When EBM is not enough...

I recently had my third child (he's 7 weeks today) and he's a boy - which is a new experience since my two others are girls. Among the various new challenges (which include changing diapers - I've managed to get sprayed on more than one occasion) one unanticipated challenge is what to do with the vaccination schedule? Since my 2 older children are girls, I didn't really worry about autism - but now that I have a son, I find others are asking what I will do?

Well, I started to answer this question with my EBM skills - I looked up the evidence to support any change in the normal practice and of course, there is no good evidence right now. However, now that I have engaged my many Mom friends on this topic, I have heard many, many anecdotes of parents who are sure that a known case of autisum was related to the vaccines given all at once.

Next week, my little one is schedule to get 5 vaccines at once - 4 injected and 1 oral. With all due respect to EBM, while there's no good evidence to support any interventions, I've decided to give the vaccines over 2 visits, probably 1-2 weeks apart. I figure there's little to lose and possibly something to gain? At the very least I wont' have to sit there and watch him scream 4 times - on the other hand, I'll have to take a crying baby home on 2 different days...

Any thoughts on this issue?

Playing nice

Recently, we've been teaching Melly to be nice.

Some of the kids at her day care were hitting and we were shocked to discover that she was one of the perpetrators. So we took it upon ourselves to train her not to hit.

Me: "Melly, don't hit the babies. The babies are your friends."

Melly: "Fwends."

Me: "So what are you going to do with the babies?"

Melly: "Hit the babies." (Repeat x 100)

But we were eventually successful and now the day care is reporting that she gently pats the other babies and says that they are her "fwends." We have successfully trained our daughter to be nice.

Now it's my turn.

It's not that I'm not nice. I'm nice enough. But when Melly woke me up at 5:30AM and I've just seen 15 back pain patients that morning and now I'm on #16, it's hard to keep a smile plastered on my face. Especially when patient #16 showed up 20 minutes late and now I'm going to have two minutes for lunch.

(I tend to get really irritable when I think I'm going to miss lunch. I hate the fact that it's totally acceptable in our field to have zero lunch break in a day. Sometimes my morning clinic ends later than my afternoon clinic, so I have negative lunch. I guess that means I'm supposed to throw up?)

My new resolution to be nicer comes from a recent visit to my youngish female primary care physician, who was clearly running an hour late and doing my physical exam during a time when most people would be eating lunch. Yet through our visit, she kept the brightest, most cheerful smile on her face. She was so nice, I wanted to hug her. And I'm not such an awesome patient to warrant that kind of niceness.

Obviously, it's great to be a master diagnostician, but I am most impressed with doctors who can exhibit that kind of unconditional, overwhelming niceness. (Especially in a field where there are, let's face it, a lot of assholes.) My PCP is a physician mother as well and I'm sure she has all sorts of stress in her life, but I wouldn't have known it from looking at her. When I look at my PCP, I think to myself, "She is a born doctor."

When I meet a doctor like that, I resolve to walk into every patient's room with a huge smile on my face. It generally lasts for about a day, sometimes less. Sometimes I can only smile through my first patient. Still, I'm working on it. If my two year old daughter can be nice, I can too.

My golden anniversary

When I realized that this was to be my 50th post on this blog, I decided I want to make it good. (Not my usual crap, right?) I asked around for advice and got some suggestions that were good, possibly topics for future posts, but didn't quite have the WOW! factor I wanted. I wanted to make a post that was not just interesting, but.... SHOCKING.

So here goes:

When I joined this blog back in its infancy, one year ago, I had an ulterior motive. The truth was that I felt that going into medicine was a huge mistake for any woman who wanted to become a mother. And I was determined to share that opinion.

Anyone who has read some of my earlier posts would know that I came dangerously close to blurting out that opinion on several occasions, but I always just barely stopped short and ended with some cheesy phrase like, "But it's all worth it." I didn't say what I truly felt because I was scared. I knew this opinion would not be popular. Nobody wants to hear that a woman shouldn't follow her career aspirations just because she wants to have a family. And moreover, I was embarrassed to admit that after seven grueling years of training and 100's of thousands of dollars in tuition, I had major regrets. But I felt that it was important and needed to be said.

(Maybe that's why I've written so much. I'm like the guy who buys twenty unneeded items at the newsstand, hoping the one issue of Playboy goes unnoticed.)

A year later, I still haven't made a definitive post warning mothers-to-be not to go into medicine. But not because I'm chicken anymore; it's because reading these entries over the course of the year has actually changed my mind. Hearing about all these female physicians (both the bloggers and the commenters) who love being mothers in medicine has inspired me. I'm changed. If you guys love it, then I'm optimistic that I can too. Maybe I'm just giddy about graduating residency, but I no longer feel a dire need to tell young female pre-meds to run before it's too late.

