MiM Mail: Nontraditional student, school pressures, stalling

Hi MiM community,

I am a 31-year old medical student just finishing my first year (M1). I'll be 32 this fall. I got married last summer before starting school, and while my husband and I considered having a baby during the pre-clinical years, we didn't want to try until we had gotten used to our new married life and were sure we had gotten into the swing of school. Earlier this year I thought that maybe 2nd year would be a good time to have a baby because although my school has an attendance policy, it would be easy enough to stream. But then I started to stress out about Step 1 and wasn't sure how a new baby would enable me to put in 12-14 hour studying days and so I have been stalling. At this point, timing seems pretty bad.

I met with someone at school about best times and what I should know for planning, and they of course told me to do whatever I wanted, but that it was easier to take blocks of time off in 3rd and 4th year. So, right now we are thinking about trying starting later this year and having a baby sometime in 3rd year ideally, or 4th if it takes longer. We would like to have two, and I'm hoping that maybe we could have a second after intern year of residency (when I'd be 36 or 37). If it didn't happen, hopefully we'd at least have one, but I know we would both be a little disappointed.

I feel like I'm running out of time and I don't know how to handle it. I know everyone says there is never a good time, but it seems like all the times are downright bad and every time an opportunity comes up I get cold feet. I've been honoring most of my classes and would like to at least leave the door open for matching in fourth year and hopefully eventually a career in academic medicine (probably not in a hugely competitive specialty - right now considering EM, neurology, family med or internal med). I am nervous that I won't be able to keep it all up with a baby, or that the feelings of guilt I already have towards my husband and dog will only get bigger as our family expands. I already hardly see my family or friends and spend most of my time at home holed up studying.

What I'm hoping for advice on is:

1) Anyone have experience with a first pregnancy/new baby in M3 year? Any advice on how to plan for it or handle it well? Pitfalls to avoid?

2) In my situation, is it better to just try and wait until M4 and then PGY2? My fear is that since pregnancy is unpredictable, I'd rather start early.

3) Does anyone have advice on managing competition in class? I feel like I am putting a lot of pressure on myself to succeed to the point where I actually make myself unhappy and burned out and I'm not even sure how much it matters much in the long run.

Thanks for all you do. This is a great community and I am really glad to see the support.

A bursting moment

We signed up the whole family to run our school's annual 2K/5K Family run this past weekend. Last year was our first year running it together; despite my protests at the time (I might die, go into rhabdomyolysis, etc etc given my baseline inert state since having kids), I ended up having a really fun time. It even got me into running regularly for the past year. Granted, I've been running short distances, around 2-3 miles at a slow pace, but I'm doing it 2-3 times a week without fail and have come to enjoy it. (Added bonus is watching TV shows while on the gym treadmill which I would never otherwise be exposed to, including Long Island Medium and Hoarders: Buried Alive. Fascinating.)

Being in better shape and actually used to running made me much more excited to run the 2K this time around. Also running it would be Jolie (9), JL (6), our au pair M, and my mother-in-law. I convinced my husband, an Ironman-distance triathlete, to do the 5K instead of running with us since he'd lap us anyway by the end. Our 3-year old would wait on the sideline with my parents.

Now, last year, JL ran with me while holding my hand the whole time. Yes, this was sweet, but making it physically more difficult to run. Believe me, I did not need any added difficulty. He told others after the race that maybe he could have won if he didn't have to run with (running-challenged) Mommy. Gee, thanks, kid.

At the start, everyone took off way too fast. I tried to keep up with Jolie and JL and keep them in my sights. JL, in particular, zoomed off- could not believe how fast he was going. I had to go much faster than my usual pace to catch up and run with him. We were flying and passing people. Probably about 3/4 of the way done, JL started to feel it.

"I need to walk!" he said. "My legs hurt!" "I'm tired!"

I switched to rally mode. "C'mon, JL! We're almost there! You can do it!"

He really wanted to walk. I told him he could walk, but that I would keep going and he could catch up to me later. This got him to push it out more. He didn't want to walk alone.

We kept running. He grabbed my hand. We ran for awhile like that. I kept cheering him on - Let's go, JL! Let's finish it! I know he was struggling. But, I also knew we were almost there.  Just a couple of more blocks and then we'd turn and see the finish line.

He was a trooper. He kept pushing it. We held hands. When we turned the corner and saw the end with the banners and the crowds, we dropped hands and he spurted ahead to finish.

