Moments When Mothering and Medicine Don't Mix

This post was inspired by one I just read from Genmedmom, on her own blog.  It is called Falling off the Work/Life Balance Beam, you can read it here.  I was oozing empathy, after all, she is going through this in real time, and it made me remember one of my worst moments.

When Cecelia was 5 and Jack was 3 (or thereabouts), I got a page on clinical pathology call.  It wasn't a good time - I was just telling the kids we had to find a new home for our almost one year old dog Mason.  Long story short he was a bullish German Shepherd that kept getting out of the gate and terrorizing the neighborhood animals.  Even though we were within city limits, there was a family down the road that had a chicken pen with 6 or 7 chickens - I walked down with the children and visited them on occasion.  They are a wonderful family - the wife has a healthy local business.  My family had been celebrating someone's birthday the night before - extended family - and one of the kids announced "Oh look!  Mason's in the back yard playing with a stuffed animal."  It wasn't a stuffed animal.  It was a chicken.  Emphasis on WAS.  That was the last straw.

After a bad first home we placed him with a medical student who was going to be alone for a year in her parent's house while they traveled abroad; she needed a good guard dog/companion.  She wanted one that was house trained.  It was a good fit - Mason did not need to be around small kids, being like a bull in a china shop - I was forever tightly wound if he was in the back yard when my kids were navigating the flagstone steps from the deck to the patio.  He was a sweet dog, but one squirrel sighting and he shot off like a rocket with no heed to anything or one in his path.

So I was telling the kids about Mason, and they started crying, and I got paged.  It wasn't just a, "Here's a critical value and I can't get in touch with the doc could you help me" from the lab page, it was a "we need an emergency plateletpheresis now, they're over a million!" page.  Ugh.  The kids were howling so loud I stepped out on the front porch to listen to the heme/onc tell me the patient history so I could contact the dialysis nurses with the right amounts/formula to get things going while I was getting there.  I called my sis-in-law who agreed to come over and watch the kids while I went in.  Then I turned to the front door to go back inside.  It was locked.

My frantic kids were trying to get to me and accidentally locked the front door.  My heart skipped a couple of beats until I realized I could flip the mail slot and see them, touch them, talk to them.  They were sniffly but ok.  I coached my daughter on how to unlock the door and when we eventually were successful I tumbled in and we all collapsed on the floor in tears.  Mason.  Needing Mommy.  Loss.  We were a big mess.  Sis-in-law walked in thankfully when we were on the downswing, drying our tears, and I announced, "I think milkshakes are in order!" I pulled out the ice cream and was happy to see smiles as I was walking out the door.

I cried all the way to work that evening.  I think I called a friend, hard to remember.  I think I was crying more for my children's loss than my loss - I don't know it was all rolled up together, emotions indistinguishable from one another, muddied and blended.  And I was crying for Mason, even though I knew he needed a better fit.

Good luck Genmedmom, it gets better when they get a little older, or at least easier.  And the moments where mothering and medicine don't mix are just that.  Moments.  Most of it is incredibly awesome.  Although us MiM's have unique challenges, I think I can speak for all of my mom friends, SAHM or mothers not in medicine, to say that all of us have these moments.

MiM Mail: Should I uproot my family?

I've followed this blog for many years and I desperately need help. I recently had to take 1 year off from residency due to medical issues. My daughter and I are both doing well now and it's time for me to go back. Despite many challenges, this year has been a wonderful experience bonding with her. When I return to residency she will have turned 1 year old and I will be transferring to another program. The problem is I don't know where to live and I hate to uproot my family. If we stay where we are now my husband will be 15 minutes from work and my daughter will get to maintain her relationship with our part time evening nanny whom she absolutely adores (she helps me now about 3-6 hours/week). Additionally, my mother in law loves the area we live in now and would probably stay with us for maybe 6 months if we stay. The only problem is that my commute would be about 1-1.5 hours driving or via public transportation. I've been away from medicine for over a year and I want to succeed when I go back, I'm not sure if commuting is such a great idea. And I've never been away from her for more than a few hours, seeing her for a few hours each night after a long commute is going to be a huge change for both of us.

