Guest post: Applying to Residency: Me + Baby, Husband, 3 dogs, 2 cats

In less than one year’s time, I will be embarking on two major life changes: having my first child and beginning residency.

I began medical school single with 2 large dogs and a cat.  People thought this was absurd.  How can you find the time to take care of these animals?  This was simple: my mental health is a priority.  The dogs don’t care if I have a test tomorrow and they certainly don’t care whether I make an A or not.   They have no care for what happens tomorrow or in a year…throw a tennis ball for them, and they have it made!

But my final retort was always: “some students do this successfully with kids; I just have dogs.”  (and you can’t put kids in a crate!)

In the meantime, I met a non-medical man – a writer, a professor and a breath of fresh air from the smog of medical school.  He reminded me of who I was before medical school: I liked to read and write; I liked creativity and conversations.  Long story short, he moved down here and we were engaged and married in a little over a year.

Continuing the quest to balance my personal life and mental health with my medical training, I am going to become a medical student, then resident, with not just 2 dogs and a cat (well, 3 dogs and 2 cats now…I’m an animal lover), but also a husband AND a baby.  Is this absurd?

Once interview season is over I will be back on rotations at the community hospital where I have done my core rotations.  After spending almost a year here, I feel like I have a big hospital family.  Revealing my pregnancy has been met with nothing but enthusiasm.  I feel secure in balancing baby with the last of my rotations here.  But before I can take that deep breath…I have to take boards, go on away rotations, apply for residencies, HAVE A BABY, and after my maternity leave, go on interviews…and hopefully match!

First, I debate over how open I should be with programs about having a baby.  During one of my audition rotations, I will be noticeably pregnant.  I suppose this is a good litmus test for the family friendliness of the program.  However, by the time I am on interviews, I will be at least 6 weeks past delivery and will not necessarily have to disclose that I recently had a baby.  Of course, depending on the length of the interview day, I may need to pump!  Perhaps I need to be confident that I can be a mother and a good resident and thus be open to programs.  But this is the problem: will I be a good mother and resident?  Or are these two things going to be mutually exclusive?

I am also debating where to apply and concurrently having the ultimate debate over what I want to be when I grow up.  Fortunately the debate has been limited to psychiatry versus neurology or perhaps both? And has been limited to such parameters since undergrad, maybe before.  I now wonder what's going to change when this little boy arrives?  How am I supposed to know who I'll be 5 months from now let alone 5 years?

My thoughts race from one obsession to another.   Neurology vs psychiatry, neurology vs psychiatry, neurology vs psychiatry.  Graco vs Chicco.  Graco vs. Chicco.  And boards!  Oh no!  Last night I had one of those ugly recurring medical student dreams of nephritic versus nephrotic disorders...

Sometimes I feel like my head will explode. 

I’ve concluded it is easier to just make decisions.  There is no way to determine the perfect decision, and I imagine that there is, in fact, no “perfect” decision.  I decided to go for neurology.  I am intimidated by the work hours, the larger hospitals and the fact that there are no programs in my hometown where my mother could help with our baby.  But I don’t want to live my life afraid of a challenge.  Besides, I probably haven’t said enough to explain that I have the most supportive husband.  He’s even willing to put my career ahead of his (yet again) to be a stay at home dad.

Life is scary and thoroughly exciting, and these feelings are never mutually exclusive.

And I really have no idea what I am getting myself into…

"Emmylee"

Two Years of Eating McDonalds

In my last post, I talked about "my cousin" who fed her daughter McDonald's every day after school for a year. I wasn't entirely honest about that. It wasn't my cousin. It was me. I apologize for the ruse, although I'll explain in a minute.

In any case, I wasn't the one who fed my daughter the McDonald's. I was the one who ate McDonald's. From roughly ages 9 through 11, my mother brought me to McDonald's for dinner every weeknight.

