The Difference

So, I made it! I survived the last few weeks of overdrive at the old job, moved halfway across the country, and started my new position a couple of weeks ago. The differences are amazing. The practice I came to is a much larger one, with several doctors and several locations. The offices run like well oiled machines, and the staff is top-notch. Everything is also on EMR, which makes it an interesting learning curve. The work is the same, but I always loved the actual job. The biggest difference, however, is the impact on my family and life.

Instead of having only 4 days off a month, I now average 4-6 calls a month (and this month there are only 3 calls...breaking me in easy). No longer am I mentally dividing myself between work and home every night. I get to come home at night and turn off my brain. When I am not on call, I am free to make plans...go out with friends, take the kids for a walk, go to my little girl's swim lessons. I no longer feel as though I have one foot out of the door at all times. I'm not obsessively checking the hospital census trying to spy potential labor patients. I'm doing what I love to do again, playing with my kids, reading books, going to movies, and seeing live music. I have a life again, and life is good. Mr. Whoo remarked, unprovoked, how happy he was to have "me" back. I had no idea how much of myself had been squelched by my lifestyle. I see the difference with my children, as well. CindyLou exclaimed to me just yesterday, "I love my happy mommy!" I love *being* a happy mommy. It was a scary leap to make, but so far, so good. May the scales of work and life balance tip more favorably for us all going forward, it makes such a difference.

Trading Places

So I was having one of those precious days, where I thought I might actually get to sit down and eat lunch. It was 12:15 and there was just one patient left. A “routine” OB at about 20 weeks. She’s one of my favorite patients. I had delivered her little girl a few years earlier and now she was having a boy. Boisterously, I entered the room, but seeing her tear stained eyes, I quickly changed my tone.
I listened as she described the frustration that was her current life. She could barely handle her 2 year old and wasn’t sure she was ready for another. Also, her husband wasn’t overly supportive. What she wanted, more than anything, was a career. She had been taking premed courses before getting pregnant with baby number two unexpectedly. As she asked my opinion about her likelihood of making it through medical school, I tried to be supportive, but also give her a realistic picture of what that entailed. More than anything I just listened. Letting her cry and talk for most of my lunch hour. Holding her hand. Passing her tissues.
The irony, of course, is that I would give anything to trade places with HER. Not that I am ready to give up my career (neither is she unhappy about baby #2), but I my heart aches for another child. I coveted her fertility, much as she coveted my job. Genuinely I felt compassion for her, but to be honest , there was some amount of jealously as she lived out her own version of the American dream : a healthy boy and girl 2.5 years apart.
By the end of the visit my eyes welled with tears. She thought they were for her… but that was only partially true.

Negative flexibility

I was talking to a colleague today who had two kids of school age. She explained to me that on days when it would snow, she was told to call the school at noon to find out if they would be closing early for the day. If they were, the kids would have to be picked up.

"Oh my god!" I said. "What do you do if the school closes??"

"Panic!" she replied.

When I finished residency, the most important thing to me was finding a job that would be flexible. My residency was not that flexible... in fact, I joked that my job had "negative flexibility." I invented this term to refer to situation that came up repeatedly when I was pregnant:

On the inpatient rehab unit, we admitted patients every day from Monday to Friday. It was impossible to know at the start of the day if there would be an admission coming that day. When I had my OB appointments (first monthly, then bimonthly, then weekly), I tried very carefully to schedule them in such a way that nobody would get stuck with my work. I chose the last appointment of the day (4:15) and did my best to get all my work done before it was time to leave. I let everyone know well in advance that I needed to leave a bit early.

Then, almost like clockwork, at 3PM, I'd find out there was an admission coming in an hour. Despite all my planning, I'd be stuck with the dilemma of trying to reschedule my appointment (again) or beg another resident to cover. Some residents were quite nice about covering ("anything for the mama!"), but others held it against me for the next three years ("and what exactly will you do for me?"). Luckily, once my daughter and I became two separate entities, my husband was able to deal with some of the doctor's appointments by himself.

I think very few residencies provide any flexibility. My own father deals with residents and fellows, and he says that he gets very upset when one of them asks to leave early for something child-related. "Don't you have a spouse who can do it?" he asks them.

So when residency ended, I was looking for positive flexibility. I didn't care as much about the job's hours so much as the flexibility to stay home for a morning or even *gasp* a whole day if I was sick or the daycare got snowed in. As a doctor, this is not so easy. You have to think long and hard before canceling a whole clinic or calling a colleague to cover.

