Disgusting

Abscess incision and drainage does not disgust me; in fact, I find it out-and-out gratifying. Most clinical events which might make non-medical types blanch induce absolutely no squeamishness in myself, including hemorrhage, open fractures, limb amputation and digital rectal exams. Diagnosing lice makes my own head violently itchy but doesn't make me squirm. Contrary to the belief of every patient whom I have asked to remove their shoes, feet - no matter what their condition - will not offend me. Same goes for unshaven legs and unmanicured perineums: I truly take no notice.

As a mother, the list of biological events with potential to repulse me has long since dwindled to almost nothing. I have survived the following with grace: vomit splashed down the neckline of my shirt, infant stool jetting up the back of a onesie and beyond, nares perpetually flowing with green discharge, and potty-training errors on carpet.

Between the two professions, I've got almost all offensive agents mastered. Almost. There are a few holders-on whose power to disgust me I can't dislodge:

1. Soiled bandages. Whether it's gauze peeled from a surgical incision or a tiny band-aid ring that's fallen from my daughter's toe, there's something about absorbed drainage that I find revolting.
2. Eyes. Specifically: globe rupture.
3. Earwax. Cerumen being flushed into a little basin in my office is acceptable. Q-tips dropped into a wastebasket without being shrouded in Kleenex is not.
4. Collections of cheesy substance in body creases of those who don't wash with due diligence.
5. Vermin. I'll examine insect bites with interest, but bedbugs scuttling from the cuffs of a patient's shirtsleeves across my desk is too much.
6. Prolonged coughing or throat-clearing where the sputum is clearly substantial in amount but difficult to expel.

Tell me yours.

The Book Report

The other night at about 7:15 p.m., 15 minutes from teeth brushing, book and song time in my house, Sicily announced excitedly, "Mom! I've got something we need to work on! A book report! Let's do it now."

She ran to her backpack and got the worksheet. I told her, "Sicily, I've already seen the note. We've got two weeks. You need to pick out a book, one over 32 pages, to read. That's what we will do tonight. Then you can write it, I will help, and we can practice the presentation and get the outfit so you can dress up like your favorite book character. It doesn't all have to happen tonight."

She grabbed a book I bought for her over a year ago - Hope For the Flowers. I read it to her a few months back. I bought it because I remember reading it when I was little and loving all of the pictures. It was well over the 32 page limit, and it had a nice moral, one that I probably failed to pick up on when I read it as a little girl. Get out of the rat race - it is pointless. Follow your heart and you will fly.

I told her, "You have plenty of time to read it on your own." She is reading chapter books well into the late evening now - lots of Amelia Bedelia and Junie B. Jones. Her reading level has shot up by leaps and bounds in first grade this year. While I was reading and singing to John, she had her own agenda. I entered her room after I settled him down.

"Mom, I've got the report almost done. Will you check the spelling?"

I noticed she had basically copied the first few sentences of the book in her summary. It was her first book report - and she clearly didn't have the rules down. I explained to her gently, "Sicily, you can only write a book report about a book you have read yourself. Remember, the characters had names? Stripe and Yellow, I think? You have plenty of time to re-read it, and I'll teach you how to summarize it in your own words. I know a little about writing, so I can help you."

She barely contained a total melt-down, but she contained it well. "What do you know about writing, mom?"

"Well, I write a little on the computer. That is what I do at night, while you are getting to sleep. Lots of people read what I write, and I get a lot out of it. A sense of community."

"Is that what all that clicking on the computer is?"

"Yes."

She went to the task of picking out her own book, even though we were well past bedtime, now. I told her she only had to pick her book tonight, and the rest had time. She entertained and rejected a few Amelia Bedelias. At about 10:30 at night, while I was on the couch reading, she sneaked in the living room. Kept her distance, and quietly announced, "Mom. I found the perfect book. Hello Kitty. It is 42 pages. I read it and I wrote a report. Please read it for me?"

"I'll read it tomorrow, Sicily, and we'll talk about it then. You really need to get to bed. It is a school night."

Ever since she started reading well, she stays up way too late. She is like a teenager in the morning, grumping around and wallowing in the covers until I lose my temper and start ordering her around like a prison warden. We both hate it. I have a hard time outlasting her stamina - she is like the Energizer bunny at night. On Easter eve, I accidentally fell asleep on the couch reading. When I woke up, I worried that I had missed my charge, and frantically looked at my watch for the time (midnight, thank goodness - still time to head to the attic and get the baskets - fill them with the goodies I had stashed in the basement). When I was supposed to be the Tooth Fairy a couple of months ago, and forgot, I had to frantically put some $$ under John's pillow and make up a story that the Tooth Fairy got confused.

When she is not reading at night, she is performing elaborate art projects on her bathroom counter. One morning last week she had nothing short of a sheer masterpiece - a beautifully decorated jewelry box full of original art (glue, colored stones, glittery tiles, etc.) for her first grade teacher.

My heart goes out to her, because I remember reading with a flashlight under the covers on the top bunk of my sister's and my bunk bed, long after lights out. She is very different from me - way more extroverted and spunky, but once again, the apple does not fall far from the tree.

My question to any readers is, what do I do? How do I draw boundaries, here? Do I draw boundaries? Mornings are so rough - I feel like I need to try, but I don't want to stifle her creativity and thirst for knowledge. Anyone have similar experiences with a 7 year old in their house - present or past?

In the carpool line the next morning, after she and her brother fought the whole way there (some mornings are more difficult than others), she got out of the car, and I told her I loved her. To have a great day. I promised her I would read the report, and we would work on it. I told her I would search for a good Hello Kitty costume, for her presentation on April 15th.

