Once upon a time, before maternity leave was available, I had to return to my university clinic job 3 weeks after birth of first child. A home day care provider was chosen who had lots of good references. She was mid 50’s, her own children grown, with husband who worked as the maintenance engineer in a nearby condo. Only cared for two children at a time. The couple fit their roles well, except they lived in the condo instead of a double wide. She was overweight, teeth gone, smoked over a pack a day (but not when baby was there). His teeth were also gone, and he had a 2pack/1pack habit. (2 packs cigarettes/1 six pack beer daily). But she was a fantastic care-giver for a newborn. Content to rock the baby for hours a day, extreme caution and attention to safety, etc.
It was a dream situation for three years. Then, one day, day care provider found out maintenance engineer husband had been having an affair with the “dumb fat front office receptionist” as she phrased it. As soon as husband came into their apartment, with the two children there, she chased him around with a butcher knife threatening homicide. He left. I picked up son later, unaware of the drama. Later that evening she took an overdose. Local ER trip for stomach pumping. That’s when I was called by her daughter-in-law that I couldn’t bring son back in the morning. Next day, she hired a U-haul, loaded in all furnishings except one twin bed, one chair, and one cup, dish and utensil set. Even cut up the wall to wall carpeting to roll it up into the U-haul. And rode off into the sunset.
Grandparents were called into town until new arrangements could be made. Child was initially upset with new day care situation. But – he’s now an MD himself, and fantastic father to two toddlers. What can I say?
DR.NANA
Wednesday, September 16, 2009
Still figuring it out
We had my daughter midway during a two-year research hiatus from my residency. Our daughter is now five and just started kindergarten.
Because my husband and I both had flexible schedules for her first year of life, the two of us split our time with her for that first year. We then put her in a Montessori school when she was one year. We have been fortunate with this because she thrived and continues to thrive in that environment.
My husband gets most of the credit. He is the one who continues to take our daughter to school/camp/activity most mornings while I am already at work at some early hour. He is also there when I am on call or have an emergency in the hospital.
The other important thing that has made our lives easier has been his income, which even while I was in training made it so that we could afford her childcare. In addition to school expenses, we have also needed to have someone pick her up at the end of the school day (typically 4:30 pm) and care for her until one of us gets home (typically 6pm). We have achieved (in our minds) “equilibrium” with our daughter.
Fast-forward to now. I am at home on maternity leave with our 4-week old son. We are thrilled to have him – as we waited until I finished surgical residency training and fellowship and started practicing last year.
But as we have known for some time and now experiencing personally these past few months – the childcare process, particularly with infants, can be overwhelming. So far, our solution this time is a “patch-work” approach with the help of our parents who are not nearby. After the first 6 months, there is still more to figure out.
Our “patch-work” is something like the following: 2 months of maternity leave with me, 1 month with husband’s mother staying with us, 2 weeks of husband (delayed paternity leave), 1 month of my parents staying with us, 2 weeks of me (personal leave), one month of husband (delayed paternity leave).
Yes, my husband’s work offers 6 weeks of paid paternity leave, and he is going to take it.
I guess the lesson is that you have to be adaptable. And that resources and support help. But the process can be scary. Maybe looking at our oldest and seeing how things have worked for her has reassured us (perhaps falsely) that things will simply “work out” if we are diligent. We certainly hope that that is the case for this one.
Because my husband and I both had flexible schedules for her first year of life, the two of us split our time with her for that first year. We then put her in a Montessori school when she was one year. We have been fortunate with this because she thrived and continues to thrive in that environment.
My husband gets most of the credit. He is the one who continues to take our daughter to school/camp/activity most mornings while I am already at work at some early hour. He is also there when I am on call or have an emergency in the hospital.
The other important thing that has made our lives easier has been his income, which even while I was in training made it so that we could afford her childcare. In addition to school expenses, we have also needed to have someone pick her up at the end of the school day (typically 4:30 pm) and care for her until one of us gets home (typically 6pm). We have achieved (in our minds) “equilibrium” with our daughter.
Fast-forward to now. I am at home on maternity leave with our 4-week old son. We are thrilled to have him – as we waited until I finished surgical residency training and fellowship and started practicing last year.
But as we have known for some time and now experiencing personally these past few months – the childcare process, particularly with infants, can be overwhelming. So far, our solution this time is a “patch-work” approach with the help of our parents who are not nearby. After the first 6 months, there is still more to figure out.
Our “patch-work” is something like the following: 2 months of maternity leave with me, 1 month with husband’s mother staying with us, 2 weeks of husband (delayed paternity leave), 1 month of my parents staying with us, 2 weeks of me (personal leave), one month of husband (delayed paternity leave).
Yes, my husband’s work offers 6 weeks of paid paternity leave, and he is going to take it.
I guess the lesson is that you have to be adaptable. And that resources and support help. But the process can be scary. Maybe looking at our oldest and seeing how things have worked for her has reassured us (perhaps falsely) that things will simply “work out” if we are diligent. We certainly hope that that is the case for this one.