*cue horrified gasps*

According to some of the comments, I now am incredibly obese. I have serious stomach and liver problems. My cholesterol is through the roof. My blood pressure is sky high. I have type II diabetes. And I continue to eat horribly and take my kids to McDonald's with equal frequency.

Except none of that is actually true. My BMI is about 20. My cholesterol level is excellent, as is my blood pressure. I had two completely healthy pregnancies, and both times lost all my baby weight within a month. I certainly don't have type II diabetes. I cook dinner at home most nights, and limit our fast food trips to maybe once a week, with minimal guilt.

How is that possible? According to the comments, I should be in an ICU right now, or at least on insulin.

Let me back up a little....

When I was in fourth grade, I went to a school that was about a mile away from my house. Every day, my mother would come pick me up at school, and we'd walk home together. There was a McDonald's on the way. We'd stop inside and I'd order... well, I don't remember. Something incredibly unhealthy, no doubt. And probably very tasty, since I was a really picky eater. But I do remember I always drank two cartons of lowfat milk, no soda.

We'd usually spend over an hour at McD's. I would tell my mother about my day, then she'd help me with my homework. Sometimes she'd give me a lesson that she made up herself. She bought SAT books, and when I finished doing my homework, she had me work on math problems from the SAT books. (I scored 650 in math when I took the SATs at age 12.) Then when it was getting late, we'd walk home. I didn't watch any TV at night... when we got home, I'd pretty much go straight to bed.

Sometimes these days I'll say to her, "I can't freaking believe you let me eat dinner at McDonald's for years." Her reply is usually along the lines of, "Leave me alone, life was difficult back then. And you know I can't cook." (She really can't.) It's hard to really get angry because I actually have good memories of those days. Maybe I didn't eat the healthiest dinner in the world, but I got some exercise and I learned a lot. Is that neglect? Is that wrong? Would I have been better off if she did things differently?

I guess the purpose of my post was that we need to look at an entire picture before we make a judgement. Or maybe that these little "bad things" we do as parents aren't as harmful as we think they are, as long as we're doing other things right.

Should I say something?

I think that as moms, we have a tendency to judge other mothers' parenting decisions. It's something I try not to do, although it's hard not to.

I was recently talking to my cousin (a remarried, working mom) on the phone. She has a daughter who's almost ten years old, and she told me that since her husband gets home very late from work on weekdays, she's developed a new routine for the last year. Every single day, she takes her daughter to McDonald's for dinner. Monday through Friday, the girl is being nourished by fast food.

I kept my mouth shut because I hate it when people judge me for giving my kids fast food. But I wonder, is this a time when I should have said something? Will years of daily McDonald's cause long term effects and do I owe it to her daughter to say something? Should I just slip her a copy of Supersize Me?

MiM Mailbag: Radiation during pregnancy

Hello,

I came across your blog entitled "Radiating yourself in Pregnancy." I am an interventional cardiologist and normally spend 2-4 days/week in the cath lab. I am 6 weeks pregnant and am a little nervous to be in the lab so often. I know of some other colleagues who spent a lot of time in the cath lab during their pregnancy and everything seemed to go ok. Their babies seem fine. I have a special badge and a maternity apron to wear under my lead and I have cut back to 1-2days/week. Do you think this is enough? I know there is no real answer to this question just looking for some stories to make me feel better:). I see there is a cardiologist among you. Just wondering if there are any physicians out there who have to be in the radiation for their job and did ok with pregnancy. Thanks!

A

Bad Mom

Sometimes you just feel like a bad mom. Not that you're doing anything wrong, per se, but that everyone else is doing a better job of doing everything right.

Usually I'm pretty open and honest about my experiences, but today I just don't want to talk about it.

Instead, maybe you can do something for me, to cheer me up: Give me (at least) one example of something you've done recently or in the past that made you feel like a bad mom.

I'll put one of mine in the comments.

