It was the best of times, it was the worst of times...

For me to write a post about this particular topic, that is. This is my second week of finals and in keeping with tradition, it has been a little more interesting than usual in our household. Monday night, the boys were at scouts and I had recently tucked KayTar into bed and subsequently settled in to study organic chemistry when I heard a very familiar sound...The Prelude to Vomit in F major. I sprinted to the kitchen for a bowl and then up the stairs, but I was seconds too late. She had already thrown up. I held out the bowl and caught the rest and when I looked down I was shocked to see a couple of teaspoons worth of bright red blood mixed in with her bedtime feed. Once we got everything cleaned up, I emailed our pediatrician and asked her opinion and gave her our best guess as to what happened (nosebleed that was draining posteriorly into her stomach) and she agree we could watch her for a while, but if it happened again, we'd need to go to the EC. Watchful waiting is always a little unnerving, but it is taken to another level when you know you have a final the next morning! I emailed my professor so she would be aware of the situation, in case that is how the evening played out. Thankfully, it all worked out okay, she didn't vomit again and I made it to my final, but I did have to flake on an important organic chemistry study session to be close by in case we had to run to the hospital. It doesn't always work out so nicely, though, in my Spring term, KayTar had emergency surgery during finals week. Our house was burglarized last Tuesday, the day before my music final. Finals week paints a cosmic bulls-eye on our household, but we have survived it yet again.

Before I decided to go back to school full force, pursuing a career in medicine, I talked to several physician/mothers that I respect a great deal. Balance was always a central theme in these discussions. What I learned in talking to them is that it is definitely possible to be both a good physician and a good mother, balance is possible, but it is not always an easy thing to find that balance and balance rarely means the same thing to two people. It is more complicated than usual for our family, because KayTar has special medical needs and my husband works full time and is a full time student, too. For us, these things have been key.

1. Determine YOUR priorities, re-evaluate as necessary. My highest priorities this semester included: Never miss organic chemistry. Go to all of KayTar's medical appointments/hospital visits. Be present and active in the kids' school life. Spend time in clinic. We had several rough spots in the semester, but I never missed organic or one of KayTar's appointments, and I made sure to volunteer in the kids' library as often as possible. I also spent several days shadowing. Your priorities are probably totally different than mine, but just recognizing what they are makes it easier to stick to it.

2. Compromise where you can. I did stick to all of my priority items, but I had to compromise in other areas to do so. I missed history and music on more than one occasion to go to one of KayTar's appointments. I missed several of my son's baseball games because I was in the hospital with KayTar.We skipped KayTar's dance class at least once, because I needed to study. Last night when I was working through 228 pages of organic chemistry and KayTar kept bouncing back into my bedroom like a ping pong ball, I finally scooped her into my lap and said, "I know you reeeeeally want to play with me right now, but I'm studying for my very last test right now and it is very important. After tomorrow, I'm all your for a month!" She understood and went on her way. You can't always do it all, but you can make time for a little bit of everything.

3. Our family is a TEAM. The only way any of this works is that we are all committed to it. Laundry is usually falls under my purview and dishes belong to Josh, but if I'm drowning in orgo, he'll put on a couple of loads for me....if he's writing papers and the sink is overflowing, I'll load the dishwasher for him. I usually pick up the kids, but if I'm in clinic, Josh handles pick-up. Josh cooks dinner, but if he's busy cramming for an exam, I'll cook get some take out for us. If one of us needs a hand, the other always helps out. Extended family is part of the team, too, and without their support (especially my mom watching the kids when they get sick and have to miss school), we couldn't make this work.

4. Take time for yourself/family/friends. I've found that I get a lot more accomplished if I take periodic breaks and do something relaxing, than if I try to power through and do more, ignoring myself altogether. If I'm having an especially intense study session, I'll give myself 30 minutes of free time as a reward every time I finish a section. The kids understand that mom and dad have homework just like they do and for the most part, they let us work and study when we need to. When I'm drowning in coursework and need a break, I'll ask BubTar to play Wii with me or I go have a tea party with KayTar. Sometimes a little time together is all we need. We don't have a lot of time for dates or social events with friends, but when the stars align, we jump at the chance! Everything seems easier after a great date night or evening spent with good friends.

I'm sure there are other important factors, but for us, these are the biggies. As an undergrad, I know that this is probably the easiest my life will ever be...medical school, residency, and practice will take more time and effort than school currently does. Sometimes I think I must be clinically insane to be pursuing this, but I love medicine and I'm committed to making this work. I hope that as time passes and we enter into the next stages of this process, we will continue to find a way to make it all work.

When Balance is Lost

What a time for a "Work-Life Balance" topic - just as I begin picking up the pieces of my life again. I thought I was doing a great job of juggling everything, and even (finally!) finding time to build some friendships - something I previously viewed as too much of a luxury to maintain.

