When Does The Doctor Get To Call Out Sick?

We've seen posts on this before... But I struggle every time I'm ill. This week, it's not so much my own illness that's been the major problem. It's the kids'. Because they can't sleep. And if they can't sleep, we can't sleep.

It started last week with this upper respiratory bug that's going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the "Three Year Cold". This one was really bad as it hit me on top of my undertreated seasonal allergies and having a 9 month old who doesn't sleep through the night. (I'm just not getting to the Neti pot.)

So no surprise that after a week of this virus, I started to get an earache. Within an hour the earache went from kind of annoying to consistently throbbing. I had a colleague look at my ear to confirm that there was a dull, red, bulging TM there. By the time I got to the pharmacy to pick up my antibiotics, it was screaming, pulsing, popping. I kept putting my hand to the canal expecting to feel pus and blood.

This is on top of a toddler and a 9-month old with copious nasal discharge and coughing. The baby HATES having her nose aspirated, but is used to sucking her binky as she falls asleep. With all the green mucous, she can't suck the binky and breathe at the same time. Thus, misery, for her and us. It's been over a week with this struggle to clear her little nasal passages so she can soothe to sleep...

Our toddler is a bit better off, but still cranky, clingy, picking at meals, whining... And waking up during the night coughing. A cup of juice and some quiet rocking lulls him back to dreams, but meantime, either me or hubby is up, again.

Night before last, it was midnight, and neither child had been able to fall asleep yet for more than a few minutes. Stuffy snotty noses, coughing, diarrhea poopies, fevers, et cetera et cetera, and we had spent hours trying all the tricks... Steamy shower, nasal aspirator, saline wipes, Tylenol, juice, singing, reading, cuddline, cartoons... And I had to be up at 5:15 a.m. for a 7:40 am start time in clinic.

I admit that I kind of lost it. I was personally miserable with my own symptoms, exahusted from several nights in a row of this sort of shenanigans, and I knew I would have only a few hours' poor sleep before I had to truck it to the city and take care of people.

"You have to call in sick," insisted my husband.

"I CAN'T," insisted me.

And I didn't. The kids eventually drifted into snoring/coughing but sustained slumber. My alarm went off at dawn. I hauled my sorry drugged-up ass into the shower, and made it to work alive. I popped Phenylephrine, chugged Dextromethorphan, snorted Afrin, gulped a whole lot of coffee, and tucked a full bag of Ricola into my white coat pocket. I saw my full panel of patients. I got some looks from people, colleagues and patients alike, for my red, swollen, flaky nose, and this wet cough. I kept assuring people, "I'm at the tail end of a cold, I doubt I'm contagious. It's my own misery."

I've commiserated with colleagues. Everyone's been through this before. But we all agree. You SHOULD call in sick for this stuff.... But we all feel like we CAN'T call in sick for this stuff.

So when can the doctor call in sick?

I remember as an intern on a busy overnight call, one of the senior residents started the evening with GI bug symptoms. It was severe, coming out both ends. By 1 a.m., he was laid out in the call room, and the nurses hooked him up to IVs. Still, we interns were coming to him for all the usual overnight precepting: running admits by him, reviewing labs, discussing cases. There was no question of, could he go home sick. We knew that he was febrile and dehydrated and not thinking straight, but it was like, there was no choice. And in the morning, the attendings heralded him as a hero for sucking it up and holding down the fort, despite having active nausea/ vomiting and diarrhea... that was contagious. That left a strong impression on me. Today, I think that was INSANE.

More recently, I had to fight with a patient of mine who also happened to be a surgeon. She had developed flu symptoms and wanted Tamiflu, but didn't want me to test and confirm Flu, so she wouldn't have to call out sick, as is mandated by Occ health. "I'm on the schedule, I have to operate," she explained.
Those are extremes. More common, I think, is our family's situation. We're all miserable, but can't justify calling out.

What would you do?

Mommy track

I was just thinking the other day about whether there can or should be a mommy track in medical training.

There are other fields where you can have the option of training part time while building a family. Why not in medicine? And this would eliminate resentment aimed at mothers who might need to leave early or call in sick more often due to obligations at home or pregnancy during residency.

I'd imagine residents would take longer to graduate and get paid half salary. If the residency was primarily inpatient, that might be a little trickier to manage, although in outpatient rotations, I'd imagine the resident could just work half days. In a field like PM&R, I could definitely envision how it might work.