MiM anatomy lesson

Mama: Where's your heart?
Daughter: (points to left chest)
Mama: Yes! And what does your heart do?
Daughter: PUMPS!
Mama: That's right honey! And what does it pump?
Daughter: (thought-collecting pause) BREAST MILK

Is this really news?

I turned on the computer today to see this from cnn.com. The headline for a companion article trumpeted "Bravo to Sheryl Sandberg for Leaving Work at 5:30!" For those who don't know, Sheryl Sandberg is the COO of Facebook and a frequent speaker on topics of women's equality, particularly in business. She's a dynamo--a Harvard business grad, who was Chief of Staff at the Treasury Department (at age 29), a VP at Google (at age 32), and all that before leaving to become COO of Facebook in her late 30s--as well as a mom of two young kids. She's more than impressive and likeable. She's frankly kind of irresistible. Journalists gush on and on about her. And it's hard not to get drawn in to the videos of her public speaking.

So it wasn't surprising to me to see yet another article about her on cnn.com today. But what made my jaw drop was reading this quotation from her in the article:

“I walk out of this office every day at 5:30 so I’m home for dinner with my kids at 6:00, and interestingly, I’ve been doing that since I had kids,” Sandberg says. ”I did that when I was at Google, I did that here, and I would say it’s not until the last year, two years that I’m brave enough to talk about it publicly. Now I certainly wouldn’t lie, but I wasn’t running around giving speeches on it.”

I was shocked. It wasn't that I found her leaving at 5:30 so shocking (ok, a little shocking...she IS the COO of one of the hottest companies in the world). It was that she was admitting it, publicly, on cnn.com of all places, where you can never ever take it back! And, almost immediately, I began to question WHY this should be: 1) shocking or 2) even news to begin with.

There are clearly some professional cultures in which leaving early--and by "early" here, I mean "while it's still light out"--is a no-no. Surgery, venture capital investing, and corporate law come to mind. Even in kindler, gentler fields, including many of the general medical fields or medical subspecialties, many of us leave work at an hour the rest of the world would consider normal or even a bit late--i.e. in time for dinner with our family--like fugitives with the sunglasses on via side exits, hoping to encounter no one. Why should this be?

Over the course of the day today, I have been thinking about the implications of Sandberg's self-outing for my own life. I have a part-time physician job, and I love it. It is a fantastic balance of academic/non-academic, clinical/non-clinical, and at 3 days per week, a rare gem of work/family life balance too. You'd think I would be advertising this job all over town. But I'm not. Sure, I have held court on this blog about the joys of working part-time before. I've even gone so far as to post instructions on how to get a part-time job as a mother in medicine. But none of those things really count in the way I mean here because they're anonymous.

As recently as a few weeks ago, I was giving a lecture to a group of trainees and junior faculty at a prestigious medical center. The person introducing me was briefly reviewing my bio aloud for the audience and said, "In 2006, she accepted her current position as..." He followed that up by saying that he didn't know how I had ended up in my current position, which is somewhat unusual, and suggested that I briefly elaborate on how I came to take that job and what I do there. I explained that the job enabled me to do all of the things I really enjoy about medicine--think about important questions in oncology and design trials to answer them, see patients, etc--without many of the things I find unpleasant about medicine like having to write grants or rush through patient visits. What I didn't say was that the job also offered me a ton of flexibility. I didn't mention that it's the norm where I work for doctors to work a flexible schedule, that it's the rule not the exception for doctors there to work from home a couple days per week, and that, importantly, my boss-to-be had not only been persuaded to make the position part-time for me but had continued to advocate for me in that regard over the ensuing six years, spontaneously reminding people to be sure to schedule meetings on one of my three work days and asking that they be moved when they had been inadvertently scheduled on one of my "mom" days, etc. I had a chance to stand up at a major medical center, where I had been invited to speak because I have achieved some degree of expertise and respect in my field, and out myself as a working mother doing what it takes to make it all work for my career and family. And I blew it. When someone made a comment to the effect that I had two full-time jobs (because my appointment is a joint ones that spans two institutions), I smiled politely and accepted the obvious unspoken kudos. I didn't say, "No, actually I have two part-time jobs that still add up to less than a full-time job." Why not?