So I guess for my 50th post, I'd like to say thanks. Thanks to everyone who posted or commented about how being a physician mama is a gift that only a few of us get to experience. I needed that.

once I get through May (June, July, August...)

It's Monday morning, hope y'all had a great weekend. I did, but the weekends haven't been a problem, relaxing with Husband, Just Five, and Almost Three, as silly and lovable as they all are. Work-wise, though, I've noticed a trend I've fallen into all too often of late. I find I'll have a lot on my plate, usually professionally (sometimes personally) and so I say to myself calmly, if I can just get through May, then I'll have a lot less to do. I'll just get through all these deadlines that have crept up on me for early, mid, and late May, and then I'll be set. But of course, then June rolls around and I have yet more decisions to make, work to get started on, tasks to complete, things to prepare... They are things I enjoy, usually, but a lot of things nonetheless!

Well, when I had my little fender bender last Monday (no one was hurt, kids not in the car) I had an all to harsh reminder that it was time to slow down, literally and figuratively. Might not have been my fault, after all, in an accident you don't intentionally bump into another car, maybe it bumped into you. Who knows? Then, get this, after the accident and exchanging information and seeing that every one's okay, and taking care of all those necessary details, I got back in my car, drove to my morning meeting, walked in a few minutes late apologizing that I had an unexpected delay, and proceeded to lead the meeting for which I'd set the agenda. Only afterwards did I share what had happened with a trusted colleague, and then with my mom (with whom I cried on the phone) and had already called my ever so supportive ("It could happen to any of us") husband.

So, I've decided to slow down, this month, now, today. You?

Better than a birthday

The one year anniversary of Mothers in Medicine is like a birthday for me, but better. I guess it's like a birthday back in the day when getting a year older was the most awesome thing that could happen to you. Like that day, a month ago, when my daughter woke up and said, "I'm FOUR!" with so much enthusiasm, I thought I could see fireworks and rockets swirling around her head. Turning four was so good.

I think from the idea of wanting to start a group blog of physician-mothers to the actual launch was possibly 2 weeks or less. Things happened quickly. I distinctly remember driving home one night after some event with my husband and having The Idea. That's what we need! A group blog! For mothers! In medicine! After that, it was all momentum.

Starting out, I didn't know the majority of women who joined me to become regular contributors. But, over the past year, in writing together the joys and struggles and challenges and humor that come with this territory, they have become friends.

This year has been amazing. Amazing to see the growth of this blog community which continues to steadily grow. We've had 5 topic days. 18 guest posts. Over 290 posts. Over 120,000 page loads. I'm excited to see what this next year brings.

And probably some of the best moments have been hearing from you, the readers, about what Mothers in Medicine means to you. I encourage you to write in, give feedback, suggestions, submit guest posts, be involved. Because we are all in this together.

In reflecting on this year's posts and what stood out for me, I realized many of them have already been highlighted by my fellow MiM writers. Yet, there was one that wasn't: we received a comment to one of the posts that was so, well, amazing, that we posted it as a guest post proper, even though we never did track down who it was that left the comment.

Guest Post: A comment from a daughter

Thanks for reading (and sharing your stories),
KC

MiM celebrates one year: Fizzy

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

Fizzy wins the prize for most prolific writer on MiM. While being a resident! (Any future resident writers: you have big shoes to fill!) Fizzy has made us laugh on a regular basis with her posts, which have become a staple of this blog. She's a PM&R resident, soon to finish, and mother to a toddler girl.

Fizzy writes:

It was hard to pick a favorite post, since I've written.... holy crap, 44 of them! But it would probably be this one:

http://www.mothersinmedicine.com/2008/08/mothers-dont-let-your-daughters-be.html

Fizzy, your unique writing style and contributions have rounded out MiM --you have woven your voice into the fabric of our community and have made it richer, funnier, and fuller. Thank you for being a part of MiM!

MiM celebrates one year: dr. whoo

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

dr. whoo, an ob/gyn and mother of 2, is a veteran blogger with a popular personal blog with an awesome name. I mean, Ob/Gyn Kenobi, is brilliant, no? We were thrilled when she joined Mothers in Medicine as a regular contributor shortly after we launched.

dr. whoo writes:

Hi KC! Favorite post? Hmmmm, I think I would pick "What My Medical School Accpetance Letter Didn't Say..." I also liked "Boys Club" and "How do you do it all?"


Her choices involve a) her contribution to the Topic Day on "Things we wish we knew in medical school" --apparently a popular source of favorite posts for MiM bloggers; 2) a raw look at working in the trenches of medical culture where there is still a difference in treatment between male and female physicians (Boys Club); 3) continuing struggles to balance work and home life (How do you do it all?).

dr. whoo writes from the heart, with a clear point of view. Her love for the work she does is inspiring. We're rooting for her to be able to strike the work-life balance with a better job on the horizon. Thank you, dr. whoo, for being a part of MiM. We're looking forward to hearing all about your new adventures to come.

