The Undeprived Child

Two words which could easily describe my sisters and me growing up would be "deprived children." We never went to the beach, the zoo, the park.  We weren't allowed to roller blade.  We didn't have many friends.  We just didn't experience all that much.  Part of the reason for this was that we were just too poor, but the other more important reason is because my dad was over protective and did not allow us to participate in activities that may get us sick or hurt in any way.

Now I'm a parent myself, and I'm proud that in the last month, my husband and I have taken our Doll to the zoo, the city, and the beach!  Which was a serious point of contention among my parents...

"It's too dirty!!" My mother said.

"It's too hot!" My father said.

Even my older sister who has a toddler and an infant refused to come with us.  "He doesn't like big bodies of water," she said referring to her two year old son.

We went anyway and had a blast, and sent pictures to prove it!  Here's to hoping my Doll can really experience this world... Not like her deprived Mama!

Online Mothering Mentor

Her name is Catherine Newman.

I've only commented on her blog once or twice.

I found her when I was pregnant with Cecelia, and she was pregnant with her daughter Birdy. That was 12 years ago.

I followed her weekly "blog" on babycenter.com before blogs even existed.

I read her book, even though I didn't need to because I read all those posts.

I followed her when she left to start her own blog.

She now writes on Dalai Mama, among other things.

She is a fantastic cook. She posts recipes, and when I try them once or twice a year when I have time they are fantastic.

Her crack broccoli is a fave go to at my house for a veggie on a school night. Her fried eggs with sizzling vinegar is one of my most beloved dishes.

I occasionally read what she is reading. Buy the games she is playing with her family. Recommend them to my friends.

I am still catching up on blogs from when I did not have internet on vacation last week. Catherine has been writing articles for New York Times on Motherlode over the last year or so. I read one today that brought me to my knees. It's not the first of her articles to do this to me.

That's why I'm writing this post. To share this fantastic article. Give kids your undivided attention - Or no attention at all. I'm taking an evening weekly six week parenting class from a highly experienced social worker based on a book her husband co-wrote - Parenting the Strong-Willed Child.  She trained in urban Atlanta and rural Mississippi and has two grown children. Catherine's article reminds me of what I am learning there to supplement my own awesome but lacking in some areas (aren't we all?) parenting. Strategies to gain control of your relationship to your kids and help them prosper and grow with capability and responsibility and love. I've got fountains of knowledge from this class from both the social worker and other parents despite only being halfway through it.

Thanks for everything Catherine. You don't know me but I love you!! Thanks especially for all the substitute mothering.

MiM mail: His sacrifice or hers?

Hi everyone,

I've been reading this blog looking for pearls of advice and wisdom ever since I was accepted to medical school just over a year ago (in Canada).  When I interviewed for medical school, I was actually 8 weeks pregnant with my first daughter.  I decided to defer for the first year to stay home with my daughter.  Now the time has come to decide whether I indeed do go back to school and become a doctor. This situation is complicated, and I need some advice from some women/mothers who have been there.

A little about me: I am a 32-year old (will be 33 after 2 months of school) family nurse practitioner.  I have a great job and work with an amazing team, but no I have no flexibility in terms of hours.  I have decent pay (but no real opportunity to grow). And the nurse practitioner role is still developing in Canada so there are many other "issues" with the profession as well, including barriers to practice, funding/remuneration issues, and scope of practice limits.  Not to mention that most people in Canada don't even know what a nurse practitioner is.  When I tell people, they think I am training to be a nurse. That aside, I know I would love a career in medicine.  I've been in the healthcare field myself now for over 10 years, and I think I have a pretty good idea and sense of the role.  My daughter will be 9.5 months if/when I start school, and I do want/plan to have 1 or 2 more kids.

The situation is complicated because I was accepted in a different city and province from where we live now.  My husband is working at his dream job and has NO desire to leave it.  He feels (and has been told) that he is on a great trajectory with the company, and has already been promoted a few times in the 2.5 years that he's been with them.  There is no office for this particular company in the city we would have to move to.  There is no family of either of us in the city that we have to move to (but there isn't now either). We just got into an AWESOME brand new daycare on the campus of my current job (for which I am still on mat leave), but we have to pay the monthly fees as of now in order to hold her spot until I go back to work in October.  This is pricey, plus if we end up moving, a huge waste of money. But if we stay, it is super convenient, as I would just have to bring my daughter to work with me and could pop over between patients and see her!