We crossed the finish line within a couple of paces of each other - triumphant but totally spent.

We watched as others came through - a couple of his friends from Kindergarten and their parents. We saw Nana come in, we saw my husband come in for the 5K, then M and Jolie.

When the awards were announced, we heard JL's name announced for first place finisher of the 2K for his age group (6 and under)! He ran to the podium to receive his medal, and I could see his heart bursting with happiness. BURSTING.

This is a boy - the middle child- who is often in the shadow of his big sister and more-needy baby brother. He needed this moment.

As I watched him glow, showing his medal to everyone afterward, seeing that smile on his face, I was filled with a special kind of mothering joy. If I wasn't there alongside him, he would have likely given up, started walking, falling behind. And isn't this an amazing part of what we can do as parents? Being there, cheering them on, helping them do what they think they can not. Helping to make the moments that are filled with confidence-growing, heart-fluttering, self-celebrating pride.

For me, helping JL win that medal was the best Mother's Day present I could ask for. I am so glad I was there, helping him have a bursting moment.

Hot (Scheduling) Mess

There has been a lot written lately about work-life balance. In a session with my Therapist last week, she laughed and said “you’re a Resident, for this last year of residency, I really just want you to survive!” We spent the remainder of our session coming up with ways that I can pay people to do things I don’t have the time to do. And she made me promise to work harder to eat better, sleep more, and exercise more; my turn to laugh. Next week, our family will be trying out a week of made-from-scratch meals from a local organic market while I finish a busy week of nights. And we are looking for a second cleaning person after the first one proved to be a bad fit with our family.

Scheduling time away from work for things like research, board exams, and doctors appointments is an exceedingly stressful aspect of my life. Because we get our schedules pretty late, I try my best to email the our Scheduling Attending and Chiefs at least several months before I think I’ll need time off. Nevertheless, I sometimes get my schedule and there are conflicts and then I have to forward back my original email requesting time off and the hot-scheduling-mess begins.

Last year, when I took my Step 3, I emailed the Scheduling Attending and waited so long for a response that the dates kept filling up. I had to extend my eligibility period and finally had to use research time to take the test. I have heard countless stories from other Residents recounting their shared experiences (many have to use vacation time) and how stressful it is to try to do things you have to do.

This year, my son will be spending my last Intensive Care Unit month with his grandparents while my husband is away doing research. He will spend the first 3 weeks with my parents, but once their vacation time is used up, he’ll spend an additional week with my in-laws. At the suggestion of my husband, I emailed the scheduling Attending and requested off a single day and offered to make it up during my vacation.

I feel guilty that we need our parents to watch him. I feel guilty that I asked for a schedule change. However, it would have been a very stressful and traumatizing experience for all of us if I tried to travel, get Zo acclimated, and get myself ready for life without my family for a whole month in 2 days. And then to make me feel even worse, I get an email saying that the Scheduling Attending talked to my Residency Director and my Clinic Attending and she would like to know if I really need that extra day off. They understand my unique situation but they want to double-check before they reschedule me.

As I began to stifle my tears, my husband came over to rub my back. I explained my distress and he reiterated that even though it’s hard, I have to ask for what I need. He reminded me to not feel bad and that “it’s the culture” of medicine that makes it difficult for folks to realize that what we are asking for is not unheard of.

After taking a break, I responded that yes I do need the day, that I would personally call the 2 patients I have scheduled, and that I again would be more than willing to make it up using a vacation day.

Thus ends this installment of my hot-scheduling-mess until the response email. Dunnn dunnn dunnnnnnnnnnn.

Mother's Day

Happy Mother's Day to all the mommies!  May you all have wonderful days filled with lots of sweet hugs and slobbery kisses!

MiM Mail: Toddler tantrums

Dear MiM,

I am writing you to get some advice on toddler behavior.

I am a 3rd year medical student, mom to an almost 3 year old little boy and currently pregnant with baby number 2. I have been struggling lately with my son's behavior. I used to have a sweet, smart and energetic little boy. Since he has been out of his crib and potty trained, my husband and I have had a tantrum monster on our hands. We have what we call a "spirited child," with a very strong personality and stubbornness beyond anything I have seen in other toddlers.

