The Late Dr. Fizzy

Some of the residents in my program have been accused of being persistently late for the morning lectures. I'm not one of the major offenders, but I'm not the most prompt person in the world either. I'm not very late, but maybe five minutes late every now and then. Maybe once a month. Maybe a little more.

The argument is that if you're five minutes late a lot, how come you can't just leave five minutes earlier in the morning?? Good point.

I can't really use the baby excuse because other residents in the program have kids, so I mostly say something along the lines of "I'm a senior resident and I'm pretty much checked out." I'm embarrassed to admit the real truth, which is that it often is Melly that makes me late.

I have good intentions: I'm usually dressed and ready to go with plenty of time to get to work. But then sometimes as I'm walking out the door, I hear her crying... and I think to myself how rare it is that I get to see her in the morning. I almost never get to be the one to rescue her from her crib and give her a bottle while holding her. That's so much more important to me than any lecture could possibly be. I don't think my priorities are screwed up.

And of course, if I hear her cry "Mama!" there is no chance of me getting out the door on time. I'm not made of stone.

It's especially hard for me because there has never been a time in Melly's entire little life that I have NOT been a resident. Except for my 6 weeks of maternity leave, I've never gotten to have an extended period of time when I could wake up with her every morning and spend the day with her. Or even part of the day.

Those extra five minutes in the morning are all I've got and I just can't make myself walk out the door. It's well worth getting yelled at.

Pictures….Not!

A fellow Peds resident took his dream job on the North Shore of Oahu. In our former lives, we enjoyed windsurfing together the sounds of the East Coast. He dreamed of bigger waves, and he found them. He sends me pictures from time to time of his beautiful and expanding family. His last set was taken along the shoreline of Hawaii. I want pictures like that, I thought. Serene. Idyllic. Outdoors.

Then I saw KC’s pictures of her family. Sweet pictures to be regarded for years to come. Happy baby pictures. Sibling enchantment (however brief). Glowing parents. I want pictures like that!

So I’m on a quest for some visual memento of my seven and eleven year olds. How else can I freeze them in time? I want to capture Harry’s tossed salad blond hair, and Will’s prepubertal glow. Not only would pictures satisfy my mommy-lust for holding back the sands of time, I could use them as Christmas gifts for family and Husband.

One of my office staff showed me her Christmas pictures. They were urban and modern, and I loved them. Her website showed pictures of playful kids in old chairs outside. This photographer, like KC’s, had the gift of not only catching the image of the subjects but their spirit as well. Sign me up!

So we were all set Tuesday afternoon to meet this photographer after school. The rendezvous point was a field of wheat on the other side of town. Prior to this meeting, I had run all over town looking for the right wardrobe. I had settled on solid color sweaters and t-shirts, and had tried hard to pick items that the boys would wear anyways.

Will, Harry, and I piled into the car for the 20 minute drive to this field – my rough directions in hand. We dodged traffic lights. The boys muttered about interrupted play time, but understood that surprising Daddy was part of the adventure. I chatted them up about how much fun this would be – trying hard to keep the atmosphere light. We found the field on the side of a road, and pulled over to park and wait. We were a couple minutes late. No problem – we had 30 minutes of daylight left.

My first clue to impending failure should have been that the wheat was actually weeds – a disaster for my allergic seven year old. The second clue was waiting for 20 minutes with two antsy boys in the car. I’m not sure I would have wanted the pictures of that afternoon. Surly Will. Pouting Henry. To be honest, I was pouting like a toddler, too. The photographer left us in the field. No show. Nadda. Disappointment is an understatement because then I had to explain to Husband why the boys were so moody when we returned home. Surprise revealed. Ta dah!

Maybe a trip to Hawaii for pictures is not such a bad idea after all. Hmm….

Getting into the spirit

My daughter is finally old enough to understand the concept of Santa. At 3 1/2, she can grasp the concept that a jolly bearded man in a red suit might bring her presents IF she is good all year. I have just started to capitalize on this fine new tool of behavior blackmail. At the dinner table during a whine fest. During a sleep-deprivation inspired meltdown on the kitchen floor. You better watch out...