Essentially, it has come to either myself or my husband sacrificing for the other.  He has his dream job with great future prospects.  I can have my dream job in medicine, but not for another 8-ish years (I would probably specialize). Plus, we will go from a two-income family living a comfortable life, back to going into debt and living a student lifestyle. Also, I don't really know how much time I will have for my kids during all of this training. And is that what is best for them? I really don't know what to do.  I feel so guilty about uprooting and making him quit his job if we go.  He doesn't have any prospects in the new city as of yet either, which makes it hard for him to visualize being there.  I can visualize myself there because I know I would be starting school etc.  We have decided that we need to do what is best for our family (daughter and future children). But we can't seem to figure out which path is "best." I wish I had a crystal ball to look into the future and see how each path would turn out.  I really really want to go, but he really really wants to stay.  We both said we would sacrifice for the other, but that still leaves us with a decision to make, and we are having such a hard time.  Any thoughts or advice or wisdom would be MUCH appreciated.

Signed,
Confused

What Does "Lean In" Mean? Whatever You Want It To.

Genmedmom here. You'd think that as a doctor and a mother and a blogger with a focus on work-life balance, that I'd have been psyched to read Sheryl Sandberg's Lean In. Truthfully, I dreaded reading it.

I figured I'd have to read it sooner or later, given what I do, and I wasn't looking forward to it at all. From the bits and pieces I'd heard about it, I assumed that it must be a pushy, finger-wagging manifesto designed to make me feel more guilty that I already felt.

But I felt guilty NOT reading it. So one day, when I ordered a bunch of books on Autism (our son is autistic) and a few Barbara Brown Taylor essay collections, I also ordered Lean In. It sat on my bedside table for about a month. The other books got read (I read a lot), but Sheryl's smiling face looked up at me night after night, book closed, waiting.

Finally, one night, after the kids were down and charts were done and my brain needed some book reading for an hour or so, I realized I had nothing else to read but smiling Sheryl. I very reluctantly opened it...

And she had me at the second paragraph of the introduction.

She describes how she gained seventy pounds in her first pregnancy, and suffered from brutal nausea the whole time; how she struggled with simply walking, and realized that Google needed to have pregnancy parking close to the building, for all pregnant employees. So she made it happen. Wow.

Flashback to my pregnancies, where I gained, yes, seventy pounds, and felt awful, and struggled with simply walking... Like many employees of my big city hospital, I park at a garage about a mile away, and walk in. For my first pregnancy, my manager gave me a handful of parking passes that I used in the last ten days. That was great, but it was the last ten days, and there weren't any for my second pregnancy. I remember waddling painfully to and fro...

The point of her sharing the anecdote is to illustrate that she didn't realize how helpful pregnancy parking would be until she experienced it for herself. She wondered how no one brought it up before:

"The other pregnant women must have suffered in silence, not wanting to ask for special treatment. Or maybe they lacked the confidence and seniority to demand that the problem be fixed. Having one pregnant woman at the top- even one who looked like a whale- made the difference".

The book continues in this style, outlining the significant challenges women face in today's workplace, dotted with personal anecdotes and shared stories, humor, and problem-solving suggestions. There's plenty of data, but it's not boring. I was surprised at the praise, validation and encouragement for women at all angles of leaning in, including those who work part-time or stay at home. There is very little by way of exhortation; actually, I had to search for anything:

"I have written this book to encourage women to dream big, forge a path through the obstacles, and achieve their full potential. I am hoping that each woman will set her own goals and reach for them with gusto."

I actually enjoyed this book, and strongly recommend it to any woman considering a career in anything.

So, why did I dread reading it? Why did a book described everywhere as "an inspiring call to action" sit gathering dust on my bedside table for a month?

Well, as an internist who works part-time and mother of two young children, I've been exhorted, invalidated, even attacked. So, I assumed Sandberg's book would be another attack. It's not every day, but I'm sure I'm not the only part-time physician who has encountered this, the face-scrunching and "So, how does THAT work?" or a "Don't your patients get frustrated that you're not fully available?" kind of thing.

