MiM Mailbag: Need some help (urgently)

Dear Mothers in Medicine,
I need your help. I am in a sudden mid-training crisis and after years of being absolutely sure of what step comes next… I now have choices and that leaves me in a panic. I’ve been reading this blog for about a year now and I respect and enjoy reading the posts that go up. So I need your help in the form of unbiased opinions about what to do with my life.

I’m an internal medicine resident in my second year, with a 19-month-old son and a loving husband. I’ve been interested in Endocrine casually for a while now but recently I’ve decided that I would like to specialize in it. The unfair thing is that the match application for fellowship occurs in December of the second year of residency… for a spot after the third year is over. So after the whirlwind of intern year, it seems like this crossroads comes up way too quickly. This is also the time that my program sends out the call for Chief Medical Resident applications (there are 4 chiefs every year for my program), again, for the year just after I graduate. I’ve been asked twice by one of the associate program directors to apply for CMR, which is both flattering and shocking to me. I want to stay at my current program for fellowship, but this is a year when 5 of my colleagues also are applying for Endo and 2 out of the 3 spots have already been promised to people. Basically, no reason to apply for the match this year. I’ve been told that if I did do CMR that I would be guaranteed a spot when I was done. I literally have to make a decision in 2 days (deadline for CMR). So I made pro/con list (or, sort of a stream of consciousness) for the jobs that I’m considering.

Endocrine Fellowship +/- Chief Medical Resident vs. Primary Care Internal Medicine

Endo...

Pro: Focused on limited problem set - thyroid, pituitary, diabetes, PCOS... Overall nice colleagues. Maybe a little better salary than primary care... Don't have to deal with musculoskeletal issues or runny noses. Get to potentially see some really crazy pathology and treat thyroid cancer.

Con: Have to apply for fellowship, including a personal statement, letters of recommendation, trying to start and somehow make sense of a research project. Being stuck in a fellowship for 2 more years while not making a full salary. Possibly having to end up doing primary care anyway after 2 years of training (the market in my area of the state is completely saturated and full time endocrine jobs are extremely hard to come by from what I’ve been told).

Primary care...

Pro: Tons of jobs available. Weekends off, no more overnight call in-house EVER. Making a decent salary in less than 2 years. Happier husband. Potentially really nice patient-doctor relationships with the sane and reasonable patients.

Con: The overwhelming amount of follow up labs, etc. MSK complaints that I never know what to do with. The fear of missing a big diagnosis. The awful gyn complaints (though I think outside the VA where my continuity clinic is at, internal medicine primary care is probably a lot less gyn since women usually have their yearly pap by an OB/Gyn).

Chief Medical Resident. This is an esteemed position that comes as a bitter-sweet combination of administrative work, no clinical time, teaching, politics, and pretty much an 8-5 M-F schedule, and a few more bucks than a regular resident. It would be one more year past my 3 years of residency and would essentially guarantee a spot in my institution's Endocrine fellowship after I'm done. On my curriculum vitae it would be a plus for any future job application. What's one more year out of my life? Well, I think I'm hesitant for two reasons: 1) my husband is not a fan of making 1/2 the salary of an attending for one more year of delay to a real job 2) I don't want to have to deal with all the politics and new ACGME rules that are coming down the pike, i.e. the new rules of interns only working 16 hrs in a row (which is ridiculous, but I'm sure all the new interns for next year are happy about that). I think I would be a good chief and I've always liked mentoring along my younger colleagues (mainly medical students, at this point), teaching, realizing that I actually do know some medicine.

Here’s the rub… My husband has been in his career for 10 years. He is making great money… but he hates his job. He has stuck by me for years now… moved with me to medical school, moved back for residency, supporting me through the overwhelming debt I have from medical school and college, being the primary caretaker for our son last year when I was an intern. He would like nothing better than for me to finish IM residency, get a job in Primary Care, and start having a regular salary and consistent schedule. He’s sure, now more than ever, that he needs to change his career drastically for the sake of his happiness. I want this for him too. After all, he has been supporting me this whole time… when is it his turn? How long can he wait? We will both be in our late 30’s by the time I am really done if I continue onto fellowship.

So. Here I am. I feel like there are a few ways this could play out… and any of them I would find a way to be happy. That’s just who I am. That’s what makes this decision so tough… In any of these, I think I could be happy.

1. Primary care – as a career

2. Primary care for 4-5 years, then apply for Endocrine fellowship - my fear is that I become too comfortable in my current salary/job and just bag the whole idea of going back to training

3. Chief year, then Endocrine fellowship directly after – this is what I would choose in the alternate reality where I’m not a wife or a mom

Any comments or ideas I would greatly appreciate!

NiqueKee

A Letter From Your Doctor

Dearest patient, this letter is for you.

I hope you read it, all the way through.

There are a few things I want you to know,

First, I am sorry for being so slow.

I can’t seem to break this habit of mine,

of sleeping in until 4:09.

I roll out of bed and onto the floor,

wondering what the day will have in store.

Rounds in the hospital run hour after hour,

The patients’ desire to ask questions is beyond my power.