Like most part-timers, I have busted my tail at my job for the last 6 years. This is probably the result of some combination of typical doctorly compulsiveness, genuine career aspirations, work ethic, and desire to "prove" to my boss that letting me start and remain part-time was a good choice, both for myself and for future employees. But the truth is that it also allowed me to remain productive enough that colleagues in my field at other institutions never questioned whether I was full-time, and I was just fine with that. I had a sense, rightly or wrongly, that if they knew I was part-time, I would be in some way discounted as not as serious or not as dedicated as the almost exclusively full-time male doctors, or even the full-time female doctors. I'd be in a class all my own, and not in a good way. To this day, many of the people I work with at my own institution have no idea that I work part-time! Almost none of my colleagues at other institutions know.

With the publication of the cnn.com article today, I had a realization that, although I am not now and will presumably never be the COO of a large corporation, I have to some degree arrived in medicine. Whether it's my age or my productivity or ideally both, I am officially mid-career. And I owe it to my colleagues, both those at similar places in their careers, but more importantly those who will follow in our footsteps, to talk explicitly about work/life balance and physician/parenting challenges and solutions so that we can finally walk out the main entrance and call out a cheerful goodbye to all we encounter. It's time to end the stigma of working parenthood. I have decided, it's time.

back to work

Comparing maternity leaves and deeming one the all-out winner feels a bit like comparing the children themselves. I am back at work after my second leave and feeling reflective on what has been the best three months of my life. The same cannot be said of my first leave, but I think I can make a pretty good argument that it was extenuating circumstances unrelated to child A or B that resulted in a very different experience.

First, I wasn’t interviewing for fellowship. As someone accustomed to multitasking long before mommyhood, I mistakenly thought I’d prepare for interviews in the few weeks after my daughter was born. Not surprisingly, this ended up not being a poor plan and I spent the interview season in a state of frazzled exhaustion. In retrospect I wished I had contacted each program, explained the situation, and asked if they could arrange a different day for me to interview while I was still pregnant. I don’t know if they would have agreed, but it never occurred to ask.

As if the pressure of interviewing weren’t enough, the perpetually drunk and/or high man who lived above our apartment flooded us when our daughter was five weeks old. Our apartment was uninhabitable for three weeks, a period during which we were set up with some of our belongings in an apartment close-by.  I had to deal with the agents from our insurance company, his insurance company, and our property manager, as well as itemize and dispose of everything that was ruined.

I was determined that this time things would be different. Obviously there was nothing we could have done about some idiot who decided to make our apartment into a rainforest, but I would make a concerted effort to avoid multitasking if it meant making life more stressful. Formal baby announcements? I decided a Facebook pic was good enough. Baby scrapbook? He doesn’t have one. (Some people are good at the scrapbook thing and enjoy it. I’m not and found it yet another source of stress). Thank goodness I didn’t have any interviews. I told family and friends that if they wanted to see the baby, they had to come to us. I decided to expect very very little of myself on a day-to-day basis.

I am not someone who gets bored easily, so spending an entire day under the weight of my newborn son was pretty close to heaven. I did a lot of reading, writing, and listening to books while pushing the stroller. Dinners were simple.

And I just feel better about the time and attention my son got as compared to what I gave my daughter.

But life moves forward and it is time to get back to work. As a side note, I thought the comment thread after Fizzy’s 4/11 post was fascinating. I guess the question of “how much time is enough” is pretty mommy-and-baby specific.  I myself would love a few more weeks, but I am far from dreading my return.

So lets hear it, ladies – the good and the bad of going back to work. What you did and did not miss about maternity leave.

I’ll get it started-

Looking forward to

More frequent adult conversations. Yes, I miss them.