The attack most famous came from a senior female physician. I remember how sick I felt when I read anesthesiologist Karen Sibert's Op-Ed "Don't Quit This Day Job" in the New York Times (June 2011). In this essay, she doesn't just frown upon women working part-time in medicine: she crushes them. Worse, she crushes the aspirations of those considering medicine as a career:

"I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor....You can’t have it all."

The death blow, however, was to people like me,

"Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work."

The... what do you call this? It wasn't an implication or an accusation, it was a sound dismissal of MY life's work. I have a small panel of patients, commensurate to my four clinical sessions per week. I work in a warm, nurturing environment, in a group practice of all part-time female internists. We have excellent clinical support staff. We enjoy great flexibility in our hours. We also are also regularly evaluated and rated by our patients, as well as our hospital, on various criteria ranging from patient satisfaction surveys to outcomes data comparisons between practices, and we perform extremely well.

I also have two small children, ages two and three, a working husband who is a wonderful partner, and family close by. I'm almost always home for dinner, and enjoy most weekends with my family. Yes, we carry pagers and are on call for ourselves Monday through Friday, with weekend calls shared, and there are occasional calls at less opportune times (bathtime, bedtime..). And, with the advent of the patient portal, where patients can communicate with providers online (kind of like email), they can send me a message basically anytime. But overall, clashes between work and family are few and far between.

My gut sense is that what I have going works. Most of my patients are working women, and I'm open and chatty about being a working mom (can you tell?). My kids' photos are up in my exam room, regularly updated, and patients eagerly ask about them, just as I inquire about their families. We trade stories. I receive solidly positive feedback from patients and colleagues alike. (I feel weird putting it on paper, all this positivity, but isn't that what we women do, is downplay our achievements?)

THIS is my "leaning in". I do not aspire to be a department chair, to publish in the peer-reviewed literature (though I have), or to have my own office with puffy leather chairs. I have made the considerable achievements of graduating from medical school, surviving residency, and thriving in a highly regarded primary care practice. I want to be a good doctor and a good mother (and to write about it!) I believe that you CAN have all this, because I do.

That is the beauty of the message from Sheryl Sandberg: "leaning in" isn't a one-size-fits-all formula. As in the quote above, she hopes that women set their own goals and reach for them.

Sandberg also talks about how women need to help other women achieve their goals. I agree with that, and it starts with pregnancy parking! It also includes calmly ignoring even senior female docs like Karen Sibert when they try to force a one-size-fits-all, my-way-or-the-highway approach onto a career path as variable and malleable as medicine. Sandberg discusses the phenomenon of senior women not only being unhelpful, but even hindering the progress of the up-and-coming women:

"Critics have scoffed at me for trusting that once women are in power, that they will help one another, since that has not always been the case. I'm willing to take that bet. The first wave of women who ascended to leadership positions were few and far between, and to survive, many focused more on fitting in than on helping others. The current wave of female leadership in increasingly willing to speak up. The more women attain positions of power, the less pressure there will be to conform, and the more they will do for other women."

So, read the book, and either make your way up, or reach a hand down. Set goals and "lean in" any way you choose, because only you know what is right for you, and if it's right for you, it's all right.

And I'm interested to hear what others think of smiling Sheryl's book.

evolution

I've been a practicing oncologist for all of seven months, and so was surprised when my chief asked that I take part in our quality review panel. The quality review panel is an internal group that is tasked with the responsibility of looking into allegations that a patient's care was not in keeping with best practice or what is generally considered the standard of care. Cases (often in the form of a complaint) can be submitted by patients or the nursing staff, but more frequently come from other physicians.

Cases are reviewed and scored individually by each member of the panel, and the composite score is used to determine whether corrective action should be taken. Although physicians whose cases are repeated scored "P2" - in which the standard of care was clearly violated - can be forced into remediation, the purpose of the review panel is didactic, not putative. And to that end, the standard is different than that of a legal proceeding - there need not be a bad outcome in order to determine a case P2, only that the expected level of care was not that which was delivered.