Our Nanny - a true gift
When Eldest was born, I was still a resident. Our first attempt at day care was, in short, a disaster.
Despairing at our choices in traditional day care, we decided to look for a nanny. I signed on with a "nanny agency", praying that we would find someone suitable - and quickly. I still remember the first day we met Nanny. We had already gone through several interviews, and hadn't found anyone that we thought would work. Then Nanny walked in. She was obviously a little shy and self-conscious. She teared up when discussing the children she had cared for in her previous job, mentioning how much she missed them. Then, when Eldest toddled over for a closer look at her, SHE GOT DOWN ON THE FLOOR WITH HIM AS SHE WAS SPEAKING TO US. Her rapport with Eldest was immediate and obvious. For us, the decision was made at that moment. Was it the correct decision? I like to think so, as she was with us for more than 10 years. She was available if I had to work late and Husband was on a business trip. She was available on the rare weekend that we didn't have a parent or in-law to sit with the kids and we wanted to go out on one of our infrequent "dates". Although she didn't live with us, she probably knew my house better than I ever will. She still keeps in contact with my children. She was (and is) a phenomenal person. I fear that despite my attempts to thank her my gratitude has fallen far short of what it should have been. So Nanny, if you happen to be reading this, THANK YOU THANK YOU THANK YOU.
A
Despairing at our choices in traditional day care, we decided to look for a nanny. I signed on with a "nanny agency", praying that we would find someone suitable - and quickly. I still remember the first day we met Nanny. We had already gone through several interviews, and hadn't found anyone that we thought would work. Then Nanny walked in. She was obviously a little shy and self-conscious. She teared up when discussing the children she had cared for in her previous job, mentioning how much she missed them. Then, when Eldest toddled over for a closer look at her, SHE GOT DOWN ON THE FLOOR WITH HIM AS SHE WAS SPEAKING TO US. Her rapport with Eldest was immediate and obvious. For us, the decision was made at that moment. Was it the correct decision? I like to think so, as she was with us for more than 10 years. She was available if I had to work late and Husband was on a business trip. She was available on the rare weekend that we didn't have a parent or in-law to sit with the kids and we wanted to go out on one of our infrequent "dates". Although she didn't live with us, she probably knew my house better than I ever will. She still keeps in contact with my children. She was (and is) a phenomenal person. I fear that despite my attempts to thank her my gratitude has fallen far short of what it should have been. So Nanny, if you happen to be reading this, THANK YOU THANK YOU THANK YOU.
A
Too poor for daycare
I'm not one for shooting off numbers, but man, this is a story I can't help but tell:
We recently moved and had to give up our previous beloved daycare. It was a big sacrifice, but when the commute gets to be over a hundred miles, it's time to start looking elsewhere.
I started calling daycares in the vicinity of our new apartment and many of them were full. I started to have a panic attack. How could I go to work? What was I going to do???
Finally, to my relief, one daycare told me that although they were full, they might have someone leaving soon and could secure a spot for my daughter. I was so relieved. I started making arrangements. I casually asked them what the daycare would cost.
"Our tuition," they told me (I should have known there was trouble the second they called it tuition), "is $2400 per month."
I almost choked. $2400 per month. Almost $30,000 per year. For a two year old to sit in a big room of toddlers and color. Presumably she'd be coloring with solid gold crayons because I can't imagine where else all that money is going.
What baffles me is that they daycare was FULL. There were several dozen parents willing to pay this gigantic sum of money. Who are these people?? And what if you have two kids in daycare? That's nearly $60,000 per year just for daycare!! What sort of salary do you need to be making pre-taxes to pay for this? Each parent would have to be working and earning six figures just to break even with daycare and rent.
I did manage to find a daycare with a somewhat more reasonable "tuition," although still kind of horrifying. But now my problem is the hours. They close at 5:30, no exceptions. What sort of daycare is closed by 5:30?? How many working parents are there who are presumably earning six figure salaries to afford two kids in daycare yet can manage to be AT the daycare for pick-up by 5:30 sharp every single day?? Who ARE these people and how can I become one of them???
We recently moved and had to give up our previous beloved daycare. It was a big sacrifice, but when the commute gets to be over a hundred miles, it's time to start looking elsewhere.
I started calling daycares in the vicinity of our new apartment and many of them were full. I started to have a panic attack. How could I go to work? What was I going to do???
Finally, to my relief, one daycare told me that although they were full, they might have someone leaving soon and could secure a spot for my daughter. I was so relieved. I started making arrangements. I casually asked them what the daycare would cost.
"Our tuition," they told me (I should have known there was trouble the second they called it tuition), "is $2400 per month."
I almost choked. $2400 per month. Almost $30,000 per year. For a two year old to sit in a big room of toddlers and color. Presumably she'd be coloring with solid gold crayons because I can't imagine where else all that money is going.
