At the heart of Mr. Eule’s novel Match Day, about three female medical students who go through the infamous residency match, is the concept of sacrifice. I think we female physicians, especially those of us with families, understand better than anyone what it means to make sacrifices. And as Match Day reminded me, so do their families. The novel describes in detail the sacrifices that women must make for the sake of their careers or for families which they might not even have started yet.
You can tell even without reading the back flap that Mr. Eule is a journalist because the novel is sprinkled with factoids about match day and residency. A lot of it was information I already knew (my class was the one that got punished by the results of the catastrophic urology match screw up), but some of it was new to me. Sometimes the book felt more like an expose on match day than a novel about three women, but either way, it was a very entertaining read. And now I can honestly say I know everything I ever wanted to know about the history of the residency match.
The scene that hit closest to home for me was when Rakhi, an intelligent young woman applying for internal medicine, is debating giving up her dream residency in order to be in a program closer to where her husband wanted to go to graduate school. Even though the rest of the book deals with more serious topics such as palliative care, this above all was the scene that brought tears to my eyes. Because when I submitted my match list for residency four years ago, it was not the one I had dreamed of. I gave up my dream residency for my other dream: to finally live with my husband. It was a sacrifice that I never regretted, but reading Rakhi’s familiar story brought back some bittersweet memories.
Unfortunately, as we all know, sacrifice does not end with match day. Intern year and residency, as the novel describes, is also filled with sacrifices. We give up our free time, our family life, and allow ourselves to be treated like dirt on the side of the road in order to realize our goal of becoming a physician. If you can get out of residency with your personal life intact, you can consider yourself lucky. One line that stuck in my head was about a surgery program that had a divorce rate of “over a hundred percent”, since one resident got divorced twice. You can’t make this stuff up.
The other highlight of the book was author himself. As a resident who is married to a man who isn’t in medicine, it fascinated me to get inside the head of a doctor’s husband. What’s it like to be Dr. and Mr.? How do they put up with us?? I only wish that Mr. Eule had dedicated more of the novel to himself, as the opportunities inside his own head were few and far between. But maybe that’s a topic for his next book.
I had the privilege of corresponding with Mr. Eule in the interest of asking some questions for the purpose of my review. I got a thrill out of the fact that his writing in the emails sounded exactly like his writing in the book. And what an incredibly nice guy, who clearly adores his physician wife. Here were some of the questions I asked him and his responses:
Q: You wrote a book about women who are becoming doctors. You are a man who is not a doctor. Explain.
"That's exactly the point. I was an outsider to this world, suddenly thrust into it. These key moments and decisions would affect so many lives, including my own. But I was also a journalist who knew how to dig into a story to find answers to all of the questions I had. Often, it is the outsider who sees the issue and topic most clearly. (You'll notice, for example, great books written about Presidents are often not by Presidents.)"
(There goes my dream of becoming President and writing a successful book about it.)
Q: Who do you feel is the intended audience for your book?
"I like to think that there are several audiences for the book: mainly anyone interested in doctors (anyone who has ever known a doctor); friends and family of medical students and residents, interested in this strange and demanding world they've only seen from afar; as well as those beginning their careers in medicine, beginning to make these key decisions. At a time when media stories about health-care and the quality of medical care in America are a constant, understanding the process by which doctors are selected, trained and groomed in this country seems more relevant now than ever."
Q: Since your book is called Match Day, why did you decide to include the stories from intern year in the book? Was this your intention prior to starting the book?
"Match Day is a play on words. There are multiple matches occurring in these people's lives at this time-- matches with career and matches with spouses and families, in particular. Yes this was my intention-- I was excited by this crucial turning point in all of their lives, when these people go from student to professional, and I wanted to follow these people as the first year of their career played out to show how things turned out after the Match and how they changed from student to doctor. Medical students often don't realize the impact these moments and choices will have on the rest of their lives."
Q: What are your top five tips for non-medical husbands of female physicians?
"It's hard to give tips for such a diverse group as that. I recognize people are very different. For me, a few things that have made this difficult time more bearable are: trying to remember to have patience, keeping a sense of humor, recognizing the amazing sacrifices my wife is making, realizing how many people she is helping, and reminding myself that she's human. That, and giving her some space after a 24-hour call shift!"
Q: How do I get my husband to write a book about me?
"Hahaha. Have him drop me a line and we can talk about it."
Thanks for your offer, Brian, but I don’t think it’s going to happen. He’s a mathematician, so the best I might get is a theorem named after me.
*****
MiM Editor's note: We'll be giving away 10 free copies of this book on our Match Day Topic Day this upcoming Wednesday, so stay tuned! While we received two copies of this book for the purposes of reviewing it for our site (second review to come), we are not otherwise compensated for these reviews and are under no obligation to provide a positive review.
Sunday, March 15, 2009
Wednesday, March 11, 2009
Topic Day Next Week: MATCH DAY
You may or may not know, but the official Match Day where fourth year medical students find out their residency fate is next Thursday, March 19th. In honor of this momentous occasion, we are hosting a Topic Day on "Match Day" the day before: Wednesday, March 18th. We'll be featuring posts about our own experiences on Match Day and invite you to share alongside with us. We love guest posts!
Match Day is such a unique experience for doctors-to-be: the suspense, the ceremony, the Moment, the hugs and joy and surprise and sometimes, despair. It changes our lives, that computer program.
We have some special surprises in store, too, for our readers, so stay tuned next week! Send your Match Day stories to mothersinmedicine@gmail.com.
Match Day is such a unique experience for doctors-to-be: the suspense, the ceremony, the Moment, the hugs and joy and surprise and sometimes, despair. It changes our lives, that computer program.
