A sucker punch

A few months ago I had brought the kids home from school (daughter, 6 and son, 3), got settled, and then they started to play in the playroom. I could see and hear they were playing in their 'hideout'--an elaborate  tent with toys and places to spy on adults. As they started to play together, I went the business of getting dinner ready.

I heard my son say to my daughter, "Ok, I'm going off to work now. Love you!" They were pretending to be grown ups. Then my daughter replied, "Ok, I'm staying at home!" It was like a sucker punch to my gut.  She was staying home while the 'man' was going his job outside the home.

That comment stopped me in my tracks. I have worked as a physician her whole life! Where had she gotten the idea? Most of her friends and cousins had mothers who also work. So I inquired, "[Daughter], you are staying home? What are you going to do?" Without missing a beat, she said, "Take care of the kids." I commented that she could work and take care of her kids, like many moms do.

In reflecting on the conversation, I want her to make life for herself in whatever way makes her happy--working outside the home or staying at home. Now when I ask her what she wants to be when she grows up--it's consistently "a veternarian".

Needless to say, it was a teachable moment for all of us.

MiM Mail: Lost

Hi, I just started a 3 year residency program, and I'm feeling desperately close to quitting. In fact, if it weren't for the huge financial investment I've made up to this point, I almost certainly would have quit before I even got to this point.

I have a daughter who was born at the beginning of 4th year, and I think 4th year was probably the best year of my life. I loved spending time with her at home (despite being bored and lonely for parts of it). Now that she's older, she's even more wonderful and funny and fascinating, which I didn't think was possible. I dreaded the start of residency, which was, unfortunately, a black cloud over that otherwise wonderful year.

Now that it's here, I don't know whether it's worth it to continue. I don't find the work difficult or all that unenjoyable; I kind of like it and I definitely like the idea of contributing to our family financially. I feel like I could surely handle it all if I didn't have a child. I grieve every single day the lost time with her and the opportunity to watch her grow and be there for her babyhood, which is so fleeting and the part of my own life I want to experience more than anything. Add to this some chronic health problems that I am dealing with, and I feel so depressed. And of course there's no time to seek out treatment or professional help. I really have nobody to talk to about it. I feel like I'm drowning.

I have a supportive non-medical spouse who has a good job, though it would still be a blow of course to give up a future physician income. And I do have some loans, though well below the national average. So...I guess I'm looking for advice. Do I stay or do I go? Or should I approach my PD about some sort of part-time compromise (guessing that's a huge long shot). If I somehow make it though, and don't destroy all relationships in the process, my husband and daughter would probably be better off long term. If I go, I can start to recuperate some sense of sanity and mental and physical health, and I think it's better for me personally. Maybe I could convince myself it's better for my daughter since she'll be in a less stressful environment. I feel lost. -J

Routines

I love routines. I am the kind of person who is perfectly happy to eat the same thing for breakfast and lunch every day, while cycling through a handful of choices for dinner. I like knowing what I am going to do, and when, and with whom, and for how long (and then what I am doing afterwards). Not surprisingly, I have found the lack of routine to be one of the most challenging aspects of the clinical years of medical school. As one of my classmates said: "Going through your MS3 year is like having a new job every four weeks". With each new rotation comes a new schedule, new preceptor, and new set of expectations.

One of the perks of the research year sandwiched between my MS3 and MS4 years has been the freedom to set my own schedule - which has meant the freedom to develop a routine for my family. These summer months have been particularly wonderful. I am loving the daily habits my 18-month old daughter and I have developed. In the mornings before daycare drop-off, we go for a walk around the neighborhood. She starts by insisting that she wants to walk, trotting beside me and excitedly pointing to various objects with an exclamation of "diiss?!?" (this), then nodding in agreement ("yah") when I identify them by name. After a few blocks, she puts up her arms for me to carry her - which thankfully doesn't last long (the one-armed toddler carry while pushing the stroller is something of a feat these days). Finally she consents to sit in her stroller, sipping on some milk while we walk to the nearby market or just around the block.