Being able to eat, drink, check email, and use the restroom on my own schedule

Less back pain

Wearing normal clothing

Eating in the seated position while using both a knife and a fork

Screaming, red-faced men? Not as likely to be my problem

Not looking forward to

Pumping. As a resident I once spilled 4 oz of breast milk on myself at 2am. Arg.

Call nights and weekend workdays

The pager

The everyday drags of medicine that have nothing to do with good patient care

Commuting

I will miss

Being present for every milestone (Gurgling! He gurgles! Brilliant)

Long mid-day naps under a heavy newborn

Blogging! (as frequently…)

Planning the week’s meals around the CSA box’s arrival

Walking my daughter to school in the morning

Mommy and me ballet (on hold at least until the summer)

Lunch with my husband, who works at home

I will not miss

Spending the entire day with no cause to wear a shirt. This gets old.

Which comes first, the pet (companion animal) or the child (companion human)?

Most MiM's probably consider themselves mothers to human babies, toddlers, teens, or to grown children. But a MiM might also be "mother" to a companion animal, i.e. to a pet.

Which did you (you alone or you and your partner/spouse) have first?

The pet as practice for a kid?
The kid as practice for a pet?

Some upsides and downsides either way. Can't learn to breastfeed (or pump) with your pet, but can learn to be responsible, to love a helpless being, to nurture, to teach/train/grow up another living lovable animal.

Toilet training <-----> litter box
Diaper changing <-----> pooper scooper
Taking for a walk <------> taking for a stroll, and then alas those first steps!
Doggy day care <-----> child care

The challenges and triumphs. The shared responsibilities with spouse. The work-family balance. The feeding, sleep training, getting up early, staying up late, clipping their nails, bathing. Not sure if anyone reads to their pet, like they would to a child, but could certainly sing to either!

Taking them to the vet/pediatrician (the two are periodically confused, for that matter). Does a MiM do some of the medical care for their own pet like they might for their own child?

We had our children first, and then (at the daily, no make that TID urging of daughter) brought a bunny rabbit from the local humane society into our house. Was not even a difficult transition (the more the merrier) and quite a learning, loving, sharing experience for us all. The bunny eats better than the daughter (way more kale, greens, carrots). We don't attempt to provide vet/medical care for our bunny (not qualified!) and are recognizing the importance of primary care. Son and daughter aren't quite sure (it changes day to day) if they are "mother and father" to our bunny, or big siblings to the little guy.

Which did you have first, and why?

Worked a day in her life

I'm sure some of you have heard the recent "gaffe" by Democratic strategist Hilary Rosen. When Mitt Romney commented that his wife Ann is his connection to women in this country, and she said that they are most concerned about the economy, Rosen responded by saying the following:

"His wife has actually never worked a day in her life.... she’s never really dealt with the kinds of economic issues that a majority of women in this country are facing in terms of how do we feed our kids? How do we send them to school? And why we worry about their future?"

The Republicans have jumped on this comment as anti-SAHM and even anti-women, and the Democratics have distanced themselves from it and apologized. Rosen was forced to apologize.

Am I the only one who feels that Rosen's comments were incredibly true? I know Ann Romney has dealt with serious health issues and I have nothing against her, but I find it very hard to believe she has anything in common with 99.9% of women in this country, including SAHMs. I mean, how many SAHMs have housecleaners, cooks, gardeners, nannies? (If the Romneys have none of these things, I apologize, but I'm guessing they do. I mean, I would if I had that kind of money.) Most SAHMs are alone all day taking care of their kids, and likely have to economize more than anyone, living on a single income.

Hilary Rosen, on the other hand, is a mom who works full time, and I feel her frustration of having her needs "understood" by a multimillionaire.

In Rosen's apology, she said: "Let’s declare peace in this phony war and go back to focus on the substance."

Very true. I'm really beginning to like this woman.

(Apologies for a somewhat political entry, but this is about being disappointed in both parties. Anyway, it's a Saturday morning, so nobody is reading anyway.)

