Awesomeness

Yesterday I worked with one of our part-time attendings.  She had two cases scheduled.  The first went smoothly.  It was a bit complex and atypical of an operation but it went well and the patient did well. The second case...different story.

Back story: This attending is a part time surgeon, an enigma that you hear about but never see.  She became part time after her second child was born and I've been told I should get to know her ever since my daughter was born.  Now, I've finally gotten the opportunity to work with her.  Mom surgeon mentors are still still nearly impossible to find, especially those that are relatable.  She is a regular person - her husband isn't independently wealthy, she doesn't have 4 live-in nannies and a stay at home dad, she is a regular person, awesome surgeon and a mom.  With a bit of timidity, I've had the occasional opportunity to pick her brain about her career choices when I've taken call with her and she's been an amazing resource.  I also know that she recognizes the career advancement sacrifices that come with her choice to work part time.  She seems a little frustrated by the trade-off but not at all regretful.  

Back to the present: Ok, second case, she decides to try out a different approach she read about to increase exposure.  Unfortunately the change in the approach makes some parts of the operation a lot more difficult.  However, we press on.  Then we hit a key part of the case where a structure needs to be identified to ensure that it isn't injured, and we just couldn't find it!  She called for back-up.  I hear her mutter under her breath: "Can I just get through one case without asking for help!"  One of the senior surgeons came in and helped out.  The remainder of the case proceeded with continual second guessing her every move - "does this look right" "I think I'll go here"  "do you think this looks okay?"  She was reduced to what I like to call 'resident uncertainty.'  We finally finished.  All went well, the patient was fine, the final result actually looked great but I could tell she was defeated. She apologized to me at the end of the case.

Its not uncommon that attendings help each other out and scrub together.  Its one of the things I like about the group of surgeons at this hospital.  I tried to tell her I thought the case was fine that no apologies were needed.  But, I could tell she was disappointed in herself.  I wanted her to know what a great teacher she is, what a great role model she is to her residents and her children.  I wanted to remind her of how her patients gush about how amazing she is.  This attending trained at my institution and I have literally NEVER met a single person - faculty, resident, nurse, administrative staff, who had anything but extremely positive comments about her skill and her judgement.  I wanted her to know that I have operated with senior surgeons who have come to work every day for the past 20 years and still occasionally need to call in back up.  When I think about the two cases we did that day, I think that there are two people that may no longer have cancer because of her.

I read an article recently about how motherhood completely and utterly changes your life.  No matter what you have invested in your career prior to having children, being a mom will profoundly change your career and who you are and every decision you make.  This is so true.  I feel like I'm struggling with it every day.  Fulfillment in two places, work and home, often at odds with each other.

As she walked out of the OR my attending told me that she was on call tomorrow night and that unfortunately I would be stuck with her again.

My response ..."It would be my pleasure"

the world's longest adolescence

I've been undergoing more frequent bouts of financial incontinence of late. I bought five sweaters in a recent end-of-season sale and a side table from Serena and Lily that is made of carved wooden swans. My husband describes this purchase as the Most Ridiculous Thing We Own. 

I can feel the end is in sight. I am almost done with my training, after which I will be making several times more money than I ever have before.  

Saturday morning I went to a financial planning seminar for graduating medical residents and fellows. After a brief introduction, the speaker guided us through a program he had developed specifically for medical trainees to calculate exactly what income was required to develop and maintain the life we projected to lead with our future salaries. 

I don't know what my salary is going to be next year. I am looking at positions that vary over $130,000 between them, adjusted for part time vs. full time, and private vs academic. So I entered a figure somewhere in the middle. It's even more difficult to project my husband salary as he owns his own company with a salary that varies month to month. He's gone months without a salary at all, which I've always thought taught us to live beneath our means. 

Beneath our means, but perhaps not beneath our expectations. 

It took about 90 minutes to complete the program.  There were a few numbers I didn't know how to estimate - like the expected rate of inflation and expected rate of return on our investments. There were some shocks along the way - the projected cost of a 4 year state education for my 1 year old son is $360,000 if tuition costs continue to climb. I entered the tuition cost for two kids at the most expensive elementary and high schools in the city, the cost for two weddings, and my medical school debt. I figured in the cost for a standard 3 bed, 3 bath house in our community with a 20% down payment. The program included costs I hadn't thought of before, like the cost of an accountant, orthodontia x 2, and home owners' insurance. It calculated the estimated yearly expenditure of feeding and clothing two kids. I felt pleased to enter the amount we've manage to save in retirement and savings accounts. 

I got to the end.

-$118,455

OMG. 

