MiM Mail: PCP to PM&R?

I am an older mom to a one and only, fabulous, wonderful little boy. I had a career in human services before medical school. I completed my internal med residency. I have worked as a PCP for about a year and, frankly, it's awful! I like my patients. I chose to work in an underserved area with a lot of folks who are newcomers to the United States and I really like this part of the work. I feel like all I do is tap on the computer instead of really dealing with the human being in the room with me.

I had never heard of PM&R in med school. The more I hear about it and read about it, the more I feel like it might be a good match for someone like me. (You know, someone who likes to talk to patients, take a history, do an actual physical exam, maybe have time to do a procedure....)

Does anyone have any suggestions about residency training? It doesn't sound like the PM+R residency would be that much worse than the schedule of an attending PCP. I am able to sacrifice salary due to a very type A doctor dad in the picture. (In that way, I am very, very lucky.)

Thanks!

From premed to med

So in the last two months I managed to do most of the things on my list. We moved nearly all our stuff down and unpacked while I was 37 weeks along. SK's birthday bash went smoothly. Our house is rented. Baby #2, SE arrived and is happy and healthy. We waited until she was two weeks old, packed up our remaining items in a U-haul and made the ten hour drive to our new home. (It's really only supposed to take six hours, but every 30 miles someone either needed to be fed or had to pee.) And now we are here, adjusting to life with a new family member, in a new city, with new schools and jobs. Everyone I've told about our moving experience has thought we're completely nuts, which we are, but we had a plan, stuck to it as much as we could and anything else that came up, we decided to just roll with it. In fact, these last four words have really become my motto as of late, so much so that I can basically take a picture of our crazy lives at any moment and have #justrollwithit be a fitting caption.

My first week of school was packed with such moments. No one to drop off or pick up SK from school on Monday? Just stay home with grandma and do some crafts, eat lots of treats and watch too much TV (#justrollwithit). Get to school and realize I brought my pump but forgot all my pump parts at home? Use the lactation room's backup pump and try to ignore the idea that others have used the same pump (#justrollwithit). Motion-sensor lights turn off in lactation room while pumping, leaving me fumbling around in the dark? Dance like a mad woman in the chair, still attached to my pump until the lights turn on (#justrollwithit....ok there might have been some expletives here and there).

I'm starting to realize that my med school experience is going to be a little bit different than what I had envisioned. I missed out on most of the socializing opportunities my first week because I had to run down to the first floor lactation room to pump while everyone else ate lunch. In fact, it is lunch time right now as I write this and I'm being serenaded by the gentle pff pff pff of my lovely pump. When our social calendar first came out I foolishly rsvp'd to several different events which I'm now realizing was a tad bit ambitious. I guess having a preschooler made me forget what newborn schedules are like; I forgot about the eating every 3 hours thing and the getting up multiple times at night routine. I am feeling a little bit left out, but I know the social aspect of med school will come with time, especially when the little one is a bit older. My biggest struggle right now is trying to figure out when I'm going to find time to study and I'm hoping with some trial and error I'll figure it out. Yesterday an assignment took me 5 hours...maybe 1 hour of actual work in total, 1 hour playing DJ for SK so she could perform dance routines in the living room, 30 minutes of reading Fancy Nancy books, 30 minutes of redirection, timeouts and talks, 1 hour of snuggles and cuddles, 45 minutes of breastfeeding and 15 minutes of accidental sleeping. By the time everyone else is actually in bed and I can study without distraction, I'm about to face-plant into my laptop.

I am loving what I'm learning though and I'm thankful to be in a great program. It's the logistical part that's scaring me right now. I can feel the dreaded "what have I gotten myself into" question creeping into my mind sometimes, but I'm pushing it aside for now. I'm rolling along and I'll be rolling with it for the next 4 years and probably thereafter.

MiM intro: Hopeful MS1

Hopeful. That's the best way I describe myself going into medical school as mom of Toddler. Hopeful. As in, I hope I can handle the work. I hope I can find time for research. I hope I can keep up with Toddler. I hope Toddler can get some siblings over the next four years. I hope that I am not completely wrong about everything and foolish for even attempting the life I think I am trying to build. So I am hopeful.