What baffles me is that they daycare was FULL. There were several dozen parents willing to pay this gigantic sum of money. Who are these people?? And what if you have two kids in daycare? That's nearly $60,000 per year just for daycare!! What sort of salary do you need to be making pre-taxes to pay for this? Each parent would have to be working and earning six figures just to break even with daycare and rent.
I did manage to find a daycare with a somewhat more reasonable "tuition," although still kind of horrifying. But now my problem is the hours. They close at 5:30, no exceptions. What sort of daycare is closed by 5:30?? How many working parents are there who are presumably earning six figure salaries to afford two kids in daycare yet can manage to be AT the daycare for pick-up by 5:30 sharp every single day?? Who ARE these people and how can I become one of them???
Guest Post: Loving daycare
I am an internal medicine intern (9 months of q4 to q5). We live across the street from our daycare. They open at 7 and close at 6 and Luke is generally there during much of their open hours. Since I am a resident, there are many days when dad drops him off and picks him up. I also made the decision to do a residency in the same town as my parents, so that they could help out when we needed them to. We also hire one of the workers there to give us a date night every couple of weeks. Many of my co-residents have nannies, but one plus of the daycare situation is that there are always at least two people watching our baby. And we have everything on video. Another plus is the cost, which is half of what it would cost us to hire a nanny.
We are loving the daycare situation. Both of us were daycare kids so we are personally aware of the pros and cons of daycare. He was 14 weeks when he started, though there are 6 week olds that start there. He is now 8 months old. We pay $800/mo for daycare, a price that decreases as the child gets older. Most good nannies require at least $10/hr, a fair wage if you ask me, but it would be hard for us to afford that with the money we are bringing in. I know people who went into (more) debt to pay for a nanny during residency. Also, there was no daycare at the hospital I work at. A few hospitals in town offer that, and we would consider that, but it is nice not having to drive the child to daycare. Our daycare offers 4:1 supervision, there are some in town that offer 3:1 but they cost more and there is a waiting list. We registered our child there when I was 6 months pregnant to be sure to get a spot. Most places will tell you how far in advance you need to register. I would do it while I was pregnant if you live in a place with relatively few options. Once we have more than one child, the nanny thing might make more sense.
Side note: we use the child care savings account so much of the money for our child care is tax free. Some of the tax incentives for childcare are income dependent and may best apply to those in residency or fellowship.
Another side note: How are you providing health care for your nannies if you have them? Seems like most of the ladies at the daycare where we send our child do not have health care. I think it is crazy that the person you have caring for your child wouldn't even have access to basic services. Anyone have thoughts on that? I am trying to get those who need it into our resident clinic, but it is not easy due to lack of availability.
We are loving the daycare situation. Both of us were daycare kids so we are personally aware of the pros and cons of daycare. He was 14 weeks when he started, though there are 6 week olds that start there. He is now 8 months old. We pay $800/mo for daycare, a price that decreases as the child gets older. Most good nannies require at least $10/hr, a fair wage if you ask me, but it would be hard for us to afford that with the money we are bringing in. I know people who went into (more) debt to pay for a nanny during residency. Also, there was no daycare at the hospital I work at. A few hospitals in town offer that, and we would consider that, but it is nice not having to drive the child to daycare. Our daycare offers 4:1 supervision, there are some in town that offer 3:1 but they cost more and there is a waiting list. We registered our child there when I was 6 months pregnant to be sure to get a spot. Most places will tell you how far in advance you need to register. I would do it while I was pregnant if you live in a place with relatively few options. Once we have more than one child, the nanny thing might make more sense.
Side note: we use the child care savings account so much of the money for our child care is tax free. Some of the tax incentives for childcare are income dependent and may best apply to those in residency or fellowship.
Another side note: How are you providing health care for your nannies if you have them? Seems like most of the ladies at the daycare where we send our child do not have health care. I think it is crazy that the person you have caring for your child wouldn't even have access to basic services. Anyone have thoughts on that? I am trying to get those who need it into our resident clinic, but it is not easy due to lack of availability.
Guest Post: A variety of arrangements over the years
We had a variety of arrangements as the kids grew up, some better, some not. When they were tiny we had a wonderful woman who came to the house. She took great care of the kids and also did all the laundry including cloth diapers (now I'm dating myself). Sadly, she did not come with us when we moved out of state (I tried). After that we had daycare, then daycare/at home combo where I hired their favorite daycare worker to bring them home early and start dinner (almost all of the workers were--just barely--part time so the centers wouldn't have to pay benefits). After they went to school we had after-school day care, and later after-school home care by a series of high school or college students. Said students also functioned as drivers for after school activities and worked for a longer day during the summers to drive to summer activities (I always had the summers pretty well planned by March). What I remember mostly, especially when they were young and got sick a lot, was that the whole thing was like a house of cards. If somebody woke up with a fever one of the cards came out and the whole thing fell apart. The chicken pox was a major disaster. Luckily I had a supportive husband and (in a pinch) a mother in law who was able to come help when things really got bad. It really was terribly hard a lot of the time and I doubt it's got any easier since. Like I told a younger colleague the other day, "eventually it does work out. They grow up and leave home."