That's the amount of yearly income we lack in order to meet what I thought were fairly modest goals. 

I've heard medical training as the world's longest adolescence. I've never felt it to be as true as I do now, starting down the last few months of my training and still uncertain of what I am going to do next year. 

After a collective gasp, our speaker smiled and admitted to a slight "glitch" in his program - while the program took into account the rate of inflation, it did not adjust the physician salary for that rate of inflation. In other words, the cost of every itemized expense would go up, but our purchasing power would go down with time. 

That didn't seem right. Of course my salary would go up, perhaps to cover the gap between the estimated salary and the projected cost of our lifestyle. And then he made what I think was the most striking point of the presentation. The partners he left in private practice anesthesia in 1993 are making the same salary now as they were 20 years ago. 

OMG x 2. 

It is unlikely that physician salaries are going to go down, but it is highly likely that, with the restructuring in health care underway, salaries won't go up with inflation. I've heard that said before but didn't think too much of it. Now seeing a dollar amount placed on what had seemed like conjecture has given me pause. And in that pause seeped a now recurring frustration. 

How is it that I started med school a few short weeks of my 22nd birthday, I will graduate when I am 33 and I still can't decide what I want to do next year? What is in the best interest of myself, my family, and the longevity of this career I've been working for since I was 21? 

During my ongoing job hunt, I received the unwelcome advice to "not make any decisions based on money alone", which does seem like sound advice and in keeping with the best interest of my young kids, who would benefit from a mother who is around more, and my career should I decide on an academic path over the more lucrative private route. But in that room I started to re-appraise the relative benefit of the options ahead of me. If I work part time in academics, does that mean my kids don't go to college?

The exercise served to broaden what had been a frustration specific to not knowing myself to include the more generalized frustration that I don't know anything. 

And it put to rest any lingering consideration I'd had on the idea of a third child. 

MiM Mail: Refusing the bottle!

Returning to work from an 8 week maternity leave has proven more stressful than I thought but for a reason I didn't anticipate!

I'm currently a second year internal medicine resident and welcomed my first child into our hectic world 8 weeks ago. I was all set to return to work (but more time is always be better) ready with my pumping gear and planning out a loose schedule to hopefully make pumping work. I missed the chaos of inpatient medicine but thankfully, I've been eased into my return with an outpatient block but will have to cover a few random overnight calls in the next 2 weeks. As I'm sitting in my office pumping and texting back and forth with my stay-at-home full-time husband, we realize that our LO is refusing her bottle!! We did trial runs prior to this day and she happily took the bottle from her daddy but now she either plays with the bottle (even with her hunger cues) or flat out spits it out and then cries. He has tried many different tactics (different room, walking, holding her different positions, not waiting until too hungry, having something close to remind LO of her mommy or taking it away, etc), and we've discussed our situation with a lactation consultant who offered some additional tips. LO finally took a bottle once while relaxed in her swing after a short nap but struggled with the next feeding. She used to make wet diapers early AM/late night when I was home to breastfeed overnight but this has dropped off during the day. So far (it's only been a couple of days) she's still happy and playful in between her naps. Of course I nurse as often as she wants when I'm home but this makes me nervous as my days can be 14-16 hours long when I'm not on overnight call. This of course brings up the times when I'll be at the hospital 28+ hours. What will happen if she's still refusing the bottle? I know some people will say if she's hungry she'll eat from the bottle, but I don't completely buy that line of thought and she can't make up a whole day's worth of not eating in a couple of feeding sessions. She's not breastfeeding anymore than usual when I return home right now. I'm hoping she'll take to the bottle again, but I wonder if anyone else ran into this challenge.

Thanks for any words of wisdom and support.

Birthday FAIL

It's my older daughter's birthday tomorrow.

At her daycare, they do a little party for them during snacktime at 3PM. I bring in cake in the morning and everyone sings, and if you're the mom watching, you get little tears in your eyes.

Last year, I happened to have the day off, so I went to the party and then brought Mel home afterwards. This year, it didn't work out that way, but I was still hoping to go to the party. I work pretty close to the daycare, so I could have easily slipped out, gone to the party, and then gone back to work. But I know from prior experience that if I show up at daycare, Mel will not let me leave without her. I don't want to make her cry on her birthday.

After much internal debate, I finally asked my boss if it would be all right if I brought Mel to work with me for a couple of hours, and she'd be totally quiet and good. "Oh God, don't bring her to work," my boss said. "Just go home after the party. It's okay." (My boss is a sweetie.)

