A few years ago, my eleven year-old came down with something. He felt horrible, and after a long day in the clinic, I dosed him with ibuprofen and tucked him into bed. I reassured him that he would feel better soon. I’ve got this, I thought. I’m a doctor. I wasn’t going to panic about a day of fever and malaise. I pulled out the Gatorade and chicken soup and enforced naps. My quarantine was effective, and no one else got sick.
Four days later, he was still vomiting. He stopped drinking. He had no interest in his favorite ice cream. Soon, he was barely making urine. Kicking myself, I imagined simultaneous appendicitis and rhabdomyolysis, Occam’s razor be damned. Or instead, rashless HSP. My quarantine mocked me: no one else had caught it because it wasn’t contagious. I called my pediatrician and showed up in the office with a child whose moaning broke my heart and accused me of neglect. Had I waited so long his appendix had burst? What good was all my training if I couldn’t even trust my own abdominal exam?
I shared my broad and crazy differential diagnosis with our pediatrician, who gave my son one dose of ondansetron and sent urine, blood and a rapid flu to the lab. While we waited, the magically dissolving tablet did its job, and my son sat up, asking for a drink. When our doctor came back in with the lab results, the patient was begging for apple juice and Dairy Queen. I hung my head in shame. Ready to do an appendectomy for Influenza B, I had become the hysterical mother I routinely saw in my own office.
Once the sting of fear wore off, I realized that while being a mom has made me a better doctor, being a doctor hasn’t necessarily made me a better mother. I have yet to locate the elusive sweet spot between the extremes of doctor and mother. I cannot be objective when it comes to my own children. Which is why I keep my pediatrician on speed dial and a supply of ondansetron in my cupboard.
--Ann Dominguez, mom to four children, writer and Family Practice attending. I have been in community health for 16 years. My novel, The Match, came out in November, and is available on Amazon, iTunes and Kindle.
Friday, April 1, 2016
Thursday, March 31, 2016
Surviving long distance
It's been awhile since my last post so a quick update before I go into this topic. I am currently 11 weeks away from finishing my radiology residency! I will be continuing on at my home institution for my breast imaging fellowship. My little C just turned 3 in January and is doing very well in pre-school (and an update to my prior post, she is finally pooping in the toilet!! It turned out she was just very stubborn and decided one day to do it and never looked back.). My husband big C is finishing up his fellowship in spine surgery on the east coast and will be coming back home at the end of July. He got a job on the west coast, which is about 2 hours north of my home institution so we'll be doing another year of "long distance" but I don't consider a 2 hour commute "long distance" after a year of "west coast and east coast, 3 hour time difference, and 2 flights and a layover to see each other long distance."
I am by no means an expert on long distance relationship and this year has been my first year of ever being in a long distance relationship. I was definitely a hot mess for a good part of it but now that we're less than 4 months of it coming to an end, I am starting to see the light at the end of the tunnel and wanted to share how we, me and little C, survived a year alone.
1. Communication. This is the biggest part of any relationship especially in a long distance relationship. Big C and I talk every single day usually via text message. It's hard at times especially when he is doing a 9-10 hour case but he always manages to text me in between cases. It's important that we check in on each other and know what we're doing even thought there is an entire country in between us. This is our way of maintaining our adult relationship and marriage because when we do FaceTime in the evenings, we try to make it about little C. Usually from the hours of 6 to 8 PM (west coast time), we have our FaceTime on. We usually aren't talking the entire time but big C is able to see us eat dinner and our usual bedtime routine. This way little C gets to at least see her daddy almost every day. No matter how busy we are, we always check in on each other!
2. Don't forget about the light at the end of the tunnel. I am guilty of forgetting this at times. As a single mom this year (minus most weekends when we go an hour north to my parent's house), my days just revolve around surviving. I am just trying to make it to bedtime but it's important to realize that there is an end goal. There is reason why we are doing this. It's easy to get caught up in the stressful moments but whenever I am feeling stressed, I think of our family living under the same roof once again and being able to provide for little C all the things we talked about and hoped for in the near future and the stress does melt away some. It definitely helps to know that it is only temporary because there is a bigger picture in mind!
3. Making each moment count. I am not brave enough to travel with little C alone to the east coast, mostly because where big C is training, there is no direct flight and it's a whole day ordeal to get to his place and his place = bachelor's pad. I've been out to the east coast a couple times this year when my mom graciously watched little C. We didn't get much sleep but in its sacrifice, we got to treasure these few days of adult time and made memories to last us to the next visit. When big C visits us here, which is about once every 6-8 weeks, we will fill every minute with family time for little C whether it be going to an amusement park or something as simple as going to the playground. We just strive to create memories and experiences for little C as a family of three.