The content of my day may vary (lately including thesis edits, manuscript preparations, half-day clinics, and residency applications), but I know that in the afternoon I'll pick up my daughter from daycare and we'll spend a few hours at the playground or splash zone while we wait for my husband to finish work. In the evenings after dinner, I give her a bath and brush her teeth before settling in for some board books (Corderoy is the current favorite, followed by Chicka Chicka Boom Boom, Goodnight Moon, and Machines at Work). Then we turn off the lights, put on some jazz, and snuggle for a few minutes before she falls asleep.

My research year is coming to an end, however, and soon we'll be back to living life four weeks at a time. I'm excited for the rotations I have scheduled for my final year of medical school, but I'm also sad to leave behind the daily rhythm we've developed. With only a few more days of our summer routine left, I'm soaking up as many walks and baths and trips to the park as I can.

Any tips from other MiM's on how to maintain some semblance of a family routine while on busy services or when working long or unpredictable hours?

Going to the Doctor

Recently, I took Blur2 to the doctor. He’d been having a diaper rash for weeks. Initially, it started out like any other rash and my usual treatment (40% zinc oxide) worked. But weeks later, it was worsening and my treatment wasn’t working like it should if it was a typical diaper rash. So we went to our doctor.

I love my/our doctor (and the whole office) but I hate going for these minor ailments. As an ED doc, I knew what the next step was likely an antifungal cream; as a Mom, I didn’t want to be treating my own kid. Some of my colleagues and doctor friends would have just called in their own prescription. I feel dumb sitting there, telling the story, just really wanting reassurance. I do have a small supply of medications and laceration repair supplies at home for minor things; we don’t go for every URI/fever/etc but when things aren’t going how I expect, we go to the doctor. When Blur2 went through ear infection after ear infection, I kept hauling him into the doctor, to get them all documented because I was afraid he was going to need tubes - he ultimately did.

We have a separate Pediatric Emergency Department that is staffed by Peds EM and plain EM doctors. I do about 20% of my shifts there and most of them on the overnight shifts. I remind myself of my feelings that I have sitting in my own pediatrician’s office and teach my residents that the parents are often just looking for reassurance - that this fever is a virus, that this GI bug will pass, that this rash is not a serious rash, that the simple closed head injury does not need a CT scan - and guidance as to what to look out for next that would mean something serious.

I got my reassurance and prescription for an antifungal cream. And I feel better and so does Blur2.

When do you take your kid to the doctor? What’s your threshold? What do you take from your personal healthcare experience and add to your practice?

MiM Mail: Taking the Plunge

Mothers In Medicine,

I am a married mother of 2 girls, 7 and 10. I work full time in the Information Technology, and am going back to school in the fall to complete my Medical pre-requisites.

I don’t remember not wanting to be a doctor – except maybe the phase where I was determined to be an astronaut. It wasn’t any one incident, or any driving force, just the knowledge that that was where I belonged.

Life has a funny way of getting in the way of plans. I struggled throughout my undergraduate degree with both depression and endometriosis, which meant I never managed to get the prerequisites under my belt. When I finally got those in control, life laughed again and I found myself a single mother to a beautiful girl. My program and parenting were not compatible, so I transferred out – determined to provide a stable life for my daughter. I met my husband, had another baby and went to work in a non healthcare field. It was fine. It put food on the table, clothes on my kids’ backs and a roof over our heads. We were able to take a yearly holiday, put money away for retirement and have the kids in competitive sports. I still thought about medicine, but it was what I considered to be a missed dream.

I made the mistake of taking a temp job in the healthcare field – just for a week to help out a friend. I was invited to come observe a surgery, and all of those feelings came rushing back. The closest I can describe it is the feeling I had when my children were first placed in my arms – I belonged there. Suddenly, I knew I had to go back to school and complete my missed dream.

For years I struggled trying to figure out how to get back into school. My husband and I couldn’t afford for me to quit work with two young children, and his support was limited. No one, not even him, understood why I would risk giving up a lucrative job in a stable industry, a good retirement plan, and a path up the corporate ladder. Eventually, this (among other issues) wore on both of us and we ended up separating.

Finally the stars have aligned. 10 years since I left the medical school path, 10 years since my first daughter was born and I am registered in fall classes. My husband and I have since reconciled, and he is now on board. The others in my life still don’t understand but are aware of the changes I am making. But I am terrified of the change. What if? What if I leave my career and don’t get into Medicine? What if I sacrifice my family in the process? What if we can’t afford it and I have to leave? What if I take this gamble and lose?