The potential is huge.

But, I've been recently having second thoughts about this Santa-biz. I don't want Christmas to be all about getting. Sometimes, the way she acts, I think: wow, you have no idea how lucky you are. Sometimes, she is a complete brat. How to make her understand how blessed she is? To appreciate the joy of giving gifts (in all senses of the word) to others? Can they get that at this age?

And then I think of my friend Jen and her daughter M and know that they can. Jen runs a homeless shelter in the Bay Area and M, very close to my daughter's age, helps out at the shelter from time to time. Hearing about M at the shelter is inspiring. Her daughter is sensitive, loving, empathic, and so utterly giving it takes my breath away. I want that.

It may be cliche to volunteer at a homeless shelter during the holidays but what better time to start a family tradition of giving? I want my daughter to really understand that people out there don't have homes, don't have food, and sometimes, the only difference between us and them is luck. I want her to know this intimately, more than the times she asked me why I rolled down the window at the stop light to give money to the man standing at the island. (Why doesn't that man have a house?)

So I'm looking for local shelters where our whole family can go and help. The experience probably won't overshadow the receiving of Christmas presents for my daughter this year, but I'm hoping it will be a seed of awareness, of goodness, that grows.

Seriously, I wanna know...

Do you have a favorite memory of gift-giving? What has been your favorite gift to receive? Any favorite gift-giving tips for the holiday season?

Guest Post: In the round and then for real

We held a fantastic event at our medical school Wednesday night. We were a little disappointed in the student turn out, but otherwise, it was wonderful. We had a panel of eight female physicians speaking about being a woman in medicine. Seven of the eight are mothers, so there was a lot of discussion about pregnancy, babies and family. I was happy with the diversity of our panel. We had one Chinese doctor, a few Hispanics, a lesbian (who humorously advised us to wait until menopause and then let our partner carry the baby), a few Jewish doctors, and only two WASPs like me. Unfortunately, the two black doctors (I don’t like the term African American, which rarely applies to the frequently Caribbean born blacks in South Florida) who we invited were not able to attend, and neither were the Indian doctors. We are blessed with a diverse pool of professors and physicians associated with our school.

I wish we videotaped or had transcripts of the discussion. We got great advice, from having a fire drill-like plan of what to do if we get groped by a patient or a fellow physician (which has happened to members of the panel), to how to answer (or not answer) illegal questions in interviews about how soon we were planning on getting pregnant, how to manage when our kids are sick, and other wonderful bits of information and experience.

The next morning, I was driving 4 year old Z to school. He was sitting next to the big contraption the catering company rented to me to keep the food warm for the event. He was confused, somehow thinking it was for me to bring food to the people at the hospital. I explained to him that I was still in school to learn to be a doctor, then I would go to the hospital to help people.

Z paused for a second and then asked, thoughtfully, “When you are a doctor and you go to the doctor place, will you still be my mommy?”

“Yes,” I said. “I will always be your mommy.”

“Will you still come home to me?”

Oh, kid, you’re killing me. “Yes, I will still come home to you.” In my head, I was thinking, sometimes, during residency, it may seem like I don’t. But I will always come home, eventually. When all the babies are born, all the sutures are closed, all the cases are presented, I will come home. And I will try to find out about your homework and listen to you and hug you and kiss you before I collapse into bed.



Mom TFH is one of the oldest people at her medical school. The other students learn from her various valuable life experieces: as a pizza delivery driver, a Denny's waitress, an art major, a health food store manager, a purple haired punk, a natural supplement researcher, a midwifery student, and a mother. She has two boys and is married to a public elementary school PE coach. Going to med school just didn't keep her away from them enough, so she is doing a dual degree (D.O./M.P.H.), is the president of the ob/gyn interest club, and applied for a research fellowship.