We put him down to bed around 8pm every night after the usual bed time routine and he usually takes anywhere from 1 to 2 hours to actually fall asleep. It's a combination of "I want different pjs/I need more water/I want daddy/I want a new blanket/ I want the light to be blue/ It's not dark out yet/ I don't want to sleep / I need to pee" but the list is endless. My husband and I try to be firm, we have tried to let him cry it out but he cries even louder so we inevitably comply with his requests so he can sleep. Even worse, he wakes up 2-4 times per night with similar complaints, throws tantrums where he arches his back, cries hysterically but won't tell us what is wrong. As a result I am getting increasingly frustrated and exhausted.

Today must have been the worst of all days yet when after 4 overnight wake ups and very little sleep overall, my son woke up at 5:30 whining, rubbing his eyes, yawing and saying that he does not want to sleep anymore. I found myself yelling and screaming, which is unusual for me and ended up breaking down in tears since I had only gotten about 5 hours of sleep myself.

Being very pregnant at this point, I am anticipating some sleep deprivation once our new baby arrives but I feel like I cannot deal with my son anymore. I cannot imagine how this situation is going to work out when I have two kids in the house who wake up multiple times per night.

Worst of all, I feel like I am failing as a mother. I am having a hard time enjoying time with my son during the day when nights are so painful and feel guilty about it. I can deal with daytime tantrums but the nights are draining my energy.

Do other moms or pediatricians have experienced similar situations and have tips on how to deal with toddlers? Your help would be greatly appreciated. Thank you.

Medmommil

Question: Maternity leave

Lately every night I'm on call I seem to be the magnet for pregnant patients - trauma, acute abdomens, appys, choleys - you name it.  During my last call as we talked about my pregnancy magnet, it lead to a discussion about having babies during residency.  We happened to be a diverse group of providers with a diverse and international training background. The take away from the discussion was basically that in the US we don't value new moms, dads or babies.  Those who had trained elsewhere (in surgery) seemed to feel that it was just natural to expect residents to take 4 months, 6 months, or 1 year off (mom or dad).  Meanwhile we all told stories of post c-section residents NSAIDing their way through full operative days 4 weeks after giving birth.  We talked about how broken your body can feel so soon after giving birth, both mentally and physically.  We talked about those itty bitty 6-week old babies in daycare.

So, for those of you who have trained elsewhere in the world:

What is the attitude towards new moms and dads in other countries with more flexible and lengthy maternity leave policies? 

Are residents looked down upon for taking leave (like they often are in the US)?  

Does a culture of more family centric leave create a more equitable distribution of gender roles in the home and the workplace? 

I'm just wondering...

Mommy Call

After my six-week maternity leave was over, I showed up to work after having been up all night because my Doll must have felt the change coming--she didn't sleep a wink!  And I was up with her, trying to soothe her back to sleep.

I was quite embittered (is that  word?) that I was scheduled for a 24 hour overnight in-house call just 4 days later, as I thought there was an agreement that I would not be on call for at least a month after returning.  That night on call was a particularly slow night, and I was called by the nurses only about twice.  One of the calls required me to handle a situation on the floors, and as I was writing my evaluation note, one of the nurses said to me, "it's nice to get some sleep while you're here, huh?"

No, it's not.  I would have rather been up every night all night with my Doll than sleep all at work.  That's how I felt then, and that's how I feel now, 9 months later.

It is finally May.  I see the light at the end of this very long tunnel!  Two more months until what seems now to be the golden year of residency.

Guest post: Gaining More Than Just Weight

Twenty pounds into my pregnancy with no end in sight, I began to dread stepping onto the scale at my Ob/Gyn appointments. Even more, I began to dread that moment in the exam room when my doctor would review my numbers for that day. My blood pressure was invariably okay and my urine dip was normal, but my weight continued to bound upwards in increments larger than what was apparently advisable. I would nod with shared concern as she read out the new tally – seven pounds since my last visit? Oh, my – and with determination as she listed suggestions to watch what I ate and try to get some exercise. Even just take a walk a few times a week, she said. The implication being, how hard could it be?

I would leave the office with new resolve to pack healthier snacks for work and to make time to go back to the gym, or at least to start taking the occasional evening stroll. The snack resolution I met with reasonable success, but the exercise portion proved difficult. Now in my second year of residency, I had stacked my schedule so as to complete my months on certain services – those with the greatest intensity and the longest hours – in the fall and winter prior to my delivery in exchange for a reasonable stretch of call-free maternity leave in the spring. As a result, I left the hospital each night in darkness, exhausted. I stopped even pretending that I might stop by the gym or venture out along the icy sidewalks near my home. Besides, I spent at least half of every shift on my feet, rounding on the wards or hurrying between emergencies. Surely all that activity must count for something.