"Mom, I don't want to be Hello Kitty. I want to be the puppy. Look for a puppy costume, OK?"

I told her I would try.

(Sort of) Home cookin'

I thought when I moved to a neighborhood filled with little shops and restaurants, I was going to be in takeout heaven. As it turned out, not so much. All the restaurants are overcrowded and overpriced, and the only place with reasonable prices is the supermarket, so I've found myself cooking at home most nights.

Top Chef, I am not. At the end of the day, I'm usually too tired for an elaborate meal, and if I spend more than 30 minutes cooking there's threat of a revolt. Plus I don't have lots of what you chefs might call "raw ingredients."

So I try to be resourceful. Most of the time, that involves a bag of frozen pasta and sauce "for two" (that is usually enough for one), then add frozen meatballs/chicken and frozen vegetables. It all sautees into a reasonable meal for three.

Lately, I've been slightly in love with my $20 crockpot though. That is the ultimate for those of us who can't really cook and don't have much time. I toss in carrots, potatoes, celery, green beans (all vegetables optional), lean beef stew meat, a package of Lipton's onion soup mix, and a cup of water, then I turn on the crockpot and go to work. When I come home, either the house has burned down or I have a delicious beef stew cooked that people comment on (favorably) in the hallway. Pour it on some instant rice. You cannot screw this up... it's not possible!

And the best part is, there's usually tons of leftovers, sparing me having to eat lunch in the hospital cafeteria the next day.

All right, so I've divulged my secret. What is your easy 30 minutes or less recipe?

Guest Interview with a...... Lawyer??

I know there are a lot of people who read this blog who aren't physicians or are at least considering other professions. Therefore, as a little change of pace, in this post we will be hearing from a friend of mine who is a working mother and also a LAWYER. (A mother in law, so to speak. Heh.)

Lindsey is the mother of three girls ages 3, 1.5, and 4 months. She's also a full-time attorney licensed in two states, manages a 25-person department, and has been married four years to her college sweetheart. Her loves include sci-fi, pretty shoes, red wine, and anything princess-related. She's tired pretty much constantly, but still finds time to screw around on the internet. Her blog can be found at High Heeled Mom.

Anyway, I had a few questions for Lindsey about what it's like to be a mother/lawyer:

I've spent most of the last ten years being jealous of lawyers because you go to school for only three years, then you graduate and make a billion dollars right out of school, whereas doctors have to do a grueling, low paying residency after med school. Am I right to be jealous? Tell me something awful happens when you graduate law school that is equivalent to residency.

HAHAHAHAHA. Not nearly as many of us make a zillion dollars right out as you think. Only the ones who go to big firms in big cities make what one might categorize as a zillion. And they work eighty-hour weeks, much like residents. The vast majority of us who come out and get a job at all (these days, it's not something you can count on) start in a medium or small firm, or in public service. Your average city attorney in my area, right out of law school probably starts at 45K. No lie.

That said, yes, you're right to be jealous. My sister is a doctor finishing her residency this spring and med school plus residency took way longer, was much more expensive, and seemed much more grueling than law school. We have the bar exam, which we whine about plenty, but you have boards.

I think becoming a lawyer is a walk in the park compared to becoming a doctor, and I'm shocked we're so often compared.


If you had to do a Lawyer Demo for your three year old's class (like I recently did a Doctor Demo), what would you do? No fair if you break out balloon animals.

I absolutely have no answer for this question. There is nothing I do whatsoever that a 3-year-old would find interesting. Oh, wait- the girls do like trying on my shoes, and I wear neat shoes. I'd do a "Dress Like a Lawyer" program for kids.


You have three kids three and under, and work full time. When people say to you things like "I don't know how you do it," does that make you happy or irritated? By the way, I don't know how you do it.

A bit of both. (And yes, I hear it CONSTANTLY). Happy that people find me impressive, but irritated for two reasons:

1) Usually when people say this, they aren't actually interested in how I do it, they're just sort of goggling at me like I'm a freak to want to. (Um, I don't get a choice at this point.) If they actually want to know how I do it, that's why I'm blogging.

2) I'm not impressive. The receptionist at my office who makes half my salary, has six sons between 8 and 18, , recently got divorced, and still manages to be so incredibly gorgeous that I wish I were a lesbian... SHE is impressive.


This is something that really bothers me: I've been reading a lot of chick lit lately, and there are tons of strong female protagonists who are lawyers, but none who are doctors. Doctors are allowed to solve medical mysteries, but apparently not get engaged to the wrong guy and then get lured away by another guy who initially seems like a jerk yet is ruggedly sexy. What's up with that? Why do lawyers get all the romance?

We dress better. Courtrooms are dramatic without actually being scary (as in, people rarely die). Your average chick lit reader understands what we do, or thinks she does... there are a lot of armchair lawyers out there, while doctors seem more "above it all". And one of the defining moments of chick lit came in 1997... when David E. Kelley brought us a sassy, unlucky-in-love, short-skirted, sexually active young lawyer forced to find her way through a series of dramedic misadventures featuring:

a sassy, black best friend, and a slutty, ditzy best friend
a hot, blonde rival (and later another hot, blonde rival when she won over the first hot, blonde rival)
a handsome ex married to the hot, blonde rival
a quirky, endearing fellow "drawn" to our heroine
and eventually Robert Downey, Jr.

And every one of these chick lit archetypal folks? You guessed it. LAWYERS. (Well, except for the slutty one, who was a paralegal). No wonder we're classics in the genre.


