MiM Mailbag: Should I stay or should I go?

For my entire life I knew I always wanted to be a doctor, that was never a question.  At the age of 5, I declared I wanted to be a pediatrician, when the bossy know-it-all older sister of mine demanded I have a career in mind.  Since that time, I have had many experiences, working in a veterinary, dental and "human" hospital setting and ultimately chose medicine as my career.  I was a straight-through kind of girl.  College, med-school, residency, boom, boom, boom.  That being said, I always had someone telling what, when, are where, that is, until 4th year.

I finally had the chance to choose what I wanted, where, I wanted, etc and I found it totally overwhelming.  Before medical school, in college, I spent a lot of time in OR's and doing clinical research.  I was for sure I was going to be a surgeon.  Within the first month of medical school, I had an OB shadowing experience and fell in love.  Since that point, I continued clinical research in OB and had a fascination with the pathology, physiology, and academic side of OB.  I did my surgical rotation 3rd year and hated it- except peds surgery which I thought was amazing.  I then did OB, enjoyed the surgery part, but was less than charmed by the OB lifestyle, attendings' attitudes, and inherent "risks."  I then did peds, loved the patients and parents, especially low risk, "pleasant" growth and development outpatient issues, but truly disliked inpatient and the "medicine" behind peds. 

Then began the indecisiveness, peds ob peds ob, I weighed it back and forth a million times, ultimately deciding I would miss the children in my life too much not to do peds and regret the "lifestyle" of OBGYN and malpractice of surgery and deliveries if I chose OB. I didn't even know if I liked surgery, given that as a medical student we were lucky if we even got to gown and scrub much less try our hand on the instruments.  Like many others, I was told, "If there is anything else you like, don't pick this."  So, there was something else I liked, and I didn't pick OB.  I thought, "How will this choice affect my future life and family?" 

I am now an intern at a top program, I got my first choice, interviewed everywhere I applied, and even got married and graduated medical school. With each "celebratory" experience I had this sinking feeling that I had sold myself short.  That I chose what I "thought" would be better.  Chose what would be a "rosier life" where everyone looked happy and ate dinner with their children at night.  But deep down as much as I tried to convince myself that I was happy, I was never really "sold" on academic  pediatrics.  Do I love reading peds articles and treatments? NO.  Did I feel sad when I unsubscribed from the ACOG listserve because it was like a slap in the face each month when I got their mailings? YES.

So here I am, August of my intern year thinking, OH GOD, what did I do?  I did inpatient for a month, NOT a good fit.  I am doing ER now and like the pace, but cannot see myself in that ADD environment for my life, and I only like the quick, "This is a cold you will be fine," not the trached, g-tubed chronic kids because frankly, they break my heart.  I just cannot get the gusto to pick up a peds journal and read the stuff, I have no interest in antibiotic choice for pneumonia, differentiating between nephritic and nephrotic syndrome on a CMP or UA.  I just don't think I love pediatric medicine, but it makes me sad to think of leaving the patients, happy attendings, and lifestyle behind. 

My husband and I laid out a beautiful plan: work hard for a year or max 2 in residency then have a baby and finish in three quick years, BUY a house and become real people with 2 real salaries and get rid of the med school debt.  I want this plan.  I like this plan, the banker and the happy, smiley little pediatrician wife.  The only problem is, I am not sure I can be that person,  Looking toward the next 2.8 years of residency looks like a long lonely road- 3+ months in a chronic care facility, LOTS of months on the floor for heme onc, neurology, and chronic GI patients.  I want to like it, and there are some things I do like, but I am not sure I can fall in love with the medicine, more with the idea of it all.

I have felt a strong calling to switch to OB but every time I get close to doing it, I back away and convince myself not to.  But am I crazy to leave peds at a top program for a specialty I am not sure is right?  It seems so shiny and exciting but is it?  Will I feel better or think, oh no, why did I leave peds?  Is it work the risk?  Should I just stick it out, finish peds, then do a second residency if I really feel that I need/want to?  Is a second residency even a feasible option? 