-By a FP with grown children
-By a FP with grown children
Friday, September 11, 2009
Teachable Moments - do they come with a glass of Merlot?
“Mom,” Will says, “Harry carved his initials into the neighbor’s front door.”
Angel: He did what?!? No, it can’t be. That door is made of METAL.
Devil: That’s my boy! Metal, Schmetal.
Angel: How could my sweet, cherubic Harry do such a thing?
Devil: Hmpf! My cousin, Grover, sits on his left shoulder and talks really loud.
Angel: Hush! You’re not helping over there.
Devil: Just let it go – boys will be boys.
Angel: Boys will be juvenile delinquents, too. You need to call his father.
Devil: That’s my boy! Metal, Schmetal.
Angel: How could my sweet, cherubic Harry do such a thing?
Devil: Hmpf! My cousin, Grover, sits on his left shoulder and talks really loud.
Angel: Hush! You’re not helping over there.
Devil: Just let it go – boys will be boys.
Angel: Boys will be juvenile delinquents, too. You need to call his father.
“But, it’s a steel fire door. Have you seen it?”
“No, not yet, but he did it with a pocket knife.”
“Well, I think an immediate apology is in order.”
Devil: Oooooh! Now you’ve gone and done it.
Angel: He needs to apologize and offer to repair it.
Devil: Yeah. Can you imagine an eight year old repairing a front door?
Angel: OK, then he needs to pay for the damages.
Devil: You mean you need to pay for his damages.
Angel: Whatever. This is a teachable moment, and he needs to learn from his misstep. Besides, they’re trying to sell their house. Who’s going to buy it when they think their neighbors are a bunch of vandals?
Devil: You’ll never get him in the car.
Angel: Wanna bet?
Devil: I’m always willing to make a deal.
“Hello, Haley? Harry and I need to apologize for your door.”
Devil: Are you happy? You made him cry in front of the neighbor.
Angel: I know. I know. I feel like dirt. Parenting with a conscience is hard work. WWMW MD.D? (What would Marcus Welby, MD, do?)
Devil: Like Haley, I told you to just let it go. She has two boys, too. She understands. It’s just creative expression.
Angel: Well that creative expression goes by the name of vandalism, too.
Devil: Killjoy!
Angel: Just wait until his father gets home.
Angel: I know. I know. I feel like dirt. Parenting with a conscience is hard work. WWMW MD.D? (What would Marcus Welby, MD, do?)
Devil: Like Haley, I told you to just let it go. She has two boys, too. She understands. It’s just creative expression.
Angel: Well that creative expression goes by the name of vandalism, too.
Devil: Killjoy!
Angel: Just wait until his father gets home.
image from google image
Friday, September 4, 2009
Announcing our next Topic Day: Childcare
We're planning our next MiM Topic Day on Childcare for Wednesday, 9/16. If you're not familiar with our Topic Days, this is a day that we devote to one specific topic. Please join us and submit a post on anything related to Childcare: your childcare decisions and how you've felt about them; daycare; babysitters; childcare regrets; finding a nanny; before/after school programs; really, anything about the topic is fair game.
Submit guest posts to mothersinmedicine@gmail.com by Monday, 9/14 to be included and include a short bio for yourself (as anonymous as you want it to be).
See our past Topic Days for ideas.
Hope to see you on the 16th!
Submit guest posts to mothersinmedicine@gmail.com by Monday, 9/14 to be included and include a short bio for yourself (as anonymous as you want it to be).
See our past Topic Days for ideas.
Hope to see you on the 16th!
Tuesday, September 1, 2009
Thanksgiving
Forgive me for getting carried away here. I know it's the first day of September, but I stepped outside, and it was CRISP today. School buses were lumbering down the road, which I noticed more than usual since I have a kindergartener today for the first time. Regardless of when the autumnal equinox is, it's fall. I can feel it. My favorite season. And close to Thanksgiving, my favorite holiday.
In a half-hearted attempt to get our chaotic home in order before school started, I cleaned out our file cabinets this weekend. Well, actually just one of them. And just one drawer. But as JC points out, you've got to start somewhere. I picked an easy one, our "professional" drawer, with copies of diplomas, DEA forms, board certifications, licenses, transcripts, and hospital privileges forms, that usually doesn't require excessive discarding. At the back of this drawer was a folder I had almost forgotten about in the overwhelming busy-ness of my life as a doctor mom of three. It is labeled "Feedback" because that fits on the tab and is less embarrassing if discovered than "Affirmation" or "What you are doing does matter, Dr. Tempeh" or "Yes, your doctoring career has taken some hits because you have small kids, but take heart-- you have been good and will be again, and this is the folder to prove it". The folder includes glowing letters of recommendation (possibly intended for someone else) from when I was a young, energetic, childless resident applying for fellowship, over-the-top attending evaluations (clearly intended for someone else) from when I was a 36 week pregnant first-year fellow continuing to moonlight to save up for our first baby, and mostly a lot of thank you cards and letters from patients. I love this folder, and not only because it buoys my spirit when I wonder if I am losing my way, navigating these two lives that often run parallel and occasionally collide head-on. It is a little time capsule of my former doctor self that resides in our home. And it can bridge the gap when there is a dry spell of gratitude at home and at work.