4. Be considerate. Sometimes it's very easy in a long distance relationship to get caught up in your own life that you forget to think about what it's like to be in your partner's shoes. I am very guilty of this as well. I often lash out at big C about how he has no idea what's it's like to be a single parent doing residency. But at the end of the day, I am so grateful I get to snuggle little C in bed and how she gives me 3 kisses, 1 on each cheek and 1 on lips right before bed and she calls me her favorite. I get to pick her up from pre-school every day and I get to come to a home filled with pictures and memories of our family. There are hard days but I am not alone. I remind myself that he might not be here but he has his own battles. He lives alone and away from his family. He's experiencing a rigorous fellowship that often involves 5AM days that sometimes end at midnight. He's on call constantly. All 3 meals are often from the hospital cafeteria. He's in a new environment where he doesn't know anyone. And at the end of the day, he's not just doing this for himself. He's doing it for our family and for that, I am truly grateful to have such a hard working, selfless husband.
5. Make short-term plans. This was more relevant when we first started our long distance relationship. I would make a big deal at each 10 week mark. I still continue to make a big deal for each time he gets to visit. There is a light at the end of the tunnel but we still need something to look forward to get through the day to day. Now, we're days away from April and making plans to attend each other's graduations. I still can't believe we have survived this far!
I am by no means an expert on long distance relationship and this year has been my first year of ever being in a long distance relationship. I was definitely a hot mess for a good part of it but now that we're less than 4 months of it coming to an end, I am starting to see the light at the end of the tunnel and wanted to share how we, me and little C, survived a year alone.
1. Communication. This is the biggest part of any relationship especially in a long distance relationship. Big C and I talk every single day usually via text message. It's hard at times especially when he is doing a 9-10 hour case but he always manages to text me in between cases. It's important that we check in on each other and know what we're doing even thought there is an entire country in between us. This is our way of maintaining our adult relationship and marriage because when we do FaceTime in the evenings, we try to make it about little C. Usually from the hours of 6 to 8 PM (west coast time), we have our FaceTime on. We usually aren't talking the entire time but big C is able to see us eat dinner and our usual bedtime routine. This way little C gets to at least see her daddy almost every day. No matter how busy we are, we always check in on each other!
2. Don't forget about the light at the end of the tunnel. I am guilty of forgetting this at times. As a single mom this year (minus most weekends when we go an hour north to my parent's house), my days just revolve around surviving. I am just trying to make it to bedtime but it's important to realize that there is an end goal. There is reason why we are doing this. It's easy to get caught up in the stressful moments but whenever I am feeling stressed, I think of our family living under the same roof once again and being able to provide for little C all the things we talked about and hoped for in the near future and the stress does melt away some. It definitely helps to know that it is only temporary because there is a bigger picture in mind!
3. Making each moment count. I am not brave enough to travel with little C alone to the east coast, mostly because where big C is training, there is no direct flight and it's a whole day ordeal to get to his place and his place = bachelor's pad. I've been out to the east coast a couple times this year when my mom graciously watched little C. We didn't get much sleep but in its sacrifice, we got to treasure these few days of adult time and made memories to last us to the next visit. When big C visits us here, which is about once every 6-8 weeks, we will fill every minute with family time for little C whether it be going to an amusement park or something as simple as going to the playground. We just strive to create memories and experiences for little C as a family of three.
4. Be considerate. Sometimes it's very easy in a long distance relationship to get caught up in your own life that you forget to think about what it's like to be in your partner's shoes. I am very guilty of this as well. I often lash out at big C about how he has no idea what's it's like to be a single parent doing residency. But at the end of the day, I am so grateful I get to snuggle little C in bed and how she gives me 3 kisses, 1 on each cheek and 1 on lips right before bed and she calls me her favorite. I get to pick her up from pre-school every day and I get to come to a home filled with pictures and memories of our family. There are hard days but I am not alone. I remind myself that he might not be here but he has his own battles. He lives alone and away from his family. He's experiencing a rigorous fellowship that often involves 5AM days that sometimes end at midnight. He's on call constantly. All 3 meals are often from the hospital cafeteria. He's in a new environment where he doesn't know anyone. And at the end of the day, he's not just doing this for himself. He's doing it for our family and for that, I am truly grateful to have such a hard working, selfless husband.
5. Make short-term plans. This was more relevant when we first started our long distance relationship. I would make a big deal at each 10 week mark. I still continue to make a big deal for each time he gets to visit. There is a light at the end of the tunnel but we still need something to look forward to get through the day to day. Now, we're days away from April and making plans to attend each other's graduations. I still can't believe we have survived this far!
Doctor Day advice
The teacher at my younger daughter's preschool says that they're going to start a unit on different careers, and she asked me if I could come talk to the kids about being a doctor. Of course, I said yes.
While I did this once before for my older daughter's class many, many years ago, I feel like recently what I do has diverged significantly from what little kids think of when they think of a doctor. I still have the equipment, but I can't even remember the last time I took someone's blood pressure. (And that person was probably my husband, who is always convinced his BP is high.)
Has anyone else done a Doctor's Day for your child's class? If so, what did you do? What was a big hit?
While I did this once before for my older daughter's class many, many years ago, I feel like recently what I do has diverged significantly from what little kids think of when they think of a doctor. I still have the equipment, but I can't even remember the last time I took someone's blood pressure. (And that person was probably my husband, who is always convinced his BP is high.)