And then, not one, but two of my family members were diagnosed with serious illnesses within a few days of each other. When Husband was initially diagnosed, I remember thinking "Wait a minute - this is the kind of thing that people read about and think Thank God that's not us" - except it WAS us, and I wasn't reading about it, but living it. And suddenly, my carefully constructed house of cards was crashing down around my ears. Scrambling to find coverage so that I could be at his side for two surgeries (one to remove a cancerous tumor, one absolutely unexpected correction of a bizarre bleeding complication) within 10 days strained not only my extended family, but my work relationships. As he was recovering and we had received the fabulous news from his surgeon that the margins were clear and no chemo or radiation therapy would be required, I dared to breathe a sigh of relief.

Barely done exhaling, the next day I received a call from my mother (yeah, I wish I was making up this timing) who lives several hours away. "Can I send you a report from a test I had done?" The report described a biopsy of an intra-abdominal mass lesion, which based on the sample received, appeared highly malignant and possibly metastatic. Um, WHAT? When did this start? You've had symptoms for how long? Back onto the patient-advocate wagon I climbed, this time trying to keep track of everything from hundreds of miles away. And now, several weeks later, Mom is beginning to recover from her surgery, with a follow-up appointment with a radiation oncologist still pending.

So what did I learn from this about balance? For one, that it was remarkably easy to jettison areas of my life that I thought were "musts". A phone call here, a brief (or not so brief) explanation there, and I was able to rearrange paperwork, lectures to residents and even days of patients. The "extra" things outside of work that I used for relaxation and ways to build friendships - gone with the blink of an eye and the click of a "send" button heralding an explanatory email. Will I restart these? Absolutely - at some point in the future. Because although it was easy to dump them now, I know I'll eventually miss doing them - and ultimately, these "extras" are part of what I use for balance.

But for now, I'm focused on making sure that the pieces of my life that I hold dearest are intact before I start juggling again.
A

An exercise in work life balance

I can’t get no… exercise. That’s what went. It left me sometime around the second trimester, about 7 years ago. Previously near daily jogger and once even a marathon. I have the rest of the balance, most days, between what I do at work and what I do at home with daughter, son, and my life partner. As an outpatient pediatrician I only rarely have weekend or evening obligations such as taking phone call, but as an academician I am working for fun (ha!) from home during the late (after the kids go to bed late) evenings because I’m often productive at that time. And then it “frees up” more time during the work day to 1) drop off my kids at a reasonable hour, 2) pick up my kids at a reasonable hour, and 3) interact with other people at work.

But back to the exercise, that is what I gave up, and I am feeling off balance about it. When I read my MIM peers who carved out that time, I am jealous, but the other thing I can’t do is get up early to do it. Love my sleep in the morning, right up until and including those little snugglers who, well snuggle in with us most mornings. I can stay up late at night, too late, easily, but other than using our brand new Wii, I don’t have exercise equipment at home to use in the wee hours. I think for my next big birthday I’ll get a treadmill for our basement. Or maybe Wii bowling will do the trick. Doubt it though. A recent development, while both kids are in non mommy-and-me swim classes I do get to use the workout machine, overlooking the pool at the Y, so that's once a week. Not enough, but have to start somewhere.

Got to get you into my life, exercise.

How to be a resident with a baby (and not lose your mind)

Having a baby during residency is a scary thought. Residency is scary in itself and adding a whole person you're responsible for into the mix makes it even scarier. But I survived it without losing my mind. Here are some tips:

1) Be in a cushy residency.
It's easy to act like a big hero juggling a residency and a baby when you're in a residency that's probably less work than most attending physician jobs. I can't imagine a better residency to have a baby in than my PM&R residency. I took call from home, worked only a handful of weekends each year, and even had several rotations with built in mornings or afternoons free. Sure, it would have been nice to work parttime or not take call at all. But for a resident, I think I had an easier time obtaining the work-home balance than most.

2) Have a husband who's Awesome.
Well, we all have husbands who are awesome, right? My husband was a student when my daughter was an infant and he was able to stay home with her a lot, which was great bonding time for the two of them. My mother is still amused by the delicate care and knowledge with which he prepared her bottles. I can't say it was a perfect situation though, because childcare sometimes got in the way of his studies. Our situation is different now in that he has a full time job, and I'm curious to see how it will affect his relationship with our next child. (He's really close with our daughter.)

3) Have a nanny who used to be a cleaning woman.
When I came home from work every day, the dishes and laundry were done and the house was spotless. That helped a lot.

4) Learn to type with baby balanced on chest.
Probably my first several work presentations were composed in such a way. Very efficient.