I make my way through morning traffic and into the clinic,

Go through the labs and many calls in a panic.

By 7:30 I must see the first patient,

The hours in a day are never sufficient.

Sarah is next in line to be seen,

Telling me about her headaches and rebellious teen.

The lobby is getting crowded as the time flies by,

Patients are restless but my mind is on Sarah, I cannot lie.

Mr. Anderson tells me he is mad about the wait,

I apologize and tell to stop smoking or a heart attack will be his fate.

Oh and by the way,

He won’t be able to pay today.

I can only smile and say alright, for you see,

The patient’s well being is really what matters to me.

The next patient is certain he has the Juju Joogled.

I will tell you now, doctors hate being Googled.

The complaints roll in about coughs, pains, vomiting and loud farts.

I finally finish at 5 o’clock and then there are hours of finishing charts.

I rush home to see my family, and as I walk through the door I hear,

“Hey, Mom, my project is due, what do you know about the 1800s and the western frontier?”

Before I know it the day has rushed by to an end.

I fall into bed at a quarter ‘til twelve only to wake up and do it again.

Many familiar faces flash in my dreams,

My patients will never leave me it seems.

So I beg for your forgiveness the next time I am running late,

I can only pray that the care you receive is worth the wait.

*All patients are fictional.

The Colorful Cupcakes

About a month ago, my seven-year old Sicily came home from school.

“Mom, we’ve got to do a booth for the school festival – a food booth. It’s in October. Please can we do one? Maybe we can make those Oreo truffles.”

Oh yeah. Those Oreo truffles I got the recipe for about two Christmases ago when I brought them home from a work party and the kids were wildly impressed. I promised them we would make them two years ago. We still haven’t. The school announced its first ever fall festival fundraiser as an experiment to replace their fifty year old Harvest Fest. They asked 25 parents to volunteer to do food booths.

“Maybe your dad will do a food booth.”

Her dad likes to cook a lot more than me, and I imagined him smoking ribs or pork butt with his giant trailer smoker. I was trying to put it off – I had a lot on my plate last month (moving, divorcing) and didn’t want to commit to a booth. A couple of weeks later she still hadn’t gotten her dad to sign on, and she was pretty relentless about it, so I finally agreed and signed up on e-mail. I called the school to ask, “How many food items do we need to make for a booth?”

“Five hundred.”

Jeez. Maybe I should have been paying attention better on parent-teacher night when they were talking about the food booths. They might as well be asking me to fly to the moon for the festival. No wonder the food coordinator was shocked I didn’t want to go in with another parent – most people flying solo were attached to local restaurants, somehow. But since I had already said yes (i.e. promised Sicily), I was determined to make it work. But I’ll be damned if I was going to be the one doing the cooking. I called one of my favorite apheresis nurses – she had just baked me an amazing cake, strawberry with cream cheese icing, for my birthday.

“I don’t do bite-sized concoctions, but I know someone over in North Little Rock who does. I trained with her – she is a dialysis nurse over there. I think she does mini cupcakes and cake balls.”

I called her, and we agreed on a price for five hundred mini cupcakes. She said, “Wow, I’ve never done five hundred! I think I’ve done two or three, but this is my biggest order ever. Since I am off the Thursday before that Saturday, it should work out fine.” I was so excited to tell Sicily about it one afternoon when I picked her up from dance. We discussed it on the way home in the car.

“Mom, we need to think of a really cool name for the booth. Something that rhymes with cupcake.”

My mind started racing through the alphabet. “How about ‘Help Us Eat these Baked Cupcakes?’ Or, ‘No! These Cupcakes Aren’t Fake.” Or, ‘Don’t Throw your Cupcake in the Lake!’ Or, ‘Don’t Eat this Cupcake, I’m Saving It for Jake.’”

She rolled her eyes at me in the rear-view mirror. The last dig was personal – she has declared a boy in her class named Jake the “Grossest Boy on the Planet.” She had to be separated from him because she got sucked into his antics and “lost apples” for behavior infractions (oops – I almost let this post go with that last word being infarction – as in myocardial). She’s pretty letter of the law as far as school rules go, so I imagine he must be pretty entertaining to distract her.

“No mom! Those are terrible. I guess I don’t mean a rhyme. It just has to be catchy and fun. How about ‘The Colorful Cupcakes?’”

“Sounds good, Sicily. The nurse talked about covering them with sprinkles, and making different flavors of batter and icing, so that should work great.”

Last weekend, when she was with her dad, I got a call from her. She had just scraped her elbow and was crying – she wanted me to come pick her up. My heart was tearing in two pieces, but I didn’t let on and tried to distract her out of it.

“Well Sicily, your dad only gets about four overnights a month and he would be pretty sad if I came to get you. I know once your arm feels better you will be excited about staying with him and Nicole (his dog). But you know the festival is next weekend, so how about we talk about the posters we are going to make? You need to plan them. What do you want to do?”

She calmed her sniffles with ideas. “Well, it is getting close to Halloween. How about we do flying cupcakes with pumpkin heads and bat wings? Under a big harvest moon?”