Obviously I can't go into the specifics of the cases or the physicians, but what I've been impressed by so far is the recurrent sin of omission. The incidences in question didn't involve the wrong therapy, intended deception, or malice, but the accumulation of small omissions - documentation, timely follow up, etc that morphed into a larger problem. Data management and communication also came up as frequent offenders. 

In one or two cases I felt the problem was that the physician - a few of whom had been practicing medicine while I was still in grade school - couldn't or weren't able to evolve with changing expectations. We are expected to be transparent, thorough, and accountable for what the patient does and does not understand. There's an astounding amount of information to be managed, including but not limited to the electronic medical record, patient email, open notes, and the near-entirely of uptodate and pubmed.  I can speak better to what is happening in my own field - where fifteen years ago there were about that many different types of chemotherapy. Now there's fifteen new drugs coming out every year. 

I started thinking about what it means to evolve and what its going to look like for me over the course of my career. I've found the review experience hugely instructive in that I understand better how physicians get themselves in trouble, but I've also found it unnerving. Twenty years from now the central tenets of"being a good doctor" might be entirely unrecognizable when compared to today. 

I wish I had a note of conclusion on which I could end this post, but I don't. I am just beginning to see how important professional evolution will be, but I have no idea what that really means. 

Safety Goggles

I am becoming friends with a pediatrician mom - her twin daughters and mine are in the same class. I have learned a lot about her family through Cecelia, and have chatted with her at school events and after sleepovers. She is pretty amazing. I love to hear stories about being a pediatrician. What a hard road (like we all have). She recently discussed frustration over a 10 minute well child visit that turned out to be small kids who have never seen a doctor and had recently been rescued from a bad home life. Never been vaccinated. "How on Earth am I supposed to tackle that in a well child visit?!!?" And do all your charting on EMR, I thought. And realize your time will be bundled in payment. And how do you pay for the sleepless nights you end up with trying not to worry about those kids, when you don't even have enough time with your own children?

But we don't just talk about work, we love to share stories about the kids. I bumped into her in front of the Dr.'s lounge recently. She recounted a weekend tale; she also has a six year old in addition to the twelve year old twins. "The kids were running around downstairs shooting rubber bands at each other. (Her husband, also a peds doc) was on call. I was wracked with anxiety about the danger of the situation but so excited they weren't buried in their ipads that I let it go on way too long. Sure enough, one of them came crying to me with a superficial eye injury. I debated - Stop this? No. How can I continue? I pulled the swim goggles out of the closet and made them all wear them. The fun went on while I worked upstairs. It was one of those magical mornings, ones spun out of nothing, to remember forever."

I laughed so hard I almost spilled my coffee. I love rare magical mornings. Her story reminded me of that old adage, "Put on your oxygen mask first." We try to do this, as mothers and doctors, but we forget. Through sharing we are constantly reminded of how important that is for us and our families. Play is just as, if not more so, valuable to our lives as work. And what we do for our patients within the system is enough. It's ok to constantly strive for more despite the constraints. That's what makes us what we all intended to be when we started this journey. Healers full of hope.

Guest post: Everything changes when you become a mother

It’s a cliché, and I hate clichés. But it’s also a truth. And it beats me over the head on a daily basis.

I never wanted to be the type of person who thinks, let alone says or writes, that there are things that people without children just don’t understand. And I won’t pretend to know what anyone else feels or understands. But I can say with absolute certainty that my own understanding and experience of life has changed immeasurably since I became a mom. And I’m still trying to learn to navigate not just the logistics of life with a baby, but a very new emotional terrain.

My son was born in February after a healthy, uneventful pregnancy. At three months old, he is thriving – sleeping well, eating heartily, and smiling and cooing in ways that melt my heart anew every day. My husband and I try not to make assumptions about the future, but like all parents, we have high hopes for him. And we look forward to every day that we will spend together as a family, watching him grow and learn and discover the world.

Yet today I am sitting on the living room couch sobbing while my baby naps peacefully in the other room. Why? I am no longer painfully sleep-deprived, no longer terrified that he and I will never master the art of breastfeeding and that he will not gain weight and grow. My hormones seem to be back in check and I have largely adjusted to being back at work and away from him, although it is still hard to leave each morning. I am sitting here in tears because I just read a blog post written by someone I don’t know, someone whose story I came across when it was shared by one of my friends on Facebook. It was about a woman who just lost her little boy to cancer. And I am feeling another mother’s pain.