Friendship and Female Physicians

I've noticed over the past several years that it hasn't always been easy for me to make friends.

Sometimes I wonder if I'm the reason.  Am I simply un-like-able?

When I was in grade school I constantly found myself blurting out goofy things and wincing afterward.  I'm sure my social awkwardness cost me some friendships at that age.

Then there was high school  Oy.  Recently a friend from high school whom I've always admired told me I could sometimes be intimidating back then.  ME?!  Intimidating?!  But I'm so sweet!  And shy, and awkward! And un-tall!  But I suppose my love of Renaissance history, French poetry, and molecular biology might have struck some people as off-putting...

I had a great time in college.  I found like-minded people, kindred spirits, people in different spheres who loved a lot of the same activities, subjects, books, etc.  I made some life-long friends in college, as many of us do (and a few good friends in med school and internship as well, though not as many).

I can think of a few things that can make building new friendships and maintaining existing ones hard after college.  Relocation. Marriage.  Parenthood.  Jobs.

And if your job is in medicine as a resident of some kind, you get the added challenge of sleeplessness, no time, no energy, no patience, high stress, contact with suffering on a daily basis, making lonely decisions in what can be an isolating profession, all free time spent sleeping or running errands.  Relationships of all kinds suffer during residency; friendships are no exception.

But I think there's yet an additional layer for female doctors.  I can't quite put my finger on what it's made of, but it's there.  

When people find out you're a doctor - that's if you can even get around to meeting new people in the first place - sometimes their whole vibe toward you can change.  It's almost imperceptible, but there's a turn somewhere.  It's there. A pulling back, maybe, or the inexplicable sudden presence of an invisible veil between you and the person you'd like to befriend who happens not to be a physician.

I'm not sure why that happens, or even if I'm making something out of nothing.  Women-doctors want to hang out and watch chick flicks as much as any group of women friends, or go to cafes to chat, or cook together.  Why the sudden barriers?

I have a friend - a drop-dead gorgeous, brilliant, super-sweet, supportive-beyond-measure, talented, couldn't-be-nicer friend, fellow-mom, and fellow-physician - who meets with a group of women on a regular basis to engage in a much-enjoyed activity.  She told me that for a long time she didn't tell the other members of the group she was a doctor.  She was concerned they might not be as relaxed, or their attitude to her might change, with the knowledge of her profession.  I have another, newer friend - also multi-talented, also a fellow-mom and physician, very nice, with lots of different interests - who has observed a shift in others when she strikes up a conversation but then reveals that she's a doctor. 

I don't think we're all just imagining this.  There's something about us female physicians that seems to make some people hesitate to get too close, which makes making friends even harder in the context of busy, demanding lives juggling work and family.  I tried googling "women doctors" and "friendship" to see if I could learn more, but no one seems to be talking about this much, or I'm not looking in the right places, or no one else thinks there's an issue.

Do male physicians experience anything similar?  Am I just being over-sensitive?  I don't know.  But I do think the whole subject of physicians and friendship in general, and women doctors in particular, is worth exploring.  

Cross-posted at Notes of an Anesthesioboist.

Future Mother in Medicine?

I was reading a story on the Washington Post about a girl graduating high school with 13 years of perfect attendance. She has not missed one day of school in 13 years.

It's easy enough to say that this is a great accomplishment, one to be proud of, but I'd actually say it's a little bit scary that such a young person feels so driven that they did not stay home once since the age of 5. *cough cough* Sound a little familiar to some of you?

I think it's really admirable to have perfect attendance, but not at the expense of being human. This student was mourning the fact that she couldn't go visit colleges because she was unable to miss a day of class. Although I snickered a little bit at these warped priorities, I have to say that I've been guilty of the same line of thinking myself. I recall last year that I dragged myself to work with a really bad stomach bug when any normal person would have stayed home. Instead, I went to the bathroom to vomit between patients. (Yes, I had mints.)

On another occasion, I went to clinic when I had severe laryngitis. I could barely speak a word. I don't know how I thought I was going to interview patients... sign language? As soon as I opened my mouth, my attending said to me, "OH MY GOD, GO HOME." I would have tried to argue with her but I couldn't talk.

Come to think of it, I was kind of the same way in high school.

The end of the article states that this girl is going to be pre-med in college. What a shock, right? She'll fit right in.

Of course, I want my daughter to have a good work ethic, but I don't want her to feel like she's not allowed to be sick, the way I do. A mother always wants her child to inherit her good traits, not her bad traits... I'm not sure where this sense extreme responsibility fits in there.