I imagine it as jumping into a lake. I’ve done my research, I know what the outcomes may be; now I just have to hold my nose, close my eyes and jump in. It’s terrifying and exciting all at the same time. For those of you who started medicine late, or after children - how do you take the risk?

Thank you, S

Every little bit

2 weeks into attendingdom, I am starting to realize how life has changed fundamentally. Gone are the days of working 75 hours a week. Gone are the days of calculating TPN and anion gap. Gone are the days of being questioned about details that you struggle to remember and know you’ll never need again outside of residency. I now work 4 days a week and can pick up a weekend day if I want to. We haven’t had an office emergency that I have managed yet, but I’ve got emergent management for the 15 or so minutes until EMS arrives down. I’ve got that!

In spite of my nice schedule and awesome colleagues, I realize that it will take a while to let go of my resident mindset. During residency, a resident-mommy-friend and I would chat and comment about how guilty we felt missing out on things. Not being able to care for a sick child. Not being able to make it to bedtime. Missing out on weekend fun. And I realize now that although I won’t be able to always take off to care for my sick child, I have more flexibility to. I now can make it to bedtime every day of the week. And other than my one Saturday a month, I’ll be around for the weekend fun.

Last week on my off day (every Friday), I attended Zo’s first summer camp performance and the joy on his face when he saw me cheering in the front row was priceless. It’s taking my breath away now to remember it. I took him home early, we played at the playground and then went home for family dinner time. I am at a coffee shop now writing this post before restarting a timed section of the 2014 Prep pediatric board questions. This week, I got to attend his second performance and it was just as cute. This week I was strong enough to let him stay for a few more hours while I study (last week I just couldn’t - since in the old days I very rarely could pick him up early).

I want to be able to enjoy every little bit. I want to be a present parent. I want to be a present provider. And I am (for the most part, I was kind of late for his performance today, but I just had to do 5 more questions and get that samosa from the local shop)! After so many years of waiting to “get there”, it’s here and it’s mine and I’m committed. Next time they ask who wants to work overtime I think I’ll pass and stay at home to snuggle with my family. Here’s to enjoying the little bits, the fundamental shifts, and this new phase in life. Question 151 here I come.

MiM Mail: Studying in residency

I'm a 4th year medical student with young kids wondering how others carve out time to study in residency? Of course I'm sure I'll be learning quite a bit "on the job," but I'm certain I'll still need to be learning and studying more outside the hospital as well.

I recently finished my MS3 year and was able to have a strong performance on the wards and shelf exams this year because my husband was a rock star; there were so many times that I stayed at the hospital after a 12 hr day studying and he put the kiddos to bed on his own. I also got babysitters on the weekends before exams so he wasn't doing everything on his own. And of course I carried around study materials and studied whenever I could like when I was waiting to pick up my kids from activities. I'm just curious what other solutions people have come up with. I don't want my husband to feel like a single dad forever; needless to say 3rd year was tough for him because he also works full-time. My youngest (and last!) will be 2.5 years old when I start residency and my older children will be in elementary school. I'm going into anesthesiology.

Thanks so much!

Intern of the Year

Eight years ago this month, I entered the hospital for the first time with the label "MD". My assignment was a prestigious transitional year internship at a large private/academic hybrid hospital. Amongst my rotations would be Internal Medicine, Surgery, ICU, and some electives.

My internship year was wonderful. I relished in the new freedom of managing patients and writing orders. I thrived on the stress of the endless to-do lists; each time I checked a box on my paper, I got a sense of thrill. The learning curve was so steep, and I became addicted to finding ways to be efficient. I enjoyed my co-interns, the staff, and the attendings. At the end of the year, they voted me Intern of the Year!