I can’t imagine what it feels like to lose a child. I couldn’t before I had my own baby, but now whenever I encounter such losses, all I can think about is how, once upon a time, that child’s mother had high hopes for her baby, had her heart melted by each smile and coo. Which is not to say that I would not have cried at the same story before I had my son, or that people without children would not shed tears over it. But the feelings behind my tears – the fiery, gut-tearing pain that churns within me when my mind even dances near the edges of the real question that arises with every story of loss: What if it were my baby being taken from me? – are awful and new.

So with my newfound understanding of motherhood, and the attendant capacity to imagine maternal grief, I face a new challenge. Since medical school, I have wanted to be a pediatric oncologist and treat children with cancer. I adore children, I love working with families, and I am fascinated by the science behind the diseases that afflict them. Back in medical school, one of my classmates confessed that she would have become a pediatrician if she hadn’t already become a mother. “I can’t,” she said, shaking her head and looking pained at the thought of caring for sick children. “I just can’t.”

I did not have children at the time, and although wondered how I might be affected once I started a family, I thought that perhaps I would gain some degree of immunity by entering the field before my own children arrived. When I began my pediatrics residency, I certainly felt sad when children were sick, and extremely sad when they died. But I was able to let go of that sadness and move on.

Then, during my second year of training, my own baby arrived. And after my brief maternity leave, I returned to work on the pediatric oncology ward, a place that had always gripped and excited me. And suddenly everything changed.

I still loved the strictly medical side of things: working up a new diagnosis, puzzling over the best ways to manage the side effects of chemotherapy. But the family meeting to discuss a little boy’s grim prognosis nearly sent me into a fit of sobs. I had to look away and sing songs in my head just to get through it. All I wanted to do was to cry with this mother. For this mother.

Which leaves me in a confusing state. Everything that I have always felt about caring for children, I feel much more strongly now. The uplifting and the soul-crushing both resonate in ways I could never have anticipated. Will this effect wane with time, or intensify? Will it render me better able to care for my patients and their families, or become a barrier to pursuing and surviving the emotions of this career about which I once felt so sure?

It’s hard to know anything for certain, other than, finally, what it feels like to be a mom.


Becky MacDonell-Yilmaz is a second-year pediatrics resident at Hasbro Children's Hospital/Brown University and mom to a three-month-old son. She blogs at The Growth Curve .

A rare day of triumph

I'm not going to get into specifics, but there's been an issue that my mother and I have been arguing about for the last five years. Basically, I gave her a piece of advice and she's been telling me for five years that I've been wrong.

Then yesterday, she took my advice. And after five years of arguing, she admitted, "You were absolutely right."

Aha!

Later that day, I made an offhand comment about how I was wrong about something. My older daughter quickly said, in all seriousness, "But you're never wrong, mama."

This day will live in infamy as the day I actually got respected in my house.

MiM Mail: Is part-time possible?

Hello MiM,

First of all, thank you for publishing this blog! Reading your posts has helped me to feel less alone in the crazy world of being a mother in medicine.

I am a third year medical student with a 3.5 month old daughter. I've been back at my clerkships since she was 8 weeks old and have found myself pretty miserable. I hate being away from her while I am working, and I hate that when I come home I am often too tired to do much more than nurse her and hand her back to my husband. Our hope has been that after residency I will be able to work part-time, but recently I've been wondering if that will be possible. I'm interested in pediatrics/psychiatry/child psychiatry, which I know are considered to be more "family friendly" fields. But I'm starting to despair that even in one of those specialties I will not be able to find a job that will allow me to spend significant amounts of time with my family, especially while my daughter (and hopefully her future siblings) are young.

I'm wondering what your experiences are with trying to work part-time in medicine. Is this dream possible? How significantly might it limit potential for career growth? I'd also be interested to hear from those who have chosen paths other than clinical work (research, administration, education, etc). Are these areas more flexible?

Thank you for your comments!