MiM celebrates one year: FreshMD

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

FreshMD was one of the first women I recruited to join MiM. I came across her personal blog and fell a little bit in love. Since then, we've enjoyed her poignant, articulate, witty, insightful posts here on Mothers in Medicine.

She writes:

"Hmmm, hard to decide. I think this one: http://www.mothersinmedicine.com/2008/11/full-days-work-by-9-am.html

It was fun to review them! I don't remember writing some parts. Some of the details about my son breaking his arm I had no recollection of."

FreshMD, thank you, for writing with us for the past year. We wouldn't be the same without you. (And while we are sad to hear you will no longer be posting at your personal blog, we are glad you will be able to pursue new creative endeavors and thrilled we can still read your words and insight here.)

Dandelion poetry

We brought dinner to the beach last week, and afterwards we walked out to the dock and played along the shore. Leif found a cluster of dandelions gone to seed and hunched over, snapping the hollow milky stems and double fisting his prize.

"I'm going to make a wish!" he said. "I wish for . . . " I could see him searching for something extravagant. "A chocolate cake!" he said expansively.

puff puff spit huff spit puff

"I'm not going to blow anymore. I'm just going to whack the wishes off now," he said, striking the fluff balls against the railing, then plucking them apart manually. "Look - a school of wishes!" He watched them drift off in a hazy clump. "Hey! The wishes are all hugging each other!" And then he spotted some goslings and trotted off down the beach.

How wonderful to wish for chocolate cake. To have to think hard for something to wish for, to have all your needs met, to have no cares or sickness or worries to wish away.

For me, my children and their pure, unspoiled interactions with the world are the most potent antidote to the suffering I witness at work and sometimes carry home with me as a little black cloud over my heart.

MiM celebrates one year: RH+

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

RH+ writes:
In reviewing my posts these are my favorites:
Cry (Guest Post)
Reverse Penis Envy
Oh the Places You'll Go!

We first met RH+, an ob/gyn, when she submitted a guest post last July that knocked our socks off and landed us on Kevin, M.D. We were thrilled to have her join us here.

Since then, she's contributed funny, touching, real stories including the humorous Reverse Penis Envy and the "Things We Wish We Knew in Medical School" Topic Day post, Oh the Places You'll Go.

It's been such a pleasure writing with you this past year, RH+. Looking forward to your stories to come.

Role Reversal

Ever since my husband made the decision to stop working in order to balance our family and home life, things have been ever so much more manageable in our lives. Groceries get bought, laundry gets done, dinner gets cooked, and life is a little easier for all of us. It has been a necessary, though not a permanent, change. As my husband has assumed the "traditional female" role with respect to keeping our house in order, I sometimes find myself falling into the role of a 60s sitcom "traditional male." I come home, grunt a few times, stare at the television or the internet until dinner, hug and snuggle the kids, get them fed and bathed, and become basically a zoned-out zombie until the weekend rolls around. It is only then that I awaken to my real "maternal instinct." It is only then that I can interact with my kids as more of a mommy than a "provider." I know that I haven't changed, but, right now, my role in their lives has. I'm the breadwinner. I'm working for our family, and somehow, it is taking a lot from me. Lately, I find myself more sympathetic to those 60s fathers, bearing the weight of the world on their shoulders, but always ready with a bit of wisdom or a pithy saying. I know my husband respects the hard working (not bon-bon eating) housewives, as well. Still, at the end of the day, I know my mother's heart is still alive and well, especially when Bean holds my face close and memorizes every feature, softly saying "nose," "mouth," "eyes," and "hair." My heart just melts, and I feel so blessed to just be "Mommy."

MiM celebrates one year: Juliaink

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

Juliaink has brought a unique perspective to this blog, both as a psychiatrist in academics, as well as mother to two grown children. She writes eloquently and thoughtfully, and at times, passionately.

Juliaink writes:
I think my favorite is still The Speech I Never Gave though I also like the one I did on mentors/models.


The Speech I Never Gave gave me goosebumps and one I wish was required reading for every female medical student. And her post on mentors was honest and rich.

Thank you, Juliaink, for having the courage to write about what moves you, and to share your opinions on issues seen through your multiples lenses as a mother, physician and concerned citizen. Thank you for your stories.

Seriously, I wanna know...

Over the past week, school systems across my state have administered tests that will determine for some children if they will advance to the next grade. This fourth quarter assessment causes no shortage of angst among the children of my community, and I have seen my fair share of nonspecific headaches and belly aches as a result. It makes me pause and wonder, are we teaching only one side of the anxiety equation? Some anxiety is helpful - it motivates, creates energy for us to act upon a situation. Like all things, though, there is a balance between the constructive state and the paralyzing fear of the unknown. Is there some sort of curiculum that we can use to instruct students about constructive ways to relax? Do you have favorite techiniques you use to guide your children and/or patients through nervousness?