I'm the doctor my mother wanted me to marry

When I first started medical school, I had not yet started dating the man I was to marry and I had only an inkling of what qualities I wanted to find in that man. Sense of humor? Probably. Brilliant? Definitely. Tall, dark, and handsome? Sure. But I knew one thing with absolute certainty: I didn't want him to be a doctor.

I had a stereotype in my head of male doctors as men who were constantly chased after by women, regardless of their looks or personality. I figured male doctors believed they could have any woman they wanted, and I didn't want anything to do with a man like that. Modesty is a quality I value highly in the opposite sex.

Over the course of my medical training, I've met a lot of men who fit that stereotype to a tee. It's been frustrating seeing the way (some) female nurses swoon over my male counterparts. I've been shocked at the attention some of my male colleagues have received from the opposite sex, when it was clear they would have had trouble even getting a date if they were in a lot of other professions. It's especially frustrating for a female physician to observe this, since a lot of men are intimidated by our profession; whereas a male physician is "a catch". Damn double standards.

Of course, I've met a lot of male physicians who have proved me wrong. (Mostly, those men didn't become surgeons.)

So in the end, I didn't end up marrying a physician. He's in the sciences as well, but not medicine. Although it might be nice if he could understand some of the more medically complicated stories from my day, I'm usually pretty glad I veered away from marrying a doctor. I wouldn't want to come home to a doctor any more than I want to come home and turn on House, MD. He's my much-needed escape from the medical world.

Another unexpected added benefit of not being married to a doctor is that now that we have a child, we don't have to concern ourselves with working out our call schedules so that at least one of us is always home. He's home every night. Lucky bastard.

But I'm sure lots of women out there will assure me that being married to a male doc is all that and more, as long as you find the right one.

Boys and Girls

So we have a girl now. And they are different than boys. With Son, I'd just lift up the penis and wipe up any poop on it.

With Daughter, poop gets mashed in between the labia, and I'm entirely freaked out using the wipes on such a sensitive area. And what if I inadvertently shove some fecal matter into her urethra? The state may not allow me to complete this adoption if I were to cause UTIs.

Husband laughs because I've had all this fancy training and I can't change a diaper.

To tell the truth, I've never been much into newborns, but this kid is special. She's mine.

We are having a stellar holiday season thus far. I hope your families are enjoying this season, too.

Guest Post: Do-It-Yourself...?

Every day, I grope for new ideas to save time and help get everything done, despite knowing *it won't ever all get done*. I usually manage to just keep my head above water, but there's always this panicky feeling of near drowning in the sea of work.

It is popular everywhere, evidently, to employ physician extenders to help get it all done. PAs triage patients in the ER and treat the more straightforward problems. Nurse practitioners make rounds on the critical care patients and the cancer patients, writing the detailed progress notes before the doctors arrive. They do casting for the orthopedists and see routine followups at the family practitioner's office. There's even a push for them to write prescriptions, although that's not happened yet in our state.

One of my partners has a PA. He sees 90% of his post-op patients at followup in the office, sees new hospital consults, does all his medical records, and screens all his incoming pages on call. He also often is the only person to see my hospital inpatients on the weekends when they're on call. This frees my partner up to be more productive and to have more time at home with his family.

So what's the matter with me? I admit, it's been very tempting to engage a PA myself. I'd love to have someone else dictate all those discharge summaries. I might even be able to see my family 5 nights a week instead of 3. How can that be a bad thing? Why don't I just hire somebody to help? *Everybody else is doing it!*

I just can't do it. Maybe it's a little OCD, but I keep hearing my mom saying to me years ago, "If you want a job done right, do it yourself." It's the mantra of my Type A surgical personality. I know you can't really do *everything* yourself, which is why we have an office staff. But when it comes to patient care, it's a different story.

My patients come to me because they trust me to help them. Most are in pain or critically ill, and they're vulnerable in so many ways. They are *my* responsibility. No one else can evaluate them initially, because I have to make the decisions about what patients need surgery. No one without surgical training can or should do that. In the hospital postop, there are so many subtle things that can go wrong, I don't feel comfortable letting anyone else other than my partners make rounds. (I dislike my partner's PA seeing my patients when they're on call, and my patients have told me they don't like it, either.)