Then again, how much flexibility does any job have? If I were a teacher, I couldn't just abandon my students at noon and rush home. If I were a lawyer, I'd have deadlines and hearings (or whatever lawyers do).

However, I would like to think I have found a job with a modicum of flexibility. But ask me again in six months.

Meeting MWAS

We've been writing together here for over a year, but like most MiM contributors, I have never met MWAS in person. I find it so interesting to know facets of someone's life - insights on their children, their practice, their families, their photo shoots gone awry, their Match Day experience - yet never meeting IRL. (1)

So, when MWAS told me she would be visiting my area last week and did we want to meet up, I said, Yes, of course!

Meeting someone you've only known online is fraught with the unknown. Will we meet each other's expectations? Will it be awkward? Is this some crazy psychopath killer who has only pretended to be a Mother in Medicine for over a year, just to lure me to my surprise death? (Just kidding. I felt I had verified her identity enough to be safe that she was, in all actuality, a pediatrician running a private practice, and mother to two boys.)

We planned our meeting at a nice, safe public place: where else, a nice mall. I'm not sure what first impression I gave her, since I had gotten there early and was testing out some serious Brookstone chair massagers when she and one of her sons walked by. I believe I was full-body vibrating and unable to stand since my calves were locked into the massage contraption.

It was so great to meet MWAS, this woman I feel like I know so well after all of our online and off-line email exchanges. Her son was so handsome and sweet.

I'm not sure what kind of second impression I gave her, since I was in *a very rare* stimulate-the-economy mood (I was celebrating a recent, and hard-won, academic success) and I hope I didn't scare her and progeny by my *very rare, no more shopping for the rest of the year* splurges.

Over lunch, we talked about our jobs and how great this was, being able to connect through the blog, since sometimes it can be hard getting together with other physician-moms in person. And really, who else could really understand?

Our time together was short, but it reinforced to me how wonderful it is being able to connect with such a larger community here (and not limited to MiM contributors) of mothers who understand. It's a sisterhood, really. And I'm glad to be part of it.



(1) In Real Life

MiM mailbag: Doctor aspirations in high school

Hey There.

I am a high school student looking quite forward to being a doctor, but i have mixed feelings.

since i was in 6th grade, i have known that i was meant to be a doctor. i have a friendly "charismatic" personality (as my dad likes to tell me frequently), i enjoy children, love mysteries (puzzles, ect.), and i love love love to watch those shows on discovery health that everyone else in my family is too disgusted to watch. okay, this may not make me a good doctor, but it's my dream, and i am one of those people who end up getting what they want. i always have been the type of person that if someone tells me i can't, i'll make sure that i can.

but more than anything in the world, being a mother is my dream. i want to be a wife, and mother of many children. (many many children according to my mother- i want at least 5 kids). i know this is possible reading your posts. i can be a mother and a doctor. but i also read some of your posts stating that you wouldn't recommend doing this, and if you had to do it all over again you wouldn't.

although i have at least five years before i would enter medical school, my whole life is based upon one day being a doctor. i am taking all advanced classes, including math and science (sigh). and if you MiM's don't think it's worth it, i'm really not sure what i'm going to do.

i guess what i'm really asking is: do you love it? do you think those excruciating years of medical school, residency, ect. were worth it for your life right now? are you there for your kids in the best possible way? or are you dreading going to work every single day because your going to miss your wonderful family?

i have two dreams, and i know i could do them both; i just don't know how fufilling it would be to try to do "everything" so to speak. i want to have the relationship i currently have with my mother, with my kids. is this truly possible having a career in medicine?

p.s. (sorry i have to sneak this question in here) i know i have tons of time to truly figure this question out in med. school, but as you can tell in my post above that i'm a planner, and i need to know these things ahead of time. I have in the past thought of being a pediatrician, but i really want to truly make a difference in someone's life -and i'm not sure this is the way for me to do it. i am currently thinking of being an Ob/Gyn- the process of a growing child is just amazing, but i prefer the Ob part compared to the Gyn part. Do people do that? or is it pretty unheard of? or is there any other specialty that would be a better fit for me?

My interests include
1. children (preferably babies)
2. pregnancies
3. multiples (twins, triplets, etc)
4. psychology (the way the mind works- not really diseases or drug abuse)
5. " "(but i am interested in physical and emotional abuse and how it effects future dealings)

sorry- one more question: i am thinking of having a psychology major in college (along with the typical pre-med classes). anybody do this?

thank you and sorry for the very longgg question. i love all of your blogs and you really are helping me decide my future.