I couldn’t have dreamed a better poster. We colored every night last week.

Yesterday was the big day. We hung our artistic posters and met the dialysis nurse, who delivered them during set up time. The cupcakes – chocolate, candy corn, birthday cake, and spice cake, artfully displayed on cupcake stands - were so amazingly good that we got a fast reputation and they were over halfway gone less than two hours into the four hour festival. I think Sicily was pretty happy with how it all turned out, which is all that really ever mattered to me anyway.

Welcome to Metablogging Topic Week

This is the week where we'll feature posts from our regular contributors and guests on the topic of Metablogging- blogging about blogging. Some of us blog in total secrecy, while for others, blogging has become part of our professional identity. Hope you enjoy the posts, and thanks to the reader who suggested this topic.

Scroll down to find the posts...

To Blog or Not To Blog

I've been blogging for a number of years at this point. My original blog started as a non-medical place to play with writing, but soon evolved (devolved?) into a medical-based journal. I participated in Grand Rounds and kept up with multiple individuals through their blogs. I cried with Fat Doctor when she was hospitalized for her recurrent strokes, and was appalled when one of the "name" bloggers was publicly outed during a malpractice trial. It was in the middle of this that KC approached and asked about this site - for a short time, I tried to do both. But life changes, and so did my job; I soon learned that private blogging was frowned upon in my new group, and so my blog was (reluctantly) deleted. I'm still debating whether I want to start a new blog; if I do, it would have to be public, not anonymous. And as already described by so many, the concerns about self-censorship leading to a dry (BORING!) output has held me back.

When I was blogging regularly, I thought it was "secret" - but kids (especially teens) know everything, and I'm pretty sure my sons read my blog routinely. I haven't shared my blogging with this site with too many; in part, I'm frustrated by my lack of output. Like many of the other mom-docs who share in this site, life too often gets in the way of trying to put together a post.

My goal is to discover a better way to incorporate writing (this blog, NaNoWriMo, crazy ideas like "Elena Kagan Effectively Kills the Exercise called Kegel in Early Court Decision") into my daily life - much like exercise, time for family, and everything else beyond that black hole called work. I'm happy to be a part of this group, even if my contribution remains small. But trying to figure out this whole life-in-balance-thing was part of the reason for this blog's existence, right? Let's keep figuring it out together - one post at a time.

A

Blogography.

I started blogging in August of 2006, shortly after KayTar's medical and developmental issues became obvious. My life had just been turned upside down, I had no idea what was going on with my child, I had to quit my job to manage her very busy 5 therapies per week/8 specialists to juggle/endless testing/care schedule, and I felt isolated and a little like I had lost myself. I am a very private person, emotionally-speaking, my best friend is kind of enough to look away if God-forbid I ever start to tear up, because I absolutely hate being outwardly vulnerable like that. Because of my private nature, I never felt comfortable expressing my sadness or anxiety about having a medically-needy child to the people in my every day life, but I needed to process it and and release it somehow, and so I turned to blogging. I know, a blog is PUBLIC, how does that jive with my private nature? I never intended to have actual readers, I just wanted to write through my struggles in an effort to turn the amorphous feelings coursing through my veins into something concrete that I could set aside without having to explain myself or my feelings to anyone. I didn't want to write a post and have my mother call me five minutes later to discuss my precious feeeeelings. I didn't want to hear all of those supposedly comforting platitudes that often come across more like a slap in the face than actual comfort. I just wanted to have my own space to process the new (and sometimes scary or stressful) developments in my life. Thus, The Journey was born. I wrote my first post, "The Waiting Continues..." on August 24, 2006. The name of the post makes me chuckle now, I was so naive and hopeful back then. I thought we had been waiting so long for answers...but here we are 4 years later and we don't have many more concrete answers than we did back then, but life is so much easier anyway.

After publishing that first post, I got three comments...from STRANGERS; warm, compassionate, kind strangers. The simple act of writing the post had made me feel so much better, but the responses were icing on the cake. You know how the story goes from there, I visited their blogs, we made a connection...I visited new blogs, those bloggers visited mine...and I found myself in the midst of a beautiful, supportive community. I didn't feel isolated anymore, I was a part of something. I met people that I never would have had the privilege of meeting in my daily life, people scattered across the nation and world. Some of them had similar lives to mine, some were very different. When it came time for KayTar to get her g-button, it was a few of my blogging friends with personal experiences in this area who talked me through it, three long distances phone calls made all the difference in the world in those moments. When KayTar was inpatient last week for the worst test in the history of tests, the controlled fast, many of these same people were virtually cheering us on. Blogging has never simply been words on a page for me; it has provided support, information, and understanding when it was hard to come by in every day interactions.

Blogging has also afforded me interesting opportunities. When my daughter lost health insurance and could not be accepted into a new program because of her pre-existing conditions, I blogged about it. It was picked up by Johnathan Cohn, who was working on a piece for SELF Magazine. They also flew KayTar and I (and my mother) up to NYC for a photo shoot. I never thought I'd pick up the phone and have a magazine editor ask me when they could fly me out to New York! It was pretty amazing, and without blogging, I never would have been a part of something like that. I've done a lot of advocacy work for children's health insurance reform in my state and at the national level, and my blog has aided in that as well. 