As I sent my little guy off to full-day kindergarten today, I found myself wondering if I should have done these last 5 years differently in some way. I started working part-time 3 years ago. The extra time it has given me with my 3 kids is priceless beyond measure. But, at times I have wondered if it was worth it from a career perspective. After all, it wouldn't be that long until all of my kids were in school with full-time jobs of their own in some sense. Would I have sacrificed so much in my career by that point that I wouldn't be able to "get back," whatever that means?
The truth is that my career has changed for having kids, and it is probably kind of irreversible. Much like your body before and after children, you don't have to take the changes lying down, but you do need to come to terms with the fact that you won't ever get back to exactly the way you were before you had kids. And if you want to get back to something that closely approximates it, you are in for a long road and a lot of hard work.
But today, as I watched my little boy walk into his kindergarten classroom, then turn around to come back, kiss me on the cheek, and say, not "I love you" but "thank you, Mommy," I realized that I was in no rush to get back to my old life. I am happy right where I am. Fellow Doctor Moms, Happy Thanksgiving!
In a half-hearted attempt to get our chaotic home in order before school started, I cleaned out our file cabinets this weekend. Well, actually just one of them. And just one drawer. But as JC points out, you've got to start somewhere. I picked an easy one, our "professional" drawer, with copies of diplomas, DEA forms, board certifications, licenses, transcripts, and hospital privileges forms, that usually doesn't require excessive discarding. At the back of this drawer was a folder I had almost forgotten about in the overwhelming busy-ness of my life as a doctor mom of three. It is labeled "Feedback" because that fits on the tab and is less embarrassing if discovered than "Affirmation" or "What you are doing does matter, Dr. Tempeh" or "Yes, your doctoring career has taken some hits because you have small kids, but take heart-- you have been good and will be again, and this is the folder to prove it". The folder includes glowing letters of recommendation (possibly intended for someone else) from when I was a young, energetic, childless resident applying for fellowship, over-the-top attending evaluations (clearly intended for someone else) from when I was a 36 week pregnant first-year fellow continuing to moonlight to save up for our first baby, and mostly a lot of thank you cards and letters from patients. I love this folder, and not only because it buoys my spirit when I wonder if I am losing my way, navigating these two lives that often run parallel and occasionally collide head-on. It is a little time capsule of my former doctor self that resides in our home. And it can bridge the gap when there is a dry spell of gratitude at home and at work.
As I sent my little guy off to full-day kindergarten today, I found myself wondering if I should have done these last 5 years differently in some way. I started working part-time 3 years ago. The extra time it has given me with my 3 kids is priceless beyond measure. But, at times I have wondered if it was worth it from a career perspective. After all, it wouldn't be that long until all of my kids were in school with full-time jobs of their own in some sense. Would I have sacrificed so much in my career by that point that I wouldn't be able to "get back," whatever that means?
The truth is that my career has changed for having kids, and it is probably kind of irreversible. Much like your body before and after children, you don't have to take the changes lying down, but you do need to come to terms with the fact that you won't ever get back to exactly the way you were before you had kids. And if you want to get back to something that closely approximates it, you are in for a long road and a lot of hard work.
But today, as I watched my little boy walk into his kindergarten classroom, then turn around to come back, kiss me on the cheek, and say, not "I love you" but "thank you, Mommy," I realized that I was in no rush to get back to my old life. I am happy right where I am. Fellow Doctor Moms, Happy Thanksgiving!
Monday, August 31, 2009
Bill
I wrote this entry about a week ago about a former resident colleague of mine named Bill. I hesitated to post it because I don't kid myself that the internet is completely anonymous and there's enough information here that Bill might be able to identify himself. But then I thought to myself: would that be so awful? I respect Bill, but I also wished I could tell him personally some of the things I wrote here, but I didn't have the courage. Sometimes it's hard to see things from the other person's perspective. For all I know, he's writing about ME in his "Men In Medicine" blog.
(And maybe next week, if I work up the nerve, I'll tell a story in which roles were reversed and I was the "evil" resident.)
So here it is:
I met Bill as a med student both rotating at the same hospital. He always struck me as a really upstanding, solid, reliable person. He was the kind of med student that any residency program would be lucky to get, not so much because he looked good on paper, but because he actually WAS good.