So I was all set, or so I thought. But then several things happened, including that my census of patients exploded and I can't reduce my list without begging other people to see my patients, which I really hate to do, especially considering Friday is generally a busy day. I also stupidly scheduled a doctor's appointment for today, which means I can't stay late today either.

And then I got a call from the scheduler for my clinic, asking if I could add on a couple of extra patients for Friday.

I am beginning to feel like I am doing too much to make it to this party. I am calling in favors, inconveniencing other people, canceling appointments, all just to make a 15 minute party. She probably won't care if I'm there anyway and we're having a regular birthday party on the weekend. I should just accept that it isn't going to happen.

But then I think to myself: this is WHY I took a flexible job, so that I wouldn't miss special moments like this. If being there for my daughter's birthday party isn't high priority for me, then I feel like my priorities are screwed up.

It's hard being a working mom.

Mental Yoga

My yoga teacher, of 1.5 years, is taking a hiatus.  Jeanie is 60+ years old and she is much more flexible than I.  She looks like a white version of Tina Turner - lithe body and blond spiky hair.  She and her husband are going to Russia for 18 months on a mission trip.  Last Tuesday was her last night teaching my class before she left.  While we were in corpse pose at the end, she told her favorite parable, one about an eagle raised with chickens - who finally learned to fly with the coach of a naturalist.  As her soothing voice and wisdom flowed through my ears, silent tears streamed uncontrollably down the side of my face.  "We are all eagles, constrained in one way or another by our surroundings, but we all have the capacity to fly."  She gave me a big hug as I rushed out the door to pick up my kids from their dad and stepmom's house.  I told her I would miss her, but I'll bet I'm not nearly as sad as her family.  She told us when she leaves she has 22 grandchildren, and when she returns she will have 25 or maybe 26.  Much of her stories and experiences are family centered, she is one of the most grounded and knowledgable individuals I have ever met in my life.  Russia doesn't know how lucky they are.

The other night I was e-mailing my friend.  She was discussing an issue she was having with her daughter - stomachaches.  They seemed to be school related, so she was worried they were stress, but also not wanting to miss something medical - she was researching reflux.  I told her that my daughter was having some big time stomach issues around the time of my separation and divorce.  While the pain was certainly real to her, I could see that it might be an outward manifestation of inward turmoil.  My stress has always gone to my stomach, ever since I was a little girl.

I told my friend that I had taught Cecelia a relaxation technique that I picked up somewhere along the way, in high school I think.  One night at bedtime, I told her to lay down and practice breathing in through her nose and out through her mouth, like a type of yoga breathing.  As you breathe in through your nose, imagine a healing color filling your body, focusing in on the area of pain.  I use bright white light.  As you breathe out through your mouth, imagine you are expelling the pain as a color of your choosing - I use red.  I think the slow breathing is the key, and giving a concrete aspect to it, the color, helps you feel that you are in control of your body and have the power to soothe yourself.  I told Cecelia to take it with her and use it throughout the day if she needed it.  It helped her.  I still use it on occasion - my stress continues to go to my stomach.  If my friend uses it, I hope it helps her eight year old daughter.  If it doesn't, she can continue to problem solve medically.

There are many things I use these days as mental yoga - blogging right now, for instance - this is a busy, stressful week and writing is therapeutic for me.  Yoga and exercise also help.  Listening to music.  Reading.  A glass of red wine.  I pass these onto my daughter and son (except the wine, ha ha), and hope that they can learn to relax and soothe their body and mind in a healthy way.

Last night I went to yoga for the first time to meet the new teacher.  After a three mile run and watching a recent Colbert re-run, I had to fight my inner two year old who was throwing a tantrum telling me to stay home, Jeanie's leaving sucks, no one can replace her.  I quieted the tantrum (Jeanie's voice in my head helping me), grabbed my yoga mat, and met Matt, the new guy.  He is young and is very different, with his masculine energy.  A clipped voice and a different style.  I am going to be sore today in a whole new way, and was more tired than usual after yoga.  I'm still sad that Jeanie is gone, but I'm also excited to explore new heights and stretch new limits on my body and mind with my new teacher.  After all, yoga is a process, not perfection or competition.  Who knows, this guy could teach me a thing or two.  

As I am writing this, I am wondering what other techniques people use to calm their children and themselves, especially along the lines of relaxation.  I would be curious to hear suggestions in the comments if anyone has any.  While Cecelia's stomachaches around school abated a couple of years ago, every new age and stage of life brings frustration and anxiety; we problem solve pressures from school and society on a weekly basis.  Jack is a more laid back fellow, but he has unfulfilled wishes and desires, as we all do, that weigh silently on his mind.  We have lots of fun too - we are not all seriousness here, but we could all use more mental yoga.