I don't like being the girl who cries all the time with a charmed life, being tormented by the coulda shoulda woulda bug.  But I don't want to be the mom who wakes up in 10 years thinking "why did I switch?"  or better yet "why didn't I?"  I don't want to be the ONLY unhappy pediatrician anyone ever met because I was wishing I was something else.  

Now, in the midst of intern year, I am trying to sort out- do I hate pediatric floor medicine and is that why I didn't like my first month?  Was it just bad chemistry with my seniors and that made everyone unhappy? Do I hate pediatric medicine but like the patients? Should I give it the old college try and stick out a whole year before I make a hasty decision and switch because once I apply to switch, I am locked into that and out of this?

What is hardest for me in making this decision as that I love the children and the families. I love making them smile, laugh, and feel well.  I love reassuring the parents, and it breaks my heart thinking of leaving them now.  Truly breaks my heart. But academically it is just not there for me.  I want to be that person, but I am concerned that I cannot get up enough interest to learn it all. Are most days in gen peds outpatient clinic happy and well or are they chronic, and labs test follow-up kind of stuff?  Are the NP/s and PA's taking all of the pleasant easy patients away?

I am scared to switch and the uncertainty it brings.  What if I don't like the OR?  What if I have terrible hand eye coordination.  What if I am scared and don't actually like the OB setting?  I have heard that pediatric gynecology exists, but how many of these are sweet chubby babies and how many irresponsible teens?

If I leave peds, that will delay everything, life, children, etc.

I stand in limbo- should I stay or should I go?
 

It's been a while

It’s been a while since he died.   

And yet…   

He is with me daily as I see him in my children, in my own interactions (when I’m at my best), in how I organize myself, in how I enjoy life, still.  

A marker of time passing.  I have now been alive for longer without my father (alive) than with him (alive).  

He did not live to see me in medicine, as a mother, married, making my way.  

And yet…

As a feminist father, back in the day, he helped me know I could be who and what I wanted to be. He was a kind and patient person, who listened, who cared.  Like everything you would want in a doctor, though he was not in medicine himself.  Like everything you’d want in a father of a mother in medicine.

Did I tell him thank you?  I can't remember.  I hope so.

Can Women Have It All? Depends On How You Define All.

I just finished the just profoundly awesome article Why Women Still Can't Have It All by Anne-Marie Slaughter, in this month's Atlantic. This is the article that has all the buzz going about professional women and work/life balance.

It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what I have been feeling and trying to voice to the women coming up the ranks of training in medicine.

Though I disagree with one fundamental point. She feels that most women can't Have It All, and by All seems she means breaking into the higher echelons of their professions, making the highest possible achievements. I agree with her on this.

My feeling is that All can mean something else. All, to me, means achieving total personal and professional fulfillment. And this does not have to mean being the CEO/ Secretary of State/ Department Chair/ Nobel Prizewinner.
When I am asked advice by pre-meds or medical students considering a career path, I hedge my response based on their answer to my questions-- "Do you have or want to have a family? And do you want to spend time with them?"

There are few professions that require as much schooling as medicine. It took a long time for women to get into those schools, to break into the profession. Women now comprise 50% or more of the students entering medical schools. However, we still don't see many women in positions of power in medicine or in certain subspecialties. While women in medicine has been a long time coming, women in power positions in medicine, and women  in certain subspecialties, may be a long time coming yet. The basic reason? The paths to those positions mean too great a sacrifice at the expense of a family.

I wish I could say to any of these incredibly bright, hardworking, determined women that "Hey, with enough brains and hard work and determination you go anywhere in medicine!" But that's bull, and Anne-Marie Slaughter says so in the pages of the Atlantic.

But they can have it All.

If All means achieving personal and professional fulfillment, of finding that elusive work/ home balance, then I'd say, it's entirely possible, but think it through very carefully. Look to the future- Look to the women who are working and practicing doing what you want to do. What kinds of positions are available? Is anyone working part-time? Are family values promoted and respected? Would you be expected to be at work and working endless hours? Is there a lot of call? Would you need to go into the hospital unexpectedly? Etc etc.