In the office postop, patients want to see their surgeon, not somebody else. I want to see them, because it's rewarding seeing how they've (usually) improved as a result of what I've done. I hear patients complain frequently that "when I go to my family doctor, I never see him, just the nurse practitioner." (That attitude may be unfair to a very good nurse practitioner, but it's that patient's real response.) To me, it's important to nurture my rapport with each patient. I can't do that if I don't see them and talk to them.

There are real legal issues, too. If my PA misses something resulting in a bad outcome, that's my responsibility, and I take the heat. If my PA doesn't document something adequately, that can mushroom into a huge problem under the right circumstances. And if I check everything a PA does, it's not worth having them, because I might as well just do the work myself.

This is not to insult physicians who employ physician extenders or to insult the physician extenders themselves. It may be that with the growing population and the physician shortage, my approach may not be workable or realistic, just like house calls are a thing of the past. I may one day eat these words.

But for now, I'll keep treading water, doing my own thing.


gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.

Code Indigo

The season's first snow is falling. It's raw and grey outside the hospital. Inside, Ella Fitzgerald croons a languid "White Christmas" from the internet radio station. We're wrapping up at the O.R. desk after an uneventful morning case.

"Attention all personnel. Attention all personnel. Code Indigo, third floor. Code Indigo, third floor."

I look at the nurses. "Indigo? Which one's that one again?"

Every hospital has coded security alerts for unusual events - emergency room on diversion, airway crisis or cardiac arrest, infant abduction, bomb threat, unruly patient or family member, etc. I don't recall having heard a Code Indigo* recently.

"Missing patient," says one of the nurses.

"Probably just went out for a smoke," says another.

I go to do post-op rounds. The all-clear sounds overhead for the Code Indigo. But when I get to the post-partum ward, a nurse there tells me as I leaf through a patient's chart, "Don't bother. You won't find that patient."

"Breast-feeding class?"

"No. Just gone. That was the Code Indigo."

"Oh! I thought I heard an all-clear a while back."

"Yeah, because the patient's definitively gone. Baby's still here, though. Wanna see?"

She lifts a swaddled bundle of warm, sleepy perfection out of a bassinette. The baby starts drinking formula from a small bottle the nurse is holding.

I start to think of another baby, a patient I had had to discharge to a foster parent during my internship. The baby had been hospitalized with bilateral spiral femur fractures. Yet every time I approached his crib to examine him, his face would light up with a bright smile that held nothing but joy. After I turned him over to foster care, I went into the call room, called my husband, and sobbed on the phone to him, utterly disconsolate.

My mind starts churning around my current situation, trying to figure out if there's some way we could take care of this baby ourselves. But of course we're not at all prepared for a decision like that right now; all I can do is call the social worker and make sure she's on top of what needs to be done to get this child into a suitable pre-adoptive home. It seems like such a small, ineffective measure to take.

The snow has turned into something a little wetter and clumpier. It's dark by midafternoon on days like this. I've turned on a mix of Christmas music - a little Nutcracker, some Kathleen Battle, a little Boston Pops and Leroy Anderson. I go back up to the nursery to hold the baby. The nurses welcome the break.

"Here, Dr. T - have a seat right here."

The baby sleeps in my arms. His cheeks bulge out like rosy little fruits. He is totally at peace. He has no idea that either nobody loves him at all, or someone loves him so much that she felt she had to set him free. He is blissfully unaware that he is alone in the world. Abandoned.

"At least she didn't try to flush him down the toilet, like the kid we got last week."

Thank heaven for small blessings.

Advent starts today: the liturgical prelude to the Christmas season, and the new beginning of the liturgical year. There's something in the baby's given name that conjures up images of light. Light, on this grey, darkening day.

"The people who walked in darkness have seen a great light." I wish, I wish, I wish.

I start humming the baby a lullaby. My favorite song of the season, half ancient chant, half carol for a newborn.