What is that I see?

What is that I see?

Can it be?

A cavity?

Are you are kidding me?

A mother in medicine, a mother in pediatric medicine, a mother who has been trained in primary prevention of dental caries, a mother who has been trained in how to teach pediatric residents about primary prevention of dental caries...

Could this mother have a sweet little twenty-toothed three year old with a cavity? And one so large that it recently became blatantly obviously visible to this mother?

Couldn't be.

But it was.

And not 1 cavity, but let's just say more than one.

Self doubt, blame, shame, worry, sorrow, guilt.

Relinquish my hypothetical license to mother and my actual license to practice pediatric medicine?

With the MIM degree comes connections with pediatric dentistry division chiefs and friends in psychiatry and other caring colleagues who help me see the bigger picture, one that continues to contain a twenty-toothed (more or less) beautiful smile inside and out.

I think of all the things this is not, and feel better.

I think of all the ways this could be worse, and feel better.

I think of my own bad teeth and think no less of my own parents.

I think of my patients and their parents and feel more like them.

I think of my daughter with no holes in her teeth except the joyous one that is about to be there when her first loose tooth falls out (could be any day now).

I take comfort in realizing that Mothers in Medicine need not be perfect nor have perfect kids.

I seek to re-define perfect as a work in progress.

Time flies

We measure time in seconds and minutes, hours and days, weeks and months, years and decades. Sometimes seconds drag. Sometimes days and weeks fly by.

I see patients with chronic conditions, so my relationships with them are typically measured in chunks of three to six months. It’s often a surprise to me to see a certain name on my patient list – is there a problem? Why is she back so soon? Then I check the chart – there’s nothing wrong, just a routine six month evaluation. Where has the time gone?

In my home life, too, I frequently feel like I’ve been in autopilot mode: Get up. Make lunches. Go to work. Get the laundry done. Then, like a submarine which has been submerged for too long, I have a hard time adjusting to my surroundings when I finally surface. How did Eldest get so tall? When did Youngest grow those shoulders? Is that a mustache? Two mustaches?

If I were a stay-at-home mom, would I see these changes while they were occurring? Or does every mother experience the sudden realization that her children have been quietly, efficiently, growing up? Perhaps the daily changes are so gradual that we can’t see them. Like the movement of the hour hand on the last analogue clock in the house, after a certain amount of time has passed the change becomes obvious to even the most casual observer.

I want to stop time. No, I want to be more aware of time. Any ideas how to make this happen?

A

6 words

There was a contest at SMITH magazine (now ended) where women were asked to describe motherhood in a six-word "story." It made me wonder how I'd describe being a mother in medicine in a six-word "story." Here's my six-word story about being a resident mama:

3AM, a noise... pager or baby?

Feel free to contribute your own!

Deadline for worthwhile work: age 40?

Take the sum of human achievement in action, in science, in art, in literature—subtract the work of the men above forty, and while we should miss great treasures, even priceless treasures, we would practically be where we are today . . . The effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty.

Sir William Osler, "The Fixed Period", farewell address at Johns Hopkins Medical School, 1905

I came across this quote by renowned Canadian physician William Osler a few months ago and found it disconcerting. Not because I disagree with it, but because I wonder if there might be truth in it. And because I am a thirty-five year-old mother of three who has been treading water career-wise, working two days a week, with plans to truly launch myself professionally in another five years or so.

Then I watched In the Shadow of the Moon last week, Ron Howard's documentary on the moon landings, and was struck by the fact that Neil Armstrong, Buzz Aldrin and Mike Collins were all 38 when they flew to the moon in 1969. Arguably at the pinnacle of their careers, they were three years older than I am.

So I find myself wondering - have I already peaked? Have the opportunities for my best professional work slipped by while I've been laundering onesies and making homemade chicken stock? Or have they simply been postponed, with the next decade being my professional hurrah, as hoped?

My twenties were characterized by energy and optimism. My thirties have seen an indisputable downturn in both, but gains in insight and creativity. I thought perhaps each decade would burnish some new qualities, culminating at age . . . fifty-five? sixty? I don't really think that far ahead. But I was certainly counting on having more than the next five years to make my mark.

So - if you are at the end of your career, at what age did you make your greatest contributions? If you have passed forty, do you feel that your most productive years are behind you? And if you aren't yet forty, what years do you expect will be your best?