3 Months Isn't Enough!

Three months is the standard maternity leave in the U.S. Most states will give 12 weeks of family leave, paid or unpaid (often unpaid). A lot of women, especially those in medicine, especially those in medical training, take less. *raises hand*

The reasons women go back to work very early include:

1) Loss of income

2) Fear of missing training/schooling

3) Pressure from peers

4) Fear of loss of job

Some women will cite "boredom" as a reason for going back to work early, but I honestly don't believe that if all the other factors were eliminated, they would make the same choice.

I'm going to go out on a limb and say that three months isn't enough. I'm not the kind of woman who wants to stay home indefinitely, but three months is just way too short. Six months is more like it.

Here's why:

1) Unless you have an amazing support system, you're still a mess at three months. Yes, your baby is supposed to sleep through the night at this point, but did you know that "sleeping through the night" is actually defined as sleeping five hours in a row? And that humans should be getting at least eight hours of sleep per night? So unless you're a dolphin or something, you're waking up at least once per night. You're not even close to functioning at full capacity, likely making lots of mistakes.

2) In all honesty, having done it myself, I feel like three months is too young for a baby to be in daycare. Babies that age need a lot of attention and it's so pathetic how they just lie there and can't really interact on their own. By six months, they're sitting up and almost crawling, so it's not so bad. Plus daycare is a vector for disease that their immature immune systems can't handle as well, so you're guaranteed to get lots of "pick up sick kid" calls, which further decreases your work reliability. Of course, a lot of women opt for a nanny, but that's its own set of problems.

3) The recommendation is to give breastmilk exclusively for the first six months, but that is no easy task to accomplish when you're working full time. It either puts even more strain on your employment or causes you to give up.

4) I personally felt like I wasn't emotionally ready at three months to leave the baby. Maybe that's not a good reason. Or maybe it's the only good reason.

I guess I only came up with four reasons, but I think they're four really good reasons. Unfortunately, the reasons for going back early are even more compelling.

The One Question I Won't Answer

As I looked at my screen to check which patient was next, seeing her name made me smile.

The patient was a delight. I had delivered her first baby two years ago, an adorable baby girl with curly blond hair and rolls on her thighs. The patient pushed like a champ, but despite her efforts, her 10 pound bundle of joy entered this world through a low transverse abdominal incision.

She was newly pregnant with baby number #2.

A perfect flutter of a heart beat was seen on the ultrasound, and all was good.

“Doc, do you think I should try for a VBAC (vaginal birth after c-section) or have a planned c-section this time?” she inquired, as we finished up with the usual questions.

I carefully reviewed the risks and benefits of each, encouraging her to weigh which option would be best for her.

As I finished, I noticed she was pursing her lips in anticipation of a question that she could barely contain.

“But Doc,” she asked smugly, like a jeopardy contestant who knew they had the right answer, "What would you do if it were YOU?"

The favorite question. I smiled and leaned back on my rolly stool.

“Nope.” I said as I shook my head back and forth with a smile, "I don’t answer that one.”

Somewhere there has to be a Readers Digest Article, ‘Top Ten Questions to Ask Your Doctor’ and this is probably #1, based on the number of times that I have heard it.

Initially, when I started practicing and my newly board certified brain was bursting with memorized textbook knowledge and randomized controlled trials, I would fall for this trick. I would rattle off my personal opinion on such matters. Because obviously, I knew best.

No, I personally wouldn’t VBAC, but sure, you go right ahead.

It didn’t take me long in practice to realize that every women is unique. I was biasing these women with my personal opinion on issues that really, I had no business discussing.

I am not saying I don’t give advice. Of course I do, I am a doctor. I give my best medical recommendation in all situations.  However, I do not give patients my honest, personal opinion of what I would do in their specific situation, because I am not them.  And I am not in their situation.