Hoping that my mediocre efforts had paid off to at least slow the accumulation of pounds, at the next visit I would slip off my heavy Dansko clogs, get back on the scale, and watch as the medical assistant slid the little weights ever further to the right in order to balance my growing mass. Then the entire scene would repeat.

Eventually I gave up.

My new attitude was a mixture of It’s no use, I can’t, and Why bother. I was doing what I could, I reasoned, and if I gained some extra weight, so be it – I would work extra hard to lose it after the baby arrived. I continued to attend every check-up, only now when I nodded at the numbers, my concern was only mild and my determination feigned. I left the office feeling a combination of relief and resignation, already dreading my next appointment.

And suddenly I was not so different from my own clinic patients and their families: from the children and teenagers whose growth curves make me cringe as they surge skyward, brazenly crossing percentile lines, and from the parents (often overweight themselves) who grimace when I show them this evidence of too much intake and too little output – it’s that simple, I explain. They nod earnestly as I outline a plan of attack: cut out soda and juice, add vegetables, find time for exercise. And they look abashed when they return months later to find the curve inching ever onward in the wrong direction.

I’ve been lucky in terms of weight for most of my life. Sure, I’m a fairly typical female; I have certain body parts that I find too loose or jiggly or poorly shaped and I’ve spent too much time staring from different angles in the mirror, obsessing over these flaws. I have gained and shed pounds according to my level of stress and just how hard – probably at times too hard – I have worked to lose them. But I have never been truly overweight, never begun to dance with the complications of hypertension, diabetes, sleep apnea. Never before had a doctor grow concerned about the number on the scale.

And because I had never been in their position, I had never understood how difficult it is to try to get out of it. My belief and the implication of my advice had always been: how hard could it be?

Now I knew. The specifics of our challenges aren’t exactly the same –many of my patients can’t afford to join a gym whereas I pay for a membership and don’t go – but if neither if us is working out, what’s the difference? We’re both gaining too much weight too fast and have been unsuccessful at making the changes our doctors push for. And we’ve both felt bad about it.

I didn’t suddenly develop a grasp of how to move past the roadblocks in my life or theirs. If anything, this new knowledge makes my job even more frustrating and my motivational interviewing less motivational; how can I enthusiastically pitch ideas that, given the backdrop they are set against, are so unlikely to work? What I did gain was new understanding and empathy. And while I don’t have any brilliant solutions to offer to busy, tired people with potentially limited resources who are struggling with the trials of diet and exercise for themselves or their children, I hope that I am better able to partner with them to search for solutions or simply provide support now that I have stood in their shoes . . . on the scale.



I am a second-year pediatrics resident and mom to a 2-month old boy. I blog about my experiences at The Growth Curve (www.thegrowthc.wordpress.com).

Guest post: Post Partum Pearls

An IM Hospitalist's perspective

I’ve heard that the rigors of medicine prepare women for the arrival of a newborn, and to a certain extent that is true, but there is definitely more to it than that. Our great work ethic, patience, and calmness in the midst of a storm do give us a great base. Also, we tend to “freak out” less over any minor baby medical issues. Despite those similarities, taking care of an infant is quite an unique experience.

It’s been four months since the birth of my adorable baby girl (in my completely unbiased opinion), and I’ve stumbled upon some of my own truths that I felt like sharing.

# First few months are all consuming…kind of like Intern Year

Preparing for childbirth and care takes you only so far, just like prepping for intern year cannot get you ready for the real time situations of the wards.

I was exhausted both mentally and physically in ways I didn’t know I could be. I learned the hard way that keeping my goals simple was key. Feeding, consoling, bathing and carrying an infant is enough for the day. Squeeze in some personal hygiene and eating time and feel good about yourself.

# Infant care is the ultimate roller coaster ride

I recall at the end of my 12 hour day or night of work, my husband would ask how the it went, and in my head multiple thoughts would race, but it was too mentally taxing to convey everything to him, so I’d end up saying “ it was good…” This type of response is quite similar to my days during maternity leave.

There was a mixture of highs and lows and in between. Capturing the entire experience in one sentence seemed unnatural.