If I put myself first and move the family closer to my new program I will have a 25-30 minute commute, my husband will have a 45 mile reverse commute against traffic (50 min-1hour). But mother in law help in this scenario would be unlikely for any extended period of time. We would put my daughter in daycare sooner rather than later. There would also be no nanny help at night (my daughter loves her and she is not an easy baby!) because the nanny doesn't drive.

I only have 2 years of derm residency remaining but I have so much at stake since I will be starting a brand new program after being away for a year. I really want to put myself first and move closer to the new program so that I can give myself the best chance at success but I don't want to uproot the entire family. I feel so guilty because we have moved so many times in the past. On the other hand I don't know if commuting from where we currently live to my new program will be the best choice for my career/performance. My husband is supportive of whichever route I choose but I've been agonizing over this decision and am no closer to a solution. I keep myself up at night weighing all the options until I feel sick which I know isn't healthy. Please help me!!!

a tough decision

It's time to get a job. As someone who is far more comfortable when a plan is in place, I feel almost suffocated by the decision needing to be made in front of me.

I should count myself fortunate in that I have options, and they are good options. I had three offers and narrowed the decision down to two.

Option #1 is with a small practice in our current town. I could work 70% for a wonderful boss who was one of my mentors during fellowship. He allows his physicians significant flexibility in how they structure their work days. You have to see your patients, but how you do it is up to you. Call would be frequent, but reasonable and fairly quiet. I would be working with a close friends, who graduated fellowship last year. The facility itself is one of the best run and managed hospitals I've ever seen with a staff dedicated to professionalism and superlative patient care. We could stay where we are, buy a house, and send our kids to the excellent local public schools, one of which offers language immersion (for free!). We could continue in the social lives we've created here and watch our kids grow up with the children of our now-very-dear friends. At 70% I would have one day off and four shorter days, which is going to be important when Munch starts kindergarten next year.

Option #2. Move home. I grew up 600 miles away in a town that I still love. My parents, my sister, and my brother-in-law's family (with the only two cousins my kids have) are all there. My mom is retired and wants nothing more than to take care of her grand kids. The job would be very different. A large group with a strict "no part-time" policy. I would have almost zero ability to leave early for kid-needs, whether they be scheduled or urgent. The group itself is in the middle of a tremendous upheaval and has turned over most of its nursing and support staff. Many of MDs have left or are in the process of leaving, although I liked the "new hires" who I met during the interview. Call would not be as frequent, but busier. I would make more money, but we would probably spend that money on private schools.

Part time work would mean more time for kids, less stress, and less money. Moving home would allow us to access a fully reinforced support system, which could itself make full time work easier.

I also just want to live near my family again. I hate traveling for every holiday and missing birthdays. I want my parents to be a part of my kids' everyday lives instead of the sporadic treat-and-present-filled bursts that now form the basis for their relationship. My husband is equally conflicted. He wants me to work part time but also would prefer to live close to family. Work-wise, it would also be better for him if we moved.

I've come to only one definite conclusion in this week of insomnia-inducing mind contortions - I can't predict what is going to be best for my family 5 or 10 years from now. I can made this decision based only on what I think is the better option for the next few years and hope that if I need to put us on a different path, that path is either available to me or I am capable of making a difficult decision. 

We are moving home.

Mother's Day, MiM-style

Mother's Day this year was my favorite one to date. It involved working for 7 hours at the hospital, so maybe my expectations were low that it would be one for the record books. (I had traded teams with another attending in order to get the weekend before - daughter's first communion - off, but that meant being on for Mother's Day.) Instead, I was pleasantly surprised.

8:00 am. Enter post-call team's room  - an all-woman team with resident, 2 interns, and 1 third year medical student - bringing breakfast (nothing worse than being post-call, hungry, and not having food) - and I'm met with a chorus of "Happy Mother's Day!" None had families of their own yet, but they knew about mine. Before we launched into patient presentations, they wanted to know about how my family fun 2 K run went the day before since I had warned them that if I didn't show up that Sunday, it would be because I had died from attempting to run that thing (Not a runner. Usually break things when attempting to run.) We round, take care of our patients. I write my admission notes and head home.