How do you divide the childcare responsibilities between you and your husband? Also, and more importantly, who makes more money? I bet it's you. Does that drive him nuts?

He gets off work earlier, picks the girls up, and brings them home, where they run rampant late-afternoon energy over him for about two-three hours until I show up. They're basically mine from then on, except when I take a bath or shower. On the weekend, we do almost everything in a group, with my focus more on the baby and his more on the older girls. Works out pretty well, especially as he doesn't really "get" babies.

He's a network security engineer and makes significantly more. Drives me nuts. I feel like I should make more. I'd LOVE to make more! (Would that drive him nuts? Not sure. Don't care. He likes money, so he'd probably get over it. Will cross that bridge when I come to it.)


Are female lawyers, especially those with kids, catty toward each other? (Like female doctors are, especially me. Meow!)

No, actually! My best friend at the firm is the other young female lawyer with a young child. She and I are sort of united against everyone else, because I think we get what it's like to have non-office priorities in a way no one else at the firm does. We both leave at 5. Female lawyers in general get along, I think, because it's such an old boy's club, especially in the South.

What would there be to be catty about?


Your three year old child wants a lollipop and dinner will be ready in fifteen minutes (TOTALLY hypothetical question, ahem). Use your lawyer skills of persuasion to convince her to wait. In your answer, you may address the child by my daughter's name.

Miss Melly, you may not have a lollipop (or as Christina would call it, "MY CANDY!")
Yes, I see you shouting.
No, I don't care that you're shouting.
Would you like a cup of water?
Yes, I hear that you want candy.
No, you may not have it.
Wow. It looks uncomfortable laying there on the floor.
Have you noticed how oddly loud this room has gotten recently?
[and similar, for fifteen minutes]
Okay, dinner ready.

It may seem I'm being facetious, but this really is what I'd do with Melly, and this is how I deal with conflicts at work with other lawyers. I don't go head-to-head very often in my sort of practice, but it does happen, and this is what I do... I just sit there (usually on the phone) and politely state the obvious and refuse to budge, until the other person either gets tired or bored.

I also have been known to compare my style of lawyering to an episode of SpongeBob SquarePants where Flats the Fish wants to kick SpongeBob's butt. He hits him- and his fist sinks right in, and SpongeBob giggles. He hits him again, and the same thing happens. He then proceeds to follow SpongeBob around for hours, trying to beat the crap out of him, and everything bounces right off SpongeBob, and SpongeBob is unfailingly pleasant. Eventually, Flats passes out from sheer exhaustion.

That's how I lawyer, and parent.

Lindsey has also interviewed me on her blog about being a doctor/mom. See the corresponding interview at High Heeled Mom.

Welcome to Q & A Topic Week

Welcome to another topic week on Mothers in Medicine! We'll be devoting the next week to the theme of Questions and Answers. Thank you to everyone who submitted a burning question to our community --there were many! We've divvied these up so that each post will generally address one question and a MiM's answer. For those who posed multiple questions, we tried to split the questions to answer them individually. The posted response is to serve as a jumping off point for others to join in and comment. We encourage you to share your answers and experiences in the comments for a full discussion of the question at hand.

We're really excited about the response to this topic week and looking forward to seeing your comments. If any other questions come up during the week, email us, post them on our Facebook page or @motherinmed on Twitter and we'll try our best to get these up for comments this week!

Posts will be spread out throughout the week.

Thanks so much for reading and being part of this community.

Med school with kids

I am a pre-med student (planning to apply in 2011). I am married and I already have two children, who will be no younger than 3 and 5 when I start medical school. I see that most people waited until residency or after to have children, but obviously that's not an option for me. Did anyone else go through medical school and residency with children? Do you regret it? Are you glad you did it the way you did? Do you have any advice!


Thanks,
Hannah

Hannah,

Good luck and good for you. I am just finishing up a research fellowship, and I will be returning to join the class of 2012 at my medical school. I was originally in the class of 2011, the year I hope you get in!

When my classmates ask me when I think they should have kids, I tell them all "Before you get into medical school, and then wait until they're potty trained and sleep through the night." Of course, most of them don't have that option. I am mostly kidding when I say that, but it worked for me, and I hope it works for you.

I actually wrote a guest post with advice for parents in pre-med, recently (I am squeaky brand new as an official contributor! Whee!) I especially like #4 Don’t overestimate or underestimate the understanding of your classmates, professors or administrators when it comes to your kids and #5 Don’t put your education last in your house.

I was less alone than I thought I would be. There were at least half a dozen fathers in my class, and more than a few mothers. We have three single moms in our class. I sat next to a grandmother for my whole second year. We all make it work in different ways.

This research fellowship has been a blessing. It gives me an extra year to spend time with the kids, and I can learn from my classmates who are now a year ahead of me about the logistics of rotations, so I can plan as much as possible. Mornings are going to be rough.

I felt very grounded by my family and children the first year of medical school. I saw many of my childless classmates struggle with loneliness in the beginning. It can be a grueling transition, especially if you have to move to a new place. Having home and children to go home to can be a blessing, not a weakness, sometimes. It does make applying to programs, both for medical school and residency, a bit of a challenge. My first official post (coming soon) will be on having children while looking into away rotations and the residency match.

Med school and residency strategy for a high-schooler

I am a junior in high school looking to become a surgeon. What would be the best way to get to Hopkins for their MD/PhD program, and from there to CHOP for residency?
Thanks so much.
 