Katie (MS3)

Mothers in Medicine

I haven't written poetry in many years.  This is what resulted from my last call:

Mothers in Medicine
We self-medicate with colors and sound
Suppressing every trace
until it's gone
Only to emerge the next time when we are
Destroyed

Creating new nightmares
Flashes of faces
Of skin
Of cords
Of inside
Of babies
Breeding deeper and deeper layers of hypervigilance
For our own
children


Then we step through the threshold, into the light



Cross posted at www.myrecoveryroom.com

MiM Mail: Dr. and/or Mrs?

Hello MiM community!

I am a newly crowned fourth year medical student who will be applying for residency this upcoming match cycle. In addition to that, I will finally be marrying my college sweetheart this upcoming spring. 

While I can't wait to be a Mrs. I'm struggling with what to do with my name. Since I've been a little girl I've always dreamt of being Dr. MyName. Not only will I be the first doctor in my family, I am the first to even graduate college! Becoming Dr. MyName is a great source of pride for me.

That being said, I have every desire to be Mrs. HisName everywhere outside of the hospital. While he would prefer I take his name, my fiance is supportive of whichever decision I make. All future children will have his last name regardless of what mine is.

I don't know all the licensure regulations, but what options do I have to practice as Dr. MyName, but still be Mrs. HisName? 

How have you ladies gone about this decision?

-a new MS4

Brain Candy

I met Fizzy here years ago, and long ago posted one of her first cartoons on my blog when she spun off this blog to create her own space at The Cartoon Guide to Becoming a Doctor.

I was amazed by this cartoon. It spoke to me about my experience as a resident/mom in such a good way. She made light of the angst and agony that I had recently been through, and made me laugh about it. I was already hooked to her writing here on MiM, but that cartoon drew me in to her blog and made me an avid follower to this day.

She's funny. She's droll. But most of all, she's unrelenting. I have periods in my blogging where I lag and shut down. She never stops. She's like the Energizer bunny of blogging, and her constant wit and presence amaze me. Not just me - she has built up an enormous following of readers that also recognize her talent. I like to secretly pat myself on the back for being one of her first readers. It doesn't surprise me in the least that she has come this far.

I bought her first book (see above) and it sat on my coffee table until I caught my daughter reading it and asking me questions I wasn't ready to explain. Now it's tucked away in the reading cabinet for easy access. And I had the privilege to beta read her first novel - The Devil Wears Scrubs. Do you read brain candy? I do. I don't watch brain candy on TV, but I read it religiously during stressful times in my life. Chic lit - it takes the edge off. The Devil Wears Scrubs is the best kind of chic lit. It draws you back into that horribly abusive space in time of training when you have no control and you are at the mercy of warped personalities. It allows you as a reader, like the viewer of her cartoons, to make lemonade out of lemons. Her razor sharp wit and her sarcasm brings a new element to the genre. She's a pioneer.

If you haven't read her book, you're missing out big time. I hear there's more coming down the pipes. I remember standing in line for hours waiting to see Guns N' Roses at the Memphis Pyramid (I had to pee really bad - good training for OR cases). I remember camping out all night in front of BeenAround Records to get my college boyfriend Metallica tickets (his band not mine). I remember pre-ordering the next Harry Potter book during residency and counting the days until it was released. Here I am again at 40 dying to read Fizzy's next book. I hope there's lots more to come. I can't wait.

*This post was based off of one I wrote last week on my blog.

Nicely done?

Went to the pediatrician with my daughter for routine primary care visit.  I thought she (the pediatrician) did such a good job with my daughter in terms of the tenor and content of the discussion, the calm demeanor, the subtle but savvy questions, the listening, and the encouragement.  Promoting wellness, self -esteem, and balance.

Later in the evening, reflecting back on the visit (and talking with my spouse) I realized how similar the pediatrician’s approach seemed to my own approach with my tween patients.  Or at least was what I aim to do.  But then I wondered about how circular this is.  I like the pediatrician because she practices like I do. How self-congratulatory is that?  And yet, perhaps instead it's that she and I are similarly mediocre pediatricians. Regardless, my daughter stated after the visit that her pediatrician was the “best pediatrician ever.” (Present company excluded, of course.)  

Do you learn about doctoring when, as a MiM, you go to the doctors?  I have tried to over the years. And as a MiME (Mother in Medical Education), I teach some stuff too. Actually, we chose this pediatrician in part because she trained with us.  More circularity.  Nicely done!

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.