What do you think? Is parttime residency a good idea or a bad idea?

Guest post: Bitten by the green bug

I never thought I would meet someone who is jealous of a med student. Not the kind of "Oh, I wish I got in to X school" type of jealous. The real "wow, you are so busy and love what you do and I want that" kind of jealous. Unfortunately, it isn't a friend or former classmate who was bitten by the green bug; it is my husband. Since we moved to a new city in July once I got into med school, he only had a few months to find a job before the financial and family pressure set in. Now, 2 months later, he is 3 weeks into a job- what he did think was his ideal job, but he HATES it. Hates it to the point he regrets moving, I feel like a cheerleader every day trying to make him happy at home, and this whole situation stressing me beyond the point of what I thought was stress-able. The fact that I LOVE school but also need to study all night doesn't make it too much better. Has anyone else had a spouse/domestic partner who had trouble during training/after? Any ideas?

-SmMommy

I am a mom of a beautiful, smiley 5 month old daughter, wife to a wonderful (if not too happy at the moment) husband, and first year medical school in the school of my dreams somewhere near a coast.

Having kids "young"

I felt very young when I had my first child. There were times when I felt like a knocked up teenager. Mostly because most of my friends and colleagues didn't have kids yet (there were, in fact, no parents at all amongst all the residents in my program) and seemed to be waiting for some undisclosed time in the future.

In actuality? I was 27 years old. Two years older than the average first time mom in this country. Six years older than the average first time mom in 1970.

More and more, it seems like women are waiting until their thirties or even their late thirties to have children. In medicine, I think it's a function of trying to get difficult training out of the way first, which I can certainly understand. There are times when I question my own decision to have kids so young. But ultimately, I think it was a good decision. I've written here before about how I think that career advancement can always be postponed, but having kids is the one thing that's time sensitive for a woman.

Here's why I'm glad I had kids "young":

--Pregnancy was much easier in my twenties than my thirties. The difference was actually surprising, and my glucose numbers were even worse the second time. I had zero complications in my first pregnancy. And since I was so young, I didn't have to go through any invasive testing like amniocentesis.

--Caring for a newborn was easier in my twenties than my thirties. My body was much more amenable to it when I was younger and I had far fewer aches and pains.

--Presumably I'll continue to have more energy to do stuff with my kids throughout my thirties, compared with parents in their forties. I've heard a lot of older dads complain about this.

--My parents are younger and have more energy to help than they would if I had waited till they were in their late 60s to have kids. And similarly, I'll have a greater chance of being a young grandma, who can help with and appreciate my own grandkids (*fingers crossed*).

--I never had to go through the pain of trying to conceive while all my friends were having babies and posting photos of them on Facebook. If I did have trouble TTC at 27, I would have had more time to work on it.

--Arranging coverage was amazingly less burdensome as a resident than it was as an attending.

--At this point, since I feel "done" with childbearing (IUD willing), I can expand my career and take on new obligations without worrying about another pregnancy and baby interrupting things.

--Kids are awesome

Of course, I'm sure there's a similar list of benefits to having kids at age 40.

I dread/ hate "Family-Centered Rounds"

* I apologize in advance for the number of times I use the word “hate” in this post, but it’s gone beyond dreading into the realm of hating. Let me explain:

I have a background in Health Promotion and I always try to find ways to incorporate patient understanding and literacy in to my interactions. I realized early in medical school that I dread and now hate rounding. Absolutely hate it. As I have often seen it, it is Team-Centered with the patient/ family on the periphery. It is not health promoting. The literacy level is directed to professionals. All big no nos.

After a week on the Wards, I realized yet again that I hate “Family Centered Rounding” for pediatric patients due to the following reasons:
- way too much information is being spewed at parents who have probably just woken up
- way too much detailed information is being reported; if medical students and Interns have trouble keeping up how do we expect families to?
- there are way too many people in the room who have only minimal involvement with the care of a particular patient
- it is unprofessional and unappealing when folks with minimal involvement are only half-present (ex. the other Interns working feverishly to complete notes and orders on other patients)

And my biggest concern is are we hurting patient care when we list detailed and often scary differential diagnoses and mention lab tests that we probably will not perform?