If women have or envision having a family someday, I ask them to think really hard about the kind of life they imagine. What kind of a partner do they or will they have-- is this someone who can stay home when the baby is sick/ it's a snow day/ there's an unexpected holiday/ they are sick? What kind of partner and mother do they want to be-- do they want to be present, participating, reassuring, enjoying family dinner, tucking in? If so, can that vision fit with the lifestyle of the specialty they're considering?

When I was interviewing for jobs four years ago, I had just come out of a research fellowship, and I knew that life wasn't for me. Very competitive, getting those grants. I also saw women MDs who aspired to be Heads of Something, or Experts in Something Else, and I knew I didn't want to do that either. I knew I wanted to focus on family as my priority, and to work part-time at a clinical practice with a good "vibe": supportive, flexible, mom- friendly.

I had to really search. I hired a professional job headhunter guy. He kept sending me listings. Some places wanted me to work 10 clinical sessions a week! Others had 1 week of call a month. Ugh.

Now, I'm a part-time internist, with two little kids. I was lucky to have found work in a small, progressive practice, 5 sessions a week, with 1 week of call every 3 months. The vibe? Well, just this morning, I met with my practice head and explained our situation:

Our two-year-old isn't talking. He's been diagnosed with severe delays in receptive and expressive communication, as well as some cognitive delay. He's eligible for all kinds of services. We'll be taking him to speech therapy and group therapy at least... and before that, he needs hearing testing, a developmental eval, etc. We'd also like to get him into some other activities to help him start communicating. This will all take some time, and time involves rearranging my work schedule. Like, dropping my Friday afternoon clinic.

My boss was great. There was no issue here. The support was 100% there.

All, to me, is where I am. Yes, I had to search this place out. Yes, there is tweaking here and there. I'll be glad for a promotion and a raise when it comes. I'll be glad for some adjustments to my schedule; a decrease in clinical time and an increase in admin time. Work sometimes edges into home, and home into work; I think that is natural and inevitable. But I consider all of that to be fine-tuning of an otherwise really excellent arrangement.

Can All be as easily achieved in all the areas of medicine? I don't think so, not yet. So my advice to those making their way up the ranks is to think about what will bring you personal and professional fulfillment, and to work towards a healthy work/ home life balance.

It may be that practice arrangements like mine in medicine are few and far between, but I see them popping up here and there in primary care. Where they are not, then shift work, as in Emergency or Hospitalist work, may be far more inviting to the aspiring physician-mother.

But maybe someone is driven to be the Head of a Department or the Expert in Something, and they feel they will not be happy or fulfilled until they have made the achievement; AND they want to have a family.... In that case, I think the choice of a partner, living close to extended family, and a very organized schedule could help... Personally, I don't believe that these external professional achievements give one true life satisfaction. I think many of us start off thinking they do, and hope they do, but then realize, they don't. Family does.

My way of seeing this: I was trained to do a hard job that I loved. I also wanted to have a strong, healthy family. So for me, I chose carefully. Now, I am doing the job I trained to do and that I love, I do it well, in a great hospital and positive environment. I also spend alot of quality time with my two little kids and my husband and my extended family. "Alot" to me is what I need. I get the time I need with my family.

So I feel very lucky. I have it All. I think we all can, even in medicine, but it takes looking to the future, thinking hard, being honest, and choosing carefully.

Weaning

I've been posting a lot on here about breastfeeding lately, because it's a topic that's been on my mind.

My baby is almost 14 months old and we're still nursing for comfort. She eats a full diet and drinks bottles and sippy cups of whole milk. She certainly doesn't need the nutrition of breastmilk. Mel weaned at 12 months, when I realized she just didn't want to latch anymore, but Baby is much more babyish for her age and somehow it still works for us to keep breastfeeding. It's still the most effective way to calm her down and put her to bed. Plus I really don't intend to have any more kids, so I know this is my "last chance."