What started as a secret blog has remained a secret blog. My husband knows that I blog, but he never reads it. I told him that he can read it, but I never want to know if he has and we certainly cannot discuss it face to face. My parents don't know, my best friends don't know, my classmates don't know. That is how I want it for now. Proportionally speaking, my blog is still mostly about KayTar, but I recently changed the name to Life with the 'Tars because I feel like that dark, stressful portion of our journey is over and the blog is lighter now and more accurately represents what our lives are really like. A good portion of it is about me now, not as a scared, uncertain mother, but about my own journey as I my pursue a career in medicine. I also like to dabble in photography and I find it is a wonderful way to share that, as well. Sometimes I think about telling people about my blog, but I'm not ready to sacrifice that privacy yet. I find it hilarious when I am telling people stories about the kids (especially KayTar, who is incredibly hilarious) and someone will say, "Oh Kyla! You HAVE to start a blog!" I just laugh and nod. Maybe one day I'll tell them, but I'm not ready yet. I don't blog as frequently as I once did and I don't always have the time to comment on all the blogs that I read, but I an definitely not ready to step away from it yet. I don't need it like I did when I first started blogging, but I enjoy it and setting aside that time to write, purely for enjoyment, is important to me.

I was thrilled when KC invited me to start writing here, because once again I've found myself a little on the outs with my real-life community. People look at me like I'm speaking a foreign language when I start talking about medical training and everything that goes along with it, just like they did when I would start in with therapy regimens and IEPs and ARDs and MRIs and LPs...but here at MiM, discussing those aspects of my life feels perfectly normal.  I think that is the true beauty of blogging, it makes it possible to find or build a community in way that can't always be easily accomplished in your day-to-day life. There are no support groups, or book clubs, or Sunday school classes, or any other sort of easily accessible form of community for mothers of perpetually undiagnosed medically-needed children who are also insane enough to decide to go back to school for a career in medicine...but out here in cyberspace, I've been able to piece that together for myself and it is wonderful.

not blogworthy

I fear I am guilty lately of not blogging enough to warrant suspicion of revealing any concerning details.

And I fear that I am guilty most of the (blogging) time of not revealing enough about that with which I wrestle.

I self-censor in a few ways, mostly thinking about whether or not something that I've experienced, thought about, struggled with, is, well, blogworthy.

I also ask if this is a topic MIM-worthy. Is my online journal post-to-be just about being a mother (or a parent for that matter) or is it just about being a pediatrician, rather than the interdigitating of these two major roles in my life (plus SPOUSE, daughter, sister, and all that).

Often at the laptop in the evening my husband chides me with a gentle "are you blogging" (kind of like the "do you like clogging" line from some Jack Black movie). I want him to want to read what my fellow MIM bloggers are writing, to be as into the fun, the heavy, the sad, the puzzling as I am. But mostly I just pull up the latest doccartoon and we laugh, cringe, and reminisce together over those.

Then I think about professionalism, over-sharing, living in the moment instead of blogging about it, and basically I go back to overthinking it all anyway. Blogging IS one form of reflecting, of which I'm a big fan. But it is also doing so publicly, whether or not "out." I am guilty of posts that are real, but maybe read too much like they've been put through an IRB???

In life I am a person who is not afraid to emote, to tell it like it is, to feel, to cry. I don't know if I am that blogger however.

The Talker

Really, doctors who blog? That was my first response to an ACOG Today article that featured several OB/GYNs who had popular blogs. Curiosity got the best of me, so I began following OBGYNkenobi and TBTAM. It was intriguing to see the similar stories that I encounter on a daily basis, written in someone else’s voice. From these sites, I began following MIM. Despite working with other doctor moms, we rarely talked openly about the challenges the lie in our dual lives. Here was a forum for people like me.

Driving home from work one June day, I began to think of all the bad advice I got as a resident. I wished I had had a reference, like this blog, during my training. So I came home and wrote this post. With some trepidation, I submitted it to the site. Surprisingly, I was asked to join. I was excited to participate, but there was only one problem: I was most definitely not a writer. Hadn’t written anything before, hadn’t ever really ever had the desire. But the initial post was so cathartic to write, and it was so encouraging to see how others responded, that I decided to give it a try. Hey, it was anonymous!

I’ve tried to just speak from my heart. Endeavoring to share words of encouragement or hope when I can. The struggling med student, who is wondering if all the work is really worth it; the resident, who hasn’t slept for weeks between baby and call; the attending, who is trying to create balance without appearing to shuck responsibility: for you, I share insight into my life. My wish is that maybe in our shared experiences you might find some comfort or humor.

The other thing that the site has done, is give me insight into the lives of other physicians. From Physiatry to Pathology, I have developed more empathy towards other specialties. As OB/GYNs we sometimes think we have it the worst, from scheduling to malpractice; but seeing others perspective, has helped me realize that every specialty has its challenges and rewards.