When Bill and I matched at the same residency, I learned that I was absolutely right in my initial assessment. Bill was a hard worker, reliable, and knowledgeable. He also had a staunch sense of what was fair. Therein arose the conflict.
I became pregnant during my first year of residency. Among other minor difficulties this caused, one that was a frequent annoyance for me was the rule that a physician had to hold the heads of certain patients getting flexion-extension spine films. On the spinal cord injury service, this problem came up maybe twice a month on my service.
The first attending I worked with immediately offered to go down with the patients and take the brunt of the radiation. Unfortunately, the second attending refused to do this. "I don't understand," she said to me. "Why can't you just wear lead?"
(I won't get into a discussion of the safety of radiation during pregnancy and how some radiology techs wear lead counters, etc etc. All I have to say is I think it was reasonable for me not to want to be in the way of X-ray beams while pregnant if at all avoidable.)
Anyway, I was forced to find another resident to help me out. I was actually the only female resident on service and most of my male colleagues would immediately agree to go down to radiology for me. The whole thing took maybe 15 minutes tops. There was one guy who would sometimes call me and ask if I needed him for any radiation-intensive activities.
Bill wasn't like that though. I remember there were two occasions when I asked him to do this favor for me. Once he outright refused and the other time, he replied, "What will you do for me?" He wasn't smiling or teasing. He meant it.
Bill had a strong sense of fairness, as I said. He was married, but had decided not to have children. He was the kind of resident who rarely called in sick. And I understand that he didn't want to feel like a sucker who was doing everyone else's work. However, I didn't keep a scorecard. Even when I was well into my pregnancy and my work for the day was done, I would stay late helping other residents. I remember a specific situation several weeks earlier with one of Bill's patients, when the orthotists needed one of his patients' heads held by a physician while they adjusted a brace within the room... I told them not to bother paging Bill and since I was on the ward, I would hold the patient.
So yes, it frustrated me when Bill pulled out the "eye for an eye" card with me, especially when he knew I was desperate. I think that in residency, you help the people who need to be helped. And if they don't help you back, then they help someone else who needs help, and then that person will help someone else, and so forth. I finally felt redeemed for my maternity leave (two years later) when I covered two services at once for a month and a half for another resident taking family leave. It was a lot of work, but it felt good to help out.
This wasn't my only run-in with Bill. When he became chief resident, he instituted a rule that if anyone was late to our weekly morning lecture, even once, they would get one extra call. There would be no excuses. Bill said to me, "I don't care if you're in labor, if you're in a car accident... if you're late, you'll get an extra call." Again, he wasn't joking.
I was furious about this. I had the best lecture attendance of anyone in my class, other than perhaps Bill. But I was also a mother and things could come up. What if my nanny was late? "What's the difference?" Bill said. "It's just one night of call." (Those of us who have done residency can roll our eyes at that statement.)
After arguing back and forth with Bill and stressing over it for days, I finally had to take the matter to the program director, who said that the rule was directed at people who were chronically late, and I wouldn't be penalized if I had an emergency come up.
I was right about Bill that he ended up being a great resident. In so many ways, he was exactly the kind of person any program director would want to fill their residency with. And I considered him a friend. Yet it's hard for me to praise him without feeling hurt by all the times when I wished he had shown a little more compassion.
(And maybe next week, if I work up the nerve, I'll tell a story in which roles were reversed and I was the "evil" resident.)
So here it is:
I met Bill as a med student both rotating at the same hospital. He always struck me as a really upstanding, solid, reliable person. He was the kind of med student that any residency program would be lucky to get, not so much because he looked good on paper, but because he actually WAS good.
When Bill and I matched at the same residency, I learned that I was absolutely right in my initial assessment. Bill was a hard worker, reliable, and knowledgeable. He also had a staunch sense of what was fair. Therein arose the conflict.
I became pregnant during my first year of residency. Among other minor difficulties this caused, one that was a frequent annoyance for me was the rule that a physician had to hold the heads of certain patients getting flexion-extension spine films. On the spinal cord injury service, this problem came up maybe twice a month on my service.
The first attending I worked with immediately offered to go down with the patients and take the brunt of the radiation. Unfortunately, the second attending refused to do this. "I don't understand," she said to me. "Why can't you just wear lead?"
(I won't get into a discussion of the safety of radiation during pregnancy and how some radiology techs wear lead counters, etc etc. All I have to say is I think it was reasonable for me not to want to be in the way of X-ray beams while pregnant if at all avoidable.)
Anyway, I was forced to find another resident to help me out. I was actually the only female resident on service and most of my male colleagues would immediately agree to go down to radiology for me. The whole thing took maybe 15 minutes tops. There was one guy who would sometimes call me and ask if I needed him for any radiation-intensive activities.
Bill wasn't like that though. I remember there were two occasions when I asked him to do this favor for me. Once he outright refused and the other time, he replied, "What will you do for me?" He wasn't smiling or teasing. He meant it.