4:00 pm. At home, Girl (8) and Boy (5) have prepared a Mother's Day show. Boy2 (2) is an unpredictable assistant. There is a ticket booth with tickets and an information sheet informing us that we should expect to arrive between 4:00-4:15pm and the last time to get there is 4:15pm.

We all go upstairs into Girl's room and me, husband, and our awesome au pair M are seated in a row of office and desk chairs facing Girl's bed. She reads from a script.

"Ladies and gentlemen, boys and girls, before we start the 3 songs, I would like to talk to you. Over there near the bounce area, you can get raffle tickets. There are only 27 raffle tickets. You just ask for a number of tickets, I hand them to you, you sign your name, and hand them back. Then at the end of the show, I will pick the winner, give them artwork and they will keep it. I also have artwork for KC because it is Mother's Day. Now, if you are wondering where the bounce area is, it is there. (points to corner with many random pillows and blankets). You cannot get all the tickets. The most you can get is 6 raffle tickets. Boy, '1' please."

Boy runs to the CD player and starts the first song of the Holiest Kid CD Known To Man, a CD given to Girl by her first grade teacher at the end of last year - very holy bible songs in surprisingly catchy tunes - this CD deserves a post in itself. Girl, Boy, and Boy 2 stand on the bed and sing and perform. It is achingly cute. (and holy).

"Thank you, thank you. (bow)" repeat x 2 other very holy songs.

At the end, I won the raffle AND got special Mother's Day artwork. Score!

"The show is over. You can play on the bounce area or leave. Thank you for coming. You can also take one of the dolls on the floor, but not Rebecca or Baby Boy, they are my favorite. Thank you!"

7:30pm.  I am walking into Verizon Center arena with Girl for her very first concert. Taylor Swift. This is a birthday present for her, but I am secretly very psyched. It's been ages since I've been to a concert. Girl is a Daddy's girl through and through. I'm usually assisting our boys (very much Mama's boys) and the husband, her. This time with her feels very special. She is BEYOND EXCITED. Half walking-half running ahead to find our seats She screams and sings along to the songs. Watching her experience the concert fills me with joy.

Taylor Swift is fantastic. Such a great, entertaining show. The best concert I've ever been to by far. (OK, maybe not saying much given my track history - not telling - but let's just say the concert that's a distant second was Madonna's Blond Ambition tour, complete with her torpedo bra outfits. Much less family-friendly.)

11:00pm. We finally get home after the drive in from the city (and leaving before the encore - tomorrow is a school day) and get her quickly ready for bed. It's going to be a rough morning.

It was a full day, a  day of work-life on steroids. And completely awesome.

MiM Mail: Where now?

Dear MiM,

I am so grateful that I have come across this community. I have now spent many, many hours putting my 20m old to sleep and then lying in darkness and reading your posts on my iPhone.

So, I thought I would ask for some advice....

I am 35 yr old Intern and mother of 3 boys, aged 6y, 4y and 20m. I live in Australia and have been very lucky, thus far, with balancing work and family. I was able to do most of my internship part-time with two 10-week terms of full time work.

I LOVED my part time work. I had time for my boys, I could help at my son's school, I had time to read up on topics in medicine that interested me (or I needed to brush up on), I found some time to sew (my creative outlet). Ironically, I also felt that I was a better doctor - when I was at work my heart was really in it.

I am now in week 8 of one of my full time terms and I am tired, cranky, my house is falling apart, my 4yo is waking up in the middle of the night and coming to check if I am around, my 20m old is glued to me from the moment I walk in the door, I barely know what my 6yo is up to at school.... At work, as the afternoon slips away I catch myself checking the clock and trying to speed through the jobs. I am way too tired to read anyting medical. My sewing machine is collecting dust.

And, I have to make up my mind as to where from here. In Australia, we have 2 general hospital years (Internship and Residency) before we decide what to do with our careers. In a few months time I will need to make some decisions.

I went to medical school thinking that I would do O&G. However, I realised that I was a lot more 'natural birth' camp (my 3rd child was born at home) than medical intervention - which was not really compatible with O&G culture here. Also, I was not prepared to work the hours this specialty requires.