O Come, O Come Emmanuel
and ransom captive Israel
that mourns in lonely exile here
until the Son of God appear.
Rejoice! Rejoice -
Emmanuel shall come to thee,
O Israel.

I hope this baby gets his Christmas wish, the wish all babies are born with: a wish for love, for a life that matters, and for a world of hope to be cradled in.


*(Not the actual alert used.)
Cross-posted at Notes of an Anesthesioboist.

Round 3

I am a Mom of 2 kids and now soon to be 3....yes, I know it's crazy but despite the tough balancing act, my children are the best thing that has happened to me so we have decided to add one more.

It's been very interesting sharing the news of my pregnancy with colleagues, family and friends. The response I get is different for this third pregnancy.

With my first pregnancy, people were generally very excited for me. I was embarking into the world of parenting and people congratulated the decision and celebrated the novelty with me. I got lots of advice on how to manage the pregnancy and what to savour BEFORE the kids come.

With my second pregnancy, people seemed to react as though it was the natural next step. It was more a 'matter of fact' and parents with multiple children shared parenting advice on how to cope with the extra chaos.

With the third pregnancy, I find that the reactions depend on personal situations:

Those who are not yet married, or married without children, think I'm crazy to go for a third (they just can't relate);

Those with three children of their own celebrate the news and reassure me that life will just get better;

Those with two children (young and old) all recount to me how they came to the decision NOT to have a third, as if my news has made them revisit their decision;

And those with only one child feel the need to explain why they haven't yet had a second!

Ironically, even my husband has found the same trend in responses.

Regardless, we are absolutely thrilled and praying for a healthy pregnancy and baby and eager to hear any advice on going from 2 to 3!

Happy Thanksgiving!

A Lesson for Youngest - and his mom

I'm often asked to speak at support group meetings for the various conditions I see in my practice. I try to go to as many of these as I can; it's a great way to meet with individuals on an informal basis. Many of these patients don't have much insight or knowledge about their condition (or worse, have a skewed picture of the future based on misinformation), and I hope I can change some of that in the time I spend with them. As could be expected, in my attempts to balance work and home, I occasionally run across some problems with time constraints. This happened a few months ago. I had promised a group that I would meet with them, but the week became filled with mandatory department conferences and other events which kept me away from home, so on the evening I was scheduled with the support group I was greeted with a chorus of "You're going where? Why can't you stay here for a night?" In a desperate attempt to spend some time with my boys, I asked them if they wanted to come with me. Eldest declined with a bit of a sneer, but Youngest jumped up with enthusiasm. His question, though, gave me a bit of cause for concern: "Can I bring my GameBoy?"

As we pulled into the parking lot of the church where the meeting was being held we could see a steady stream of cars pulling up to the entrance. We parked in a far corner of the parking lot and while we walked to the building we watched people in wheelchairs and using walkers approaching the doorway and struggling to get through. As we got closer, I suggested that Youngest might want to hold the door for some of the people we saw. He looked at me sideways, but then ran ahead. I could hear him talking to a couple wrestling with the door (which didn't have any modifications for people with disabilities); then with a smile, he opened the door as wide as he could so that the husband could push his wife through. After he assisted a few more individuals it was time for the meeting to start.

Before I knew it, Youngest was talking with the facilitator of the group and passing around cookies and punch to the members there. He sat quietly while I spoke to the group and answered questions without bringing out his electronic toy once. As the evening was winding down, I was approached by a woman who had been sitting quietly in the back. It was obviously difficult for her to move forward, even with the rolling walker she was using. Watching Youngest's face, it was apparent that he felt removed from this group. I could almost read his thoughts, "Poor folks; too bad they contracted this disease. Thank God it will never happen to me." The woman thanked me for the information I had provided, and the enthusiasm and encouragement she felt I had brought to the group. And then she said, "You know, I've been battling this since I was 16 years old. I never thought I'd be around this long." Youngest's mouth dropped wide open at this point - with just a few words, this woman had made him realize that none of us are immune to whatever it is that our futures hold. Before I could say anything, Youngest had moved next to the woman and said, "I'm so sorry to hear that. May I give you a hug?" While I answered questions for another person in the group, I could see Youngest speaking softly with the woman.