Hello. Thank you MiM for existing. Reading this site has been a source of much calm during my post-bacc. I got engaged, married and had my first child while preparing for medical school. Just starting my training, I’m in my early thirties. I have yet to buy my books, and yet I enter with the weight of responsibilities and demands on my time that most of my peers won't experience until after residency. It's terrifying. It's discouraging. It's jumping head first, eyes shut, with no parachute into the complete unknown, hoping to land safely, or at the very least... Survive. 

I am excited, honored and humbled to join this community. As I start medical school in just under two days (what?!), I hope (there is that word again) to share my experience as a career changer, medical trainee, aspiring researcher, and most importantly, a mama. This intro post took me a while to sit down and write, mostly because it feels like this marks the beginning. And I guess I was putting it off for just a little longer… because I was putting off admitting to myself that my world is about to turn upside down. I'm ready to jump in, and I'm glad to take MiM with me.

MiM Mail: Not excited by the OR anymore

Hello all,

I was a huge fan of this forum as a woman in medicine, and now I am a brand new mother to a sweet 1 month old baby girl.

I have completed the 4th year of a plastic surgery residency at a competitive and busy program, and am currently taking a research year to have more time with my daughter. My husband is in medicine as well.

I am writing because when I decided to go into surgery (albeit plastics, which is a little bit less demanding), I had not even met my husband and did not think I wanted kids. Obviously my priorities have changed.

Since becoming pregnant, I have been strongly considering a change in specialties or leaving medicine altogether. My new priority is being a mom, being present, and being focused on my daughter's upbringing. Plastic surgery demands long hours to build a practice, rigorous call, and exhausting surgeries that take a lot out of me by the end of the day.

I know switching would mean lengthening my training at this point since I only have 2 clinical years (and probably fellowship) after this research year. But I can't help but think this will be so much better for us in the long run. It makes me a little sad since I have invested so much in my surgical training already, but I don't know if I would be happy continuing on this track. I am not looking for an "easy specialty" since there is no such thing, just one that better fits my priorities. Otherwise, what other options are there outside of medicine?

I liked PM&R when I was a medical student and found it uplifting since you got to see patients' long term progress. I also liked emergency medicine for the immediate feedback and fast pace (the same thing that drew me to surgery initially). I think I need to bite the bullet and find something with more of a fixed schedule that allows me to focus on my family when I am at home, rather than being a slave to my pager. I am just not excited about the operating room anymore, especially given all of my life changes. I have never loved surgery the way some of my colleagues do, and this confirms it.

Any thoughts or advice would be so helpful.

Thank you!

When the Patient Brings Presents… or Punishment

Genmedmom here.

This was an odd week. One patient brought me a beautiful bouquet of flowers as a gesture of thanks… and another totally reamed me out. Both are uncommon occurrences in my practice.

The thing is, I didn't feel like I deserved either.

I told a colleague about it, and we laughed. It's so funny, but so often the case, that we're as surprised by the patient who is grateful as we are by the patient who is angry.

Both cases ended up being professional victories for me:

Usually, when I've received gifts from patients, I have felt some pressure to treat them a bit extra-special, overly gently, with kid gloves. Oh, I won't go there this visit. But in the case of the flowers, I approached a touchy subject anyways, and we were able to address it in a positive way during the visit.

In the case of the reaming, which was really a lengthy declaration of my recent deficiencies as a provider, I was able to hear the patient out. They never raised their voice, used vulgar language, or got personal, so I was able to sit, impassive, and take it. I felt it was therapeutic for this particular patient to get it all out… I apologized for the perceived inadequacies, we reflected together, and then we were able to move on to actual medical issues. Usually, when I get criticized, I get heated up, embarrassed, emotional.

I don't know exactly why, but I was able to stay cucumber-cool. Maintain that professional distance. And, best yet, not bring it home with me.

Of course there have been other cases that have found their way into my head and into my home, intruding on the kids' bedtime routine, making their way into quiet conversation with my husband, delaying desperately-needed dreaming…

In our practice, we have a monthly Balint-style group moderated by a psychologist. We often share cases that get in our heads, and these themes have definitely been explored. Be it gifts or criticism, we have all experienced it. It's been very helpful to hear not only what other providers do in response to these challenging situations, but also to hear what they feel.

We're not made of Teflon, and the water sometimes soaks us. How do other physicians respond in these cases? and, more importantly, how does it make you feel?

I'd love to hear!

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.