We have some special surprises in store, too, for our readers, so stay tuned next week! Send your Match Day stories to mothersinmedicine@gmail.com.
Monday, March 9, 2009
Let me know if you need anything...ok, how about right now?
So, it's almost here. We've known it was coming for more than 6 months, but in less than 48 hours, my husband will be deploying for 5 months, leaving me to manage the madness of 3 kids under age 5, two part-time physician jobs, and a home (can someone remind me why we thought a half-acre of grass was a good idea?).
We recently had a few families over to dinner. They are dear friends--originally the parents of our kids' friends from preschool, now our close friends in their own right. They live 5 minutes away. As they were leaving after dinner, a few weeks before my husband was to deploy, one of the women said to my husband, "Well, if we don't see you, stay safe" and to me, "Let us know if you need anything." My heart sank, and my husband immediately saw it on my face.
Now, I'm not complaining...well, not that much anyway. Believe me, I know it could be waaaaay worse. He's only going for 5 months, not the 12 or 15 month deployments that Army families cope with all the time. It's pretty safe, as deployments go. We'll even be able to talk on the phone for about 20 minutes once a week. And, most of all, I fully expect him to come home to us. At some point, he won't be in the Navy anymore, and all of this will be behind us.
But the fact of the matter is that I will definitely need things. When people say, "Let me know if you need anything," the implication is that you probably won't, but just in case, you know how to find us (and we won't be finding you). The fact is that needing things is not the exception; rather it is the rule during deployment. I need things right now, and he hasn't even left yet. Like someone to babysit my kids for a few hours so that I can have a date with my husband where we finish sentences (or do our taxes), someone to help me cook and freeze a bunch of meals to decrease the evening madness, someone to invite us to dinner on the sad evening of d#1 of deployment, and most of all, someone to reassure me that I can do this, we can do this, and we will all get through it.
I have been giving "Let me know if you need anything" a LOT of thought since then. As far as I can tell, we only say it when it is clear that help will be needed...and a lot of it. Someone's husband dies: Let me know if you need anything. Someone's baby is born prematurely and is in the NICU: Let me know if you need anything. Someone loses his job: Let me know if you need anything. And, most relevant to us, when we are the bearer of catastrophic medical news: Let me know if you need anything.
If these words make it to the antechamber before your lips, STOP THEM RIGHT THERE! This is probably a situation where the person in front of you needs not just anything, but everything. I have decided to banish the phrase from my vocabulary and instead make a concrete offer. She can say no or barter for something different, but at least she knows I expect she will need help--it's not a sign of weakness and not an exception. If she wants to refuse it, she is free, but I won't make it easy. From here on out, I'll be saying "I'd like to bring dinner tomorrow night for you and the kids. Is 5 o'clock okay?"
We recently had a few families over to dinner. They are dear friends--originally the parents of our kids' friends from preschool, now our close friends in their own right. They live 5 minutes away. As they were leaving after dinner, a few weeks before my husband was to deploy, one of the women said to my husband, "Well, if we don't see you, stay safe" and to me, "Let us know if you need anything." My heart sank, and my husband immediately saw it on my face.
Now, I'm not complaining...well, not that much anyway. Believe me, I know it could be waaaaay worse. He's only going for 5 months, not the 12 or 15 month deployments that Army families cope with all the time. It's pretty safe, as deployments go. We'll even be able to talk on the phone for about 20 minutes once a week. And, most of all, I fully expect him to come home to us. At some point, he won't be in the Navy anymore, and all of this will be behind us.
But the fact of the matter is that I will definitely need things. When people say, "Let me know if you need anything," the implication is that you probably won't, but just in case, you know how to find us (and we won't be finding you). The fact is that needing things is not the exception; rather it is the rule during deployment. I need things right now, and he hasn't even left yet. Like someone to babysit my kids for a few hours so that I can have a date with my husband where we finish sentences (or do our taxes), someone to help me cook and freeze a bunch of meals to decrease the evening madness, someone to invite us to dinner on the sad evening of d#1 of deployment, and most of all, someone to reassure me that I can do this, we can do this, and we will all get through it.
I have been giving "Let me know if you need anything" a LOT of thought since then. As far as I can tell, we only say it when it is clear that help will be needed...and a lot of it. Someone's husband dies: Let me know if you need anything. Someone's baby is born prematurely and is in the NICU: Let me know if you need anything. Someone loses his job: Let me know if you need anything. And, most relevant to us, when we are the bearer of catastrophic medical news: Let me know if you need anything.
If these words make it to the antechamber before your lips, STOP THEM RIGHT THERE! This is probably a situation where the person in front of you needs not just anything, but everything. I have decided to banish the phrase from my vocabulary and instead make a concrete offer. She can say no or barter for something different, but at least she knows I expect she will need help--it's not a sign of weakness and not an exception. If she wants to refuse it, she is free, but I won't make it easy. From here on out, I'll be saying "I'd like to bring dinner tomorrow night for you and the kids. Is 5 o'clock okay?"
Sunday, March 8, 2009
How many of you were hit on the heads with mallets last week?
My daughter's really into Donald Duck right now, so I've watched about five thousand Donald Duck cartoons on youtube in the last week or so. Believe it or not, they all seem to follow a similar formula: Donald does something to piss off some kind of woodland creature, then they get revenge on him.
In the past week, I've seen Donald fall from a 30 foot tree, plummet from several cliffs, and be exploded countless times. As I was watching him run his sled into a tree stump masked by a snowman, I couldn't help but think of my patients who ended up with serious brain or spinal cord injuries because they hit a tree on the ski slopes. As Donald made impact with the tree, I winced as I thought about broken bones, halo vests, intubation, central lines...