Afterwards, he and I helped the facilitator clean up the napkins and cups. Youngest didn't say anything while he gathered up debris and placed it in the trash can. As we began to walk through the now-quiet parking lot toward our car I said, "I'm proud of you. I think you did a very nice thing tonight."

His response was typical pre-teen. "WhatEVER, Mom. Race you to the car!"

I wasn't sure how much of that evening Youngest retained, or what an impact it had made upon him until recently. As we were talking about the upcoming Thanksgiving holiday, Youngest suddenly blurted out, "I guess we can all be thankful that we're healthy, right?"

Right, son. And I'm thankful for lessons that are learned without trying.

And to all of you - I wish you a healthy, happy Thanksgiving (and quick healing to you, Happy Mom).

A

Seriously, I wanna know...

What are your plans for Thanksgiving? Do you cook the turkey, stuffing, potatos, greenbean casserole or do you eat nontraditional fare? Have you tried a prepared dinner from a grocery store?

I could never be a pediatrician...

When I was first starting med school, I was Peds Girl. I was joined the Peds Club, I helped organize Peds Playroom in the hospital, and I loved kids. I was fiercely insistent on my future career choice.

Professor (who was also an orthopedic surgeon): "So what field do YOU want to do?"

Me: "Pediatrics."

Prof: "Christ, what a waste. You may as well become a veterinarian."

Me: "Um."

Prof: "You know you won't make any money in general peds."

Me: "I may specialize in pediatric endocrinology."

Prof: "They make even LESS."

Actually, I think if you do pediatric endocrinology, instead of getting a paycheck, they remove money from your bank account each month. So you really have to love it.

In planning my third year schedule, I took peds as my third rotation. If there's a specialty you think you really want to do, you're supposed to do it third. That way, you can decide early on if it's really for you, but it's not so early in the year that you're still a bumbling idiot.

Long story short, I'm not a pediatrician. I could say I hated the parents or that I had trouble looking in tiny ears, but really, it was that I couldn't deal with the sick kids... I mean, the REALLY sick kids. There was nothing more heartbreaking to me than an ill child. Even reading a fictional clinical vignette about a child with cancer ruined my day. It didn't matter to me that I was helping them or even saving their lives... I just couldn't bear it.

And now that I have a child, I am doubly glad that I made this decision. Every time I pass the peds floor in the hospital and hear children crying, I think of my daughter and my heart aches. Maybe I would have grown accustomed to it. I don't know. I'm grateful other doctors are able to distance themselves enough that they can do this kind of work.

Luckily, sick adults don't make me nearly as sad.

Extending the invitation

After Thanksgiving Dinner last year, my husband and I decided we would henceforth make an effort to invite people over who may not have family or friends nearby to spend the holiday with. Our house was feeling so warm and festive, dinner was so lovely, and it seemed a shame that we didn't have more people over to share it with. A new family tradition. One that I wanted my children to grow up with.

I can't believe I almost forgot about this.

So, today, I started to think of who I should ask. How does one go about inviting someone over? I didn't want to make someone feel self-conscious about it, like, Hey, since you seem like you have no friends or family...

I decided to start with a general probe. I asked a co-worker whether she had family in the area. (Yes) Great! Back to the drawing board.

Driving home, I thought of one of my residents. The more I thought of him, the more I thought he might really appreciate an invitation. I impulsively called him. "Hey, do you have plans for Thanksgiving?"

"Why do you ask?"

It turned out well. He said he really appreciated the invitation and he'd get back to me. He also asked whether this could extend to some of his colleagues. "Sure," I said. Smiling.

I hung up and felt the most amazing rush of, well, euphoria. The thought of opening our home to residents who might otherwise be alone on Thanksgiving filled me with immense joy. I'm hoping, hoping that we'll have extra guests at the table on Thursday. And even if they don't come, this feeling of just extending the invitation is pretty awesome.

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.