I am starting to feel the pressure to wean though. At daycare, one worker shook her head at me when I said I was still nursing. I certainly don't want to be at a point where Baby verbally asks me to nurse. I also got bitten lately, and seriously, ow.

How about you? When did you wean and why?

The living of one's dream

I just completed the first rotation of my Pediatric Intern year. Orientation was a whirlwind of events including computer trainings, mixers, a scavenger hunt, and Pediatric Advanced Life Support sessions.

I pumped when I could and if my infant son hadn’t gone on an expressed milk strike, I am not sure that I would have been able to keep up with his demand. My husband and I found our rhythm somewhere toward the end of my first week of work and thankfully, Zo has started drinking the bottles that I so diligently work to pump 3-4 times while we are apart.

Orientation ended in a flurry and thus began Intern Year. I must admit that I feel like a failure on the home front at least once a week. From not having enough time to help keep the house clean to hearing the baby cry when I am on my way out of the door, the things that send me into a you are a horrible wife/mother frenzy are never ending. Most of these episodes involve tears. Most of them end in me realizing that I am doing the best that I can and that my best is pretty darn good. Yes, my home may not be immaculately organized but it’s clean. We have clean clothes to wear and there are probably only 2 or 3 Cheerios on the kitchen floor. But most importantly the floor is clean enough for my toddler to eat them when he feels the need to have a snack. Yes, that is a huge win!

Now about the crying. I cringe when I hear Zo crying in general. But the crying that begins when I am leaving the house is a trillion times worse because I don’t have time to soothe him and I leave for work feeling extremely guilty and stressed out. Thankfully, my husband, now a temporary stay-at-home dad, has gotten extremely good at being Zo’s back rubber/ soother/distraction guru. Zo hasn’t cried when I leave since orientation because he’s either still asleep or he’s happily distracted.

More important than my once a week failure-fest, at least once a day, I feel pretty freaking awesome. Whether it’s seeing the smiling faces of my family as I arrive home or allaying fears that a patient’s family has had, my life is pretty amazing. I have worked extremely hard to get to this point and now I am a real-life doctor. 

Hearing myself be called Dr. Mommabee is like music to my ears. The first few times I was freaked out but now it sounds good!

Every day I get a chance to learn and enhance my understanding of the human body, pharmacology (which, as a Med Student, I absolutely hated and struggled to understand but now totally respect), and diagnosis. Every day, I am challenged to be a better patient educator, a more efficient diagnostician, a better human being. Every day I am able to share something that I have learned as Zo’s mother that has the potential to make another person’s life better. Every day I realize that I work with an amazing and very talented group of Attendings, Co-Interns, upper level Residents, Nurse Practitioners, and Respiratory Therapists.

Every day I make someone feel better. That is the stuff of dreams!

MiM Mailbag: Mention daughter in personal statement?

Hello Mothers, I've been following your blog for some time now and I am a fan! I'm a current pre-med and have been receiving conflicting advice on what to include in my personal statement. A brief biography: I'm a single mother who has a 5 yr old little girl. I have wanted to be a doctor before having her, but I also realize that she is responsible for the person I am today and the physician I will be in the future. I have been given various opinions that admissions committees could possibly frown because they would be uncertain of my commitment to medical school because I'm a single mother. What are your thoughts of mentioning her in my personal statement?

Locking Up Formula

Today I woke up to this article about a new health initiative in NYC to "treat formula like any other regulated substance, keeping it locked up and given out only under certain conditions."

This makes me furious. Similar to regulating the choice of drink size, this is yet another initiative to take away our choices rather than provide us with more options to help us.

Here are the largest barriers I found to breastfeeding, none of which are being remotely addressed by this initiative:

1) It hurt a lot at first and I didn't see a lactation consultant until I was already in agony

2) My pump cost over $200 and insurance refused to contribute

3) My job was not particularly friendly to pumping

But instead of helping women to subsidize pumps, adding more lactation consultants, or doing anything to give women more protected time to pump, let's instead just take away formula for the two days the baby is in the hospital. That should do it.