But none of that happens in the cartoon. Obviously. Slamming into a tree at 60 MPH definitely is an annoyance to Donald, but the only thing he appeared to damage in the accident was the winter coat he was wearing. (The winter coat was destroyed virtually beyond repair.) When a bunch of ants pushed him off a 100 foot cliff to get at his picnic basket, he yelled out in fury and climbed right back up the cliff to get revenge on those ants. When ten sticks of dynamite explode in his face, he just adjusts his beak and moves on.
Yes, I know cartoons are not supposed to be realistic, but this is really beginning to bother me. It disturbs me not just as a mother who wants my daughter to know the consequences of violence, but also as a doctor who has seen countless veterans with severe permanent brain injury from IED blasts. I need to see Donald experience the consequences of his actions in some way. I mean, they don't have to show him on a ventilator, but if he falls off a cliff, at least show him limping a little in the next scene.
And for the record, a second head bonk is NOT a cure for brain injury.
In the past week, I've seen Donald fall from a 30 foot tree, plummet from several cliffs, and be exploded countless times. As I was watching him run his sled into a tree stump masked by a snowman, I couldn't help but think of my patients who ended up with serious brain or spinal cord injuries because they hit a tree on the ski slopes. As Donald made impact with the tree, I winced as I thought about broken bones, halo vests, intubation, central lines...
But none of that happens in the cartoon. Obviously. Slamming into a tree at 60 MPH definitely is an annoyance to Donald, but the only thing he appeared to damage in the accident was the winter coat he was wearing. (The winter coat was destroyed virtually beyond repair.) When a bunch of ants pushed him off a 100 foot cliff to get at his picnic basket, he yelled out in fury and climbed right back up the cliff to get revenge on those ants. When ten sticks of dynamite explode in his face, he just adjusts his beak and moves on.
Yes, I know cartoons are not supposed to be realistic, but this is really beginning to bother me. It disturbs me not just as a mother who wants my daughter to know the consequences of violence, but also as a doctor who has seen countless veterans with severe permanent brain injury from IED blasts. I need to see Donald experience the consequences of his actions in some way. I mean, they don't have to show him on a ventilator, but if he falls off a cliff, at least show him limping a little in the next scene.
And for the record, a second head bonk is NOT a cure for brain injury.
Sex in the City
Today I was finishing up the afternoon at the office. My last patient was a 40 year old mother of three there for an annual exam. After I finished the exam and reviewed the usual preventative health recommendations, I asked if she had any more questions… I’ll admit I had one hand on the door as I said this. There’s just one more thing doctor. I just have no libido.
At this point I sit back down and take a deep breath. This happens to me a least twice a day. I start with the usual questions (I’ve answered with the most common answers):
Does it hurt? No
Do you like your husband/partner? Yes
History of abuse? No
How often do you have sex? 2-3 times a month *
Do you like sex when you have it? Mostly, I’m just so tired I don’t ever feel like doing it.
Does your libido improve when you go away for the weekend with your spouse? I don’t know, we haven’t done that in 10 years
It’s at this point that I want to say, and occasionally do depending on how well I know the patient, “You mean after working full time, taking care of 3 kids, dishes and homework, you don’t suddenly feel like Samantha on Sex in the City the minutes the lights go out.?”. I don’t know it this is “normal” but I know it’s very common.
Women are multitaskers. But the one place not to be a multitasker is the bedroom. There was a recent study that showed women enjoy sex more if they are able to “live in the moment.” Well DUH!!! Honestly, it is hard to be in the moment, with so many “to do lists” floating through your head.
When I first start clinical rotations in medical school I definitely had a time of transition. After watching my first Vag Hyst as a student I couldn’t have sex for a week. Slowly, like all the other issues you some how learn to separate work from home, most of the time. The pager does occasionally go off at an inopportune time.
Although, I have become a little jaded from my profession. During a recent conversation with my husband I remarked “We have a great sex life, I mean… it doesn’t hurt, I don’t get yeast infections and I don’t have to worry about you giving me Herpes.” He gave me quite the incredulous look. I guess its all relative.
*I had a newly wed patient who was having trouble with painful intercourse. After several visits, ultrasounds, creams ect. I finally asked her how often she was able to have intercourse. When she said 5 times a day for 6 months straight…… I discovered the cause of her discomfort.
At this point I sit back down and take a deep breath. This happens to me a least twice a day. I start with the usual questions (I’ve answered with the most common answers):
Does it hurt? No
Do you like your husband/partner? Yes
History of abuse? No
How often do you have sex? 2-3 times a month *
Do you like sex when you have it? Mostly, I’m just so tired I don’t ever feel like doing it.
Does your libido improve when you go away for the weekend with your spouse? I don’t know, we haven’t done that in 10 years
It’s at this point that I want to say, and occasionally do depending on how well I know the patient, “You mean after working full time, taking care of 3 kids, dishes and homework, you don’t suddenly feel like Samantha on Sex in the City the minutes the lights go out.?”. I don’t know it this is “normal” but I know it’s very common.
Women are multitaskers. But the one place not to be a multitasker is the bedroom. There was a recent study that showed women enjoy sex more if they are able to “live in the moment.” Well DUH!!! Honestly, it is hard to be in the moment, with so many “to do lists” floating through your head.
When I first start clinical rotations in medical school I definitely had a time of transition. After watching my first Vag Hyst as a student I couldn’t have sex for a week. Slowly, like all the other issues you some how learn to separate work from home, most of the time. The pager does occasionally go off at an inopportune time.
Although, I have become a little jaded from my profession. During a recent conversation with my husband I remarked “We have a great sex life, I mean… it doesn’t hurt, I don’t get yeast infections and I don’t have to worry about you giving me Herpes.” He gave me quite the incredulous look. I guess its all relative.