# Self-sufficiency is overrated

Though in our profession we are encouraged to ask for help every step of the way, what I’ve found more true with my few years post training, is that most of us strive to work out issues on our own. Asking for a consult every time a question pops up is not an enticing option unless absolutely necessary.

Well when it comes to infant care, support and help are key. The truth is you need your “own time” off from your infant to maintain a healthy relationship. Sure there is satisfaction in bathing, feeding, and nurturing your child all by yourself at times, but not all the time!

Take up your family and friends’ offers to help out. Learn to separate your attending/resident hat from your mother hat! Oh and single mothers, you completely deserve a lifelong standing ovation.

# Don’t feel guilty about not doctoring

As my baby has grown up over past month or so, I have found more free time during the day. At first I immediately thought (after catching up on sleep), that I should do some medicine related things, so my brain doesn’t decrepitate with time. So I filled the hours with intermittent medical reading and reviewing some stuff here and there. I even created my own blog regarding hospital medicine, but as time wore on during my maternity leave, I still found it hard to keep up with everything, and then the guilt trip started. So what I have concluded is to give up pseudo doctoring unless it truly invigorates me, like writing this article. Don’t worry, the skills will not disappear. I realized that after doing a few shifts here and there. You have the rest of your life to doctor away, no need to do fret over it now.

# Embrace your free time, it’s okay to be domestic!

If you’re blessed with more just six weeks off, you will find that your free time will actually increase (not dramatically but noticeably so). I found myself cleaning up the clutter in our apartment and going on an organizational binge. There were moments when I’d stop in the midst of my activities, and think “ oh god, what am I doing?? Did I study, train, work all those hours, and accrue all that debt to only be doing this right now…? “ And then, after bouncing these thoughts off my husband, I slowly snapped back to reality. And reality was pretty great if you are willing to accept it within the context.

For once in my life, I was not working or studying. My hours were completely dedicated to my child and to myself/family. I’d never had this type of time before, except maybe the two months between medical school and residency, except now I was more settled in my life, and that was comforting.

What did I use this time for? Well, to be honest, at first, I binged on TV. Then I started getting into social media especially all the medical related stuff. I’ve also been exploring my creative side again – doing DIY projects for décor, learning lullabies on my acoustic guitar to sing to my little girl, and learning to cook different dishes. It’s been quite refreshing.

Take Away

Overall, it really has been an internship of sorts, and this “learning how to be a parent” is going to continue for the rest of my life just like perfecting the art of medicine never stops. I do hope that my experience will make me a more caring physician when I jump back into the field. I have much to learn, and I’m looking forward to it. To all the other mothers in medicine, I applaud you. I’d love your advice and comments!

@psanyaldey is a 34 year old internal medicine trained hospitalist. She is married and has a mini siberian husky along with her newborn girl. 

Rocket Scientist

My daughter Cecelia (11) has never wanted to be a pathologist. She is completely disgusted by what I do. She likes looking under the microscope, but when I showed her the Blood Bank a couple of years ago with refrigerated stocks of blood and she saw an amputated leg (shrouded by a red biohazard plastic bag) one day when we visited the gross room - "What's that Mom?" - she was mortified. She wants to be a rock star. Fine by me. I'm all up for supporting dreams coupled with education.

Jack (8), has always wanted to design video games. But he's also great at math, graduated from struggling to read Skylander captions at the beginning of this school year to hungrily devouring novel series in weeks (Percy Jackson, Hunger Games - I know, but he begged for months and had seen the movies with his dad and sis so I finally gave in), builds lego sets, and loves winding down at night making me and his class Rainbow Loom bracelets. They adorn my wrists and serve as office decorations.

But no pathologist admiration yet. Over the weekend I bought Jack an air blaster gun and he has enjoyed building the flat paper characters into 3D figures to "blast" with the air gun. One he was working on this morning while I fixed lunches had a lab coat. "Mom, you have to take this one to work with you! It's The Evil Pathologist." He wrote it painstakingly and lovingly on the back of the head.

Cecelia chimed in. "Mom, you have to put it with your rocket ship microscope cleaner." So today when I went to work I created a moon scene to show them tonight. The Evil Pathologist, my rocket scope cleaner, some "moon" sand Cecelia made for me years back, and a nice bright Emergen-C background that looks I think a little otherworldly; planet like. C said it just looked like Emergen-C packaging. Oh well.

I don't need my kids to want to do what I do. But I'm happy they finally think it's kinda cool. Confession: I wiped the dust off of the shelf before I took the pic.