So, what is left:

Option 1 - Anaesthetics. I like the 'doer' aspect of it, I would love to have all that knowledge of physiology, I like the science of it, I love being organised, I like putting lines in, I like OR, I like that at the end of my training I would be able to control my hours and that part time is a real option here. BUT I would need to put in at least 3-4 years of full time work (and how will I cope if I am a mess after 8 weeks of full time?). Getting on the training program is difficult; it is very competitive. I have some advantages - I have a PhD (in Molecular Biology) and research background.

Option 2 - Family medicine (or, as we call it, General Practice). What appeals is the possibility of doing a lot of women's and children's health (I love this aspect of Medicine). I would love to do a Diploma of Children's health and Diploma of O&G which could focus my FM practice a bit. I could also easily train part time. But, will I get bored (I do not like office that much), will I end up in some 'sausage factory' medical centre, will I ever be able to focus my practice to the areas that I like. There is a fair bit of discontent amongst FM doctors here - about mountains of paperwork they are expected to do, about poor pay, about pressure to 'churn' patients through... Will I become bitter?

I should also mention that my husband works full time and has a very busy job with fair amount of traveling. He is supportive of whatever career choice I make but ultimately I am the primary carer of our boys.

I am now obsessed with making a choice, chosing a path, getting settled onto something. I cycle through these options many times a day, and it all seems like a big Rubic's cube to me - I line up one side just to find out that the others are not in order.

Dear MiMs could you please give me some advice?

Dr Mum & 3 boys

Guest post: Choosing part-time work in emergency medicine

First I want to tell you all how grateful I am to have found your site.  I now check it regularly and see it as my "lifeline" to others who have been through (and are going through) a lot of my own struggles and joys of being both a mom and a doctor.   I am a part-time practicing Emergency Physician 6 years out of residency.  I live in the Midwest.  I have two children, a 9 year old girl and a 4 year old boy.

For a while now I have been wanting to write something about choosing to work part-time.  I have been inspired by all the great posts from the other MiMs, so here is mine:

I am a part-time ER doc.  It is something that has taken me a while to feel proud to admit.   I love being an Emergency Physician, and I know that there is nothing else in the world I'd rather (and am meant to) do.  BUT....I am also a mom.  I had my daughter right before intern year started, and nothing could have prepared me for that experience.  I think I must have deluded myself in thinking that it would somehow be doable to juggle the responsibilities of both a newborn and intern year.  Without my husband it would have been impossible. I missed out on so many moments with my daughter during her first few years!  Do I regret this?  I guess in a way I do, but I know that if I didn't miss out on those moments I would not have been able to succeed in this career I love, and would not be able to support my family financially as I do now.  I want to tell all you other MiMs out there--nine years later, my daughter has NO recollection of the first 3 years of her life, she has NO idea that I was gone for most of those years, and despite all those missed moments we have a very close relationship. 

I started working full time after residency to pay off debt and our mortgage, but I cut down to 80% when my son was born.  This has allowed me to continue to support my family and enjoy our life by going on vacations, going out to eat, and spending time as a family.  But after a few years the time had come to decrease my hours even more.  Being in EM for so many years has taught me one thing:  life is short, and you never know when it is your time--time to get sick, time to become injured, time to die.  I know that there is a lot of controversy and stigma out there about "part-time docs", but in the end this is a personal, not a socioeconomic decision.  I have dedicated 13 years of my life to medicine.  After 3 years of residency and 6 years of practice I am confident in my skills and knowledge.  It is now my children's turn to have my focus and attention. They will only be this small and will need me this much for so long.  It is their time.

MiM Mail: Pregnant and joining a new practice

Hello,

I've stumbled across this page from time to time and have found it very supportive and informative.

I am a soon-to-be graduating neonatology fellow in the south.  I have one son who is almost a year and a half.  I am married to a very supportive, non-medicine type husband.

A few months ago, I accepted my first position as an attending in a private practice, community hospital setting to start a month after I graduate from fellowship.  I just recently found out that I am 7 weeks pregnant with our second child.  While my first emotions were excitement and joy, very shortly after came apprehension and guilt about joining a new practice while pregnant.  I am know I am not the first, and will certainly not be the last, to be in this position but I would like to hear from other moms in medicine about their experiences with this.  When should I tell my new practice that I am pregnant?  As soon as possible or just show up to work 20 weeks pregnant and tell them then?  How and when should I broach the subject of the length of maternity leave?  I would really appreciate any advise or insight from other moms in medicine.