*I had a newly wed patient who was having trouble with painful intercourse. After several visits, ultrasounds, creams ect. I finally asked her how often she was able to have intercourse. When she said 5 times a day for 6 months straight…… I discovered the cause of her discomfort.
Saturday, March 7, 2009
Favorite Things
For Rinda,
To the tune of "My Favorite Things" from The Sound of Music
Four month old giggles and nine month old babbles
Dermatology cases in which I like to dabble
E-prescribing program that I am now trying
These are a few of my favorite things
A parent who stops me in Target to say thank-you
Tough diagnosis and putting together the clues
Recognition from a preteen that I am connecting
These are a few of my favorite things
Coaching new parents and caring for preemies
Referrals from OBs who bring their kids to me
Hugs at the knees and scared children now smiling
These are a few of my favorite things
Insurance pratfalls
Noncompliance
When the ED calls
I simply remember my favorite things
And then I don’t feel so bad
Four month old giggles and nine month old babbles
Dermatology cases in which I like to dabble
E-prescribing program that I am now trying
These are a few of my favorite things
A parent who stops me in Target to say thank-you
Tough diagnosis and putting together the clues
Recognition from a preteen that I am connecting
These are a few of my favorite things
Coaching new parents and caring for preemies
Referrals from OBs who bring their kids to me
Hugs at the knees and scared children now smiling
These are a few of my favorite things
Insurance pratfalls
Noncompliance
When the ED calls
I simply remember my favorite things
And then I don’t feel so bad
Cross posted at momwithastethoscope.wordpress.com
Friday, March 6, 2009
Why I Do This
Lately, for me, all you have been hearing is bitch, bitch, bitch about how this or that sucks big hairy ones (can't wait to get the misguided google searches on that one). So why, you collectively ask me, either outright or in your minds, do you put up with all that you do? Why not quit and become a garbage collector or something? This list, my friends and frenemies, is why:
~ Bringing babies into the world is, quite simply, awe-inspiring. I love it. It is so special and intimate, that moment when a family is born (and re-born), and I feel privileged to be a part of it.
~ I love helping women. Women are way too busy taking care of every one else to worry about taking care of themselves. It is good to have 15-20 minutes to sit and listen to women, and make suggestions on how they can better care for their own needs.
~ I like to *fix* things. I am, at heart, a fixer. I want to change things for the better, and being an Ob/Gyn allows me to do this more often than not. I find this infinitely satisfying when I can make things better through surgery or medical treatment.
~ I enjoy the continuity of care that being an Ob/Gyn affords. I love being able to deliver multiple babies for the same patient, and then be able to take care of their Gyn needs once childbearing is over. I like the lasting relationships the field can foster.
~ I like to do Gyn surgery. General surgery, to me, was overwhelming, but Gyn surgery affords me the ability to do a variety of cases in a limited area of the anatomy. The perfectionist in me enjoys the focus on one organ system, but there is always good enough variety to keep it interesting.
~ Procedures are fun. Not just surgeries, but colposcopies, LEEPs, IUD insertions, polyp removals, and endometrial biopsies are all very enjoyable, and the results are often immediately evident. Highly satisfactory.
~ There is a limited amount of pharmacology. For me, it is pretty much antibiotics, hormone replacement or suppression, birth control, anti-inflammatory meds, the occasional hypertension or diabetes med, and some anti-depressants. I loathe polypharmacy, so I enjoy the clean and simple pharmaceutical profiles that Ob/Gyn provides.
~ The patients. That's right, for all that they do to drive me crazy, it's the patients that keep me coming back for more. Be it the infertile woman that I helped to conceive, or the anemic, miserable woman whose ills were cured by a simple procedure or surgery, or even the chronic pain patient who got the correct diagnosis, treatment, and subsequent improved quality of life. I do this for the patients, plain and simple.
~ At the end of an exhausting day, I feel that I am making a difference and an impact for good in people's lives. That fact makes the unbearable actually bearable.
So, look, I love my job. I love it. For all of my whining, I wouldn't do anything else. I hope this answers the questions out there. Thank you for listening.
**Cross posted at Ob/Gyn Kenobi
~ Bringing babies into the world is, quite simply, awe-inspiring. I love it. It is so special and intimate, that moment when a family is born (and re-born), and I feel privileged to be a part of it.
~ I love helping women. Women are way too busy taking care of every one else to worry about taking care of themselves. It is good to have 15-20 minutes to sit and listen to women, and make suggestions on how they can better care for their own needs.
~ I like to *fix* things. I am, at heart, a fixer. I want to change things for the better, and being an Ob/Gyn allows me to do this more often than not. I find this infinitely satisfying when I can make things better through surgery or medical treatment.
~ I enjoy the continuity of care that being an Ob/Gyn affords. I love being able to deliver multiple babies for the same patient, and then be able to take care of their Gyn needs once childbearing is over. I like the lasting relationships the field can foster.
~ I like to do Gyn surgery. General surgery, to me, was overwhelming, but Gyn surgery affords me the ability to do a variety of cases in a limited area of the anatomy. The perfectionist in me enjoys the focus on one organ system, but there is always good enough variety to keep it interesting.
~ Procedures are fun. Not just surgeries, but colposcopies, LEEPs, IUD insertions, polyp removals, and endometrial biopsies are all very enjoyable, and the results are often immediately evident. Highly satisfactory.
~ There is a limited amount of pharmacology. For me, it is pretty much antibiotics, hormone replacement or suppression, birth control, anti-inflammatory meds, the occasional hypertension or diabetes med, and some anti-depressants. I loathe polypharmacy, so I enjoy the clean and simple pharmaceutical profiles that Ob/Gyn provides.