I’ve also started writing for a blog, as myself, which I find to be much more difficult. I overanalyze every post thinking what will my patients or colleagues think if they read it. It’s hard to be entertaining, informative, HIPPAA compliant and not controversial. Despite my angst, for the most part, I’ve found that most people don’t really care.

Only my husband knows that I write for this site, and he’s supportive. He said that he liked my anecdotes and my posts seemed pertinent to the readers. As an aside, he also said that my writing isn’t so much “writing” as me just dictating how I talk. Initially, I thought this was not a flattering comment, but I realized that essentially it was true. I’m not a writer, but I am a talker… and most definitely a great story teller. So, essentially that’s what blogging is for me: my chance to tell my stories. Thanks for listening.

That's So Meta...

My blogging started off way back in July of 2006. I began blogging for a number of reasons, the first being that one of my good friends had a blog about her life that I enjoyed reading, and loved how it was like a journal that could "talk back" to you, so, I totally copied her idea. The second reason was because I enjoyed writing and wanted a creative outlet, the practice of day-to-day medicine does not often lend itself to creativity. The third, more distant reason, was as an anonymous outlet for the frustrations surrounding my job at the time.

Since that time, my job and circumstances have changed for the better, but, save a handful of people, I try to keep my blogging anonymous. I do worry about being "outed." Not so much because I don't stand behind every word I write (because I do), but because I know that not knowing where I am/who I am affords my patients (and me) additional protection/anonymity. Not to mention the fact that it is more and more tempting to self-censor if your identity is known. I do a lot of "keeping up appearances" in my day to day life. I like to have a place to let it "all hang out." At times I worry about what my new partners would think of my blogging, but, at other times, I also have urges to spill about the blog. My husband knows (and he wants to "out" me all the time), a select few of my friends know, and some of the lovely ladies with whom I blog know "the real me." Sometimes I wish that I were not an anonymous blogger, mostly because I'd like to direct my family or friends to certain posts to let them know how I feel about particular issues, and, let's face it, sometimes because I am proud of the blogs that I write and want to brag a bit. Most of the time, however, I am very content to remain anonymous.

Life often gets in the way of blogging for me, and so many times I am struck with the urge to spill all of the thoughts from my head onto the screen. I love blogging. I love that it brings patients and physicans to a common ground, so the better to communicate as people, rather than 'doctor' and 'patient.' I also love the community of blogging physicians, it is so nice to share stories, laughs, and frustrations with those of us in the trenches, and it is also great to provide information and guidance to upcoming residents and medical students alike. Sometimes, however, I feel obligated to blog. I feel as though I am letting people down when I don't write. Then, if I feel obligated to write, sometimes the ideas don't flow as freely.

Ultimately, blogging has changed the way I think about people, patients, and medicine. In many ways, it reminds me every day to think of my patients as real people and not just problems to be solved or diagnoses to be made (or numbers to force through the treadmill). I try to keep in mind that even though it may be my 9th delivery of the day, it is *the* delivery of the day for my patient. I am thankful to be part of this blogging community, and hope to be blogging for many more years to come!

Hate mail, non-anonymous blogging and a favourite comment

I started my personal blog in October 2007, when I was working part-time and mother to a one-, three- and six-year-old. It made perfect sense to me that I take up blogging during the very busiest time of my life: blog posts were tidy, tangible, creative packages I could set afloat on the Internet, when everything else in my life felt messy and abstract.

I knew that if my blog attracted any kind of readership, I could expect hate mail. I prepared myself by deciding that when the first nasty comment arrived, I would see it as an accomplishment, a marker of an ever-widening circle of readers. Then someone called my kids f***ing ugly and interpreting that as a mark of success proved more difficult than I had anticipated.

All posts are vetted by Pete. On more than one occasion he's responded with, "I'd actually file that in the Who Cares Department." I post those ones anyway and invariably they're particularly well-received.

I've never blogged anonymously. For one, I wanted to take responsibility for what I wrote. I also wanted full credit for it. When I write, I consider that anyone could be reading: patients, employers, ex-boyfriends, my mother, my child's teacher. This keeps me cautious, and keeps blogging from landing me in any sort of real trouble. That also means that out of respect for family, friends and even institutions, most of the very best fodder for writing is off-limits.

For example, I won't write about:

• being actively discouraged from pursuing medicine by family
• being raised in a small, religiously and ethnically homogeneous community wherein women pursuing careers was rare and having a child in formal daycare was unheard of
• the refining of my Christian views as medicine affords me glimpses into human hearts, lives and suffering
• the complexities of relationships with friends who home birth, don't vaccinate and seek medical advice through Facebook status updates
  

Though I no longer blog at freshmd.com for reasons detailed here, I continue to blog at Mothers in Medicine for several reasons. For one, writing is a good exercise in putting one's thoughts in order. I agree with Emily Carr:

It seems to me that it helps to write thoughts and things down. It makes the unworthy ones look more shame-faced and helps to place the better ones for sure in our minds.