Bill had a strong sense of fairness, as I said. He was married, but had decided not to have children. He was the kind of resident who rarely called in sick. And I understand that he didn't want to feel like a sucker who was doing everyone else's work. However, I didn't keep a scorecard. Even when I was well into my pregnancy and my work for the day was done, I would stay late helping other residents. I remember a specific situation several weeks earlier with one of Bill's patients, when the orthotists needed one of his patients' heads held by a physician while they adjusted a brace within the room... I told them not to bother paging Bill and since I was on the ward, I would hold the patient.
So yes, it frustrated me when Bill pulled out the "eye for an eye" card with me, especially when he knew I was desperate. I think that in residency, you help the people who need to be helped. And if they don't help you back, then they help someone else who needs help, and then that person will help someone else, and so forth. I finally felt redeemed for my maternity leave (two years later) when I covered two services at once for a month and a half for another resident taking family leave. It was a lot of work, but it felt good to help out.
This wasn't my only run-in with Bill. When he became chief resident, he instituted a rule that if anyone was late to our weekly morning lecture, even once, they would get one extra call. There would be no excuses. Bill said to me, "I don't care if you're in labor, if you're in a car accident... if you're late, you'll get an extra call." Again, he wasn't joking.
I was furious about this. I had the best lecture attendance of anyone in my class, other than perhaps Bill. But I was also a mother and things could come up. What if my nanny was late? "What's the difference?" Bill said. "It's just one night of call." (Those of us who have done residency can roll our eyes at that statement.)
After arguing back and forth with Bill and stressing over it for days, I finally had to take the matter to the program director, who said that the rule was directed at people who were chronically late, and I wouldn't be penalized if I had an emergency come up.
I was right about Bill that he ended up being a great resident. In so many ways, he was exactly the kind of person any program director would want to fill their residency with. And I considered him a friend. Yet it's hard for me to praise him without feeling hurt by all the times when I wished he had shown a little more compassion.
Sunday, August 30, 2009
Gotta start somewhere
They told me over and over again. Don’t let get sucked into too many commitments. Stay away from committee servitude. Learn to say NO! I was listening, really I was... but no woman-in-medicine can truly prevent another woman-in-medicine from making the mistakes that perhaps need to be made to learn for ones self.
This is my rumination as I walk the several block course across campus to spend the afternoon wasting away on a thankless large university committee. Making matters worse the temperature is 100 degrees, 80% humidity (why did we want to live in the South?) Packed between my office (within the ivory towers of Heart and Vascular) and the administrative fortress where I am headed there are, I kid you not, six fast food restaurants. Who would ever need to eat a 1/3 pound beef burger, covered in roast beef, jacked up with liquid cheese and dipped in au jus? Since when did they start selling KFC and Taco Bell in the same building? Exactly what does it smell like in there, I cannot even imagine. It is lunch hour and cars are wrapped around the drive-thrus. I am a heart doctor, I see patients who need heart transplant. These are the sickest and youngest people adult cardiologists take care of. Seriously I think America is completely unconscious of what we are doing with food. Granted my position is from an extreme perspective- recent Weight Watching, point-counting exercise worshiping alertness. It is so hard (seriously as working mom or anyone) to navigate healthy choices for regular meals. Working people will rush over lunch hour, eat a 1400 calorie value meal, finish without pause, lack satisfaction and ultimately feel hungry four hours later. It is so easy, almost necessary, but a trap that so many people are stuck in. Finally arriving at my meeting I find the provided lunch, deep dish pizza and chocolate chip cookies- just wonderful.
Few hours later I survived the session- and have a one track mind headed to Subway for a 345 calorie 6-inch sub. I am behind a tall 350 pound man in line. He looks at me, smiles and shares, “It’s my birthday I should get what I want but I will be good and choose a salad.” He then requests the sandwich maker to go light on the lettuce, add two scoops of tuna salad, cheese, pickles and extra thousand-island dressing. Waiting patiently for my turn in line a grin sneaks across my face. The birthday boy and struggling young cardiologist share a moment, and I recognize the lesson offered to me. As with my slow progress learning to say no, you’ve gotta start somewhere.
This is my rumination as I walk the several block course across campus to spend the afternoon wasting away on a thankless large university committee. Making matters worse the temperature is 100 degrees, 80% humidity (why did we want to live in the South?) Packed between my office (within the ivory towers of Heart and Vascular) and the administrative fortress where I am headed there are, I kid you not, six fast food restaurants. Who would ever need to eat a 1/3 pound beef burger, covered in roast beef, jacked up with liquid cheese and dipped in au jus? Since when did they start selling KFC and Taco Bell in the same building? Exactly what does it smell like in there, I cannot even imagine. It is lunch hour and cars are wrapped around the drive-thrus. I am a heart doctor, I see patients who need heart transplant. These are the sickest and youngest people adult cardiologists take care of. Seriously I think America is completely unconscious of what we are doing with food. Granted my position is from an extreme perspective- recent Weight Watching, point-counting exercise worshiping alertness. It is so hard (seriously as working mom or anyone) to navigate healthy choices for regular meals. Working people will rush over lunch hour, eat a 1400 calorie value meal, finish without pause, lack satisfaction and ultimately feel hungry four hours later. It is so easy, almost necessary, but a trap that so many people are stuck in. Finally arriving at my meeting I find the provided lunch, deep dish pizza and chocolate chip cookies- just wonderful.