Best,
Anonymous

Don't Trust Me, I'm a Doctor

Yesterday I got coverage to go to my kid's school to bring birthday treats - they are celebrating Summer birthdays before the end of the year, and Jack turns 8 on June 3.

I stopped at the hospital gift shop on the way out and bought a beautiful balloon, a "double bubble," it had clear plastic surrounding a pretty pink flower with a purple and blue butterfly on top.  The effect, I thought, was breathtaking and I couldn't wait to share it with Jack's class.  I considered sending the treats with him and skipping the class party in the interest of my large workload, but that morning at breakfast Jack asked eagerly but guarded if I thought I could make it so I determined that even if it meant staying late at work, I would.  He was thrilled.

It was raining cats and dogs when I pulled into the school parking lot at 9:35 - designated time was 9:45, so I covered the treats with my yoga mat and darted in the double doors briskly.  I stopped to check in with the secretary.

"I'm just going to bring these treats for Jack's birthday celebration."

"What are they, do they have nuts?"

"Um, I don't think so - we've been eating them for years.  My kids hate nuts, and it's a fave, but I've never asked the bakery.  I got them from Sweet Love - they are called Ninja Turtles.  They are condensed cookie dough around homemade caramel with chocolate drizzled on top, they are amazing."

"Oh, never mind, I think the kid with bad nut allergies is in the other class.  But I'm going to have to ask you to take the balloon to your car.  It's a choking hazard.  I had to turn away a Mom bringing 18 balloons to the class the other day."

I looked at her perplexed.  "I'm so sorry, I had no idea."  She softened.  "Well, if you just bring it for the party, then take it back to your car, I guess it's ok, just the one."

"Oh thank you, I promise I'll do that."

I walked into the classroom with the box of treats.  The teacher introduced me, Jack gave me a hug.  She then said, "Do those have nuts?"

"I don't think so, but I've never asked.  My kids hate nuts."  The teacher pointed to a kid with nut allergies, the first kid that my son was excitedly indulging with treats.  I watched him take a big bite.  Jack finished passing out all the Ninja Turtles, and gave one to his teacher.  The children were munching happily; Jack was on Cloud Nine.

The teacher walked over to me.  "Can I see another one of those?"  I mistook her mood - thinking she loved them so much she wanted another.  She started dissecting the Ninja Turtle.  "I think these have nuts in them.  I got that nut caught in the tooth sensation."  I told her, "I'll call the bakery and find out for sure."  The baker confirmed a small amount of crushed pecans, and I relayed silently to the teacher in alarm.  She walked over to the boy with the allergy.

"I'll need to take you to the nurse."  He protested, saying that nothing was happening, while I reeled in horror but assured her that I would watch the classroom while she left.  I was in scrubs, pager on my hip, wishing I was back in my office at my scope, but worried about the kid.

I was at the helm, and I did well.  Another boy stood up, announcing his nut allergy.  Luckily he had already done this earlier and I watched the teacher artfully blow him off, so I didn't have a heart attack on the spot.  I asked him, "What happens to you when you eat nuts?"

"The tips of my ears turn bright red."

"Well, that is not happening right now, but I'll be sure to be on the lookout for it."  He smiled and sat down.  Most kids were simply alarmed that they had enjoyed a treat that contained hidden nuts.  Jack said, "I've never had any idea that these had nuts!"

I entertained the kids by showing them a picture, one by one at their tables of a wax couple - Queen and King of Hearts, that made Jack laugh so hard the other weekend I thought he was going to explode.  Got similar laughters from the children.  It was fun and calming.

The teacher returned, apologetically.  "I'm sorry it was my fault, I should have checked into it more.  He is in a nut challenge study and is building up his resistance, so this is probably a good test for him.  His nut allergy is not that bad.  It will be OK."  Whew.  I melted with relief inside and resolved to text the mom, who I knew, who was equally relaxed in return texts.  Note to self - No more Ninja Turtles at the school.

The teacher also said, "I can't believe you even came, you're a doctor!"  I embarrassingly replied, "Yes, so you trusted me, about the nuts.  Because I'm a doctor!  That makes it even worse."  She laughed.