Then I started my residency in anesthesiology. I had done no anesthesia rotations during my transitional year and had instead chosen to focus on getting exposure to things that I was likely to not see much in the future. The change was abrupt and was not exactly smooth. Like the swipe of an eraser on a white board, all the positivity and excitement quietly vanished. The sheer volume of material to learn was overwhelming, not to mention the technical parts of the job – placing IV’s, preparing and dosing drugs, mastering the anesthesia monitors and ventilators, patient positioning, and the delicate dance of the patient consent process that is unique to anesthesia. Every day was a great battle to keep wits and stay calm while learning the academic and procedural aspects of the specialty.

As the fall months spread into winter and the days became shorter, a gloom washed over me. Rushing to work in the dark and returning home in the dark… was this what I had signed up for? Were other residents feeling the same way? How did I compare? These questions never really get answered since we don’t work together in the same OR. Come wintertime, performance evaluations from faculty started to trickle in. Some comments were positive, but the negative ones cut deeply into my motivation and self-esteem. But I was the "Intern of the Year"; what was wrong with me?

I continued to struggle with procedures, and my In Training Examination scores were well below average. I suffered from incredible fatigue and knew deep down that something was wrong. It took many months, over half of my residency, to figure out what it was: a pituitary macroademona had taken residence in my sella and was wrapping its tentacles around my optic nerve. I was going blind and didn't even notice! Within a week after my MRI, I was on the OR table being anesthetized by one of my attendings. What followed was a long hospital stay and complications of hyponatremia requiring readmission. After a long period of healing, I returned to residency and finished my training.

A stay in a hospital ICU will change you forever. My achievement record during residency, despite having been crowned Intern of the Year, may have ended up being quite lackluster... but my experience as a patient was a priceless learning experience that I'm grateful to have had. It helps me connect with my scared and vulnerable patients every day, and it is a constant reminder of how lucky I really am. And as an attending, I now thoroughly enjoy the practice of anesthesia.

I'm shortening and simplifying a very long and detailed story, but I write this to inspire all the new interns and residents with their sights set on perfect ITE scores, accolades, votes, and awards. In the end, none of that matters. Your years of training will hold a mix of times of difficulty, times of gratitude and times of great learning. Do your best to navigate these times with balance, and make sure to take care of yourself!

MiM Mail: Spacing of siblings

I am a third year medical student interested in pediatrics and my husband is a 4th year medical student applying to EM. We have always wanted a large family and lately our (almost) three year old son has started asking incessantly for a baby as well. (When I asked him what he wanted for his birthday this year, his response was "a brother and sister.")

Our original plan was to have our second child during my relatively less busy 4th year, but now that I've started 3rd year rotations, I'm starting to wonder if it is a good idea or not. Balancing motherhood with being a student for the first two years was one thing, but these last few weeks have been an entirely new level of chaotic and stressful! Is it really realistic to add another baby to the mix right now?

On the other hand, having a newborn in residency seems like it would be just as daunting, and waiting until afterwards would mean that my son would be almost 10 before he has his first sibling and I would not have enough reproductive years left to have the big family we envisioned.

I know that there never is a "good" time to have a baby, but in your experiences - what has been the better timeline?

Thank you all so much! You have no idea how much this blog has helped me survive these last couple of years!

-K

Did I miss out?

It recently occurred to me that both my kids are getting to an age where staying home all day is not really an option. Whether she likes it or not, my older daughter has to go to school. And my younger daughter is at an age where most kids are doing at least part time preschool.

Basically, the period of time when it would make sense for me to be a stay-at-home mother is just about over. I can now go to work guilt free.

But there's something a little bit sad about it. I know a lot of women who have been home with their children during this entire time, and are now just starting to go back to work, and it makes me feel like maybe I missed out on something that is now gone forever.

Should I have taken a year or two off from work? Should I have been present for every bottle or lunch or afternoon nap?

My brain tells me no. Taking that kind of time off was just not feasible. And my kids are fine. I spent plenty of time with them.

But I didn't get to have that prolonged period of it just being me and my toddler. And now I never will. I can't help but feel a little bit sad.

MiM Mail: What happens to friends and family?

Mothers in Medicine,

I'm a pre-medical undergraduate from Boston, entering my junior year. I aspire to be an Emergency Medicine physician. I'm finished with my pre-medical coursework, and the next step is taking the MCAT this Spring.