Better yet, why not add a sin tax to purchase of formula? Because that's what they're saying: Giving your baby formula is a sin.

Join the discussion

We're discussing the article in the Atlantic "Is Medical School a Worthwhile Investment for Women" on our Facebook page. The article is written by the authors of a soon-to-be published study in the Journal of Human Capital (yes, there is such a journal) looking at the financial impact of a woman choosing to become a doctor versus physician assistant. Some interesting and insightful perspectives (international; MD/PhD; MBA, etc) shared so far. Join in on the discussion (or lurk) if you're interested.

the vitamin racket

I try hard not to substitute my medical judgement for that of a pediatrician. Even though I know it's probably a virus and I don't want my kid on antibiotics unnecessarily, when my little mom voice whispers "oh but wouldn't it be nice to just check in with the pediatrician....?" I listen, and usually give the office a call.

The balance between mom and momMD can be difficult to maintain. When my son was 22 days old he developed a low grade fever for which we sought care in our local ER. Two failed LPs and countless futile attempts at IV placement later, the little mom voice that usually serves me so well was screaming Grab your son and get the (expletive) out of here NOW. But I didn't. I thought of countless febrile-but-stable patients I had met in my short training. How, in the span of a few short hours, some of them would be actively dying in the ICU with clear plastic tubes coming out of every natural and man-made orifice. I thought of the two people I knew who had suffered the sequelae of childhood meningitis - one was almost deaf, the other had had partial amputations of all four of her limbs. I ended this internal debate by breaking into loud, messy tears. At one point I started choking on my own snot. For better or worse (and to this day I'm not sure I made the right decision) we stayed and were admitted to the hospital. And my son is fine. 

I tell that rather unpleasant story to make a point - I try to be a good patient. A good mother-of-the-patient. Even when it conflicts with my own instinct. But there is one thing I don't understand - vitamins. My 3 year old daughter was never on infant vitamins. But my six months son has two different vitamin prescriptions. Two. Our first pediatrician told me it was mostly for "vitamin D supplementation". Perhaps I am prejudiced, but as an internal medicine resident who dutifully checked vitamin D levels on most of her patients, I came believe there was something wrong with the test because every single patient had a low or undetectable level. My husband - a healthy 32 year old who eats a balanced diet and works out in the garden - has an almost undetectable level. I guess I'm saying I don't know what to make of the vitamin D hysteria, so I didn't prioritize (or really, remember), my son's infant drops. When my husband admitted to the second pediatrician that we hadn't been very dutiful vis a vis the infant drops,  she appeared quite taken aback. And then wrote a new prescription, this one for infant vitamin drops with fluoride. I hope "poor compliance with medical therapy" wasn't entered into the medical record. In my defense, we've been very compliant with use of iron fortified cereals - an enthusiasm directly attributable to my hematology training. 

I am all for prenatal vitamins and fluoride supplementation in the water, but my son? He doesn't even have teeth yet. 

Hard, but worth it

I love being a medicine attending in July. It's often more intense work since everyone's in a new role. Bright, fresh interns. Excited new R2s and R3s. And the medical students- the new third-year students who have toiled in the classroom finally get to focus on patient care. Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it's a bit of a vicarious thrill to be re-living that excitement again  - the realization that we have such a privilege to care for patients and to make a real difference in their lives, of being empowered by knowing and understanding, and being consciously aware of our own growth as physicians. As a medical educator, July is a highlight of the year. Hard, but worth it.

On a recent weekend day, I was rounding with my residents and students. Working on the weekends is my least favorite part of attending on the wards. These are days that belong to the family unit; I always feel an anticipatory dread leading up to a weekend work day. Of course, once I'm there and working, it's all about teaching, about patients, and it goes by quickly.