For another, I value having records of events. I am certain I would not remember the small details of my son's radial/ulnar fracture had I not documented it. I'm grateful I made the effort to describe what my typical day looks like. For me, writing captures memories far better than photography does. It also feels like the most authentic me; my writing represents me much more accurately then my CV, or my wardrobe, or my library.

But what I enjoy most about blogging is having others derive pleasure from my writing. The best blog comment I ever received was from someone who wrote:

When I saw that you were gonna describe each of your morning patients I got so excited I actually got a bowl of chips and some coke to thoroughly enjoy the read.

When I tell a story face-to-face, the response is immediate. When a piece is published in a journal, that very fact is affirmation enough. But a blog audience, for the most part, reads in silence, and that inscrutability can be unnerving. Learning that someone out there is settling in with a snack to enjoy a post is a huge incentive to continue.

Metablogging

Blogging about blogging. I had never heard the term "metablogging" before this topic week, and I love it. There are people out there wondering about why we blog, and how our families feel about it.

When I first started blogging in November of ’08, I didn't really understand what it was, I was just following a suggestion from someone I know. I felt kind of vulnerable, and my now ex voiced his opposition to being subject matter - I honored that as best I could. I chose an anonymous name, and made up names for my kids. Occasionally I would weave him into a tale involving a great parenting moment with the kids.

Blogging became an emotional release for me. Although being anonymous felt somehow protective, I was still cautious about what I blogged about, understanding that when you are putting yourself out there on the web you are never truly anonymous. I had my mentor from residency read my first few blogs and give me tips about what to include and exclude. When I compose stories about work, I often bend the encounter to a point beyond recognition and make sure the time frame of the blog is far removed from the interaction. It was frustrating at first, because I am a stickler for details and precision, but eventually it became fun to fictionalize.

Positives about blogging:

A sense of community. Something to do besides reading after the kids go to bed. I have met a lot of incredible women, and made some amazing friendships through e-mail. Having people read and comment on my own blog makes me feel a little less alone. I do not keep my blog secret from my friends and family, and it has pulled me closer to my brother and his wife, who live pretty far from me, and my other brother who is in law school in another state. Local family generally doesn't read it, because they get enough of me as it is. I was honored when KC asked me to join MiM last fall, and my presence here has widened my blog social horizon significantly.

Knowledge. These girls are smart! I get tips on mothering, doctoring, books, politics, history, and life. When you are a professional and a mother, especially single, there is little time to nurture relationships with other moms at school through activities and play groups. Blogging, following blogs, and commenting on blogs supplements that. Some of my favorite blogs are SAHM blogs. It's great getting mothering tips from those who get to spend 24/7 doing just that (a sometimes escape fantasy for me, on my bad days).

Entertainment. Smart=funny. Nowhere is that more true than our own Fizzy’s cartoon blog. I remember when she started I was instantaneously enamored. Now she has a million more followers than me (not jealous!). Recently, her hosting of Grand Rounds led me to a lot of other blogs that I enjoy following.

Negatives about blogging:

Well, there really haven’t been any.

I’ve been blogging a little less lately, because moving and divorcing are stressful life events - both occurring for me in the last two weeks - but I also made partner Friday, which almost outweighed the negatives. Instead of blogging at night, I’m unpacking boxes. But I was off Monday to meet the U-verse man, so that should change.

I read a fabulous book last week called The Year of Wonders by Geraldine Brooks. The author was a Middle East correspondent for The Wall Street Journal when she happened upon a small town in England that lost 2/3rds of its population to the Plague (Yersinia pestis) in 1666. She was drawn to the history of the town, and studied all patterns of 1600’s sociology from witching to farming to medicine to personal accounts in her research. The tale she wove about a handmaid to the preacher was exquisite. I especially recommend it to Mom TFH, Dr. Whoo, and Rh+ because a midwife passage was one of the most incredible I have ever read - I don't want to spoil it but my eyes got a little shiny and the words blurred. The main character, Anna, lost her whole world in a year, but instead of folding into depression she worked and created a new life for herself. I’m not sure where this book came from, but I found it last weekend in a box when I was desperately looking for an escape, and the story I encountered made me feel the find was serendipitous. We always look to others to buoy us in hard times, and that certainly helps, but the strength we need usually resides within ourselves.

That is what blogging has been for me. An escape, an emotional outlet, and a way to find myself. I’m not tending plague victims, but it has been equally important to me. A couple of years ago, I was desperately lost. Was blogging my only savior? No. My family, my kids, my friends, my partners all helped. But blogging has been invaluable in getting me from there to here, where I'm much happier.

Blogging ad infinitum

In 2006, my daughter was 1. That first year was so full of everything new: new feelings (both good and awful -hello, postpartum loveliness), milestones, joy, challenge, humor...I made some lame attempts to record what was going on in a journal, but I always felt like the richness of that year was lost forever. Sure, I had plenty of pictures (digital camera + first baby = photojournalism insanity).  But, it didn't seem quite nearly enough.

I  soon thereafter discovered blogs, well, mommy blogs (as unappealing as that phrase is to me), and realized what I had been missing. Here it was, the richness. I particularly recall coming across Dooce's blog and being captivated/jealous/inspired by her monthly letters to her daughter which captured the essence of that month in her daughter's development.