As I drove back to work I realized I had left the balloon in the classroom in my tizzy and called the school to tell them.  The secretary said, "Thank you so much for calling.  I'll run get it out of there right away."  I imagined my beautiful balloon as a menacing creature in disguise, exploding into tiny suffocating bits that were about to fly directly into each child's larynx, creating mass chaos and asphyxiation.  I hoped she would get there in time.

It was hard for me to get back to work - the experience was so traumatizing.  I texted my friend about it, "I think they might call me in on the child abuse hotline.  Next birthday I guess I'll just bring a carton of cigarettes and a case of beer.  I've set an awful precedent.  I'm THAT mom."  He and my partners empathized and laughed.  "You're experience is so 2013.  So different from when we were growing up."

I recall back when my kids were 3 and 5, at Montessori School, I had a rare fit of baking resulting in peanut butter balls.  I used the wrong chocolate that melted at room temp.  I proudly brought them to school, freshly refrigerated, only to be turned away with consolation and mild reproach.  "This is a peanut-free school, remember?"  Fail.  It was winter, temps in the 20's and 30's, so I kept the peanut butter balls with chocolate that needed to be refrigerated in my car passenger seat, and ate them all over a week.  You'd have thought I learned my lesson.

I hope to in no way belittle the seriousness of peanut allergies by this post.  It served to remind me of the importance of checking in on ingredients.  We are baking a tres leche cake this weekend for a Spanish project for my daughter Cecelia, and I checked and double checked the ingredients as there is a serious nut allergy kid in her class. But I am a nut hound, and I forget.  If you look in my office food drawer right now you would find almonds, pistachios, and pecans.  I apologize for any perceived but not intended insensitivity and understand the seriousness of the topic, but found the incident today quite amusing, with a luckily happy ending.  Here's to the King and Queen of Hearts.  Who look as alarmed and upset as I did, when I found out about the hidden nuts.

Guest post: Maternity leave, or lack thereof

I am a psychiatry intern currently about to have my first baby towards the beginning of my second year.  I feel so blessed to have this baby, who we recently found out is a girl.  I am not the emotional pregnant lady everyone speaks of--just so so happy about our family's future.  It took me a long time to decide to do psychiatry, and when I wasn't sure if I would have kids in residency, I thought of ob-gyn.  Now, seeing how accepting and supportive my program has been of my pregnancy, I am happy with my decision.

But, there are a few things they can't change, and they have made that clear to me.  For example, if I want to fast-track into child psychiatry, which I do wish to do as the fourth year curriculum at my program isn't ideal, I absolutely cannot take more than 35 days off during my second year.  This includes all vacation and sick time.  After some deliberation with the program director, we have come to decide that I will be taking my four weeks of vacation, plus 10 days sick time, to make a total of 6 weeks maternity leave.  This leaves me with 5 days of baby sick time or emergencies for the entire remainder of my second year.

While I am okay with this scenario, and actually it's more than I expected to have in residency, I grow more and more bitter towards the field of medicine.  Family and friends are always so shocked when they hear about the above "maternity leave."  My friends in finance always fire back with, "What! So-and-so at my job got pregnant and had 4 months paid maternity leave, without using vacation."  Gosh, wouldn't that be so nice.  When MIL heard about the maternity leave, she couldn't believe it.  Her response was, "But that's not fair!"  Who's to decide what's fair?

I am beginning to think more and more about simply extending the residency and doing a fourth year as much as I don't want to.  It's an easy call free year and I may like to have the time to spend with my little daughter.  However, with looming debt over our heads, I would really like to be able to make an attending salary sooner.

Some that read this post may think, "Wow you are lucky, that is a great amount of time!"  But I don't feel lucky to have to pass my baby on at 6 weeks.  I don't feel lucky that I'll be taking a lot of call while my baby is an infant.  Or that after much hard work, I still have to squeeze pennies to buy baby stuff.

Does anybody else agree that medicine just sucks for motherhood?

And many more

In honor of Mother's Day, I was interviewed for Radio Rounds about Mothers in Medicine - why it was started, how it's grown, and whether I thought mothers in medicine could "have it all." (An enthusiastic Yes.)