~ The patients. That's right, for all that they do to drive me crazy, it's the patients that keep me coming back for more. Be it the infertile woman that I helped to conceive, or the anemic, miserable woman whose ills were cured by a simple procedure or surgery, or even the chronic pain patient who got the correct diagnosis, treatment, and subsequent improved quality of life. I do this for the patients, plain and simple.
~ At the end of an exhausting day, I feel that I am making a difference and an impact for good in people's lives. That fact makes the unbearable actually bearable.
So, look, I love my job. I love it. For all of my whining, I wouldn't do anything else. I hope this answers the questions out there. Thank you for listening.
**Cross posted at Ob/Gyn Kenobi
Thursday, March 5, 2009
a gray area
Just read a NY Times article about our presidents going gray. Every now and then I see a stray gray of my own pop up (surprise!). In terms of how I feel, well, you know, it's a gray area. I'm in the early stages of seeing one or two here and there, so I usually feel somewhat amused and am proudly reminded of all my accomplishments. These include first and foremost, being married with children. That is, having met my life partner and our shared attempts at raising two strong and silly kids together. Despite their (all) contributing from time to time to yet another gray hair. I still feel young (except for the occasional hip pains) and think I look fairly young (delusion or reality, I'll never know), so for me I actually welcome the few grays to help on the job, where I am supposed to have the authority to guide patients and families through important decisions about their health and well being. Where I work to educate and advise medical trainees (a few grays among them). Certainly, it's just hair, but it's aging and stress and experience and evolving self-concept as well. No need to pull them out gray by gray, I'll just let them blend in and go with the flow (tucked away in a pony tail, of course).
Wednesday, March 4, 2009
Fired
It was 7:30 AM, the front door was open in readiness for the five of us to brave the morning chill and head for the van, and I was crouching in the front entrance hurriedly attaching boots and mittens to my dawdling four-year-old.
I ushered him out the door, entreating him to pick up the pace as he ambled down the walkway, stuffing pinecones into his hoodie pockets. Once in the van, I had to remind him several times to climb into his car seat, as I strapped in his sister and deposited backpacks in the trunk.
I read once that children have no sense of urgency, that it's a waste of time to try to make them hurry, and I must say that in my seven years of parenting, truer words have never been spoken.
However, from time to time I can't resist trying to instill the importance of efficient house-departing routines into their little heads, and so this morning I told him earnestly, "Mommy and Daddy can't be late for work. If we are, we could be fired!" Unlikely though that scenario is, against the backdrop of today's economy the statement sounded sufficiently grim.
My words seemed to have an effect. I had his full attention. "They would set you on fire?" he asked with real interest.
Sunday, March 1, 2009
All the sweeter
Today, a patient's family member hugged me. When I saw her standing in the hallway, by the room her father was in when he passed away peacefully last week, I wondered who she had come to see. Her father, a patient who was "comfort care," was now gone. The room held someone else.
I smiled at her and the next thing I knew, she was throwing her arms around me in the middle of the hallway.
She was here with the rest of the family, wanting to thank the staff, wanting to tell us of the funeral arrangements. She had told us last week that if she ever had cancer, this was the way she wanted it to be. This was the care she would have wanted.
My team has taken care of many, many patients with cancer these past few weeks. In a way, it's been depressing. There's just so much cancer. But in ways like this, it has been deeply fulfilling to be able to make a difference in the lives (or end of life) of patients and families.
I'm reaching the end of a particularly long stint of attending on the medicine wards. I thought that I would be ravaged by working the weekends, of not being able to spend as much time with my children as I wanted. I thought I would be impatient, tired, and annoyed.
Yet, today, coming home after a day of weekend rounding, I feel renewed.
Several patients expressed how much they appreciated me taking care of them. One grandfatherly figure said that he felt better just by me coming to talk to him and joked that even his gouty ankles were smiling at me. One, despite being frustrated at still not feeling completely better, told me how much he felt I made a difference. One, slowly getting better, said thank you in a way that made me humble. One, confused about what was going on, shook my hand with both of his after I gave him the diagram I drew of where in the biliary system we thought his obstruction was.
I don't know whether, with time, I'm getting better at interacting interpersonally with my patients, or that I just happen to be taking care of an appreciative bunch, but I can tell you I feel like each conversation I have with a patient lately has been therapeutic. I feel like I am personally making a difference in their hospitalization, that my joking with them, or trying to make their illness experience better in small, tangible ways, is making a difference.
Today, I came home, picked up, and twirled my 13-month old son, delighting in feeling his weight, his sweetness.
All the more sweeter from having such a fulfilling day in the hospital.
And, I thought to myself: I am good at this. This is my calling. I can't imagine doing anything else.
I smiled at her and the next thing I knew, she was throwing her arms around me in the middle of the hallway.
She was here with the rest of the family, wanting to thank the staff, wanting to tell us of the funeral arrangements. She had told us last week that if she ever had cancer, this was the way she wanted it to be. This was the care she would have wanted.
My team has taken care of many, many patients with cancer these past few weeks. In a way, it's been depressing. There's just so much cancer. But in ways like this, it has been deeply fulfilling to be able to make a difference in the lives (or end of life) of patients and families.
I'm reaching the end of a particularly long stint of attending on the medicine wards. I thought that I would be ravaged by working the weekends, of not being able to spend as much time with my children as I wanted. I thought I would be impatient, tired, and annoyed.
Yet, today, coming home after a day of weekend rounding, I feel renewed.
Several patients expressed how much they appreciated me taking care of them. One grandfatherly figure said that he felt better just by me coming to talk to him and joked that even his gouty ankles were smiling at me. One, despite being frustrated at still not feeling completely better, told me how much he felt I made a difference. One, slowly getting better, said thank you in a way that made me humble. One, confused about what was going on, shook my hand with both of his after I gave him the diagram I drew of where in the biliary system we thought his obstruction was.