So I guess in summary I don't really have any super secret Jedi tricks in order to survive being a resident with a baby. I survived mostly through a combination of luck and making the easiest choices.

MiM Mailbag: Resident mom barely keeping head above water

When I heard about the latest topic week on work-life balance, I became excited to participate and finally submit a post. I've been a long-time reader and often refer new mamas in medicine to the site. I’ve spoken at a Resident Physician Parenting Workshop for the last two years and was a member of a recent Task Force that authored a document called Medicine and Motherhood: Can We Talk? I'm a mother to a joyful (but sleep depriving) 2-year-old, spouse to a wonderful MD/PhD student, and very happy to be finishing a family medicine residency here in Canada shortly. I thought I could write something witty, something useful, or share some secret for success… but all I can do is shout out for HELP!!!

I'm looking for help because, well, this teetering balancing act of physician, mother, spouse, friend, and committee member is about to fall apart!

I've cut back on committees and extracurriculars and even did a career switch (internal medicine to family medicine) in attempt to regain some equilibrium. I have in-laws that are happy to help, use money from my line of credit to have cleaners every other week, and have a fabulous daycare. And yet, I'm still barely keeping my head above water.

Hubby and I barely see each other -- this month I'm working nights in Emerg and he's on 1:4 call for the general surgery service. I think we spent less than 8 hours awake in each other’s company this week.
I never seem to have time to study or read around cases. Hubby feels like he's barely prepared for days in the OR and for exams. I feel like I could be a better doctor if only there was more time or energy.
And this beautiful child, well, he doesn't like to sleep much. And although my brain screams "No Way!", my heart is ready for another baby (or two).

How do you other MiM make it work? Everyone else seems to do it "better" than us -- they study more, are more well prepared in the OR, their dinners are home-made, and their kids are sleeping longer.
Said only very slightly tongue-in-cheek...

-Resident

Balancing Act

I come from the generation of women who were raised from a very young age to believe that they can be and do it all. College, career, friends, marriage, kids, and a perfect family life, unhindered by a stellar career, and of course, a kicking body. As most of us in medicine, I have a strong tendency toward demanding perfection, of myself, of my relationships, and especially of my work. Anything worth doing was worth doing perfectly, down to the last detail, or I just wouldn't do it. Ha. Ha. Ha. And then I got smacked, hard, with reality. As others have so astutely stated, the enemy of good is perfect. Many of my posts on MIM have been pertinent to work/life balance, or, more specifically, lack thereof.

At first, I did a really good job balancing self care, school, and friendships. In med school I made a concentrated effort to work out several times a week, studied most of the rest of my time, and while my older friendships got put more or less on hold, I had good friends in medical school with whom to blow off steam after examinations. Then came love, followed shortly by marriage, best decision I have ever made unto this day, and I don't regret it a bit, but the gym was the first to be phased out in favor of nurturing the relationship. And, to quote the Barenaked Ladies "When we are happy we both get fat and still, it's never enough..."

In residency, he was working, and I was working, and we cherished the time we had together. We hired a cleaning lady who also did laundry, and were able to spend most of our free time together nurturing our relationship and our relationship with our family and friends. Life became infinitely more complicated with one child, and we were nearly pushed to our breaking point when, in the throes of an incredibly demanding work schedule, we had our second child. We lived 14 hours away from much of our friends and family. Mr. Whoo was working 10 hour days, I was working 12 hour days (if I was lucky), and our children were in day care 10 hours a day, despite having a twice a month cleaning lady, any spare time was spent digging out from underneath mountains of laundry, and our life together was coming apart at the seams.

There was no more robbing Peter to pay Paul, and we finally had to make some very difficult decisions. The first of which was Mr. Whoo quitting his job to hold down the home front (i.e. find it under Mount Laundry and the River of Dust) and be available for our children and family. The second of which was my decision to break my contract (which cost us a bit financially) and find a more reasonable call schedule in a location closer to our family and friends. In addition to seeing more friends in person, facebook helped so much in sharing my life with my family and far away friends. I'll be the first to admit, my life is far from perfect, but compared to a year and a half ago, my life is a spa vacation. My children are still fairly young at 3 and 6, and they still have very few extra curricular activities. I know more juggling will be in order once they start, but so far we've handled Daisy Scouts and dance class fairly well. The last thing I have yet to get totally back on track is taking care of my own health. I've lost almost 30 pounds since moving here, and plan to find a way to continue to get back into good health. My *final* frontier, but a kicking body? Likely not.

So, in short, we *can* have it all, with a little help from our husbands, family, friends, and by standing up for ourselves and finding a position that allows us to fulfill our calling as a physician and still tuck the kids into bed most nights of the week. Every woman on this board has achieved so much, each of us in our own way. We've done it all, and so can you.