MiM Mail: Time to hang up the stethoscope?

I am more and more convinced it is time for me to hang up my stethoscope.  I am a busy family medicine doctor practicing outpatient only family medicine who is increasingly longing for more time at home with my children.   I currently have two young children with one more on the way.

But I am scared, to actually make that plunge.

 

Scared to leave (what if I want to come back?), scared to leave the income (yes, I know FM doc's do not make anywhere near specialists, but my income allows us a very comfortable lifestyle but we do not depend on it), scared I might get bored being at home full-time, scared what the next step holds for me.  I often dread looking at my schedule, another day of people complaining to me all. day. long. and what seems like endless patient emails and phone calls to answer after listening to all the complaining.  I have always felt it a gift to share in peoples lives, but after doing this for 10 years, it is frankly boring.  I never thought being a family medicine doctor would be boring, but honestly, it is. 

 

Anyone else experience this?  I am a positive and upbeat person (my glass is always half full no matter what the situation is) and I wish I loved my job more but maybe that is unrealistic.  Maybe a job is just a job, no matter what the profession is?  

 

I already only work 3 days a week and the "firm" does not allow doctors to decrease any further so that is off the table.  

 

-Doctor to many, mom to almost three

A post for those in the trenches with us...

This post is for my husband and my beautiful daughter.

To my daughter:

Thank you for running and screaming "MOM-MIEEEEE" with complete happiness and joy each time I make it in time to pick you up from daycare.  Thank you for your constant big beautiful smile.  Thank you for thriving despite my many absences and nights on call.   Thank you for telling me "I love you mommy,"" GOOD JOB mommy" (one of her favorites), and "com wit me" with your outstretched little hand.  Thank you for this unconditional love.  Thank you for changing my life and making me whole.

To my husband:

Thank you for coming to meet me as I sob to you through post call tears at the violence I unfortunately sometimes see the results of.  Thank you for coming home for lunch every day I'm post call and bringing me lunch, tucking me in and putting on soft relaxing music.  Thank you for allowing me the complete and utter assurance that my precious baby girl is always remarkably cared for in my absence.  Thank you for going on this journey with me.  Thank you for surviving the many bumps we encounter.  I believe we can make it through.  Thank you for making me whole.

MiM Mail: Path for a military wife

Hello Mothers in Medicine!

I was googling for possible stories of women who finished medical school then put off residency training for marriage and family. I came upon your site, sorted the mailbag and found none similar to my problem. I hope the lovely ladies of medicine can help me sort out my options.

You see, I'm an IMG (graduated 3 years ago) non-US citizen who married the love of my life a year ago. What makes this even more complex is that my husband is committed to the US military where he can really have a promising career. We currently live outside the US for his work, but we will moving back in a few months.

As for me, I am unemployed because all medical jobs on base require US citizenship. Off-base jobs require fluency in a language I barely even know. But, I currently work for a major non-profit organization as a medical volunteer, with the idea of having something to put my resume in mind. I am taking Step 1 in a few weeks and I'm already going crazy. What more if we have kids? Plus, I have been going crazy the past few months having no income...

That is where my problem really begins. We have a plan to adopt a dog at 1 year of marriage, then to try for kids on our 2nd year of marriage. I wholeheartedly agree with this plan. I'm almost 30 and I'm scared we won't get to have any kids if we wait 5 more years. With the military lifestyle (change in base location every 2-4 years, military parent always off elsewhere etc) there always has to be one stay at home parent... Or else you rack up thousands of dollars in childcare and worse... neither of you will be there to watch your kids as they grow up.

My career options are (1) either continue with being certified to apply for US residency programs or (2) to put it off by 2-3 years or (3) to pursue a different path all together. Option 1 will eventually have me trying to match into programs that are an hour's drive away from where we will be living. With our family plan and his military commitment, I do not have the luxury to move to a different state or even county.

Option 2 seems to be okay. But, how realistic is it for me to pursue training when I will be an old IMG, 6-7 years from graduation? Will there even be a handful of programs who will peek at my application? I can also try to do vocational programs or get a masters in something medically-related, so I would be doing something. That's when Option 3 came in...

Is being a physician really a good career path for a future mom and military wife? Perhaps, I should delve into an academic career instead. Or become a public health practitioner? Has any of the bloggers/readers met a civilian physician who married a non-physician man in the military? Please enlighten my frazzled brain.

Thank you!

p.s.

I apologize for the really long message. But, I forgot to put in that we won't have family that would be close enough to help us out with care. There is a possibility that my in-laws will live in the same state as us in 3 years, but for now, there will be no one to aide us.