Guest post: I'm more like the night-time babysitter

Sometimes I feel like the night time babysitter. I am an Ob/Gyn resident and leave every morning before my 16 month old wakes up (she's a great sleeper, I should be happy). I come home and feed my daughter dinner and supervise the bath, zip up the PJs, watch a cartoon and cuddle while she drinks her bottle, and then its "night night time" and I'm done being a mommy for the day. I could keep her up later but she's tired, and I don't want her being on a special schedule just because her mommy is a doctor.

I hate being a doctor these days. I don't feel important or empowered like people say I should. I know my daughter will one day look up to me as a role model and feel proud of my career, but right now I think she just needs a mommy at home. I don't envy anyone except my stay-at-home mom friends. I wish I knew what it was like to be totally frustrated after a long day of cleaning up plastic toys and missed naps. I wish I knew what it was like to be lonely from lack of adult interaction. Instead I'm stuck taking care of people I don't know all day and getting yelled at by attendings.

I know I'm a "grass is always greener" type of girl, but many days I think I could walk away from this job and never look back. But what would everyone else think? What would my father, who paid for medical school, say? I'm "almost done" with residency-1 year and 2 months left to go, but it feels like forever. I'm already counting down until the day I graduate, so I can take a few months off, and then start whatever Hospitalist job will let me work the least amount of hours. Exactly the kind of career I used to think was an unambitious waste of a medical degree. 

I don't give myself a break or a pat on the back for managing everything. I make sure my house is fully stocked at all times, I sign my daughter up for all of the best classes and lessons (to go to with her nanny). She has an impeccable wardrobe and fresh cooked vegetables in the fridge at the start of most weeks. But I torture myself that I'm not home enough. I cried when my daughter had food poisoning for the first time and I was stuck at work overnight. I refuse to sleep during the day post-call -- what a waste of bonding time. Being a working mom is hard. Being a resident and mom is even harder, but I don't regret having my daughter, she's the best thing that's ever happened to me. I guess I'm crazy, because despite what I've been through these past 16 months, we're trying for baby #2 right now!


Sara, Ob/Gyn Resident (PGY-3)

MiM Mail: Timing is everything

Dear Mothers in Medicine,

I am not yet a mother or in medicine, but I’m currently trying for both. I guess I was never able to do just one thing at a time. I am 32 years old and I’m applying to medical school this year. My husband I were thrilled when we recently found out I was pregnant. Unfortunately the pregnancy ended at seven weeks. We are recovering and will hopefully be given the green light to start trying again soon. But now timing is an issue. I was hoping to have a baby that would be at least a few months old before starting school. Our chances of achieving that are getting slimmer each month. I could try to time things to have a baby at the end of MS1, but it took us a while to get pregnant the first time and I doubt our ability to conceive on demand. Surprise, surprise, these things are pretty difficult to plan.

My plan for now is to continue trying for both. If I’m lucky enough to have a healthy pregnancy that ends up having a delivery date close to my matriculation date, I suppose I will defer for a year. I wonder what all of you, having experience with both motherhood and medicine, would do in this situation? Would you stop trying for those months that would lead to a delivery around the time medical school would begin? Would you defer? Would you just not worry about it and wait for the perfect storm to occur? Thank you in advance, and thank you for all of your words of wisdom – I’ve been reading for quite a while!

-Anonymous

Guests of the month

My husband and I made one New Year's Resolution for 2014 together: to have friends over for dinner more regularly. Whenever we do, we love it, and the kids have a blast. However, it has always seemed like a lot of effort to coordinate, to clean ("clean" underestimates the amount of prep our house needs to be able to be opened to the public), and it's just so much easier not to do it. Plus, we're introverts. Now, it's not like we are hermits or anything (although I don't really know what a normal social life with a family is), but we both agreed that having people over more would be good for our whole family. I'd estimate that last year we probably had people maybe 4 or 5 times, but we are aiming to host dinner once a month.

As of April, we've had four families over - including neighbors, good friends we don't get to see enough of, friends we haven't seen since grad school, and new friends from church. We are loving it. We've relaxed some of that need-to-have-a-perfect-house compulsion when entertaining - and no one has run out screaming yet. (Still have some degree of compulsion, I won't lie, but it's definitely less severe that it was. Think: overall order with occasional pockets of entropy. We have a butcher cart in the kitchen that is so hopelessly disordered from top to bottom, we joke about pushing that whole thing out the front door one day in joyful riddance, imagining it dropping off the porch stairs and going straight into the garbage truck. Well, half-joke. At least I'm only half-joking. We also still have zebra streamers up from a wild-animal-themed birthday party many moons ago that will stay up until they degrade on their own. I personally enjoy the added festivity, and will enjoy it until I can't stand it anymore.)