I don't know whether, with time, I'm getting better at interacting interpersonally with my patients, or that I just happen to be taking care of an appreciative bunch, but I can tell you I feel like each conversation I have with a patient lately has been therapeutic. I feel like I am personally making a difference in their hospitalization, that my joking with them, or trying to make their illness experience better in small, tangible ways, is making a difference.
Today, I came home, picked up, and twirled my 13-month old son, delighting in feeling his weight, his sweetness.
All the more sweeter from having such a fulfilling day in the hospital.
And, I thought to myself: I am good at this. This is my calling. I can't imagine doing anything else.
Saturday, February 28, 2009
Just Like Mommy
Earlier this year, my daughter's class was doing a week on "healthy hearts," and her teachers asked if I could donate a stethoscope or two for the class. Since I am on my 5th or 6th stethoscope, it wasn't too hard to fish out the cast-offs from CindyLou's dress-up chest. The day we were to bring them in, CindyLou was sooooo excited. "My class is going to listen with *your* 'stefflstopes??' I'm so excited to be a doctor...just like mommy!" But instead of warming the cockles of my cold heart, these very words struck an odd chord of panic. I mean, what parent wouldn't beam with pride when their child wanted to follow in their footsteps, much less enter the medical profession?
Then, I paused a moment to think about what "being a doctor" really means to CindyLou. To her, mommy's work is hanging out at the nurse's station...checking out the new babies, coloring, eating crackers and suckers, and generally being fawned over by nurses, patients, and visitors alike. Or, perhaps she thinks about time in mommy's office, where SuperNurse plies her with her secret candy stash, she sits on her lap, and "works" on the computer. Being a doctor must seem a pretty sweet gig to a 4 (almost 5) year old. It also gives me hope that, for all my harried feelings about my job, they don't transfer to CindyLou; thus enabling her to feel like being a doctor is a pretty darn cool job. What ever the reason, I did feel grateful and humbled that my little girl was looking up to me, aspiring to be (despite my many foibles) "just like mommy.'
Then, I paused a moment to think about what "being a doctor" really means to CindyLou. To her, mommy's work is hanging out at the nurse's station...checking out the new babies, coloring, eating crackers and suckers, and generally being fawned over by nurses, patients, and visitors alike. Or, perhaps she thinks about time in mommy's office, where SuperNurse plies her with her secret candy stash, she sits on her lap, and "works" on the computer. Being a doctor must seem a pretty sweet gig to a 4 (almost 5) year old. It also gives me hope that, for all my harried feelings about my job, they don't transfer to CindyLou; thus enabling her to feel like being a doctor is a pretty darn cool job. What ever the reason, I did feel grateful and humbled that my little girl was looking up to me, aspiring to be (despite my many foibles) "just like mommy.'
Tuesday, February 24, 2009
The Student
In the not too distant past, I had the good fortune of having a really great student with me for an "Office Ob/Gyn" elective. When I say "really great student," I mean exactly that. She arrived early and stayed late. She was professional and comforting to the patients. She asked appropriate questions and wrote really great notes. She had a good knowledge base, and she did it all with a smile and no 'tude. Truly, an awesome student. Unfortunately for her, we spent more time in the hospital doing surgery and deliveries than we did in the office. (I think that Whooville is having a serious baby boom. They just. keep. coming.) I do think that I was able to give her a taste of what being an Ob/Gyn is like, at least as far as being a solo practitioner, any way. She is trying to decide between Ob and a couple of other more "lifestyle friendly" specialties.
During the rotation, I really tried to let her form her own opinions about the life that she saw me living. I found myself, several times having to refrain from trying to talk her out of being an Ob/Gyn. A student that any Ob residency would be lucky to have, and I kept wanting to, I don't know, *protect* her or something. Maybe it was her sweet, un-cynical self, not yet marred by years of being beaten down by the establishment. Maybe it was because I wanted her to have a chance at a less stressful life, before it was too late to look back. Or maybe I was just trying to warn her not to make the same mistake that I made when I chose my first job out of residency (an essentially solo practice). I would like to think that it was the latter, because I truly love what I do, I just don't want to do it so, um, *often.*
I want to be able to feel confident in inspiring the best students to follow in my footsteps in a field that desperately needs good physicians. I worry that my first instinct is to tell my students to run, run, run, because I know that I wouldn't have. Even if the attending told me to run, I would have made the same choice. So at the end of the rotation, after we went over her evaluation, she asked for a letter of recommendation (which I will gladly write). When I asked whether she wanted one geared toward an Ob residency, or one for more general purposes, she chose the "more general" category. She's still making up her mind. Perhaps my feelings were telegraphed more than I had realized. I do feel hopeful, though, to know that the such bright rising stars in the future of medicine exist out there. So, to all you bright med students and would-be med students...don't let the disillusioned attendings get you down, y'all. We need you more than you know.