Few hours later I survived the session- and have a one track mind headed to Subway for a 345 calorie 6-inch sub. I am behind a tall 350 pound man in line. He looks at me, smiles and shares, “It’s my birthday I should get what I want but I will be good and choose a salad.” He then requests the sandwich maker to go light on the lettuce, add two scoops of tuna salad, cheese, pickles and extra thousand-island dressing. Waiting patiently for my turn in line a grin sneaks across my face. The birthday boy and struggling young cardiologist share a moment, and I recognize the lesson offered to me. As with my slow progress learning to say no, you’ve gotta start somewhere.
Thursday, August 27, 2009
Guest Post: Introducing JC
I was proud of my husband’s decision to go with the avocado sashimi over the fried spring rolls for the first course of our Sushi dinner. Having a cardiologist-wife has its benefits, being spared from major dietary intervention with LDL cholesterol of 186 is not one of them.
As I used my chopsticks to make the perfect bite (avocado, jicama and wasabi sauce) our conversation digressed to a famous argument we suffered at a Maui grocery store, circa 1998. As a medical student I was invited to present my research at a conference in Hawaii (score!) My then MBA-student-boyfriend took an 18 hour flight to spend 48 hours with me at Kapalua. When shopping for dinner he really wanted an avocado. I was alarmed by the price- SIX dollars, which was roughly 53.5% of my allotted per diem. They scare you at med school orientation, warning that every dollar you spend you will have to pay back three once interest accrues. He had a strong case, traveling so far, avocado would taste good with fresh pineapple, yada yada yada.
We could not remember who won the argument. Years and many jobs later we have come a long way. Earlier in the day without flinching I bought a $200 pair of jeans. If you saw how awesome my 9-month post partum butt looked in them you would totally understand. For sure it was an unusual occurrence. Wandering into a boutique we were met by a designer blond in 4 inch heels. I knew I was in the right place, but still had no idea of what I was doing. What is up with the sizes anyway? Feeling the need to explain my complete lack of style: stroller pushing, no make-up, pony-tail, Teva sandals mess. OK here is the deal- I spent the last 12 years wearing scrubs, had a baby, lost a lot of weight and my trainer told me it was time for skinny jeans- and so here I am.
So at dinner, let’s just say I was feeling about as fabulous as a 35-year-old mother could. And to sweeten the deal- as a party of 2 ½ we got orange wedges and fortune cookies for three.
My fortune: Generosity and perfection are everlasting goals
JC is our newest contributor to Mothers in Medicine and will be writing here regularly about being an academic cardiologist and mother. Welcome, JC!
As I used my chopsticks to make the perfect bite (avocado, jicama and wasabi sauce) our conversation digressed to a famous argument we suffered at a Maui grocery store, circa 1998. As a medical student I was invited to present my research at a conference in Hawaii (score!) My then MBA-student-boyfriend took an 18 hour flight to spend 48 hours with me at Kapalua. When shopping for dinner he really wanted an avocado. I was alarmed by the price- SIX dollars, which was roughly 53.5% of my allotted per diem. They scare you at med school orientation, warning that every dollar you spend you will have to pay back three once interest accrues. He had a strong case, traveling so far, avocado would taste good with fresh pineapple, yada yada yada.
We could not remember who won the argument. Years and many jobs later we have come a long way. Earlier in the day without flinching I bought a $200 pair of jeans. If you saw how awesome my 9-month post partum butt looked in them you would totally understand. For sure it was an unusual occurrence. Wandering into a boutique we were met by a designer blond in 4 inch heels. I knew I was in the right place, but still had no idea of what I was doing. What is up with the sizes anyway? Feeling the need to explain my complete lack of style: stroller pushing, no make-up, pony-tail, Teva sandals mess. OK here is the deal- I spent the last 12 years wearing scrubs, had a baby, lost a lot of weight and my trainer told me it was time for skinny jeans- and so here I am.
So at dinner, let’s just say I was feeling about as fabulous as a 35-year-old mother could. And to sweeten the deal- as a party of 2 ½ we got orange wedges and fortune cookies for three.
My fortune: Generosity and perfection are everlasting goals
JC is our newest contributor to Mothers in Medicine and will be writing here regularly about being an academic cardiologist and mother. Welcome, JC!
Wednesday, August 19, 2009
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.
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.
Sunday, August 16, 2009
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.
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.
Wednesday, August 12, 2009
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.
"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.
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