I could go on and on but I won’t. I think Family-Centered Rounds has the potential to be a wonderful educational tool for families, a way to increase engagement in the medical decision making process. At least as I have seen it (at a large urban tertiary care center and at a medium size community hospital), it falls short. Rather than complaining without taking action, I am very interested in helping make these rounds better at my hospital, for our patients. I am motivated, selfishly, to at least work toward making the process less dread and hate-inducing for myself so that I don’t completely omit becoming a Hospitalist from my list of possible future careers.

Questions:
1. How do Family-Centered or Patient-Centered Rounds work (or fail to) at your institution?
2. If you could change this process and make it better given time constraints, what would you do?

I think I see a Quality Improvement project simmering . . . .

Oops Babies

It seems like there are a lot of "oops babies" out there.

I know a bunch of other people who said they only wanted one or two kids or no kids, but then "oops." It seems like everyone I know either had an oops baby or knows someone who did.

I question the concept of oops babies. I wasn't trying to get pregnant either time I did, but I know I wasn't trying very hard not to. (Mistimed natural family planning.) One of my friends in residency got pregnant "by accident" twice, although one time it sounded like she wasn't using any protection. A friend of mine who got pregnant in high school wasn't the result of a broken condom but no condom at all. I do know a woman who got pregnant on birth control pills, and I have to wonder if she was taking them correctly. I wonder how many genuine oops babies there are, or if they're really "should've known better" babies.

Right now, I feel like 99% sure that I don't want any more children and I certainly feel like the stress of another child would be unbearable right now, so I got a Mirena IUD. It's supposed to be greater than 99% effective and as effective as sterilization procedures. But the more stories I hear, the more I worry about an oops baby.

I let a patient do my hair.

Oh yes, I did.

This is not a level of intimacy with which I am that comfortable, but when it became apparent within minutes of starting our appointment that she was not going to Let This Go, I acquiesced.

I was running late, and the messy braid running down my back was obviously going to be a barrier to our getting through a few important issues in this otherwise routine follow-up visit. Before you go thinking this is terribly creepy or whatever - she identified herself as a "trained beautician" who wanted to make me look "as beautiful as the pastor's wife".  Fine. Fine. FIX ME.

I doubt very much any of my male colleagues would have allowed this to happen. I speculated as to if female physicians in other fields would have consented to an exam room "make over". Do patients ask to re-do the surgeon's hair? The psychiatrist's? Surely not. Eventually, as she was still twisting my hair this way and that, I rounded my way to the realization that few, if any other female physicians would find themselves in this position.

This might, in other words, be a me-specific problem. And I am wondering if I should be bothered by it, because, aside from feeling a bit bashful at the time, I'm not. I just hope years of medical training and motherhood aren't eroding an occasionally whisper-thin sense of self-preservation.

But hey, even if they are, I still got a new hair-do that earned me some compliments later in the afternoon. Self preservation? Ah, just FIX ME.

the other parents in medicine

Just got to thinking, is there a fathers in medicine group blog? 

Fathers in medicine who are reflecting on their careers, their choices, their balance or perhaps lack of it, their children, their partners and families, their co-workers, their time off, their time on, their weekends/evenings/late/early meetings, their yearning to breastfeed or pump (!), their commute, their biological clocks, their practice, their burnout, their paycheck, their research year, their struggles, their stresses, their joys, their tears, and...   

reflecting on us mothers in medicine, of course.

What else might they reflect on?

Much needed breaks

Upon returning home most days, I am an exhausted Intern. I have an hour long commute from the community hospital that I work at and by the time I get home all I want to do is lay on the floor and play with my infant son. At first I felt guilty about not taking time to read scholarly articles or to study more about my patients, but crawling around on the floor, having a glass of wine with dinner, and taking a long mommy-baby bath with rubber ducks and squishy toys just feels right.

My husband, ever the appropriately-timed Librarian, forwarded me an article entitled “What some people call idleness is often the best investment” last month that I have just gotten around to reading. Written by Ed Smith it discusses how regular idleness, or stillness, is essential to being extremely productive during times when intense energy is needed. The article rang true for me on so many levels. Although I hadn’t realized it, I learned the value of being idle during medical school. Marathon study sessions require intense breaks; my best breaks involved good food, good time with friends, and lots of exercise and rest.