I'll be a "single mom" haha.

Oh well, thank you so much for having your blog up. It was refreshing to read issues the superwomen of medicine have. so... I so wish you can help me out. :)

When I am a Senior Resident

One day soon, when I am a Senior Resident, I will look at my poor, tired Intern as she/he sits around on the weekend finishing up notes and say “poor, little, tired Intern, finish your notes then sign out to me and go home”. As an Intern, I now say something to that effect to the Medical Student and I’ll keep saying it as the overnight Senior.

I write this as I sit in the dark, cool call room after my notes are finished and my patients are tucked away wondering why the heck I am still here. I miss my family intensely on days like these. Days when all of my consults have been placed, all of my medication adjustments have been made with my friends in the Pharmacy, after all of my parents have been updated. After I have received several cute, cuddly pictures from my husband or our babysitter of the day. After I have called my mother to say how tired and lonely I am. After getting lunch with my fellow Interns (those with work to do) and the cool Seniors who are like “Dude, why are you still here?” My response, a shake of the head and a sigh. Oh by the way, did I say that my overnight Senior Resident, the one who I will be signing out to, the one who wouldn’t let me go home "early," is taking a nap in the call room?

Okay, okay, okay, I know, let’s look on the bright side.

I am inspired to write a poem:

Oh ye little tired Intern Soul
Set your spirit free once you are safely tucked away at home
Drive away, remove your scrubs, and wash C diff remnants away with real soap

Oh ye tired Intern Spirit
Carry on, far from here, because by this time next year you won’t have hour limitations and you’ll be stuck just like me
Until then, go be free knowing that your patients still have me.

MiM Mail: Family/relationship sacrifice

Dear Mothers In Medicine community:

I'm a PGY2 who started off residency last year in an Ob-Gyn program while about 25 weeks pregnant.  While not ideal, I thought I could make this work -- there had been an resident a few years before me who had a baby during the fall of her intern year, and many residents in the program (female dominated) had babies during residency.  My program directors and co-residents were extremely supportive, and I luckily had a very easy pregnancy, healthy baby, and smooth recovery.

While being pregnant was easy, though, going back to work was harder than I had thought.  Many days, I was at work for 14 hours a day, plus I'd work weekends or nightfloat, and this would go on for months at a time.  Despite how much I was working, I hardly violated duty hours and I really did enjoy what I was doing and hardly thought about missing out on things at home because I loved my job.  Meanwhile, my husband was left home alone for most evenings and weekends with a baby, feeling unsupported and exhausted.  He's a wonderful father and in general a helpful, loving husband, but he grew increasingly disgruntled with the situation, and soon we were constantly bickering over my terrible schedule.  Our families, while on the same coast as us, are hours away.  We live in an apartment, so there was no space for a live-in nanny, and our daytime nanny fell through, so our son started daycare (which we all love).  I offered to hire more help for the nights and weekends, but my husband resisted, saying it was unfair to deprive our son of his mother.  Honestly, I think my husband was just feeling overworked, exhausted, unappreciated, and unhappy in his own job, and I actually think he felt that even though I was at work from 5:30 am to 7:30 or 8 pm many days and weekends, my time away from home was actually a "break" from having to take care of a new baby.

Tension at home worsened after I got into a car accident while coming home from nightfloat during the beginning of PGY2.  No one was hurt, but my husband was extremely upset -- not that I damaged the car -- but that I was willing to risk my life for the sake of a "job."  I tried to explain that I loved this job.  I asked about what his expectations were.  I insisted that other people have kids in residency and make it work.  It was all to no avail.  When he basically threatened that our marriage would eventually end and he would seek custody of our baby if this situation continued, I tried to negotiate a part-time position with my residency director, but it wasn't possible.  Long story short, I ended up taking a month off from the program, talking to lots of other people, and then switching into Psychiatry, which is the other field I was considered during 4th year of med school.

My quality of life is much better, but I still feel sad when thinking about this whole ordeal.  I'm adjusting to my new program, and 4 months into it, I feel like I'm getting the hang of things, but I know deep down it's not what I 100% really wanted to do.  And every time I open my inbox and see emails from ACOG, or open my mailbox and find an Ob-Gyn journal, or run into a med student who I worked with as an Ob-Gyn resident and have to explain why they're now seeing me on their Psych rotation (I stayed at the same institution), or run into my former Ob-Gyn attendings or co-residents, or see friends posting on Facebook about how much they loooove their residencies or are doing really cool things, it's like opening the wound all over again -- the hurt, sadness, anger, and embarrassment all come flooding back.  It's especially upsetting to me when I see other female residents, especially surgical ones, who are having their second babies while in training!  I know there must be more going on in their relationships that what meets the eyes, but it makes me sad that other people's husbands must be so much more supportive than mine.