Wow. That is a specific plan you have there. I think the only thing I was sure of when I was your age was a) I wanted to go to college, b) I wanted to be a doctor. Or maybe a writer. Or  maybe some kind of unspecified star...., and c) I wanted to wear my hair in an updo for the junior prom.
 
I guess my first piece of advice is to be open-minded about your future. There are so many fantastic places to train --all which can help you become a wonderful physician. Having your heart set on one specific place could lead to disappointment.
 
You say you want to become a surgeon. That's wonderful if you know now that is what you are meant to do for a career for the rest of your life, but also be open to other possible career options. Speaking about myself, looking back at myself while in high school, to college, to medical school and now, it's hard to believe how much I've changed in every dimension.  I went to medical school thinking I would most certainly become a neurologist (neuroscience major in undergrad), then it was most certainly a neonatologist, and then it was a general pediatrician, before finally settling on internal medicine. The important thing is to always stay true to yourself and follow your heart. It's too easy to get trapped in a path that we think we should be on.
 
I think it's probably too early to be thinking residency strategy at this point, but if you're looking ahead to MD-PhD programs, good grades and strong research experience in undergrad probably goes without saying. But, in speaking of what makes a good med student applicant versus a so-so one, is less about the perfect 4.0 or MCATs, it's the entire package of the individual - what makes someone standout is what makes you unique.
 
I happened to go to Hopkins for med school. As a student there, I served as a student member of the admissions committee. What came up time and time again was that we wanted to find multi-dimensional applicants - those who clearly had outside interests and talents, unique prior experiences, and, importantly, showed a clear commitment for medicine through their application. We had the chance to mingle and talk with all of the applicants on interview day and advocated for those who were interpersonally engaging (as opposed to the clearly insincere / egomaniacs / gunners / robots / Mr.Spocks).
 
I'll close with this piece of advice: becoming a physician is a long road - you need to have fun and live life to its fullest on that journey. It is so not just about the destination.Your experiences outside of the classroom or lab are just as important in shaping you as the physician you will become. Live, play, love, listen. Don't let a singular focus for the future make you miss smelling the roses. The roses are key.

The Quartet

Medicine is a tough and very competitive field and I've seen a lot of women doctors who are trying to one-up each other - not just in their work but also in how they dress, who they date, etc. Is it hard for women doctors to develop close friendships with other women doctors? I wonder about this because I'm a lawyer and all of my closest friends (and bridesmaids) are lawyers who went to the same law school but I don't know that many women doctors who are as close to their medical school or residency classmates.

I love this blog! So interesting.

From,

A lawyer and mother of two in Seattle.


I have a quartet of women in my life who are so close to me they each deserve a blog, hell even a book, all of their own. I collected them over the course of med school and residency.

Lys - my best friend from medical school. I was the maid of honor in her wedding. Even though she ended up in a town two hours away from my own, we still talk frequently, and we are cultivating a friendship between her 3 year old and my 7 year old. She has been one of the singular most influential people in my life (well, there's mom, dad, sis, bro's - but we're talking friends here).

Mel/Mellificent - My first best friend from residency. She was two years ahead of me when I started my training, and we became fast friends. Her quick wit (I always lag behind real time - thinking of something clever to say when it is socially inappropriately late) attracted me and everyone else around her. She took me under her wing from the beginning, teaching me the tricks of autopsy and how to handle the different personalities of our all important planets - the attendings. Then she had her daughter 11 months before I did, and taught me how to pump. Showed me it was all possible: to nurse, mother, and be a resident. I don't know if I would have figured it out so well on my own. For that I am eternally grateful.

Trish-EEE! - When Mellificent left for a job in another state I was crushed. Luckily Trish had recently transplanted from Chicago and took her place. Trisha had a very different family situation from my own - she was a newlywed and I had one kid and another on the way - but we had a blast, those last few years of training. We flew together to take our Anatomic Pathology/Clinical Pathology boards in June of 2006, and had a big spa day planned back in our home town the day before she and her husband moved up MidWest to her new job. Unfortunately, our flight got delayed and we had to scramble for a room in a cheap hotel while our suitcases were stuck in Never Never Land. We begged the hotel staff for plastic Bics to shave our legs the next day and stayed up late talking. Ate a greasy breakfast in the hotel lobby and caught a mid-morning flight home. Even though we missed our spa day, I wouldn't trade that experience for the world.

Dr. Styles - My mentor and big sister. Sure, there was the faculty/trainee angst when I was a resident, most of which was created by me trying to please. I am indebted to her for all the knowledge she imparted to me, and consults she continues to help me with in my current job. I have really enjoyed cultivating our friendship in a different way over the last three years since I left training. I am no longer in a position of trying to please, and it makes us easier with each other. She is there for me now in a bigger way. Teaching me how to become a mature adult emotionally, something I was sorely lacking after a crazy few years of training and having babies. I put everyone else first, and myself last. Now I see her happiness after profound family trauma, and realize that there might be a light at the end of my tunnel.

I have a new quartet of women at my current job - ones I will write about in the future. I have always leaned on the women in my life more for emotional support, and my current practice situation is no exception.

Having said that, I have been on the wrong end of women in my job. One of my research collaborators, a non-doctor, tried to sabotage me once to a favorite faculty member. I was getting weird vibes from the faculty and wasn't sure where they were coming from. Luckily some of my co-workers saw what was happening and cleared the view of the faculty member before everything went too far South. In the end, it was tough for me to be angry with the researcher, because I could see her story, where she was coming from, and why she did it. I felt pity for her - something she probably didn't want from me - but I felt it nonetheless, and went out of my way to be kind to her in social situations. I skipped anger, and went to sympathy. One of my greatest strengths, and worst faults.