Well on this day, I had finished rounds with the team, but had something important I felt I needed to do before I could leave for the day and catch up with my family. There was a patient whose struggle with his illness had moved me, and I wanted to make sure he knew I had heard him, that I understood. So, I wrote something for him: his story, as told to me, as received by me. Not his History of Present Illness, mind you, but his real story - his loss of his identity due to his illness. This was his suffering I needed to acknowledge. I asked him if I could read something I wrote him.

That moment, of reading those short few paragraphs, was filled with light. There were tears. There was an opening of wounds. There was sharing - so meaningful and real and deep -that it nearly blew me away. Nine years of being an attending and I am still able to be blown away by the absolute honor of doing this work. It didn't matter that it was the weekend. That I was at work. I was simply filled with gratefulness for this moment and for the job I am so lucky to have.

It's moments like this that remind me it is entirely worth it, weekends and all.  It is a gift.


*This patient gave me his permission to share this moment.

Making Friends

I don't consider myself to be a terribly outgoing person, but in high school and college, I had more friends than I knew what to do with. I see these people on Facebook or at random reunions, and while I can't remember what on earth we had in common, I recall we used to be great friends. There was one girl in high school who I considered a good friend, and I'm fairly sure the entire basis of our friendship was that we both watched Melrose Place.

In medical school, it was a little harder, but I still had a group of close friends. In residency, even though I had friends that I used to talk to a lot while at work (I am very chatty, as you may have guessed), I hardly ever socialized outside of work. Between my residency hours and having a baby, I just couldn't find the time or the motivation.

And now I'm just frustrated. I meet plenty of people, but either the friendships don't work out (more likely) or if they do, the person moves away within a year. (I recently discovered the closest friend I've made around here is moving.)

Apparently, I'm not alone. I was chatting with a good friend of mine from med school, who is literally the most sweet, wonderful, and outgoing girl I've ever met, and she told me that she can't make friends. And this article in the NYT confirms what I already knew was true: it's hard to make friends when you get older, especially when you have kids.

One problem I've been finding is that the women I've met who actually have time to have playdates and socialize are all stay at home moms. And it's harder to mentally connect with those women when I'm working full time as a physician. Our problems are so different--it's hard to relate.

Much like the writer of the article, my kids recently had a playdate with the child of a woman I really connected with. We chatted non-stop through the whole playdate. Back in school, this woman might have become a great friend. But I know from experience that we'll be lucky to have playdates every other month. I met a few other women at work that I have really fun conversations with, but I know friendship isn't in the cards if I can't get them to stop calling me Doctor.

Much like that movie, I Love You, Man, I'm trying to approach friend-making the way I'd approach dating:

1) Meet lots of women

2) Don't expect much

3) Don't appear too desperate

4) Take classes or join clubs to meet more people

I also liked what the article said about compartmentalizing friends. I need to realize that my work friends are just going to be friends at work. My book club friends will just be friends at book club. And so forth.

Oddly enough, despite what I consider to be a lack of friends, my social calendar is totally booked with family visits, birthday parties, playdates, etc. Yet another part of the problem.

Facebook Good Samaritan

Like most of the civilized world now, I am on facebook.  At first it was fun and exciting, now it mainly acts as a time suck while waiting around at the hospital.  My news feed consists mainly of lovely updates of what my friends from third grade had for dinner or more recently many pictures of car thermometers in Oklahoma.   I, of course, only post extremely interesting things, like cute quotes from my kids or pictures of the XM radio in my car. Obviously everyone wants to know what song I'm listening to.

I do my best to avoid the usual internet arguments.  I skim past  the anti vaccine or homebirth conversations.  The is definitely no “poli-booking’ for me (discussing politics on FB). I’m not ‘friends’ with patients and try to make sure my behavior is ethical online.

Despite these precautions, I have found some grey areas in social media.

What do you do when people are making obvious bad medical decisions online? What is our responsibility as doctors?

A girl I went to elementary school with was recently pregnant. She lives several states away from me and I haven’t seen her since 4th grade.  Every minor detail of her pregnancy was posted in her status updates. Many of these would definitely fall in the “TMI’ category (ie: hemorrhoids ).