During the rotation, I really tried to let her form her own opinions about the life that she saw me living. I found myself, several times having to refrain from trying to talk her out of being an Ob/Gyn. A student that any Ob residency would be lucky to have, and I kept wanting to, I don't know, *protect* her or something. Maybe it was her sweet, un-cynical self, not yet marred by years of being beaten down by the establishment. Maybe it was because I wanted her to have a chance at a less stressful life, before it was too late to look back. Or maybe I was just trying to warn her not to make the same mistake that I made when I chose my first job out of residency (an essentially solo practice). I would like to think that it was the latter, because I truly love what I do, I just don't want to do it so, um, *often.*
I want to be able to feel confident in inspiring the best students to follow in my footsteps in a field that desperately needs good physicians. I worry that my first instinct is to tell my students to run, run, run, because I know that I wouldn't have. Even if the attending told me to run, I would have made the same choice. So at the end of the rotation, after we went over her evaluation, she asked for a letter of recommendation (which I will gladly write). When I asked whether she wanted one geared toward an Ob residency, or one for more general purposes, she chose the "more general" category. She's still making up her mind. Perhaps my feelings were telegraphed more than I had realized. I do feel hopeful, though, to know that the such bright rising stars in the future of medicine exist out there. So, to all you bright med students and would-be med students...don't let the disillusioned attendings get you down, y'all. We need you more than you know.
Saturday, February 21, 2009
The most important job in the world!
Melly has been going through her "toddler word explosion" lately, so one word we've been trying to teach her is what I do for a living.
Husband: "Melly, what is Mommy's job?"
Melly: "Diaper!"
Me: "Great, she thinks I'm a diaper."
While I am not employed as a diaper, it should be noted that:
1) Diapers and I both work at night as well as during the day.
2) Diapers are white; I wear a white coat.
3) Diapers and I both get crapped on a lot in the course of our duties. (I said DUTIES.)
So my job actually does have a lot in common with that of a diaper, but I am not, in fact, a diaper. Nice try though, honey.
Husband: "Melly, what is Mommy's job?"
Melly: "Diaper!"
Me: "Great, she thinks I'm a diaper."
While I am not employed as a diaper, it should be noted that:
1) Diapers and I both work at night as well as during the day.
2) Diapers are white; I wear a white coat.
3) Diapers and I both get crapped on a lot in the course of our duties. (I said DUTIES.)
So my job actually does have a lot in common with that of a diaper, but I am not, in fact, a diaper. Nice try though, honey.
Friday, February 20, 2009
Boy Perfume
“If your grandfather hadn’t worn it, you probably wouldn’t exist…”
My tween Eldest loves to use this Old Spice tag line. Like many things in his world, he’s just beginning to grasp the underlying meaning. Now youngest - age 8 - is starting to follow right behind. He came downstairs this weekend doused with his brother’s cologne.
“Whoa, Buddy. Have you been in your brother’s Old Spice?”
“Well. Maybe. “ Kind of hard to cover up an overdose of aftershave.
“A little goes a long way, ya know?”
“I like to smell good.”
“Maybe we need to get you some of your own.”
“Can we?” Sure, I think. I’ve got one I can’t get into the shower but needs it. Regularly. And I’ve got one who’d bathe in dad smell if I let him.
Smells are part of my life – they’re hard to escape in medicine. The good ones: The buttery sweet smell of a newborn that makes me ovulate on cue as KC puts it, my butter cream candle that puts me in that Zen place. The mediocre: hand sanitizer foam, plastic odor from IV tubing, syringes, and emesis basins. The stomach churners: toddler poop, third hand smoke, formaldehyde based wavicide we use to clean instruments (sends me straight back to anatomy lab), and the perennial vomit tang. A well trained nose can turn off all but the strongest smells.
At home, I have to remember to turn my olfactory sense back on – make a conscientious effort to take in the yummy clean smell of my youngest’s hair and even the pubertal funk of Eldest – pre-Old Spice. Do I really want to mess with the chemistry that goes straight to my amygdala? Cover it up with some commercial pheromone?
I wonder what I smell like to my kids. Will they get a whiff in their old age and suddenly have memories of their mom? Perfume is one thing I can rarely forgo – can go without makeup, like Fizzy, but cannot go without some sort of scent. My current favorite is Philosophy’s Grace – it’s like grown-up baby powder to me – soft, a little floral, and subtle.
So at Target, I buy Youngest a bottle of Old Spice. It’s better than some of the alternatives. We keep peace in the bathroom with separate bottles for each of my fellows. A little goes a long way.
Wednesday, February 18, 2009
Guest Post: A Parent's Perspective
Whether as a promise or warning, our psychiatry clerkship director had informed us that we would be surprised to find how much we have in common with our patients. What he did not say is how much we would have in common with our patients’ parents. My first evening on call, we were told that a nineteen year old*, who had attempted suicide two days prior, would be transferred that night from a local hospital. I called medical records to have his electronic chart unlocked. As I read through the previous history and physical from a psych hospitalization back in August, I tried to picture this kid. Numerous times in the notes, they made reference to his ‘severe acne’. I conjured up pictures of the pocked, scarred faces of the skinny, loner boys in hoodies I pitied during high school. Surely this was he?
I waited for the intern to come to the floor. I did not want to interview this person by myself. What if he admitted he wanted to kill himself again? What if I didn’t show enough empathy and caused him to feel worse, more alone or more misunderstood? What if I showed too much and embarrassed him? What if I simply projected enough of my own anxiety onto him and around the room that it became more about me and not about him, alienating him even more? I sat nervously hiding in the physician workroom.
When we entered the room, my visualization had nothing in common with our patient. He was nearly a man: well developed, almost muscular and his acne had all but resolved. Wearing jeans and a tee shirt advertising a local restaurant, he was mindlessly picking at his arm hair. One leg was swung casually across the bed. His parents sat on opposite ends of the room, both perched on the edges. Dad rested on the ledge of the room’s radiator and Mom was on the hard wooden chair that matched the pine desk. His dad was wearing a suit, looking fragile and exhausted. He, too, was well-built but unlike his son, looked as though he had just gone through an ordeal. His mom had dark hair and vivid cerulean blue eyes. She glanced up as we walked in and I could feel the breath fill her lungs. She looked over at her son and gave a sad, half smile, ‘The doctors are here, Louis* she said softly. She stood up and crossed the room perching next to him on the bed. She turned to us and motioned, "They’re babies, Louis. They’re so young. They’re practically babies." She continued to attempt a smile, and it was difficult for me to tell if she was simply openly skeptical (and rightly so) of my psychiatric acumen or if she was trying to put her son at ease. I was struck with the thought that he looked infinitely more casual about the situation than they did.