Let me digress here, and get on my soap box. There are no bad people. There are only good people who do bad things. It makes me so angry when I see mothers scolding their children for bad behavior, by saying, "That is bad. YOU are bad." Kids internalize this, and make it a part of their view of themselves and their approach to the world. They do not have the capability to isolate the situation from their own ego (I am sure I am screwing up psychological terms here - maybe JuliaInk could clarify).

So in my opinion, yes. Female doctors can cultivate wonderful friendships with their female peers. A former blog contributor who is now taking a break wrote a very different take on being a female doctor and making friends - one that KC (an incredible, laid back, capable and helpful ring-leader that I joke about being a slave driver in complete fun) shared with me at lunch yesterday. Anesthesiobiologist wrote this post, one that I encourage you to read. She is a great writer, and I empathized with her thoughts on some level.

I hope this wasn't too all over the map. I feel a little scattered, these days. Thanks very much for your question - lawyer and mother of two in Seattle - it made me think a lot and this was much harder for me to write than the breast pumping post. It is tough to condense the gratitude I feel toward all of my female colleagues for helping shape who I am as a woman, mother, and doctor.

Time with Kids

During residency, what are/were your favorite ways to spend time with your children in the 3-5 hours/week when you were not working or sleeping?


Playing with them. On the floor, TV off, giving them my undivided attention.

That being said there are a bunch of my son's baby pictures that include a William's Textbook laying beside him! I think the key is to maximize the amount of time you can spend with them at home. Also, if possible, to have your spouse bring them up for visits when you are on-call.

I planned to have a child when I was a resident, so I decided early on try to learn everything I could in my first 2 years of residency. My theory was to learn everything in 2 years, so I wouldn't have to study as much when I had a baby. I constant carried notes, photocopies of text book chapters, and notecards with me. All those little moments of down time: waiting for a case to start in the OR; waiting on L&D for a patient to deliver; waiting for your attending to arrive for rounds, these were all my extra study times. And I didn't even have an iphone back then!

This allowed me to rock as a resident and also take time management to a new level. Of course I didn't learn everything in my first 2 years, but I did learn a lot more some of the other residents and I didn't have to study as much at home. Which gave me more time with my souse AND my son when he was born.

Subject: How to pursue pre-med studies

NOTE: This is a very long question, and subsequently a long answer. I decided not to edit down the question, as all of the parts seem to be equally important to the questioner.


I have a B. Mus. in classical music performance from Oberlin. When I was wrapping up my degree, my desire to learn more about the human body trumped all my plans -- grad school, a performance career. For the past three years I have been employed in healthcare, first in a nursing home as a caregiver, and then as an EKG tech at my local hospital. I needed to spend this time working in the field to confirm my desire to become a physician and to develop accurate perceptions about healthcare.
My son is only eighteen months old, but I feel like I can't put off post-bac studies any longer. It makes me miserable to continue to put my education on hold, and it's becoming increasingly difficult to be enthusiastic about a job where I'm completely underutilized. I just accepted a new job working overnights in the ICU so that I can take classes during the day. My husband is a nurse and we work opposite schedules.
Meanwhile, I have been accepted to several programs as a transfer student to obtain a second bachelor's degree (in biology) and two post-baccalaureate pre-medical programs. Although I would love to attend one of the post-bac programs, they are all through private institutions and I'm just not sure if we can afford it or even secure adequate loans. Some of the B.S. programs are through state schools, and very, very affordable ($3000/year after grants), but not many of my credits from Oberlin will transfer and it would probably take 3-4 years to complete the degree.
Should I just take courses a la carte? It seems like a more direct route in some ways. I could afford to do this at a state school, but I hate that I wouldn't have an advisor, that I wouldn't have the opportunity to be involved with research, that it would be difficult to get to know my professors and that it would be hard to build the rapport that I would later need for recommendations. Some of the physicians I work with are willing to write recommendations, but I feel like I will still need someone to comment on my academic ability.
Should I try to complete a masters program instead? Could I tack on pre-med courses while completing an MPH? Are there other graduate programs that I should consider? I didn't apply to any graduate programs, but in retrospect, I sort of wish I had.
Did any of you work full-time overnights while being a full-time student? How did you do it? Did you ever sleep? If so, when? Were you scary or silly? I'm feeling desperate and crazed and I would be so grateful for some outside perspectives. -E.G.
(E.G. is a 24 year-old EKG technician living in Upstate NY.)

I’ll attempt to answer this as best I can, E.G. It sounds as though you’re already quite accomplished, and I understand your frustrations with feeling as though your life is “on hold” – but there are many things that you may not be aware of as you look toward your goal of becoming a physician. First, there’s no rule that says you need to have majored in the sciences to become a doctor, so looking at obtaining a second bachelor’s degree in biology may be overkill. What you do need to look at are the classes that you’ll need to succeed at the MCAT, as well as the pre-requisites for medical school. As such, the “a la carte” approach might be the most reasonable path to pursue. I wouldn’t be afraid of not being a full-time student in that scenario, and I wouldn’t worry about not having an advisor – I think that most professors would be willing to work with someone in your position in such a capacity. Even though you wouldn’t be a full-time student, you’ll still get to know your professors. In fact, you’ll likely have the same professor for several of your courses, and they’ll be able to easily comment on your academic abilities when needed. And why are you even considering an MPH? Is it something you think you’ll ultimately use? If not, at this stage of the game, it’s likely to be more of a burden than a benefit.