Near the end of her pregnancy she began having swelling, and she would post daily pictures of her 'c-ankles.'

One night she posted a status that made my obstetrician’s heart skip a beat, “I have the worst headache of my life, and I’m seeing little squiggly lines.  I just checked my blood pressure and it’s 170/95”

This update, received several ‘helpful’ comments from friends, family and other third grade classmates, such as “take a relaxing bath” or “try Tylenol”.

I quickly sent her a private message recommending she proceed to the hospital.  These symptoms met the criteria for severe pre-eclampsia. She replied that she had called her doctor and her doctor wasn’t concerned.

Now this was a dilemma. Is she lying? Is her doctor an idiot?  What is my responsibility here?  

I tried to go to sleep, but every time I closed my eyes I kept picturing her having an eclamptic seizure.

I posted a comment or her update, encouraging her to go to the hospital that I was worried she had a serious life threatening condition.

She did not respond.

Two days later she posted that she was going to her doctor.  She was promptly delivered.

Luckily she and her baby were fine, but since this incident (which is entirely true) I have been left wondering, what if she had seized?  Did I do enough to just tell her to go?  Should I have tried to track down her phone number and call her?  Should I have ignored the comment all together?   

Technology had introduced many grey areas in our ethics.  Since we have a social media expert in our midst and many of you are bloggers, immersed in the internet, I thought I would toss this out there and see what you think.

Apparently I’m only worth ¼ of a man

This weekend I attended a surgical conference in a beautiful location.  I had been looking forward to bringing my family with me to enjoy a nice weekend getaway.  I barely got out of the hospital on Friday in order to get there, and as a result I felt totally rushed and nervous about the talk I was supposed to give Saturday morning.  I was slated to give my talk right after the big state of surgery update talk by a surgical big wig.  He talked about the health care reform, the surgeon shortage, the effect of hours restrictions on surgeon proficiency at the end of residency and then he talked about the detrimental effect of the influx of all these pesky women into medical school and now SURGERY!!!! Yes, I’m actually serious.  This dude got up in front of an audience at a major meeting and had a slide that said that four female surgeons were required to equal the productivity of one male surgeon .  Yes, these words were on his slide.  He prefaced the slide with a line about it potentially being controversial, but asserted that it was based in statistics and facts that were not cited at any point in his talk.  One of my mentors was sitting beside me and made an immediate rebuttal in addition to commenting again at the end of his talk.  She made it clear that she was a productive female surgeon and that statements like his are what lead to unfair hiring practices.  I whispered to her that I planned to take one more dig at him when I got up to talk.  And she smiled and told me to “go for it!”

I then got up to do my talk after my introduction by a very prominent female surgeon leader.   Suddenly, all my prior nervousness was gone - I’ve always been good at making waves!  So, I loaded my talk, got behind the podium and calmly mentioned that I was never one to shy away from controversy and that as a former economist I was well aware that statistics can easily be manipulated to support your agenda.  I then mentioned that I would now present the research I completed while pregnant in the lab and more productive than anyone else with me.

It is ridiculous that we continue to fight against these types of stereotypes and misinformation.  The only reassuring thing about the entire situation was that so many people came up to me afterwards in support of what I had said.  Women add value to medicine in so many ways, we are essential.  I don’t have to say much about it.  I’m preaching to the choir here.

ROAR!!!

The Real Deal: My Intern Orientation Part 1

In my idealized vision of Intern Orientation, my first week would be busy, yet amazing. In reality, it was one part separation anxiety hell and one part meeting really cool new colleagues with a dash of partner arguments.

The hell: knowing that I would miss my baby and then really, really, really missing everything about him. Having spent the last 9 months at home with him full-time, gone are the days of sleeping in, play dates with the other stay-at-home mommies, the almost daily home-cooked meals. The first few mornings have involved me trying to ease myself out of bed without waking the baby or my husband only to have the baby pop up and begin screeching as I brush my teeth. I learned after the first day that the only way to make it out of the house on time is to ignore his cries. I have cried on my way to the hospital on more than one occasion. I have questioned why I chose this path. I have felt like a horrible mother, especially since Zo refused to drink more than 0.5oz of expressed milk for 2 days and morphed from a content, happy baby into a fussy fuss-face in the blink of an eye. Half-jokingly, I have contemplated moving to a country without extradition laws to escape the mountains of student loan debt that I have accumulated so that I can stay at home with him comfortably until he begins elementary school.