No balance on the crazy train

I must admit, work- life balance is something I lack.

To be honest balance was a problem for me before marriage and children- well before earning my MD and before I took on the responsibility of caring for extremely sick patients.

I can remember in high school rushing home from basketball practice to work on the lay-out for the school newspaper. With copy and photos spread across the dining room table I would stay up all night long until it was perfect. In college I would sometimes sleep in the laboratory in order to run experiments, even on the weekends. Because of the fear that my work would not be good enough this super human dedication provided comfort that at least I would not fall short in effort. My extreme personality served me well in residency and fellowship, and I excelled.

This is my nature, and honestly this behavior had some consequences. Over the years I learned to accommodate or “tone down” these tendencies. In personal relationships, I realized my expecting perfection was alienating (and annoying). I learned that diversification was necessary to achieve balance, so I included exercise and relaxation in my schedule. Over the past few years I recognize that these changes are working for me. I find that I am happier and more effective through letting go, and exercise continues to be a good outlet for stress.

Fast forward to now, and although a recovering perfectionist I constantly battle feeling overwhelmed and exhausted. Right now I am not working, at home with my 6 week old son. I am determined to use my return to work as a fresh start. I have been soul searching trying to figure out what changes I need to make. This is difficult. One obvious problem- I am not working at all and still feel exhausted and overwhelmed. Not unusual for a new mom, and expected based on the irregular sleeping schedule. But as I review my spiral notebook full of lists I have created…… feeling frustrated that I am unable to make much progress on the multitude of tasks…. I wonder if this is hopeless. It is a similar feeling that I experience when working, with so much to do and unable to achieve the momentum to get to the bottom of the list.

Seriously I need help. From others I know that the first step to work life balance is learning to say no….. but why is this difficult for me? My problem is not saying no (I can be really tough when necessary), my problem is being able to discern what tasks are valuable and which are not.

Examples:
Tasks that are not fun or productive but nonetheless necessary: Just because it feels like drudgery does not mean that it can be skipped.

Tasks that cannot be left undone (someone else must be found to cover): I would rather not do it, but is it worth the trouble to finding someone else? Maybe I should just get it finished already.

Tasks that are opportunities with potential strong upside: These are the easiest to say no to (many of my male colleagues would jump at the chance) but why must I pass on opportunities that I have earned?

With reflection and soul searching I realize my old tendencies are possibly still at play here. That an underlying personal expectation for perfection and fear that my work would will not be good enough still plagues me. I am afraid it is true, and despite significant personal and professional achievement I still rely on external measures of success. I now believe that this is at the heart of the matter. I hope this is the beginning of my next personal transformation…… but still at a loss for how to overcome this hurdle.

I figure that I am not alone- for the ability to withstand numerous years of training and tolerate long hours must commonly be motivated by similar ‘dysfunction’. What is the secret to better discernment? Any advice from those who already figured out how to disembark the crazy train, or from others riding along with me?

Managing Expectations

When I opened the email from KC saying that we were doing a topic week on “work- home balance” I laughed out loud. That particular day, I had failed miserably at achieving any kind of balance in my life. Poor scheduling had put me, once again, working through lunch, not giving me time to eat. I was not on call, so when I went in to tell my labor patient I would not be able to be at her delivery, she broke out into tears, begging me to stay. Home only briefly, I then had to run out to a friends Christmas party that I had promised to attend. A crying child had to be peeled off my leg, “Mommy don’t leave!” as I sneaked out the door. Arriving at said party late without a side dish, I realized I had forgot that it was pot luck. I mingled briefly, feeling guilty the whole time, then headed back home, to tuck in kids and finish editing a journal article that I had gotten at least 10 e-mails on that day (MUST FINISH ASAP!). Crashing into bed much later that night, I apologized to stay-at-home dad/husband for the week of extended hours. His answer was quite profound, “You really need to learn to manage your expectations .”

Luckily that day was the exception and not the rule. I think most days I do a fair job of finding balance. His advice was good though, communication and managing my own expectations for how much I can do is key. I am not superwoman, neither do I want to be.

So, in addition to his suggestion; here are some examples of how I try on most days to implement balance.