For the last two years, I pushed through my studies, blissfully ignorant to how my future career path may be incongruent with my deepest desire in life: to have children. So I'm writing to you because I aspire to practice medicine, but I'm held back by the concern that the doctor-mom work-life balance may not be right for me. I close my eyes and picture my future: My time is divided between my family and my career. I'm laden with guilt for missing pieces on either end. I'm in a perpetual state of "rushed."

I've been hunting through the Internet, and it seems as though some women in medicine feel this way. I'm attempting to be a nonpartisan hunter, because in the past my confirmation bias has prevented me from considering all of the information important for my decision.

I recently came across this website, which lists the 10 things you need to give up when you become a doctor. To be honest, I was disturbed by number six:

6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him. Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.

OK, so the author is a bit brute with the final comment, but as a general idea, it's that on the priority list, your career in medicine trumps the important relationships in your life.

After reading this, I thought to myself, "Well, shoot." This makes me squirm. I know in my heart that I would never be able to put my career over my family, in a general sense in life. But then I think, if any career were to necessitate this, it's medicine. It should be number one because it can be life or death; it's a privilege and a commitment.

I bet when number six plays out in reality, the choice between them is theoretical and it's all about balance. But the author does provide a concrete example of choosing between the two (with wedding example, above), and in that case, would I be able to choose my job? So... number six moves me to deeply consider my career options.

I 'd like to ask you guys how you feel about number 6. Are you saying, "Yes, medicine requires a commitment that may harm relationships, more so than other careers" or "No, you don't have to choose being a doctor over being a mom, no more than you would with any other demanding career," or "I never feel as though one is of more importance to me than the other" or whatever it is - I'd love to hear it.

Thank you so much for your time, I'm so happy to have stumbled upon your website. You are all inspiring. Wishing you the best in your dual careers.

Love and blessings. J

My Mother’s Daughter

My mother is a doctor who started a solo practice in the 1970s when there weren’t many working mothers, let alone working mother doctors.  She worked tirelessly to establish her practice and then became one of the busiest primary care doctors in the area. I think she was happy with her decision to practice medicine but I know she has regrets about working full time.  She often told me that she wished she could have worked part time or taken off time while we were young.  When I started a family, her advice was to spend less time working and more time with my kids.  

I’ve taken her advice very seriously and have tried very hard to find a happy balance between work and mothering, but in many ways, I am my mother’s daughter.  I am a doctor.  I am a mother of three children.  I struggle with issues around work and balance and guilt.  But I am also very driven to succeed and my mother’s path may be a big contributor of that drive.   By witnessing her courage, strength, and perseverance, I knew that women could work and their kids would still turn out to be great.   

That’s why it’s so encouraging to see research that supports what I always knew – that the children of working moms are very likely to succeed.  

A few months ago, researchers from Harvard Business School published findings from a study where they found that daughters of working mothers were more likely to work themselves, have supervisory roles, and earn higher incomes compared with daughters of non-working mothers.  

This is exciting and affirming news for all us working moms.  And in some ways it's not so surprising.  When I think about my kids and who they will grow up to be, I often wonder what will motivate them, what will make them happy, and what will shape their future selves.  There’s no question in my mind that role models play a huge role in shaping their decisions, their paths, and their destinies.

As for my own mother, I shared this study with her and she wasn’t surprised by its findings.  But she still feels sad that she wasn’t always around after school and on the long days of summer and in the classroom as a volunteer.  Those feelings seem pretty universal and hard to shake.  

The good news is that she is now retired, has six grandchildren, and lots of time to enjoy them.  Plus she has three kids who are successful by any definition and who deeply love her and are grateful for her hard work and for the role model that she was to us.

A Little Gift To Take To Work

We just returned from a week's family vacation. The kids have been off from school, and Hubby has been off from work, so, we've all been together 24/7.

I have afternoon clinic on Mondays, and we dilly-dallied away the early Monday morning.

Finally, reluctantly, I packed my lunch bag, kissed Hubby and the kids goodbye, and set off on foot for the train.

My three-and-a-half-year-old daughter called out to me from an upstairs window: "Mommy! Mommy! MOMMY!"

I looked up from the driveway and yelled back, "Yes, honey?"

"Will you do me a favor, after work?" She says "favor" like "fay-vow" and "work" like "wowk".