In obstetrics there are multiple situations when women really need to decide for themselves:

VBAC vs. C-section

Natural vs. epidural

Circumcision vs. no circumcision

These are just a few of the very personal decisions that women need to make for themselves. Options that should NOT be decided by their moms, NOT by their friends and definitely NOT by me.

Is this a question you answer?

When breastmilk isn't best

That's right, I said it. Breastmilk isn't always best.

I always considered myself to have a very healthy attitude about breastfeeding. I set a goal for myself to do it for a year, but was willing to occasionally supplement with formula. And when women tell me they want to breastfeed, I try to offer practical tips, including telling them not to stress if it doesn't work out.

But recently, I've realized that my attitude about breastfeeding is far from healthy.

Ways you know you have an unhealthy breastmilk obsession:

--You have passed up a chance to do something actually enjoyable in order to pump

--Your baby is 6+ months and you are still pumping

--...even though it means you leave work later and see your baby less

--Your freezer contains more milk than food

--You have fed your baby breastmilk that might have been going stale instead of fresh formula

--You make breastmilk bottles with less milk than you think your baby will drink so none of it will get "wasted"

--You feel sad/angry when the baby doesn't drink all the milk in a bottle because it is "wasted"

--You have given up sleep to pump

--You have given up sleep to keep your baby from getting a single bottle of formula

--You think formula smells bad

--When your baby does get formula, you feel guilty

--Even though you pretend not to, you secretly judge other women who don't breastfeed for at least a full year

Is this healthy? Is it necessarily in my baby's best interests? I'd say it's often very clearly against my baby's interests, actually.

The way I finally realized this might be a problem was that recently I had an issue with my pump equipment. I found some old crud on the... yellow thing the milk filters through (OK, I don't know what any of the equipment is called). I washed it daily but apparently didn't completely dismantle it properly. I worried that all the milk I had pumped was tainted. Two months worth, about 300 ounces. And I started to panic.

I started to plan: No more skipping pumping sessions. Maybe start pumping again on weekends. Somehow I had to replenish all that lost milk.

That's when I realized that I was being completely ridiculous. My baby is almost a year old and the winter is over... so what if she got a couple of months of formula? Would that really be so harmful? Would it be harmful AT ALL? In fact, might it even be better to give fresh pumped milk and formula, rather than all frozen milk?

(By the way, the above is a great reason never to use donated breast milk that isn't well screened.)

Anyway, I emailed my pediatrician's office and they said I didn't have to throw out all that milk. But part of me still thinks I should, just to cut the chains (and be safe). I haven't decided yet, but I've decided I'll be okay with it either way.

Kicking My Own Butt: 2 Months, 20 Pounds Lost

So here I am, an Internist and a mom, with a 3 month old baby girl and a 22 month old toddler boy, and with all that there is plenty of fodder for writing. All the priceless, precious wacky and aggravating moments that make up parenthood; all the touching, challenging, annoying moments that are doctoring. That's why we write, right? There's just SO MUCH.

But today, this is a simple update on my own journey back to my own body. Two babies in less than two years (plus a bit of an addiction to really dark chocolate) put alot of extra weight on me. I fell off my own fitness wagon. My runner's body gave way to... Obesity.

At 4 weeks postpartum with Babygirl, I realized I was at BMI 30. I kind of freaked out. I started a modified South Beach Diet. I lost alot of weight really fast, I think because I was breastfeeding. Then, when Babygirl was 6 weeks old, my husband was hospitalized with diverticulitis for a week. My plan went by the wayside. There were many days of like, Cheerios for dinner. My breast milk dried up. We went into Survival Mode.

Now, he's fine, I'm back at work, and life goes on, I picked up the free weights again. I started running: 1, 2 miles. Today, I ran 3 1/2 miles. Whoo-hoo!!!

And, even with my schedule and the kids, I have managed to lose 20 pounds in 2 months. I am now at BMI 27 (I'm pretty short.) It's hard, damn hard, but I can't give in to excuses or laziness. (Well, maybe sometimes...)