1. Schedule exercise. I am sure that one of the things that keeps me sane is that I exercise 3-5 times a week. I work out my frustrations on the treadmill and lap pool instead of my coworkers. I don't however routinely train for races, because this takes too much time. I would like to do a triathlon in the next couple years, but I want to plan ahead for a time when I won't have other projects looming.
2. As soon as you can possibly afford it, hire a housekeeper. This is not a luxury. I put this off way too long.
3. Communication. My husband and I have our phones synced with our home calendar, so any event goes immediately on the schedule. We’ve also started a weekly “team meeting” where we talk through our schedule and expectations for the week. You can also come up with code words for naughty things to put on calendar :)
   
4. Schedule. As my practice has gotten busier I have had to become more strict with my scheduling, for my own sanity. Previously, I would do surgeries or schedule patients during my lunch hour “if it was more convenient for the patient” or “if there were extenuating circumstances”, however these situations became more frequent over the years as my practice got busier. A few months ago, I ended up with surgery scheduled at lunch every day for 2 weeks straight. I re-evaluated my schedule. I realized that eating lunch and sitting down for 15-20 minutes a day was a necessity for my sanity.
5. Prioritizing socialization. I think this is where I feel like I fail the most. I manage to over-commit myself socially and at the same time, still have trouble keeping up with my friends.
6. Spend at least one day a week with the kids with no other distractions. In our house, this day is usually Saturday. Our kids are not overly scheduled. They will occasionally want to participate in activities, but not usually year round. I try to spend one day a week home with the kids, just hanging out and having fun.
   

Now as far as residency is concerned, balance is not always possible. Maybe for some of the residencies that don't require as much call, it may be more possible, but for OB/Surgery/Ortho residencies, its all about survival. You work, and when you 're home, you spend every moment with your kids that you can. That's all I remember, it was a giant blur. It was worth it, though, to be able to do what I loved, but those were years of sacrifice. When it was time to practice I chose a family friendly location and made it work.

My main source of balance comes from the fact that I have such an amazing stay-at-home dad/husband. (I wrote a full post on this in the past, for those commenters who were requesting more information on the topic). This year, in addition to the new baby, he has started a part-time business from home, which has presented its own challenges for us to find balance. Overall, he still does the majority of shopping and childcare. Our relationship is stronger than ever, and I respect/love/adore him more and more every year. I do feel the weight at times of being the sole provider, and I think this leads to overextending myself with my work schedule.

The key becomes realizing that the nature of medicine means that you won't have balance every single day, and that's OK, but you must have some sense of balance overall.

Walking the Line

I’m not just a mother in medicine, I’m a divorced mother in medicine. KC pointed me to Michelle Au’s blog, the underwear drawer, which I follow. She’s married to a physician (I was) , and was kvetching recently over her spouse going to a meeting for a week, leaving her alone with the kids. She lamented over the missed support, and wondered how single moms do it.

Would you believe it is easier for me, as a single mom? That doesn't speak very well for my marriage, but if it worked, I wouldn’t be where I am today.

I have grown so much over the past year, since my separation in February and divorce in September. I have come into the financial light, which hasn’t been easy, but ultimately oh so empowering. For the first time in my adult life, I am not house poor, and not dependent on another to tell me how and if I can spend money. More importantly, I have slowly progressed from a state of mental fragility to one of mental health. I’m not entirely there yet, but my perspective of myself and my surroundings is less tenuous. The highs are not as high, but the lows are not so low. I feel even and grounded. This has to be good for me and my kids.

I hired a sitter to pick up my kids this fall and carpool them around to various activities – something I can see that I needed to do for a long time. Over the past couple of years I was picking 6:00 activities that I could try to do myself with the kids and it was stretching our evenings out way too long. The last thing I need to be doing at the end of a busy day is carpooling them around to swim practice until 7:00 at night. Evenings and meal times were horribly stressful, and bedtime was rushed and, well, not fun. My kids are still only five and seven. There will be time for all this later. This fall the latest activity ends at 6 – and that is our rough day –Wednesday. I’ve managed to squeeze in more cooking and reading at bedtime.

I have less ancillary hired help than I have had since the birth of my daughter, and my house is more clean and organized than it has ever been. It feels warm and homey, instead of cold, stark and empty. I get to create what I want, when I want to. Drag out bedtime reading extra chapters until 8:30? No problem. Let my son crawl in bed with me at 4 a.m. after a nightmare? No big deal. Reading in my bed late into the evening? A luxury I have missed for 13 long years. When I am home with the kids, I get to focus on them entirely. When they go to bed – I focus on myself and my needs. This feels incredibly self-indulgent and wonderful, after years of a marriage that wasn’t working.

My seven-year-old Cecelia sometimes asks me, “Mommy, why can’t you stay home like so-and so? “ She sees the difference. But I love my work, and now that I am divorced, staying home is not an option for me. Even if I was still married, I don’t think I would do well without it. When I first got married back in May of 1997, I had three months without work/school before I started med school in the fall. I degenerated into a couch potato Lifetime addict. Remember? A Baby Story. A Wedding Story. I knew them all. It was sad and ridiculous. My now ex made me promise that I would always work or be in school, he was so fed up with my inertia. Having kids is different – much busier – but when I was off with them for nine days over Thanksgiving, despite the fact that I managed to squeeze in 24 miles of running and 10 or so of biking, as well as numerous wonderful kid memories, my mind still turned to mush and I was itching to get back to work. I do better on a schedule. I have difficulty self-imposing one. And I love what I do – I wouldn’t be the same person without the daily intellectual challenges that pathology provides.