So, I guess I'm writing to ask: has anyone else had to make huge sacrifices (such as switching residencies) in order to save a relationship or pacify a partner?  And if so, how did you handle this?  The resentment towards my husband is fading as I'm beginning to see how wonderful it is to have a life outside of work, but I'm wondering if I'll always feel a little sad about having to make this switch?

Thank you so much for your support and advice,

Anonymous

Next Year...

Next year I am getting it right. 

Last year was my first experience as a parent trying to navigate the world of preschool Valentine's Day. I had instructions to deliver 39 Valentine's Day cards, each labeled with my daughter's name  ("Homemade cards welcome!"), to school for general distribution on February 14.  With little thought as to package to package variability, I picked up two boxes of small, brightly colored cards at Target and brought them home. On February 13 I opened the boxes, thinking I would have to do nothing more than write her name on the card, to discover the assembly of each card a five-step process that, in the end, took me 90 minutes and produced a meager little offering. 

That 90 minutes seemed an eternity, and not just for me, but for my 3 year old who, after 5 minutes, wandered off in search of more scintillating activity. Dinner still needed to be made. The house was a mess. But I remained alone at the kids' table to assemble, sticker, and label each card until all 39 were complete.  

I wasn't the only one who misjudged the expectations. In Munch's class are a few children from foreign countries, here for a few years while one or both of their parents complete graduate degree or post bac.  When Munch got home from school that she had a number of artful, standard-sized greeting cards, most written in unfamiliar languages. While I had been disappointed to find myself squandering dinner prep time with Valentine's Day card assembly, I wonder if those other parents were put off by the relatively paltry offerings put forth by their children's classmates. 

This year I bought far simpler cards in early February. 

And on Thursday I realized they were missing. Nothing in this house stays in one place for very long and so, after too long a period spent looking for the cards, I resigned myself to a second trip to Target for replacements. At this late hour, my options were Justin Bieber or origami fortune tellers. 

I strongly considered the Bieber cards. No preparation, not a particularly controversial celebrity, and who-cares-its-just-a-card. But an emotion similar to shame forced me to select the latter and hope dimly they were pre-folded. 

At home I confirmed I was not so lucky. In ground hog day fashion, I found myself alone in the kitchen, the night before Valentine's day, with dinner needing to be made, up against 39 unfolded origami cards and my own expectations. 

I did was I suspected I was going to do when faced with the potential each one of these cards would take me five or so minutes to complete. (Not to mention the time it would take to learn how to fold them in the first place.) Ignoring the multitude of dotted and crossed lines, I folded the cards lengthwise twice over and slid each card into its provided sleeve. I wrote my daughter's name on each sleeve and got on with the dinner preparation. 

Next year I might just distribute an envelop full of candy. Lord knows that is the only thing I wanted when I was 4. 

MiM Mail: Pregnant and matching, oh my!

Hi MiM,

I also have a Rank List dilemma...

I am a fourth year medical student applying for a categorical spot in Child Neurology. I just found out I am pregnant with #1! We were not really trying but it was a pleasant surprise, despite the fact that I am due in early October which will be four months into my intern year, yikes!  So, I will be entering residency visibly pregnant and then after a too brief maternity leave, I will have to finish intern year with a newborn. Ideal? No. But I am not going to take the year off and I am lucky in that my husband is further along in his medical career and will have a more flexible schedule than me. We have NO IDEA where we will end up as there are relatively few spots in Child Neuro thus I applied widely and will be ranking programs from coast to coast. By matching categorical that means I do Peds for two years followed by three years in Neurology but at the same institution.  I know that Peds tends to be more family friendly than some other programs but I got a sense that some programs were much more supportive than others. None of the programs I interviewed at are aware of my pregnancy as I just found out myself.  I don't think I need to disclose this and fear that it would only hurt my chances of ranking.... But if anyone has been in a similar situation or thinks that I am wrong I would love to hear her advice.