Mothers in Medicine will turn five this month - 5 years of stories from amazing women who I am honored to write with and share this space. Some have been writing here from Day 1; others have joined in along the way. All have shared openly, these thoughts and feelings that could easily be kept private, for the benefit of this community. The blog's growth has been staggering.

This blog is still my favorite "extracurricular." I list it on my CV under "Service to the Community" because I think that's what it is: service. It's community. A labor of love. And definitely, not a business (note: we do not, nor will we ever have ads. Advertisers, please stop emailing.).

So, MiM writers, thanks for writing. You are all fantastic, and I still hope for the day that we'll hold a MiM conference somewhere tropical. I'm buying you all drinks. MiM readers, thanks for reading and commenting and liking and sharing. You're why we are all here.

To 5 years and to many more.

in the thick

I've been to urgent care three times in five days with two sick kids, one of whom almost got hospitalized for pneumonia.

A few days ago we put an offer on a house (our first ever), for which the payments would stretch us fairly thin during the six months until I start work post fellowship. 

I've signed a job contract that I had planned to mail yesterday. Just before dropping it off, I received one email and one text message, both in regards to two different job opportunities.  I have one week before this contract is due and, even though the other two leads might be better fits for me and my family, the contract I have now is not sometime I would want to walk away from. One of the leads is in another state, further complicating that home offer we made.

It's a strange week when patient care is the least stressful part of my day.

General Practice Pathology

This post is dedicated to an amazing clinician, MomTFH.  You are The Wind Beneath My Wings.

I get frustrated.  At the financial interests that pit private practice general pathology against subspecialty academicians.  It seems to happen a lot more these days than it did in the past.  Some cities get it.  They work in concert. Unfortunately, it is rare.

I have written here before about my brother.  He has an intractable case of Crohn's disease, one that has plagued him his whole life.  He has lost most of his small intestines and all of his colon.  He has been in a coma in the PICU.  He has received many infusion therapies.  He holds a Ph.D. in food science from Cornell, and a degree from the Culinary Institute of America.  He is crazy smart, a leading authority in his field.  He has overcome many health obstacles to get there.

He called me the other day.  "Hey Giz!  Guess what?  I got a family doc.  Not just any family doc, but the golden ticket one.  He works at Harvard, he is a liver specialist, but he loves family medicine so much that he devotes half of his practice to it.  He is incredibly hard to get into, but I got a referral and I got lucky.  I can't wait to get plugged in."

My brother has had a lot of issues with the fragmentation of medicine, as a patient.  He used to thrill in the bypass of the generalist - his insurance allowed him to go straight to the specialist.  And he has had a lot of specialists; derm, infectious disease, gastroenterologists, surgeons.  But now, in his mid to late thirties, he has come to the realization that he needs someone to tie it all together.  He is tired of that being him, the patient - he holds a lot of knowledge in his head but is not a trained physician.  "Giz, they don't talk.  I bounce from one to the other and get great individual therapy in their area of expertise, but communication is poor.  So I end up navigating the system, poorly as a non-clinican, and it is tough.  I'm tired.  I realize what I need is a good family doctor.  I am thrilled to finally have one."

I remember a letter recently on MiM, one from a med student looking for advice.  She clearly said, "family medicine is out - they get no respect."  I think this is a big fail in our current society. They don't get enough respect, but they should.  They should be seen as the glue that holds it together.  The ones that sweat and toil and advocate for their patients.  The ones that tie it all up in a neat knot, so that their dependents, their clients, their patients, can sit back and relax in the knowledge that they are getting good care and someone out there is advocating for them.

I empathize with the family docs because like them, as a general practice pathologist, I do everything.  I inspect labs.  I am the head of microbiology.  I look at GI biopsies every day, alongside breast biopsies.  I get called to the OR to triage unknown cases that end up being rare sarcomas or common cancers, but I don't know what until I get there.  The knowledge base I have built up over the last 7 years in private practice of the entire human being, of all of its tissues, is immense.  And I like to think that by studying everything, by getting to see all aspects of the patient, that I have become a great diagnostician.  Not a specialist by any means, but still.  I have heard the term, "Good at everything, great at nothing."  That sounds derogatory, although I can relate.  But I'll take it a step further.  I'm pretty good at everything.  And I am finally coming to the realization that my knowledge base, although not entirely specific except in my area of expertise, is good enough for what I do on a daily basis.