Now, let’s consider how realistic it will be to work full-time nights and attempt to be a student during the day. Something’s going to give, and it’s likely to be your sanity. For most of us, balancing a full-time job and a family is a stretch; adding a full load of college classes seems to be a recipe for disaster. Sleep deprivation will impair your memory, impact your grades, and potentially injure some of your relationships. To address the specific question you asked, most of us become very scary when we’re chronically sleep deprived.

I haven’t even begun to discuss the economic impact that this will have on you and your family. There’s no getting around it - medical school is expensive. It will be very difficult to work through your first few years due to the course load, so to be practical, you’ll want to have as little debt as possible prior to entering med school.

Lastly, your son is only eighteen months old. While it seems like he’ll be tiny forever, wait another three seconds and see how old he’s suddenly become. Don’t miss out on your time with him in your desire to finish your schooling. What about other children? Two kids are exponentially more difficult than one, especially if you’re working – let alone going to school.

Ultimately, although it seems that you must complete everything now, in reality you’ve got lots of time. You’re way off the path of being a traditional student at this point, so revel in your non-traditional status. Enjoy your job – use it to hone your bedside manner with the patients you see on a daily basis. Share your ambitions with the physicians you work with – you may find that they go out of their way to share some interesting findings with you. Do the best you can in the classes you take, even if it’s only one per term – professors are much more likely to write letters for students who have genuinely enjoyed and subsequently succeeded in their classes. And realize that there’s no reason to be desperate and crazed now – save those emotions for later (like when you’re post-call, your husband is out of town and your son won’t stop barfing….).

I hope this helps –
A

Why Would You Quit?

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder - why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but of course, I don't want to be so rude as to ask that question to them.


From,
A lawyer and mother of two in Seattle.

I am going to try to tackle this question, even though it is not my current personal experience or decision. I actually went through residency with a woman who did this very thing. She went through medical school, a strenuous Ob/Gyn residency, and then worked in private practice for a couple of years. She was married to another physician who eventually completed an interventional radiology fellowship. During residency, she had two children, and then had a third when she was out in private practice. Once her husband finished his training, she quit practice to be a mother full-time. When people would ask her why, her answer was simple..."because I want to, and financially, we can do this, so why not?"

I know she loved her career, and she was a very skilled, caring, and compassionate physician, but she just wanted that time with her family more, and they were in a position to swing it. She didn't think of her choice as "quitting medicine," she viewed it as choosing her family. It is no different than the other career women (lawyers, executives, teachers, bankers) who make the very same choice. She always planned to return to a GYN-only practice once her children were school aged, and she became board-certified, and kept up with the field via conferences and CME (she had lots more time to read!!) I have since lost touch with her, but I have no doubt that she was very happy with her choice. While most physician-mothers are not as extreme, I see varying degrees of women choosing "lifestyle" specialties or different levels of "part-time" practice after residency.

Even though medicine does require more rigorous training than most careers, it does not necessarily change the way you feel about how your family life should be structured. There have been many times that I have considered cutting back practice hours, myself, in order to enjoy more family (and me!) time. I recently made a move that enabled me to still work full-time, but greatly reduced my time on-call, and therefore, my time away from my family. Currently, I am the bread-winner, and I still have some student loan debt that needs to be paid, so up and quitting is not a viable option for me. However, if I am able to become a partner in my current practice, reduce my in-office time, and still manage a decent living, then I will likely choose that path. There many different ways of finding a work and home balance for women today, and I am thankful that we have the ability to "choose medicine" and we can also "quit medicine" if this is the best thing for us and for our families.

"AMA- Advanced Maternal Age"

Dear MiM,
What things did you wish you had considered before having a baby during residency? Are there any moms out there who had children after residency or who were unable to get pregnant after residency (b/c of advanced maternal age) that have regrets?


Ob-gyn resident from the Bay Area, California

Dear OB/Gyn resident:

Let me start off by stating a simple truth that we all refuse to accept. We are not in control. This was made painfully clear to me only following the dismantling of my perfect plan for having a baby.

Married a week after med school graduation, my husband and I chose not to start a family during residency. We struggled with the initial adjustments to marriage and work, and instead of having a baby had a fantastic time eating out, drinking and traveling. Looking next toward cardiology fellowship, time for baby needed to be in the plan. My first year focused on survival. The second year I volunteered to make the master fellow schedule. A small sacrifice of negotiation + mediation to have control of my own schedule. I stacked my call and cath lab months in the first half of the year. I found a research mentor and agreed to a extra year research fellowship. It would be perfect. November was my last month in the cath lab. Pregnant in December. Start research in July. Have project off the ground, maternity leave in September. With some luck I could extend my research a third year and have number 2!

In reality I was diagnosed with anovulation due to PCOS in April. I then became a fanatic triathlete. By the time I started my research fellowship I was exercising 3 hours a day and was skinny as a rail. I figured I could be the 'best' PCOS patient ever (so it seems PCOS is NOT all about adipose/obesity after all). Fertility drugs in the fall leading up to my first miscarriage. Then a freak accident leading to a broken arm, ORIF in January. Crazy girl running on the treadmill with my arm in a sling. Hip pain, months of physical therapy. Diagnosis of acetabular tear, second to underlying congenital hip dysplasia. MDs doubtful I could walk during a pregnancy. Hip surgery the next January. So by the time I spent 2 years trying to get pregnant and 6 weeks on bedrest following my hip reconstruction I finally said, I give! I get it. I am NOT in control and I cannot make what I want to happen- happen. Not even with a superwoman effort bordering on obsession!