But if I expect to see change, I have to do the work. That means making myself get up at 5:30 a.m. on a Saturday to go for a run BEFORE the kids wake up. And taking the time to do abs work before going to bed. And planning meals: buying the healthy food, packing it up for myself the night before an early office day. It means resisting desserts. Most of the time.

So, while I am not perfect at all of this, I am persisting. My goal is to lose 20 more pounds, to get back to my pre-pregnancy weight. I find myself empathizing with my patients. Commiserating. Coaching.

So much of my work with patients is in trying, desperately trying, to help people help themselves to get fit. If I can use myself as an example, I will. I know how it is, I'm living it.

I can share with patients about how it's tempting to declare "Diet over!" after giving in to a little indulgence. But this is a HUGE pitfall. I'll talk with patients about how, for me recently, one chocolate-dipped strawberry led to another... and could have led to more and more, but I physically got up from the table and got it back together, and now am seeing results. I'll talk about the merits of hot herbal tea after dinner in lieu of dessert; the handiness of packaged mozzarella cheese stick snacks; the necessity of Truvia.

I can share with patients how hard it is to get in exercise when you work and have kids. How I need to make it a priority, and stay on top of it. Can't go to the gym? Me neither. I haven't re-joined my gym, because I'm not sure I would ever get there. Try running. Jumping rope is excellent exercise. I also discovered hundreds of free fitness videos On Demand. I do abs work at night before bed. I run after my toddler and lift him like weights. And there are stretches of days when I don't move much, and that's OK. It's tempting to declare, Game Over. But that's a common error. Just Keep Going, I tell people.

And I will keep going. Persisting, Resisting. Eyes on the prize.

Next week: 4 miles.

MiM Mailbag: Pumping during fellowship follow-up

Dear Mothers in Medicine,

It's been 9 months since I last wrote to you and I cannot thank you enough for your help and guidance. I was able to continue pumping for 11 months, and just stopped 1 month ago. As busy as GI fellowship is, pumping became something I incorporated into my daily schedule, and fortunately the program was very supportive.

Overall I found that pumping three times a day worked best - once before work, once mid-day, usually after noon conference or a little earlier if I had afternoon clinic, and once in the evening (this was variable, depending on consults, scopes, etc.). Talking to my program director in advance and letting him know my needs really made a difference. So it wasn't a surprise when I showed up. And it made it easier for them to find a way to accomodate me. Most of the time I used an empty exam room to pump, and was able to get work done during that time (working on notes, returning calls). Sometimes if attendings weren't using their room, they would let me sneak in for 20 minutes. Always leaving the room clean and without a trace helped too (no one wants milk stains anywhere!). Soon after I started, I found talking to the nurses about baby and nursing went a long way towards building camaraderie, and they were often supportive if I had a scope but told them I needed to pump - they would let me do what I needed to and come back in 20 minutes (of course some days were very busy and they would let me know if I needed to start scoping right away too).

Staying hydrated is key. I kept a water bottle at our work area at all times, and kept refilling it during the day. I would use rounds or conference time as a good time to drink fluids. Gatorade is amazing, and helped keep me hydrated and held me over when I didn't have time to grab a snack. Also don't underestimate the free saltines, graham crackers, and little juices and ginger ales around the hospital. Those are fantastic!

To any mothers out there who are trying to pump, it can be done but it does take coordination. There were many times when I skipped out from joining my co-fellows for lunch (or drinks after work!) because of pumping. But there were times I didn't have to either. I think setting small goals makes it doable. I initially went in thinking that I had nursed for three months at least, and if I couldn't do it anymore it would be okay. Then I got into a routine, and tried for 4 months, then 6 months, and pretty soon 11 months came around. By then he was walking, eating more solids, and transitioning to whole milk. It seemed like a good stopping point for us. I commend all the mothers out there who make this work, and thank you for your support. I'm not sure what will happen with number two (not expecting now, but thinking about it...)

Thanks again everyone!