The cool colleagues: My Co-Interns are awesome. I was very nervous to meet them. I was worried about the clique-ish, fraternity culture of my medical school repeating itself, but the majority of the group seems very committed to providing excellent care and being collegial with one another rather than drinking it up at bars. Though, I know that I will have to make a point to plan some family-friendly events for everyone to participate in. And some wine and cheese socials for those of us who like things more low-key.

The arguments with the partner who I never argue with: The arguments started on the first day. Prior to orientation, my husband had never spent an entire day alone with Zo. Add screaming fussiness, the heat of Southern living, and a baby who refuses to drink expressed milk and you have a recipe for disaster. By Day 3, hubby and I were pretty angry. By then, Zo had begun eating fruits and veggies verociously throughout the day and we had begun mixing breast milk in everything. We devised banana and milk smoothies, rice and beans with splashes of milk for creaminess, I could go on but some of our concoctions made us cringe while the baby lapped it all up.  Additionally, Zo has altered his schedule and now wakes up 6-8 times a night instead of his usual 3-4. So yeah, the arguments about everything from not having enough veggies to me closing the door too loudly resulted in various heated debates and even one “I don’t want to talk anymore, let’s stop talking right now!”

The mid-to-final-verdict: The first few days of Doctor-mommy being away during the day means less daytime milk, many more night time nursing awakenings, and a fussy family. There will be an end, right?!? I’ll post again once the final verdict is in.

Family and distance

When I was about six months pregnant with my first daughter, I got in huge argument with my father. Because he lived so far away me, he wanted to book plane tickets to visit the baby well in advance, and he decided he was going to come on the day before I was due, and stay for a week.

I was not happy. Since it was my first pregnancy, I fully expected to deliver a week late and he'd miss the whole thing. And then be hanging around me while I was very heavily pregnant, and expecting to go out a lot. Plus I didn't really want my family (other than my husband) around when I was actually in labor.

We argued back and forth. Finally, I lied and said that they'd done an ultrasound and changed my due date to a week later. That convinced him.

I ended up delivering on time, but it actually worked out well having him there a week later, since that was when I was at my most sleep-deprived and grateful for the help.

At the same time, my mother traveled great distance to see her first grandchild for the first time. Unfortunately, she came down with a really nasty cold. I was terrified of having her near my newborn with that cold. I imagined the baby spiking a fever and ending up in the ER, and having to get an LP or something. But my mother was not exactly cool with the fact that she'd spent so much money traveling to see the baby, and now she had to stay away from her. She was angry at me for months over that one. (We still haven't decided who was right.)

I don't think I realized before I had kids how important it is to be near family. Other things that were annoying about living thousands of miles from any family members:

1) They didn't visit often

2) When they visited, the trips lasted for freaking ever until I couldn't take it another minute

3) When there was an emergency, we had no back-up we really trusted

4) No free babysitting

5) When one of us was sick, there was nobody around to give us a break aside from each other.

When I graduated from residency, my number one priority was to move closer to family. Right now, we live less than an hour's drive from my in-laws and much closer to my family too. It's not exactly right around the corner, but boy, does it make a huge difference. This time when I went into labor, I had a family member who came that very day to watch Mel. My parents were able to quickly make travel plans after I gave birth, and still arrived before I was discharged from the hospital.

We have family visiting almost every other weekend, which gives us a much needed break. When one of the kids is sick, I can often call my in-laws to come watch them if I know the night before.

I know other people who live in the same town or even the same house as family members. When I was younger, that would have been unacceptable to me, but now I'm jealous of those people. It's amazing how much of a difference having nearby family can make.