't such a fabulous career, despite how nerdishly excited I get over making a graph (see above). And I could have written that novel I always wanted to write... about the compelling protagonist with an obstacle to overcome, where some friends become enemies, some enemies become friends, and at the end my main character is richer from the experience... (you get the idea)

*Graph not based on actual data

Answer to lingering questions...

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

Note to self

Dear KC,

Hey you. I don't mean to blow your mind, but I'm you, writing from the future. No, you are not on Punk'd, I assure you. You don't believe me?

Well, I know you have a crush on that cute guy in your class you went to coffee with the other day. The one you talked to for hours, losing track of time. You are going to be married in 6 years. I know, score! Your wedding day is going to be the most perfect day, ever, complete with birds chirping and a gentle breeze blowing. Don't be scared by the weather forecast. The clouds will literally part that day.

Are you with me?

I wanted to pass on some advice because I think it will save you a lot of stress and anxiety. Listen, all of those years of stress and anxiety about everything from career choice to thoughts about the future and families really can add up (really add up = multiplying white hairs = a return to getting highlights again = major upkeep commitment = $$$). So, in essence, I'm saving you time and money by sending you this note.

1) Go with you heart when choosing a specialty.

I remember how much you wrestle with this. I know it's hard sometimes to imagine what you might like to be in the future, but whatever you choose will have to sustain you intellectually over the years. Do what you love. Do what challenges you. Your career is going to take a few unexpected turns (I'm convinced that it always does), but it will lead you to where you are now, in the future, and it is so meaningful and fulfilling for you. If you love what you do, you'll find a way to have the kind of life you want in that specialty. You'll "make it work," (reference to a show in the future that you will absolutely adore.)

2) Having children does not mean giving up on your career.

You may think now that choosing to have children early on in your career will necessarily mean a hiatus from doing anything productive, career-wise, for many, many years. You may be resigned to not being able to accomplish your career goals because of this. Don't. Because I'll tell you that having time constraints because of your family can make you that much more productive during your other times. You'll have rushes of creativity, of ideas, moving ahead productively in ways you would never have imagined.

3) Having children will make your life unbelievably rich.

It's amazing. It's all that you dreamed of and more. Go for it. (But, no need to rush in - enjoy the alone time with your husband - travel, explore, really solidfy your two-ness. Children are wonderful but you'll miss that two-ness later on.)

4) Take calcium supplements now. Hello, peak bone mass?

5) When making your residency rank list, remember that it is MOST important to be around people you love who can support you, not the fine details of the program.

6) Dream big.

Don't stop setting high goals for yourself. Don't settle. As a woman in medicine, as a mother in medicine, you can do great things. Dream big.

See you in the future,

Me

Years from Now

Dear Fat Medical Student,

You worry too much. It's gotten you this far, but enough is enough.

Years from now, it won't matter if you get a 92% instead of a 100% on an exam. You won't care if a resident thinks you are lazy for wanting to leave just two hours late. You won't even remember your step one score, but you'll remember the hangover from the celebration upon passing the test. Years from now, your patients will love you because you care. They won't care if you don't know all of the answers as long as you know how to find them.

You'll be a family doctor, a combination of all of your "favorites"...internal medicine, pediatrics, obstetrics/gynecology and psychiatry. You'll know a little about a lot of problems but not a whole lot about any of them. You will be comfortable referring to specialists. People will tell you their deepest secrets and will care about your opinion. Don't let them down.

Years from now, a lot of your "hero" teachers will seem emotionally immature to you once they are your colleagues. You'll watch them be cruel to ancillary staff, students, their families and, heartbreakingly, some patients. You'll feel superior to them in all ways other than raw knowledge. Don't put them on a pedestal until you are sure they deserve it.

Don't be so desperate to find a mate now. You will marry your best friend and have happy children. You'll see.

Years from now, you'll be sorry you quit walking the dogs when you got a fenced yard. You'll regret those drug-rep bagels, too. Stop when you are 15 pounds overweight and you'll never be 140 pounds overweight.

You will hurt many patients...not with malice but with honest mistakes, misjudgments and quirky fate. Decide now how you will handle it so it doesn't kill you. You'll cry about these circumstances because you are a good person, but don't let the bad outcomes make you jumpy.

Years from now, you won't care about money because you'll have some. Save for retirement and live below your means. Your loan payments will be a small part of your overall salary because you borrowed wisely.

Years from now, you'll find yourself wanting to snap at people in "ordinary" life. Practice now how to manage fatigue so you don't become an ass. Medical students will turn to you for a kind word or emotional support and you should give it. Always.

You'll be glad you spent time with your nieces and nephews even when finding time was difficult because the children make your life whole. Invest love in them and it shall be returned when you are back in diapers.

Years from now, you'll be a generally happy person. Of course, you'll wonder what might have been in you hadn't chosen medicine. You'll consider chucking it all and going to cosmetology school. Don't let your mind go there. On the day when you decide you are in the wrong career, a patient will tell you that they credit you for helping change his or her life. It will feel good.

Enjoy the success...it's what you wanted.

XOXO,

Future Fat Doctor