God I worried so much last year (was it only one year ago?) about the drama I would create – my ex and I work at the same hospital. But drama can be controlled, to a large extent, by how you react to it. No reaction often kills it. And it is quite amazing to learn that when you are the subject of gossip, you are somewhat immune to it – as if in a bubble. Like the eye of a hurricane – no one really questions you directly so if you choose, you can be a non-participant. I chose. It worked. It’s finally over, and it was relatively painless, compared to the struggles in my marriage. The year of counseling time we put in at the end has helped tremendously – not in friendship, but certainly in team parenting. He has gone his separate way – I don’t communicate with him at all except in regards to the kids. Our level of civility now, only three months after divorce, is pleasant. I hope it continues.

For the first time in many years, I feel somewhat normal. I am grounded in reality, not mired in fantasy. I am a part of the equation – no longer lost. My work-life balance is exactly where it needs to be. Now that I am a partner, I can choose to relinquish work and money for time with the kids, to create more balance. I finally feel like I am in control. I love being a mother in medicine. That is enough, right now. I’m certainly not an advocate of divorce. But I am an advocate of happiness. I feel like I’m finally getting there.

"Perfect" is the Enemy of "Good"

Over the years, I have come to the painful realization that I am not perfect.

OK, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don't read this, patients, because you wish even more than I do that I were perfect (especially when I'm operating on you). But it's true.

Long ago, I remember feeling that perfect was achievable. In my innocence, I pictured myself with a high-flying academic career in a big city neurosurgical teaching program. I would have a handsome husband with a powerful career of his own, 3 perfect children, and a home straight out of Southern Living. (I even subscribed to the magazine.) Of course, I would need no help taking care of the house, because I would do it all myself. I would have no surgical complications, and every patient would love me. I would be Harvey Cushing and Martha Stewart, all rolled into one!

I think it began to sink in that this was a little unrealistic just before the start of residency. My husband and I had just returned from our honeymoon. I had left myself 4 days to move halfway across the country and set up housekeeping before our first day as interns. With one night left, I found myself staring in horror at boxes still sitting implacably all over our new house. Yikes!

Through our years in residency, we added a baby and a hefty dose of realism to our lives. Thoughts of Southern Living fled from my mind. Indeed, thoughts of homemade baby food, beautifully decorated nurseries, and hosting book and supper clubs also vanished. I felt lucky to keep the bills paid on time, the vaccinations on schedule, and the house clean enough to walk through (with my husband doing a lot of the work himself). Despite all this, we both somehow made it through residency with our marriage intact.

Now it is more than 15 years since that idealistic, newly married intern walked through the door of a new life.

Looking back, I'm proud of much that I've accomplished. I have a thriving practice and a family that seems pretty well-adjusted, despite all the gruesome patient stories told over the dinner table. I'm a lucky woman.

I'm not so proud of how I've balanced work and family over the years.

Anyone who goes into a demanding surgical subspecialty knows what it will be like. There will be sacrifices and long call nights. There will be stress and (yes, Fizzy) tears. There will be time away from family. Anyone who loves a surgical subspecialist knows this, too. My husband knew this when we started dating in medical school. But he also knew how much my career meant to me. He knew I wouldn't be happy without it. He married me anyway.

The decision to marry this wonderful man has been the saving grace of my life. He has done so much with so few complaints. In an culture that is still macho in many ways, he has done a lot of laundry and a lot of childcare. He takes our son to school and picks him up. He helps with homework and goes to pediatrician visits. He has been the hands-on parent where I have not. Without him, our family would have disintegrated.

Not that I haven't done anything, in my own defense. When I'm not at work, I'm all about home and family. I have made it to every band concert and the majority of my son's sporting events. I actually made it to every single football game this season, even though they were on Thursdays. For several years, when my son wasn't eating well, I made dinner from scratch almost every night. Some nights dinner was late, some dinners were frozen from earlier weekend cooking sessions, but they were done. I supported my husband when he wanted to make a radical career change, without questions or criticism. I have tried. I have tried HARD.

But I admit, I have spent long hours at work. Because I'm busy at work, I don't fully appreciate the long gaps they feel at home. And I admit, I have taken my husband for granted a lot, which is wrong. I have leaned on our marriage hard, drawing strength from it to keep doing this incredibly difficult job. I worry sometimes that I may have weakened it too much.

Almost exactly a year ago, I wrote an anguished post here about a day in my life. Seeing it in writing and hearing all the feedback made me see that I had to have better control. Since then, I have worked very hard on finding a better balance.