And well, as it turned out it is not too hard to get pregnant. Not hard at all when you are not working, resting, reading, watching TV all day- all while on *bed rest*!

Finding the right time to have a baby is difficult for Mothers in Medicine. You have read on this blog about the challenges of managing maternity time off and negotiating with colleagues the pre-occupations of a mother. The consensus is that no time is the perfect time. In my experience, finally understanding/ appreciating the amazing gift of a healthy pregnancy made all accommodations more palatable. My story is not unique, the complicated world of the female reproductive system has it's quirks. My practical advice to you: take care of your marriage, take care of yourself. When both feel good have a baby. Because in reality we are not in control. Letting go is often required for us to find the future we desire.

Would I have done anything differently?

QUESTION: Is there anything you wish you had done, or done differently (fellowship, 6-month trip to India, get married before rather than after school, etc.) over the course of your training, starting in college?
FROM: GradStudent, child-less, unmarried 20-something aspiring science researcher and medical school instructor

Oh, the “woulda-shoulda-coulda” question! Isn’t it human nature to question what we’ve done and what might have been if we had taken a different course of action at some point?

That said, there are some things that I wish I would have known when I was at your stage of the game. Specifically, I wish that someone had told me that taking a little extra time to complete my schooling would not impact my future adversely. When we’re in undergraduate (and even high school!), there’s a pressure to complete everything ASAP. However, most of us need a little time to percolate (OK, mature) before we reach our full potential. Additionally, learning to savor time away from a job (or books) can help make our productive time that much more productive.

I’m happy that I delayed marriage until after my formal schooling was done – I didn’t have to worry about spending extra time in the library prior to exams, nor did I have to worry that my husband didn’t really understand why a lab finished at 3P one day but not until after 6 on another. I didn’t have children until the end of residency, and I wouldn’t change that – I think I needed the extra time to sow my wild oats!

But, even with these items in mind, as I look back on my experience in college and med school there are a few things that I wish I would have done differently. The college I attended for my undergraduate education had (has) a terrific overseas study program. At the time, I felt that I needed to concentrate on my science courses rather than spend time on additional language classes, and so I didn’t think twice about ignoring the information about the program that crossed my path. In retrospect, I think that to have had an experience of being completely immersed in another culture would have been good for me – personally, to have shaken me out of my cocoon of comfort, and professionally, so that I’d have some empathy for those patients I see who are new to our way of life. In a similar vein, perhaps I should have gone on the “backpacking in Europe” summer trip that I was too afraid to pursue at age 22. I wouldn’t have worried as much about majoring in a science, but would have spent more time in classes that I really enjoyed. I would have learned earlier that just because something comes easily to me doesn’t mean it’s not worthwhile for me to pursue. I would have recognized sooner that life is a journey, not a destination.

So, dear GradStudent, I hope this answered your question. As you look ahead to your career in research, or teaching (or whatever you ultimately decide on), don’t be afraid to take a detour – it might be one of the best decisions you’ll make!

A

Matching to a Different Drummer

 Hi and thanks for the blog, I love reading it when I get a chance to sit at my computer and procrastinate!

My question is this- I'm a caribbean med student from the midwest, and due to odd scheduling, I'll be done with my 4th year electives in July, taking step 2 at the end of that month.
This means I will miss this years' match, of course.
What should I do for the 10 months that I have off before residency starts in July 2011?

Get a job in research at the hospital that I'd like to get a spot with?
Get a job as an EMT?
Get a job with nothing to do with medicine and study like mad to take step 3 before residency starts?
Is it possible to start residency in September?? ( I want to do Peds)

I'm single and childless- but I have joked that those 10 months off would be the perfect time to be pregnant! :) Current BF grins while looking green... lol. I'm not looking to have a kiddo yet, just seems from reading your stories that this is the last time I'll have 10 months off in a row!

Thanks for any replies!! I appreciate you all.
AftenMD

Being out of step with the match can work to your advantage in several ways. Some positions do open up in the middle of the year, when people drop out, switch specialties and so on. I am not quite sure where such positions are advertised, but the dean of your school may know, or you can check in a specialty newsletter. If you have graduated before you apply, you are not obligated to go through the match at all. This frees up a program director to take a position out of the match and sign you up at any time before submitting a match list. If you are applying to a residency that has trouble filling slots some years, this can work to everyone’s advantage. Programs hate to have positions unfilled on Match Day, and it also frees you up to do whatever you want, knowing your position will be there in July.

If you are looking for interesting things to do, there are many opportunities in international relief related medicine, including disaster relief, maternal child health clinics, HIV clinics and so on. The internet is full of requests for people who want volunteer in Haiti, and the need is going to be there for years (try Partners in Health as a sponsor, in particular). You can also use your time to get far along with another degree—for example, if you take a full semester of courses toward an MPH, you will likely be able to finish it during residency, and that is a great credential to have later on. You could also take courses in humanities, again with the idea of cultivating medical humanities in residency and teaching in this new field in the future.

Another or additional activity is to learn to be a standardized patient—the work pays something, is very flexible, and teaches valuable patient relationship skills that may be helpful during residency. Other medically related, paying jobs that a medical student is qualified to do include phlebotomy, being on an IV team, and being a “sitter.”

Finally, there are some educational experiences that you could pursue if still enrolled, for example, the neurology elective at the Queen’s Square hospital in London or the advanced psychopharmacology clerkship at the National Institutes of Mental Health. Students also can go to some professional meetings for free as recorders—the Child Psychiatry meetings for example—and that could really enrich the time between school and residency.