Global vision: knowing your whole patient, being a pathologist or a family doc, trumps tunnel vision in many ways.  But by saying that it feels that I am slamming subspecialists.  I am not.  We can work in concert, but we are all equally valuable to the patient.  And that's all that really matters here - the patient, I mean.  My brother, and the millions of others out there like him navigating a fragmented health care system.  Our patients deserve our respect.  Family medicine, our glue, deserves our respect.  If I am allowed one wish in my lifetime, I think it would be that family comes back around, and gains back the respect it deserves.  Like me.  A general practice pathologist.  We are all, patients and doctors, in the trenches together working for each other.  That is how it should be.

MiM Mail: Medical school & baby #2?

Hello MothersinMedicine,

I just started following your blog and it has been so helpful and sometimes funny to read. I am very happy that I found you!

 I am currently a second year medical student with an almost 2 year old little boy. He was born right before I started medical school. So I only know medicine as a mother. My husband and I recently started talking about baby number two and I am getting really anxious. I would love for my little boy to have a sibling but the thought of having a newborn again scares me to death. My son was 12 weeks old when I started my first year and it was hell. He was far from sleeping through the night, I was incredibly sleep-deprived, and could only study during his naps or after he went to bed at night. With a lot of caffeine. Not to mention that he was pretty difficult as an infant, was very needy and required a lot of attention.

There is also the question of when is a good time. From what I gathered, it seems like 4th year would be a good time but I am worried about how to go through residency interview season either pregnant or postpartum. Have any MiM found that to be a problem?

I am planning to go into pediatrics and wonder if having children in general would be an advantage or a disadvantage in that specialty. Do interviewers care either way? Can I talk about my experience as a mom and how it lead me to pediatrics? Since I am busy raising my little one I have not had a whole lot of time to look into extra-curricular activities such as research and volunteer experiences. I feel like that will hurt me as a candidate. And another baby would certainly not help.

 I have to mention that my husband is active duty military and is not always home so most of the child care fall on me, although that is likely to change next year as I start clinical rotations.

 Anyway, that's my MiM experience. I love being a mother, a wife and a medical student and would not want to have it any other way. I'm trying the "having it all" thing and so far it's working great. I'm always happy to read other MiM stories, I feel less crazy trying to all make it work.

Thank you!
O

The Last Bu-bu

WE DID IT!!!  When I started breast feeding I was determined and optimistic!  But, as I persisted I got discouraged more times than I could remember.  There were latching problems, cracked nipples, thrush and the pumping!  PUMPING SUCKS!!!!  I celebrated when we hit the one year mark and I stopped pumping.  My plan was to allow my baby girl to self wean.  Well, she wasn't interested.  I stopped pumping but kept making LOTS of milk, so we persisted with morning and nighttime feeds.  When my baby girl was a year and a half I left the lab and went back to surgical residency hours.  My initial stint on transplant kept me at work around the clock and I felt for sure that my milk would dry up.  Miraculously it didn't and "bu-bu" time became a special time with me and my baby girl in the midst of all the chaos.  Well, the time has finally come.  Baby girl is losing interest, I've basically stopped making milk and my baby girl is a smart, amazing, beautiful big toddler now.  She hasn't had bu-bu in a week.  I put her to sleep by telling her princess stories or stories about my "doc-tur house" while she lays her head on my chest.  I'm a bit sad our "bu-bu" time is over but amazing grateful for the two and a half years we had of this amazing connection.  I'm incredibly proud of our accomplishment that survived even the insanity of residency and as always I am crazy in love with my beautiful child.  I can't wait for all the new memories we will make together.

Now off to pick some strawberries!  Happy Saturday!

On Being Imperfect - Topic Week at MiM

Welcome to our topic week celebrating imperfection. All the posts this week contributed by readers and regular contributors will be about this in some way - our thoughts, our stories, our confessions, our revelations. Thanks to all who have shared. All hail the sometimes messy but (hopefully) meaningful life of being a MiM.

Posts will be spread out across the week and will appear below. Thanks for reading.