I have now hired a cook to come to our house and make dinner every weeknight. She does the grocery shopping and some of the cleanup. That may seem pretentious, to have a private cook, but it's worth it to me. We also have housekeepers come twice a month, but this is not new. I have hired another physician who helps me with the patient load in the office (although not in surgery). I have committed to taking a big family vacation every summer and every winter (at least a week and a half). I spearheaded hiring a new practice administrator, who has done such a good job that I no longer stress about every detail of running the office. Things are better, although the patients are no less sick, and the job is still demanding.

I now have a Facebook page that allows me to communicate with friends and family more efficiently. My husband and I had our first "date night" last month - dinner and the new Harry Potter movie. It was wonderful and relaxing. We plan to do this every month now.

I actually asked my husband and son what they thought about my work-life balance to get their perspective for this post. Those two peas in a pod both looked at me blankly and said, "What balance?" We all laughed, and I sighed.

As I have finally admitted, I am not perfect. I am, however, doing my best. They know how much I love them, and they know I am trying. We have a saying in surgery: "'Perfect' is the enemy of 'good'." I don't want to be Martha Stewart Cushing anymore. I just want us all to be content.

Next Topic Week on MiM: Work-Life Balance

For the last Mothers in Medicine Topic Week of the year (the week of Dec 13), the topic will be Work-Life Balance. For the new readers out there, topic weeks are weeks devoted to one topic only, and guest posters as well as regular MiM writers are welcome to contribute posts on the topic. (These started out as Topic Days, but with sometimes as many as 12-15 posts, it got to be a bit much to cram into 24 hours.)

For our Work-Life Balance topic, anything related to the topic is fair game. How we each define/measure/struggle/negotiate it, times in our careers where it was the most/least struggle, strategies we use to achieve it, its importance to us, perhaps what we've done in the workplace to facilitate this for everyone else, etc.

Readers, please submit your posts, if so inspired, to mothersinmedicine@gmail.com. These can include questions to pose to everyone else, as well.

(See sidebar links for previous Topic Days/Weeks)

Hope to see you next week!

Fourth and final

The immediate, unmistakable second pink line on the test laid on the bathroom counter - oh, the power of that pink line. The possibility that it stands for, the hope for a healthy pregnancy and a perfect newborn and another loved child. One slim line that releases a cascade of happy plans.

And yet, personal and professional experience with pregnancy loss have primed me to assume nothing. I'm expecting strikes me as presumptuous. And so I am not expecting. But I am pregnant.

On discovering I had conceived, I was overwhelmed by the sense that this was obviously grand work, this close involvement with birth, and briefly, all else looked anemic. I am thrilled, at least as much as I can remember with my other children. It doesn't feel commonplace; my previous experiences - good and bad - make it that much more meaningful. It's been almost five years since Ariana was born. This me, the 36-year-old mother of three, physician to refugees, living in Deep Cove, has never been pregnant.

I first felt the baby move at sixteen weeks: a soft swipe, a sliding sensation. Then the movements changed to knocks, small thuds, bumps and turns. I often lie on the couch, pants unbuttoned, both hands on my belly, waiting for baby to buck and shift; its solid presence can take my breath away.

I'm 27 weeks, 3 days. I have a globe of a belly, a baby cardigan on the needles, three very pleased children and a non-stop pace at the office that keeps baby rocked to sleep most of the day.

I'm in no hurry to progress. Right now, everything is as it should be.

what's your own "wikileaks" moment?

Have you had anything leak out about you that you hadn't intended? Something your colleagues found out that you had wanted to keep personal. Or something your significant other, kids, family found out about you? Or are you a wikileaker yourself??

One of mine, albeit minor, occurs whenever anyone finds out I was a cheerleader in junior high school. Whoops, there, it's out. Though I am surprised and kind of proud that my feminist mother and egalitarian father "allowed" me to be a cheerleader... cringing as they both must have been until I found tennis. I think about all this anew with my own daughter.

Oh, and future wikileaks on my horizon, when my kids find out I drink a LOT of diet pepsi.

MOC, SAMs, and CME, Oh My!

Maintenance of Certification is a veritable alphabet soup.

I vowed not to blog for a couple of weeks, because I have lots of SAMs to catch up on at night by December 31st. Self-assessment modules, that is. You see, in the age of MOC, it is not enough just to go to conferences and perform the CME (Continuing Medical Education) that has been required by pathologists throughout the ages. I was part of the lucky class to be the first group required to participate in MOC. Maybe in other fields MOC has already been in place, but in pathology it just started four years ago. So now, as a part of CME, we have to find and purchase activities that mandate a pre and post test. Not only that, but we also have to get peer reviews and prove that we are part of a QA/QC (quality assurance and control) activity at our hospital. I haven't figured out exactly how to do that yet, but as the head of microbiology I do attend the QA/QC meetings once a month so I am hoping that will do.