I suppose one of the nice things about getting older is that I only feel pleased to be called young. There are days I feel overwhelmed and exhausted: a result of too little sleep paired the intense time required of young children and academic endeavors. Initially, I fought back the urge to reassure her that, I wasn’t young. In fact, I have four children of my own. But I didn’t say it because, unknowingly, Louis’s mom reminded me of exactly what I am: a student, fledgling in my career, allowed to ask obtuse questions and to fumble through interviews. I often feel that because I am a mother, I should be mature and accomplished enough to be good at this.
With that, I registered that I felt much more empathy for the parents than I did for Louis. They looked anxious: a sick, what-do-we-do now expression as their fatigue mingled with wits-end. I was partially curious, floored, and anxious that two caring, highly educated people had produced a Louis, a Louis who by most accounts had a whopping drug problem tangoing with a schizoaffective disorder diagnosis. Parents, who by all appearances and written accounts, loved their son desperately, but I imagine must have also been furious and yet terrified of him. I pulled back realizing that perhaps I was afraid of him and again, vaguely aware that I could be projecting my parental panic for my own toddler son’s self injurious behavior. Panicked that one or all of my children could end up like this despite, or worse, due to my best efforts, it is little wonder I had trouble concentrating on Louis’s answers to my first question.
After the interview, I finished the write up and drove home in a daze. I recognized that somewhere during the interview my attention fixed exclusively on the patient. While agonizing over his parents’ thoughts, I initially fought to keep his story, his feelings and his concerns as the focus of the conversation. I know I am prone to identifying with the parents; yet, being excessively caught up with their anxieties could interfere with my relationship with Louis. I attempted not to illustrate his story with my own transferred feelings and hopefully, this awareness will improve the quality of care I provide him. But that seems to be the trouble with motherhood: it can be hard to separate it out from how I see and interpret the world.
*Patient's identifiers have been changed.
msm is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.
I waited for the intern to come to the floor. I did not want to interview this person by myself. What if he admitted he wanted to kill himself again? What if I didn’t show enough empathy and caused him to feel worse, more alone or more misunderstood? What if I showed too much and embarrassed him? What if I simply projected enough of my own anxiety onto him and around the room that it became more about me and not about him, alienating him even more? I sat nervously hiding in the physician workroom.
When we entered the room, my visualization had nothing in common with our patient. He was nearly a man: well developed, almost muscular and his acne had all but resolved. Wearing jeans and a tee shirt advertising a local restaurant, he was mindlessly picking at his arm hair. One leg was swung casually across the bed. His parents sat on opposite ends of the room, both perched on the edges. Dad rested on the ledge of the room’s radiator and Mom was on the hard wooden chair that matched the pine desk. His dad was wearing a suit, looking fragile and exhausted. He, too, was well-built but unlike his son, looked as though he had just gone through an ordeal. His mom had dark hair and vivid cerulean blue eyes. She glanced up as we walked in and I could feel the breath fill her lungs. She looked over at her son and gave a sad, half smile, ‘The doctors are here, Louis* she said softly. She stood up and crossed the room perching next to him on the bed. She turned to us and motioned, "They’re babies, Louis. They’re so young. They’re practically babies." She continued to attempt a smile, and it was difficult for me to tell if she was simply openly skeptical (and rightly so) of my psychiatric acumen or if she was trying to put her son at ease. I was struck with the thought that he looked infinitely more casual about the situation than they did.
I suppose one of the nice things about getting older is that I only feel pleased to be called young. There are days I feel overwhelmed and exhausted: a result of too little sleep paired the intense time required of young children and academic endeavors. Initially, I fought back the urge to reassure her that, I wasn’t young. In fact, I have four children of my own. But I didn’t say it because, unknowingly, Louis’s mom reminded me of exactly what I am: a student, fledgling in my career, allowed to ask obtuse questions and to fumble through interviews. I often feel that because I am a mother, I should be mature and accomplished enough to be good at this.
With that, I registered that I felt much more empathy for the parents than I did for Louis. They looked anxious: a sick, what-do-we-do now expression as their fatigue mingled with wits-end. I was partially curious, floored, and anxious that two caring, highly educated people had produced a Louis, a Louis who by most accounts had a whopping drug problem tangoing with a schizoaffective disorder diagnosis. Parents, who by all appearances and written accounts, loved their son desperately, but I imagine must have also been furious and yet terrified of him. I pulled back realizing that perhaps I was afraid of him and again, vaguely aware that I could be projecting my parental panic for my own toddler son’s self injurious behavior. Panicked that one or all of my children could end up like this despite, or worse, due to my best efforts, it is little wonder I had trouble concentrating on Louis’s answers to my first question.
After the interview, I finished the write up and drove home in a daze. I recognized that somewhere during the interview my attention fixed exclusively on the patient. While agonizing over his parents’ thoughts, I initially fought to keep his story, his feelings and his concerns as the focus of the conversation. I know I am prone to identifying with the parents; yet, being excessively caught up with their anxieties could interfere with my relationship with Louis. I attempted not to illustrate his story with my own transferred feelings and hopefully, this awareness will improve the quality of care I provide him. But that seems to be the trouble with motherhood: it can be hard to separate it out from how I see and interpret the world.
*Patient's identifiers have been changed.
msm is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.
Subscribe to:
Posts (Atom)