I want to do that, I thought.

So, I started a personal blog, mainly intended to be devoted to my daughter. I wanted our family and friends to know about what she was doing, learning. And, I wanted to write (again). I (also) started a monthly tribute to my daughter on my blog, but instead of a letter, I decided I would post her developments in the form of a software update, complete with new features and known operating failures: Version 14.0 was the first release.

At first, the only people who knew about my blog were my husband (who would always be the first to read my posts no matter what) and a few friends and family. I soon discovered a whole community of supportive bloggers whose writing I admired - I'd post comments on their blogs and they would on mine. It was like having a cheerleading section with you - along for the ups and downs on your life ride.

Pretty soon, I was writing on a regional moms blog, freelance writing a blog for Disney (long story, but short version: they found my personal blog and asked me to write for them), and blogging was suddenly a very big part of my life. My husband has always been my number one reader-fan and despite my writing for multiple outlets, always made sure to read my posts and murmur supportive things about them. He sometimes would half-joke that everything - every funny conversation we had -might make it onto the blog. I tried to be sensitive about that since he's more of a private person than me. He once actually guest-wrote about what it was like being the husband of a blogger (me) on one of the blogs I was writing for. I loved reading his perspective.

My family knows about my blogging (even though it still weirds me out when I can see that my retired Dad has refreshed my blog page 20 times or more in one day) and my co-workers. In fact, a whole lot of people who know me know, apparently, sometimes catching me off guard. Mothers of friends have mentioned certain posts to me, and the other day, a former intern of mine stopped by my office to talk about a mutual patient when he mentioned HE was reading Momicillin and wanted to congratulate me on my pregnancy. (In my mind, I manually closed my jaw with my hand. In real life, I smiled back and said, "Thank you!!!")

Over time, I've tended to mask the identity of my family more and more while unmasking my own- I guess I'm making it more about me than about them which I think has more to do with giving them more privacy and exposing myself than about narcissism. (Hopefully.) Personally, I have come to believe in taking ownership for my words and my thoughts and standing behind them, for better or worse.

Blogging invaded my academic life and I started using private blogs for reflective writing with medical students and in 2008, this blog was born. I've had to give up some of the other blogging gigs along the way, but this blog, with its community of readers, with its writers, with its stories, is still one of my proudest bullets on my CV. I owe MiM for producing some of my most valued IRL friendships. These women I write with here are simply amazing.

And the versions? They continued  on until Version 42.0 when I thought my daughter was getting old enough that it was becoming less my stories to tell in so much detail. Like Fizzy, I went back and published all of those old posts in a book, to give to her eventually. Now, I'm up to Version 33.0 XY for my son (although these have become far more sporadic like hers did at the end and plan to publish his own book of posts one day. In a few months, I guess I'll be starting all over at Version 1.0 XY(2)...and so it goes.

Fat Doctor, Versions 1-3

Hello, my name is Sarah Parrott and I am a recovering blogging addict.

In October of 2005, I struggled with emotional adjustment to a health crisis. Because I needed to write to heal, I Googled "online journal", found Blogger and decided my blog's title should be The Fat Doctor, because that's what I am. I chose the username bigmamadoc. My first post was brief, raw and full of anger. I still believe it's the best I ever wrote.

I thought the blog would be just for me, but after a week or so, I realized that taking my blog public would give me more "reason to write." I'm the type of gal who loves an audience. I signed up on medlogs and eventually a few people started to comment on my posts. After I hosted a couple of Grand Rounds, the readership increased. Somewhere along the line I started thinking about my blog as a brand and renamed it "Fat Doctor" and changed my username to that as well. Readers addressed me as FD.

My blog friends became increasingly more important to me. TBTAM, Doctor Anonymous, all sorts of bloggers felt as real to me as the friends I met for movies and dinner. During my hospitalization in San Francisco in April of 2006, Husband printed out the comments on my blog and bring them to me every day. In the heyday of my blog, which was probably Fall of 2006, I was getting about 800 hits a day.

In May of 2007, I was outed at work. Too many personal details...it was bound to happen. My department chair came to my office and said that he was particularly dismayed to read my comments about a recent faculty meeting. He did not ask me to take the blog down, but I did just that. I moved to WordPress and my posts changed tone. Fat Doctor Lite, if you will. It wasn't that much fun anymore.

After changing jobs in July 2007, which probably was a result of the embarrassment I felt about being outed (and the lure of twice my salary), I kept that boring blog going. When I was laid off in 2009 and I needed to find a new job, I took it private, allowing only usernames I trusted to see it. Fat Doctor still exists, and I post there a few times a month, but only a handful (if that) of the 100 or so registered users read it regularly. I believe that blog has started the agonal breathing that signifies impending death.

Meanwhile, it seems a lot of bloggers have outed themselves. What a refreshing concept! I started a new blog as just plain old me. It, too, is extremely boring. I won't discuss work at all. I'm not sure this blog will work out, either, but it feels good not to hide behind an eponym.