Luckily, SAMs were waived for the first three years, because they were not well set up or readily available. I spent about three hours on the computer last week searching for, and paying for SAMs activities. I have to read 10 journal articles from a respected path journal and pay (did I already mention the pay?) to take pre and post tests.

I was sharing my finds with my co-hort who is a year behind me today, and lamenting over the fact that each module took at least half, if not all of the hour of credit that I received at the end of the testing. Aside from conferences, I am used to these CME activities that my group participates in taking a mere fraction of the time rewards doled out. You know - 20-30 minutes for 5 hours. Another one takes about an hour for 10 hour credits. Now I need to spend about an hour a night to get all caught up by the deadline. Don't get me wrong - I think keeping up with one's field is paramount to being a good professional, I just resent being forced to do it someone else's way and document it meticulously. For me, it takes the fun out of it.

I am currently collecting documents for Phase 2 of reporting. I completed Phase 1 a couple of years after passing my general boards. I had a heart-stopping moment this summer when I received a call from the American Board of Pathology. It was August - I had just sold my house, had six weeks to find another, and was facing the same time frame until my divorce trial. The intercom went off in my office.

"Dr. Shyder, you have a call from someone from the American Board of Pathology. Do you want me to put them through?"

"What? The American Board of Pathology?" At first I thought surely it is a hoax to get me to talk to some salesman. But if it was a trick, it was a new one. I asked her to put them through.

"Dr. Shyder, this is so-and-so from the American Board of Pathology. You were supposed to report MOC for your fellowship at the end of January. We have been trying to get in touch with you by e-mail for months."

"Oh my gosh! I've had a rough year. I'm usually really good at keeping up with these things, I promise. What does this mean? Is my fellowship license in jeopardy?"

She seemed amused, but reassuring. "No, we just need to update your professional e-mail address." I had accidentally given them .edu instead of .org. "Then you have to fill out a form requesting combined MOC reporting for your fellowship and your general boards, fax it to us, and nothing will be due until the end of the year."

Whew.

Anyone else have any MOC headaches to share? I'm not looking forward to the board-like exam in six years to continue my AP/CP (anatomic and clinical pathology) board certification. Luckily I do it all at my job - I can't imagine how hard it would be if I had settled into a national lab job reading only GI biopsies or pap smears. But still - combined boards was hard enough when I had just completed my residency and was used to stuffing massive quantities of numerical and graphic facts into my brain like what platelet aggregation patterns flag Von Willebrand's disease vs. aspirin effect and the numerical likelihood of a unit of blood containing different transmissible diseases. Now, if asked to interpret these tests or dole out this information, I can just look that stuff up - I've got it at my fingertips. I sure hope the MOC boards are open book.

Ode to Mulan

I hate the movie Beauty and the Beast.

We recently retrieved the movie from the jaws of the Disney Vault. I think I liked it the first time I saw it, when I was a kid, but this time it just left a bad taste in my mouth. The music is good, I suppose. But Belle is so annoying. What a horrible role model for girls. Here is a woman who is "smart" because she reads books about princesses falling in love, and has absolutely no aspirations of her own to accomplish anything.

Yes, she wants to leave the town she lives in. And true, she doesn't want to marry the arrogant jackass. But the joyous ending for her is just falling in love with some guy who isn't an arrogant jackass (anymore). Who appears to only like her because she's pretty. Plus she does nothing to help him when he's fighting the bad guy... aside from loving him, I guess.

My daughter has a bit of an obsession with the Disney princesses, as evidenced by the drawings on her underwear, so I can't help but notice that all the movies are like that. Ariel and Jasmine are spoiled little brats. Cinderella falls in love with a guy so generic that he doesn't even have a name and is merely defined by being "charming." It's kind of sickening.

That said, I love Mulan.

We just rewatched it as travel entertainment, and each time, I like Mulan better. If you've never seen the movie, it's about a Chinese girl who poses as a male soldier so that her ailing father is spared joining the army. She completely kicks ass as a soldier and there is only passing mention of her romantic interest in her commander.

But you know what I really love about that movie? Not that Mulan kicks ass, but I love how in the beginning, she sucks at everything. She is terrible at every part of training, and her only comfort is that everyone else is equally terrible. I totally relate to Mulan! Granted, she gets really good within the span of a two minute training montage, but I still like her for it. And I love that she continues to doubt herself until she finally gains confidence in the last sequence.

I think it's such a great movie to show to young girls. Every time my daughter watches it, I want to yell, "Isn't she awesome??!"

Does anyone have any other examples of movies we can show our daughters to inspire them not to turn into whiny brats ogling some handsome prince?