"Of course, Honey! What is it you'd like?"

With adorable preschooler excitement, she stammered out, as loudly as she could: "Will you- will you- will you... I mean, after work, will you... please just come home?"

Oh, so, so adorable. So simple. I melted, I promised I would come home, directly home, and I kissed her on the head.

I kept remembering her sweet little three-year-old voice saying, begging, …will you please just come home?, and it kept me smiling all day long in clinic.

Guest post: Miscarriage

I thought I was over my miscarriage, but I’m not. It started when I wishfully wasted a home pregnancy test a few days ago (negative.) This past weekend I’ve been taking the Advanced Life Support in Obstetrics course, delivering rubber babies with shoulder dystocia and fighting back tears the whole way.

Let me start from the beginning. I’m 35 and just starting a family medicine residency. I’m newly married to a wonderful man; he will be joining me when he finds a job in the far away city where I moved for residency. I found out I was pregnant in May. It was my first pregnancy and we were overjoyed.

One month ago, I had my first prenatal visit at an OB/GYN practice in my new city. I went alone. I wore my favorite blue dress. I was happy and confident and looking forward to taking home images of my 8-week future baby.

The appointment started with an ultrasound. I wasn’t alarmed when Monica, the sonographer, asked to switch from a transabdominal to transvaginal view. No problem, I thought. When the imaging resumed, I asked Monica if she could calculate my due date. She paused for a second, and then said, “Well, I’m seeing some concerning things here.” The floodgates opened and I started crying. In the nicest way possible, Monica described the enlarged yolk sac and absent heartbeat. The embryo had died ten days earlier.

Through my tears I met the nurse practitioner who explained my options: since I was starting residency in just over a week, I chose surgery. I spoke with the physician, who booked my D&E the following day. Everyone asked me: where is your husband? (Florida.) Do you know anyone here? (No.) Who will be with you for the surgery? (I don’t know.)

OB/GYN offices are filled with pregnant women and their spouses, best friends, mothers and sisters. It hit me hard when I waited alone for my pre-op bloodwork, then for my Rhogam shot, surrounded by women who still had their babies. I felt their eyes on me, felt their pity. An hour earlier, I too had been smugly pregnant, thinking how elated my parents would be when I told them about their first grandchild.

My husband flew in the same day (I have never asked him how much his flight cost.) The D&E was uneventful; I had no pain after the surgery. We went out for steak that night; I had red wine and blue cheese, because I could. Because I was not pregnant anymore.

The past month has been a whirlwind of excitement, of new long white coats and responsibilities and stresses. Amongst the distractions, I haven’t grieved. But I remember something my physician said before the surgery. She said: “Miscarriages are very common. They’re the norm. But in our society, we don’t talk about them. I wish women talked about their experiences with miscarriage instead of grieving in secret.” And so that’s what I’m doing here. I want to tell you that I’m sad, that I’m angry, and that I’m not okay with what happened. I hope it helps me move on.

MiM Mail: Advice on starting med school with a long-distance relationship

Hi there future colleagues!

I am a long time reader of this blog, though so far I can't call exactly myself a Mother in Medicine - I am a 28 year old nontraditional student who is just about to start medical school one state away, with no kids. I have a wonderful, extremely supportive live-in boyfriend of 5 years who has been on this fun (-ish) journey to get into medical school every step of the way, though he will be starting business school this fall 8 hours away from me by car.

Our short- and medium- terms goal are to end up with summer internships in the same city next year and get engaged sometime after my second year/when he is done with business school. I will try my damndest to get some away rotations scheduled near him during my third and fourth year, and make every connection I can in my home state so we can ideally settle back here for residency, as most of his business opportunities are here (though really, who knows what will happen with the match). Eventually we would like kids.

As a type A, uber organized planner who is madly in love with this man, the uncertainty of a long distance relationship is quite scary. I am reaching out to this wonderful community to see if you all have any advice for me regarding 1) how I can set myself up for success in medical school to enjoy myself and eventually match well and 2) any tips for maintaining healthy long distance relationships.

Thank you in advance - I am honored and humbled to be entering into a profession with the inspiring women I see on this blog and I can't wait to hear your thoughts.

J