And the kids. They run around screaming like lunatics, chasing each other in pure joy, even with children they are meeting for the first time. (Don't you miss that?)

It has been surprisingly effortless to invite people, and we're always talking about who we're going to have over next.  So far so good. Reward to effort ratio remains favorable, and no sight of inertia setting in...yet. Having the house look presentable for longer than the 1 hour after it is cleaned every two weeks (sometimes the house destabilizes in 20 minutes thanks to 3 very talented children) has the added benefit of keeping me in a better mood. And, if we skip a month or two or three...no pressure. We'll take it as long as the motivation lasts.

Guest post: Coming home

I come downstairs after grabbing a few hours sleep in between busy night shifts. I can hear Rose crying in frustration at once again trying to grab the key from the back door. I walk into the chaos in the kitchen. My husband is absorbed in the  newspaper surrounded by the toddler carnage. Why is there breakfast still on the table? Why have the pots and pans been pulled out of the cupboards?  Has she really got porridge still stuck on her forehead and what on earth is she wearing? Oh and why is she chewing hay from the barn?

I open my mouth to say something but hesitate and hold my tongue. I remember that it's his turn to look after Rose while I am in work mode. We do things differently- I'm the surgeon with the perfectionist streak wanting everything to be tidy and clean; he is the artist and is happy to let Rose run free and wild. I smile to myself. 

"Family hug?" I pick up Rose and we all collapse on the sofa together in a warm embrace. A memory to take with me to work that night. Invaluable.

Lotte is a 33 year old general surgery registrar in the UK with an 18 month old daughter Rose and a non medical husband. She works full time.

Consumer Driven Healthcare - Where is it Going?

After I read Red Humors blog on Open Notes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse.

I worry about and applaud the possible effects of patients being able to read their notes online. We doctors need our own forum to make notes without worrying about hurting our patient's feelings. But patients also need to be able to review the discussion in the doctor's office in their own space, with all of their mental focus. Open Notes seems like a step in the right direction, but not entirely. We need two spaces. One for the patient, and one for the doctor.

When I was in CT, waiting on a specimen from the lung to review, I was telling the radiologist about Red Humor's blog topic. He told me that there is a push to the radiologists for the patient to be able to see their diagnosis online, as soon as it is available, before they have even discussed it with the clinician.

RED FLAG.

I wrote a post here before, called Poker Face. In a nutshell, it was about me accidentally conveying during fellowship a patient's negative diagnosis by delaying my answer too long when being probed directly by the patient. It was an excruciating experience that taught me to use expert words to delay the fact that I knew someone's cancer had returned or was diagnosed or had metastasized. After all, I am just a pathologist. I have no treatment options or good perspective on prognosis and treatment. That is Red Humor's job, not mine.

The radiologist worried, as I do, that all the great tools and information that our oncologists and clinicians have to offer a patient will not be there, in the privacy of their own home, while they are reading the ominous information. He worried aloud that the information might overwhelm them. As he was saying that he mimed a gun to his head. I completely agree.

There is way too much misinformation out there on the internet and you need an educated professional to reassure and guide you through it. I depend on my mechanic to fix my car. I depend on my accountant to do my taxes. As doctors, our patients need to depend on us to pick them up when all seems lost.

Last week the New York Times released a big article allowing patients to look up how much their doctors received from Medicare over the last year. It's telling information, but muddy. We doctors enjoyed googling each other to find out who is getting what. Pathologists are at the bottom of the list. If you consider Medicare reimbursement is about 30% of overall practice (in conjunction with private insurance), the information is not enough. It's a step in the right direction, but like many steps mentioned above, it falls short.

I see the need for change in healthcare. But the problems are multifactorial, and it will take lots of time and energy to fix them. In the meantime, let's try to keep a proper perspective to protect our patients. Let's delve back into the reasons we went into medicine in the first place. To help people, to protect and serve. Don't give them information in the privacy of their own homes that they aren't equipped to deal with, or anything that might hurt their feelings. That's a nasty can of worms that doesn't need to be opened.