My other question is whether or not I should let the "family feel" of each program influence my rank order. Several of my top programs are very academic and I think the residents tend to be a bit younger (thus less likely to have families already) and so I wonder if it will be an issue for me to be pregnant/out for maternity/breast-feeding/etc. Part of me thinks that intern year going to be difficult no matter where I go and that I'll figure it out and make whatever I need to work. But the other part of me (the emotional, tired, newly pregnant part) wants to be a program that will be supportive and celebrate with me. I feel like I did interview at programs like that but they were mainly General Peds programs.  Thus I would have to take an extra year to complete Peds and then reapply for Child Neuro fellowship as an advanced candidate in a year. I'm not crazy about the idea of taking an extra year to train when I already know what I want to do.  Nor do I want to have to reapply and interview again. Furthermore, I think it would be disruptive to my husband's career to have to move again in three years as well. But again, if anyone has been through a similar situation or has any advice I would love to hear it.

Many thanks,
Pregnant and matching, oh my!

Fecal Transplants

Last summer, the kids and I visited my friend Trish-eee with her husband and two kids at her lake house up North.  It was restorative for me.  I hadn't seen her in a few years, long overdue.  We talk and text, sure, but there is nothing like face to face time.  She was one of my best friends in residency.  Her and Mellificent.  One of the funniest stories I remember (and there are many) was once when we were stealing away from a conference in San Diego for a little shopping time in the Bohemian district.  We asked a cabbie to take us there.  She's a beautiful blonde, a granola marathon runner, much like I might imagine Cheryl Strayed looked when she was taking her trip in Wild.  I had just read that book, and Trishie was training for a marathon during my visit.  She complained of blackened toenails, and I laughed thinking of Strayed's hiking trip.  I have never exercised so hard that my toenails blackened and fell off.  I guess there's still time in life.  Or maybe not.

Anyway, we took a cab to the district, I think it might have been called Hillcrest, which was funny to me since I lived at the time in the Hillcrest division of Little Rock.  In LR, it is a hippie, liberal area with lots of cool restaurants, bars, and fabulous old houses, some of them beautifully restored.  Trishie and I (Lizzie here) excitedly chatted about the fabulous Thai food we sought out and the wonderful second hand clothes stores we aimed to shop at.  I was winding down after presenting a paper, an on sale but fabulous Banana Republic suit happily hanging back in the hotel closet.  We were both exhilarated to be out of town and on a jaunt.  The cabbie had a question, which he asked with a heavy accent.

"So, we are going to Hillcrest.  You must be lesbians, no?"

We glanced at each other, shocked at the blatancy of his question.  And the fallacy.  Mutually decided that little explanation was better, but in retrospect I wish we would have replied yes, silently egging him on.  There were rainbow flags flying everywhere, and in another life, why not pretend?  So what if we were?

At the lake house this summer, Trishie took me on a long drive to see the area.  She told me she was on the fecal transplant committee at her hospital.  I did a double take.  Fecal WHAT?

"Lizzie, it's so crazy, but it works.  All the big research hospitals up North are doing it.  Some patients want fecal donors from their own families, but that's too rough on a small town hospital like ours.  We get a big normal stool sample, do all the testing in house to clear it of pathogens, and freeze it in aliquots.  You know those intractable patients with C.Diff.?  The ones who take tons and tons of meds and eat up hospital time?  You just do a tiny suppository of normal feces and voila!  They are cured."

I am the Director of Microbiology of my own hospital and I, subsequently confirming that all my co-workers (lab head, techs, etc.) as well, was not at all aware of this in Arkansas.  I had tons of questions for her, medical and otherwise.  She said, "Lizzie, it's so funny to sit on the committee.  There are all these poop jokes.  'I need to make a movement to approve this.'  'We need to make this our #2 priority.'"  I listened in awe and laughed until my face hurt.

A month or so ago there was an article on Fecal Transplants in the New York Times.  I also ran across it last week on Kevin M.D.  So despite my partner's reservations ('Are you sure she is not a practical joker, this friend of yours from residency?  I think she is surely pulling your leg' - you know who you are ha ha), I believe her.  It makes sense.  Replenish the gut with normal flora to fight disease, rather than blasting it with antibiotics - the bomb to kill the fly.  I wonder when it will come to Arkansas.  I am sure it will come to my attention as soon as it does.

Trishie called me a few weeks ago to set up another visit this summer, and I carved out a time.  I can't wait.  She and her husband are such wonderful parents to their kindergartner and toddler.  We played lots of games.  We watched the Olympics.  We taught Cecelia how to water ski, and she was so proud.  I got up on water skis for the first time in many years, and I was so proud.  I ran every day.  I swam laps around the lake, and my eyes burned from the muddy water, in a good way.  I learned about fecal transplants.  I wonder what I will learn about this year.  Surely it cannot compare.