Funny, but I don't seem to need blogging anymore. It really served a role when I was worried about dying, but I'm now convinced I'll live forever. Similarly, blogging served a role when I was miserable at my first two jobs post-residency because I could "safely" complain, but that kind of backfired. Now I love my work and want to stay where I am until retirement.


I need a new addiction, perhaps, but I certainly won't choose anything related to exercise. After all, my blogs may come and go, but I'll always be Fat Doctor.

Mom, Are You Blogging About Me Again?

Did you know that more than 133,000,000 blogs have been indexed by Technorati since 2002? That is an amazing number. Now regardless of how many remain active is difficult to assess but it does prove that numerous individuals have found the idea of blogging attractive enough to start one. So, why do we start to blog?

The majority of people want to be heard and known. They want to share their life experience as if the more people know about it, the more meaning it will have. Some want to share their expertise and create a stream of income. Yet others want to blog about family, friends or problems. One of the most popular blogs is a young mother who suffered from post partum depression and her airing of problems resonated with a large audience. She now supports her family with her blog.

I started blogging because I find it fulfilling to write, share my medical and parenting experiences, and I love to interact with people in a variety of modes including the internet. Now, many times I do blog about my family and friends. What do they think about this? Well, to tell you the truth my family doesn’t even read my blog. They wouldn’t have a clue that I wrote about them unless I told them. I really don’t mind because the last thing I want to deal with is the possible criticism. “Why did you say that?” “I would have said this…” Blah, blah, blah!

Blogging is a release from my daily reality for me. It is my time to share a funny story and get feedback from a mostly objective audience. Sometimes I will write about something that has lit a fire under me like watching the movie, “Super Size Me.” Oh my goodness, that got me going about the junk we feed ourselves and family, and personal responsibility that seems to have gone by the wayside in much of America. Everything is always someone else’s fault. See, there I go again! 

So, in summary, I blog for me and for you my audience…if anyone is out there. My family may think I am crazy, wasting my time, etc. But the benefit outweighs the possible criticism, at least for me.

My secret life of blogging

Ever since I was a little kid, I always wanted to have a diary.

When I was about eight years old, my grandmother bought me a little pink diary. With a lock and key! And multi-colored pages! I was so excited, I started writing in it immediately. However, I recently rediscovered this diary and found it was a mish-mosh of entries every 3-6 months, mainly focusing on either my latest math test or my latest crush. I guess grade schoolers don't have that much to say.

During college, the internet was becoming pretty big (although clearly just a fad), and I found a few interesting blogs online. In the midst of studying for my midterms during sophomore year, I decided to give it a go.

Everyone I knew was informed about this blog, which was how I found readership. My parents would make comments like, "You sound a lot more bubbly and happy on your blog than you do in real life." (In real life, I'm apparently chronically depressed.) My blog was also a good way to inform my boyfriend that I was pissed off at him. But for the most part, the entries were shit: brief random musing that had nothing to do with anything. This is a sample entry, that I presumably wrote after learning about Mendel and Martin Luther:

Monks have made a lot of important contributions in history. So I don't want any more monk-bashing, ya hear?

But somehow knowing people were reading kept me going and I wrote in the blog all through college. Then in med school, I took my blog offline, but I kept writing. And now I wrote in-depth entries about my experience going through the oft-times fun but mostly pretty horrible training process. (Anyone who says "I love med school," just know that I hate you. You and med school should go get a room.)

After med school, I discovered Livejournal, and I moved my blogging over there. It has a great format in that not only can you lock individual entries, but you can filter entries so that only a handful of trusted people can read the more personal, gut-wrenching stuff. I've been blogging there for the last five years, with all entries locked. That way I don't have to worry about that thrill of fear in the pit of my stomach when a colleague or family member discovers my blog.

It's nice to have a public web presence though, which is why I like blogging for Mothers in Medicine. But does my family know about it? Other than my husband, no. There have been tons of times when I wrote an entry that I would have loved my mother to see, but then I realized that if I showed it to her, I'd have to constantly be censoring myself here.

I do censor myself somewhat though. It's a mistake to think that anyone on the internet is completely anonymous. Whenever I write an entry, I ask myself if I would be in any trouble if everyone I knew saw this entry. If the answer is yes, I don't post it. A few times I've complained about resident colleagues on here, but I was secretly hoping they'd find the entry and realize what a dick they'd been.

When I started my cartoon blog, I fully intended to tell my parents about it. However, I showed my father, a psychiatrist, this cartoon and he declared it "not funny." I decided that I'd prefer to stay anonymous than deal with any more negative critiques. My husband reads the blog though and he says he appreciates my "really immature sense of humor."

I think the best thing about blogging is looking back on old entries. After my intern year, I went back and collected all the entries into a book, which I published on Lulu for myself:



Recently I was having lunch with some friends and one of them mentioned the idea of starting a travel blog and was looking for advice. I kept my mouth shut, not mentioning that I contribute to three blogs. If I go around telling people that, I may as well tattoo a big L on my forehead. So really, it's my little secret.... not so much because it's scandalous, but more because it's a little embarrassing.