Now as an Intern, I have to fight the urge to be busy all day long. I have been doing my best to take time during the day to breathe, get a snack, check in with our Nanny, and be idle even if it is for only 5 or 10 minutes. I cannot count the number of days hunger has assaulted me reminding me I haven’t eaten in hours or my aching breasts let me know I have gone too long without pumping.

Pumping has provided a wonderful opportunity to be somewhat idle. While my pump whirs and pulsates, I look at videos and pictures of Zo on my phone. I am a little sad that my built in “breaks” will be coming to an end in a month or so when I stop pumping. Zo turns 1 in in less than a month and my sore nipples are very tired of the 4 times a day pumping sessions. I will do my best to incorporate small “idle” periods in the workday even once pumping is over because I wholeheartedly believe that trying to be busy all day results in inefficiency and burn out. Once home, I will continue to “cut work off” unless absolutely necessary and roll around on the floor with Zo, take our daily baths, and teach him the power of being idle.

MiM Mail: Two doctor families

Hi MiM community,

I discovered this blog fairly recently and I think it is really wonderful that this community exists. However, I haven't seen very much here or anywhere (online or in life) by women who are part of two-doctor/medical student families, which is my situation. I am a mother of one, in my third year of medical school, and married to a first year resident. To say the least, my life is very busy. At least when we were both studying all the time our hours were flexible! We're fortunate enough to have both of our families close by, and we have amazing childcare. It really hurts that I see my child so rarely; he spends most days and some nights with one of two babysitters and our families, which often needs coordination on my part, but he loves them all so at least I know he's happy. So far, he seems to be handling the changes in our hours very well; I think I'm more upset by not seeing him than he is. We're slowly making adjustments to our life to make it more possible to keep everything going somewhat smoothly.

But, what it comes down to is that I'm completely overwhelmed by this new situation. I'm also uncertain that I and my family will make it through to the end of my training - I have at least five years to go and I just can't imagine continuing in this way for so long (or even longer if I want to do a fellowship.) I know that medical school and residency are incredibly hard and that this is an investment in my future, but I'm frustrated with my life and how it seems so out of control. Also, I don't think that I'm living up to my own standards of what a good medical student and a good mother/wife should be - both of those roles force me to sacrifice part of the other so in the end I feel mediocre at best in both. Having my husband often out of the picture thanks to his crazy schedule doesn't help either - I sometimes feel (almost, since thankfully I don't really know what it's like) like a single mother.

I'm sure part of this is the adjustment to a major change in our lives and our schedules. For all I know, this is typical of two-doctor families who are going through training together. This is the also the first time that I've had to confront the challenges of the 'work-life balance.' But I'm starting to wonder whether maybe I'm not cut out for this and should look at alternate careers (I wouldn't leave medical school at this point, but I'm really having doubts about doing residency). In any case, it would be great to hear from people out there who have dealt with or are dealing with a similar situation, or really anyone at all. Thanks!

R

Showerless

I've had two babies and zero baby showers.

What does it matter in the scheme of things? It doesn't. But it's still something that upsets me from time to time.

I didn't expect a shower with my first. I was just starting a new residency and lived thousands of miles from my family and friends. I certainly didn't expect the residency program to throw me a shower. And they didn't.

But there were some hard moments. Like when we were having a team meeting and they threw a spontaneous baby shower for a therapist who was a month less pregnant than I was.

The nurse manager did gather a few presents for me contributed by nurses, which was nice. It wasn't a shower, but it was a nice thought. I wasn't even all that upset about it until the next year, when another resident got pregnant and an attending told us to organize a baby shower for her.

I always thought that someday I'd have another baby and I'd be in a place where people knew me and liked me, and then I'd get a baby shower.

Then I got pregnant about two months into a brand new job. The floor I worked in my hospital was not the nicest floor in the world. As far as I could tell, they weren't big on organizing events for people. Two other women delivered before I did, and I'm pretty sure nothing was organized for them. So once again, I made it through my pregnancy without a baby shower.

Now I work on a floor where everyone is totally into organizing parties for people. I've already contributed money for a bunch of baby showers and bridal showers. And every time I go to one of these parties, it pains me. Because everyone thought to organize a party for these people and nobody thought to do anything for me. Ever.

I know it's such a lame, unimportant thing to get upset over, but I can't seem to let it go, mostly because I keep being reminded of it over and over. I mean, it seems like every other woman in the world has had a baby shower, and some of them multiple showers. Mostly, it just makes me feel unloved.

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?