How To (and not) Breast Pump at Work

A friend of mine (anesthesiologist) is expecting her first baby any day now. She had a lot of questions about breast pumps, ie how difficult was it to pump at work? How did you deal with call? What were your colleagues' attitudes towards pumping? What breast pumps would you recommend? How much time does it take to pump (on average)? How long did you breastfeed for, and was your decision to stop influenced by work issues?
I did read Fizzy's post a while ago (formula vs breast milk) but my friend and I want to know the details. If you don't feel this would be too repetitive, it would be great to hear what the other mothers in medicine think.
Liana

My daughter, Sicily, was a dream baby as far as the pumping goes. I'm paying for it now, in elementary school, but that is the topic of another blog. Pumping was tough to learn, but once my friend Mel showed me the ropes, it was smooth sailing. I had a top of the line Medela - I'm sure there's a newer model out now. It was worth it to me to shell out the bucks for efficiency. All of the books recommend that you pump as often as you would nurse, but when you have a hungry, demanding baby this seems unreasonable. I usually tried to pump twice a day at work. I was on clinical pathology rotations my second year of residency - had adequate time to manage my goals. I studied during the process.

I tried to pump in the pumping station at the hospital near OB, but it was so far away and all of the dried milk spots on the chairs, walls, and floors in the cubicles behind sheeted doors freaked me out. So I used Mel as a mentor again and pumped in an empty apheresis room - nice and clean. And I'm nice and clean so it worked out for the apheresis attending. I usually pumped at 10:00 and 2:00 - it took about thirty minutes start to finish, including rinsing out the parts and storing the milk. Toward the end I was able to back off to once a day when my production started waning. There was one unfortunate incident of a male nurse walking in on me while I was pumping - it was embarrassing at the time but funny in retrospect - he couldn't look me in the eye for weeks. I think he was more embarrassed than I was.

I was a cow as far as production goes - I remember once falling to pieces when the power went out on a weekend when I was alone at home. I called the poor Entergy company assistant in tears.
"When is the power coming back on? I have all of my milk in the freezer! If it thaws, I will have to throw it away. Are you sure they are fixing it? Can you please tell me again the exact time you expect it to come back on?"

When you work that hard, a tiny bag of frozen milk is like liquid gold.

I pumped/nursed for eleven months with Sicily. It was just time to quit - we both seemed to know it. It was a very smooth transition to frozen milk, and she was on formula by a year.

When I had my son two years and four months later, I thought I was living my dream. Perfect marriage, doctor husband, girl and boy, and well on my way to (in my opinion, and many others, some will beg to differ - there are a lot of great jobs in this state) the best job in the state. I was going to work at the hospital my dad and husband worked at. Plans don't always work out the way you want them to, but this isn't always a bad thing.

At the time, things were going according to my plan. But with my son John, things degenerated. He didn't sleep all night at three months like my daughter - he wanted to nurse three times a night. Hard to blame him - he didn't get much of me during the day - but it was killing me. I was also on some tougher rotations, so I reduced pumping to once a day. I would nurse in the wee hours of the morning, pump again after getting ready before I went to work, and suck it up until around noon, when my breasts were like lead balloons. Well, not really lead - they were a little more lumpy. Think a million tiny shrubs under your skin, full to bursting point. I had to get a third storage bottle - I was going way over 12 ounces. I didn't have time to go down to the apheresis unit on the first floor. I just ate a quick stash of processed food for lunch, and made fast friends with the residency coordinator/mom, who let me pump in her office. I could squeeze it in (or out!) in twenty minutes, now. I was a little more rushed overall, at that time in my life.

I sat on the residency coordinator's floor with my face to the wall. Sometimes she left. Sometimes she stayed, and we chatted about kids, life, and family. I really enjoyed that - it was one of the highlights of my day. Female bonding.

This style of pumping was OK for John, but not for me. I had a lot more problems with dehydration and blocked ducts. I've got a pretty high pain tolerance, but blocked ducts have to be one of the most painful experiences on the planet. Worse than childbirth (well, I did have epidurals, so that is not a fair comparison). When he was around seven or eight months, in early winter, I let him cry it out at night, and stopped nursing. This was a much more painful emotional experience because A) We weren't ready B) I was exhausted and had to start studying for my Anatomic Pathology/Clinical Pathology boards in June and C) I was beyond sad and depressed and strung out and D) I knew this would probably be my last time to nurse. It was an amazing experience overall, and I couldn't see myself ever doing it again. I was going to miss it. Luckily, I have nursing dreams to remember the rush of relaxing hormones that accompanied contraction and let-down. I am not talking about pumping here, I'm talking about the real thing.

I wish I could speak to the call, but we pathologists get a break, on the call. So hopefully someone will comment on that in the comment thread. Colleagues attitudes - I am sure I occasionally annoyed, but this was usually temporary, situational, and not always my fault. It is tough to control other people's moods, and sometimes they will project their frustrations onto anything. I did have to get coverage some days, especially with John, when I was responsible for junior residents or covering frozens. People ask to be covered for a lot of reasons, and this was one of the few I asked, so I tried not feel too guilty when others worked for me and made sure to do extra favors when I was around. I like to think that overall I was admired tremendously by residents and attendings. I'll bet if I took a survey the results would back up my hunches.

I am proud of all of my efforts and work, even though it got a little crazy, single-minded, and self-sacrificing at the end. I beat myself up way too much for giving Sicily that extra few months - I felt like John needed it more, since he was six weeks premature. But he is a happy, healthy, well-adjusted four and a half year old, so I think I did all right by them both, in hindsight.

Tell your friend good luck, Liana! Thanks for the question.