I can't end this blog without mentioning that my friend Trishie is the daughter of a self-made multi-millionaire.  She would not reveal this to you - you might only learn about it if you knew her very well.  Many of you would recognize the name of what her dad has created, which I am withholding here out of respect for privacy.  She didn't have to work.  But she got her drive from her wonderful dad, who I met this past summer.  Her determination to carve out her own niche in this world and do something amazing trumped an easy, luxurious path in life which he certainly would have provided for her.  I am so proud of him for instilling that drive in her and her for fulfilling her own dreams.  She is an excellent physician.

Happy Fecal Valentine's Day Trishie, love you!

Oh my god....

Yesterday, I collected a receipt from our daycare for tax purposes. In the past, I've always gotten the receipts on a month by month basis, but this time they had a receipt for the entirety of 2012. My husband and I couldn't stop staring at the number on the receipt:

$39,000

Spent on daycare. Before we pay our rent, before we buy even a single frozen chicken nugget. Just for daycare.

Wow.

Guest post: End of residency rant

One short, miniscule, month. And I can’t get my shit together.

I started medical school almost eight years ago. I had the world at my feet. I was married five weeks before med school started. My husband was in graduate school about an hour away. I had a wonderful social life, and the resume-padding was unbelievable.

Then, unexpectedly, just before the end of my first year, I was pregnant.

Now, I am blessed with three beautiful children, the same wonderful husband, a dog, and a cat. I am about to start an exciting, rewarding career. I have a loving family and, once we dig out from under the mortgage-sized debt of my medical training, the prospect of a secure financial future. My licensing exam is completed – and passed. My application for independent practice is submitted.

Tick, tick, tick goes the checklist.

So why am I so blue?

Because I am sitting in my “office”, in the basement, for the gazillionth time, while my husband puts the children to bed. I am supposed to be finishing my resident research project, but all I can think about is the sacrifice that went into this whole deal. And I feel like I just can’t do it one more time. I can’t sit down here, while my kids do their thing, while my husband cooks and wipes little faces and hands, and dresses and changes, and talks and explains and answers little questions, while he washes hair and towels dry and finds pajamas, while he surfs the net in lieu of my company and attention. I spent months studying for my exam down here. I still spend endless hours down here administering to administration, to licensing bodies and colleges and universities and evaluations and preceptors and the endless litany of mindless work that only I can do. And I just can’t do it anymore. I am utterly spent.

Where are the other medical mothers who feel this way? Is acknowledging this darkness akin to yielding to it? Because I have noticed that no physician who does creative writing in popular medical journals seems to get published unless there is a vein of hope, silver lining, outwardly optimistic, or putridly glowing endorsement of the profession tucked into the moral of the story. We only want to hear tales of physician woe if the tales end with the message that we are the fortunate, rarefied few who get to struggle in this way. We hold our noble heads high.

Give me a break. Give me the sweaty mothers who can’t afford a nanny or a housekeeper or even a babysitter for a night out. Give me the stressed out mothers with messy homes and offices and cluttered minds and hearts. Give me the medical mothers who nurse their infants while reading their journals, then feel guilty about splitting their attention. I want to befriend the other mothers who adore their children so much that their hearts break on a daily basis – yet can’t stand the same children disturbing their few hours of consecutive sleep. Give me the doctors who love medicine, who want to see patients all day and night, who listen to medical podcasts and fantasize about intubating crashing patients while doing their completely irregular workouts (it does get the heart rate up), who obsess over the evidence basis for PSA testing and feel crushed when they miss a diagnosis. I want to be friends with dedicated mothers and dedicated doctors, and I want to acknowledge the horror of combining those two wonderful people into one. Because it isn’t as pretty as it sounds.

So, as I sit down here, I just can’t get my shit together. I can’t decide if it’s all been worth it or not. On the very cusp of being “done” with training, with one foot raised and about to touch the start line of the rest of my life, I can’t decide. Or maybe, I’m a little bit sickened. Because maybe, I want to admit, that the sacrifice has been too great, and if I could do it all over again, maybe I just wouldn’t. Silver lining be damned. I’ve always wanted to be a mother, more than I ever, ever wanted to be a doctor. And while being a mother has undoubtedly made me a much better doctor, I cannot say that the reverse is true. In fact, being a doctor has stolen gaping wounds of time and attention from my mothering soul.

But I can’t bring myself to say it just yet. Somehow, despite the sickness in my heart, I just can’t say it. Perhaps the future knows something I don’t. Perhaps I just can’t bear to close a piece of writing on a negative note.  Maybe I am copping out, playing to the audience, telling you what I think you want to hear. I don’t know. So I sit in my basement office a little longer, the children are asleep, and soon I should be, too. Because tomorrow the children will want me, it will be my 27th-last day of residency, and there is still, always, work to be done.