Day in the life of a SAHM

If you asked me two years ago what I thought about Stay At Home Moms (SAHMs, for those of us in the know), I would have said that I was intensely jealous of them. How could someone be so lucky as to get to just stay home and play with your kid all day?

Residency ended for me on June 30 and since then, I've been playing SAHM for the month. This is my typical day:

7:30AM: Melly wakes up screaming for her stuffed animal that she went to bed with, which is likely just lost in the covers

8AM: I shower while Melly washes her hands in the sink. She can wash her hands for like five hours in a row. Is this early OCD?

8:30AM: I beg Melly to use the potty. BEG her. She laughs at me and runs around the house diaper-less.

9AM: Breakfast. I discover that Melly dropped a bunch of food on the floor last night and now there are ants. She gleefully points them out and calls them "cute." I kill them with my bare hands like in the olden days.

10AM: We go to the library. At some point, she gets away from me and runs amok in the "quiet" section. We get shushed a lot.

11:30AM: We head back home for lunch.

Noon: Lunch. (She's actually a really good eater.)

1:00PM: I attempt to get Melly to nap. This results in swearing, crying, and occasionally, napping.

2:30PM: We go to the park. This will kill at least an hour. Except where are her F#$^%ing shoes??

4PM: Trip to grocery store for odds and ends. Melly wants to eat everything in the store RIGHT NOW. I yell at her to wait and feel like a horrible mother/person.

5:30PM: Daddy gets home. I cry with relief.

So yeah, right now I'm feeling like SAHMs deserve a medal. (Although it's probably still better than surgery residency.)

Seriously, I wanna know...

Sally: I'm difficult.

Harry: You're challenging.

Sally: I'm too structured. I'm completely closed off.

Harry: But in a good way.



When Harry Met Sally (1989)

Are you a magnet for difficult patients? By difficult, I mean patients with threatening or abrasive personalities, who come to the physician encounter with 5 or more complaints, use health services extensively, or have a mental disorder - the criteria used by Dr. An, et al in Burden of Difficult Encounters in Primary Care: Data from the Minimizing Error, Maximizing Outcomes Study. Archives of Internal Medicine 2009; 169(4): 410-414. According to their data, if you are young and female, you are more likely to have encounters with difficult patients. Is burnout responsible? What about multi-tasking? Does our training leave us prepared to deal with medically complex patients but not emotionally, demanding complex? Does the difficult encounter impact outcome?

Day Dream Believer

After writing for Mothers in Medicine for a year, I took a short sabbatical from writing. It wasn’t planned or intentional. I have been carrying around this gnawing feeling that my kids are growing up so fast, and I need to spend whatever time I can eek out with them.

With six months of planning, I scheduled an extra day out of my office to spend with Will & Harry for the summer. I’m really liking my three day a week schedule, and I don’t think the extra day has put undue burden on my partners.

My fantasy about this summer with my sons was a glossy mirage of day trips to pick blueberries and find adventure together. As with most of my fantasies – going back to residency to do pediatric dermatology, starting a bead/jewelry company, surf lessons, decluttering my bonus room – reality has a way of smacking me between the eyes with either lack of skill, lack of time, or just lack of motivation.

So the score mid-summer for these idyllic trips:

Lovely Day trips with sons: 0

Loud action movies with popcorn/soda/candy in sedentary repose: 4

Afternoons spent with neighborhood boys running through my house: TMTK (too many to count)

On realization of the above score, I made the command decision last Thursday, to have an adventure and seek out our new IKEA store. (Can you hear the boos in the background? Sheesh, house wares, mom, what kind of adventure is that?) We set out for the twenty minute trek to the blue and yellow Mecca with promises (read bribes) of treats. So ninety minutes later, lost in 91 degree southeastern summer heat with limited AC in my station wagon, I discover that several “friends” have joined our trip:

Howie Mutch Longa

Tutantired Togo

Ima Lousie’n Mya Mynda (my BFF)

Dewie Hafta Ngo

Fortunately, bouncing on display beds and opening a myriad of drawers in the IKEA showroom once we found it disbanded our unhappy group of travelers. The strategic placement of the concession stand at the end of check-out taught me the power of Swedish Fish. And I have a plan to streamline our multipurpose bonus room – otherwise known as home office-guest room-exercise equipment storage-Lego & X Box central clearinghouse. I can also smile to myself when one of the boys starts a sentence “Remember the time mom dragged us to…” because I know time has a way of sugarcoating these memories as we age.

Yes, we said Facebook

Mothers in Medicine now has a Facebook page, kind of like an adjunct virtual water cooler to the main virtual water cooler (this site). If you're on Facebook, please come by, become a fan, and feel free to post questions/thoughts/links on our Wall. We'll be linking to our blog posts, as well as other interesting links we come across for fellow mothers in medicine...like the link we recently posted about part-time academic medicine careers --a great resouce with relevant bibliography, considerations, etc --taken from the Society of General Internal Medicine site.

If you're not (yet?) on Facebook, maybe now's the time to take the plunge?

And if you've vowed to never, ever be on Facebook, we understand that too - been there, done that.

Guest Post: On the lack of women mentors

None of my mentors have been women. It saddens me to say this. In fact it outrages me. The women I met in medicine prior to medical school warned me away from medicine - "Its not too late," they said. "You can quit now and find something easy." I had been bitten by the bug and there was no way I was doing anything else but medicine.

We had had real tragedy in my family and at that point I wanted to be a trauma surgeon or a neurosurgeon working 100 hour weeks, hopefully saving some lives, and the idea that I might want to do anything else with my life was so foreign.

Then at the end of 3rd year I got pregnant. We had been married 7 years. This was a planned and hoped for pregnancy and though I had thought that making the work-life balance would be difficult, I was definitely living a fantasy. Reality set in 9 months later when I held my child in my arms the first time. The responsibility weighed on me. I almost picked my specialty just on the fact I could have an easier residency. But I decided not to sell out my dream.

I am lucky and have an incredible husband who can (and will) be doing the parenting by himself next year. I chose to stay in town at an academic but not abusive residency. I've got a long road to go, but I realized long ago that it is about the journey and not the destination.

I wish there had been a woman around who had made the same decisions I made who seemed genuinely happy about them. Maybe I'll find one as an intern/resident. There are definitely some women out there who could use some guidance other than "Don't do it."


A reader left this comment a few weeks ago on a post that was part of our Topic Day on "Our Mentors." We hope this site can be a source of support and encouragement for those who need it. (I think all of us contributors here agree that it is worth it, and our lives are richer for our decision to be physcians and mothers.)

I Didn’t Join the Circus, So Why Must I Jump Through These Hoops?

One of the things that troubles me most as a teacher is watching medical students’ enthusiasm and curiosity deteriorate during medical school. Within about three months, I see them going from thinking about what they are learning to trying to pare down the material to what is likely to be on the next test. The competitive habits that got them into school provide a deeply debased motivation for studying—without knowing why, they fret about being AOA or getting into a competitive specialty . Few of them live in the present—as preclinical students, too many want only to survive to move to the clinical years. As clerks, they worry about buffing up their records to get into residency. Once in residency, I wonder if they ever recover the vitality that comes from being fascinated and engaged in learning something, thinking a new thought, or enjoying the unfolding of a new relationship .

Given the deadening effect of our current way of educating— or to be precise, training—doctors, I understand why the competing challenges of mothering appeal so strongly. With children, we have to live in the present (though we do also eventually transmit to them worries about their future and risk turning high school into nothing but a springboard to college). We can’t stop to study them for the next exam. Their development and our relationship to them propels us forward, and it is only in looking back that we see how much we may have learned in the last few days, weeks, months or years.
A lot of paper and ink is currently wasted by people pontificating about “adult learners,” postulating that they learn differently from children—because they have to incorporate new information into older structures and because they need to learn by doing rather than by rote. I often find myself doubting whether any of these theorists (mostly men, I might add) have actually watched children explore the world, puzzle out new information to figure where it fits with what they already know, and joyfully practice new skills.

I wish that I could be creative and persuasive enough as a teacher who draws on experiences as a mother to enlist others to think differently about how to engage and encourage students . Rather than spice up our lectures with video clips to entertain them, we should think about creating relationships with patients, peers, and mentors that both stimulate their felt need to learn things and reward them, immediately, for doing so. I know that a medical student will never learn the complexity of our profession in the unselfconscious, apparently effortless way that our children learn in their early years, but I think they long for it to be so, and I long to able to make it that way for them. But even if that is not possible, we need to think more about motivating them by stimulating curiosity rather than fear of failure, rewarding learning immediately rather than in the distant future, and engaging with them as teachers so that they in turn will engage with patients and be the doctors we would want to see when we get sick.