Has anyone else done a Doctor's Day for your child's class? If so, what did you do? What was a big hit?
Thursday, March 24, 2016
The Most Intimate of Jobs
A random Saturday earlier this month marked the first time I provided sedation anesthesia for patients in the same IVF clinic where I was a patient for 3 years. It was surreal and a little emotional driving up the hill to the clinic and thinking about the many times I went there as a patient myself. All the shots, the blood draws, the ultrasounds, the procedures... Also all the letdown and disappointment that was flanked before and after by hope and excitement. I now have a beautiful baby girl to show for my time as an IVF patient!
A friend of mine who is also in the medical field said to me, "I bet it took a lot of courage to do that. Creepy and scary". While I instead had viewed the experience with gratitude and excitement at the ability to give back to a group of people who had given so much to me, I can understand what she meant. As physicians, we are faced with daily reminders of unpleasant things. Things that have happened possibly to us or to our loved ones, or things that are at the very least reminders of our own mortality.
I think these reminders are a gift, one that doesn't come with many other lines of work in this world. They keep us appreciative of what we have, what we've been through. Has anyone else had an experience like this in their practice? Share your thoughts with us.
A friend of mine who is also in the medical field said to me, "I bet it took a lot of courage to do that. Creepy and scary". While I instead had viewed the experience with gratitude and excitement at the ability to give back to a group of people who had given so much to me, I can understand what she meant. As physicians, we are faced with daily reminders of unpleasant things. Things that have happened possibly to us or to our loved ones, or things that are at the very least reminders of our own mortality.
I think these reminders are a gift, one that doesn't come with many other lines of work in this world. They keep us appreciative of what we have, what we've been through. Has anyone else had an experience like this in their practice? Share your thoughts with us.
I matched!
Match Day has come and gone, and I have to admit that life looks so much brighter on the other side of that big white envelope. The months leading up to last Friday have been filled with more ups and downs than I care to count. I know I'm not alone in feeling grateful that the entire process of residency applications, interviews, ranking programs, and waiting, waiting, waiting is finally over!
Now that I've got that Match letter in hand, telling me that I matched at my first choice program (my home institution - hooray for not having to move across the country with a toddler and baby-on-the-way!) I am feeling humbled, grateful, and honestly somewhat astonished to be at this point. There have been so many times in the past 4 years that I wanted to walk away from medical school - studying for Step 1 while trying to conceive, battling first trimester nausea during my surgery clerkship, leaving my baby girl in the care of others when it was time to return to rotations, pumping when I'd rather be nursing her, hearing from my husband or mother-in-law or babysitter about the milestones she reached rather than experiencing them first-hand, tiptoeing out of the house before she awoke in the morning and coming home long after she'd been in bed...the list could go on.
But I count myself blessed to have had the support of my husband, parents, in-laws, and wonderful community of friends during this time - I know from reading this blog that many mothers in medicine are shouldering far heavier burdens with far less help. And it's largely because of those supports that I made it to Match Day. They are the ones who listened when I was frustrated, cared for me when I was exhausted, and lifted me up when I was discouraged. They are the ones who made sure that my daughter always had a safe and nurturing environment to be in (and that mama always had plenty of pictures to keep her going through the longer days and nights). My Match Day belonged to them as much as it did to me.
Even though we are staying put for residency, there are big changes on the horizon. I am thankfully finished with all of my clinical requirements for medical school, but there are all those little administrative odds and ends to take care of. And Baby #2 is due in less than 5 weeks! I still need to dig out the newborn clothes and bassinet from the first time around, maybe review our birth plan/what to expect during labor, think about preparing some food for after the birth (emphasis on think about rather than actually prepare) and pack that hospital bag. Now that the stress and excitement of the entire Match process has subsided, I'm grateful to have the time to prepare, physically and emotionally, for our transition to a family of four.
Congratulations to all the other medical students out there who matched last week - I hope that you are enjoying some well-deserved relaxation after passing this milestone in medical education! I know that Match Day is not necessarily a joyful occasion for everyone, whether it be due to an unexpected placement or not matching at all. So to anyone who is not celebrating this year, I wish you strength and courage for the discernment that lies ahead.
Please share your own stories of this Match Day and those past!
Now that I've got that Match letter in hand, telling me that I matched at my first choice program (my home institution - hooray for not having to move across the country with a toddler and baby-on-the-way!) I am feeling humbled, grateful, and honestly somewhat astonished to be at this point. There have been so many times in the past 4 years that I wanted to walk away from medical school - studying for Step 1 while trying to conceive, battling first trimester nausea during my surgery clerkship, leaving my baby girl in the care of others when it was time to return to rotations, pumping when I'd rather be nursing her, hearing from my husband or mother-in-law or babysitter about the milestones she reached rather than experiencing them first-hand, tiptoeing out of the house before she awoke in the morning and coming home long after she'd been in bed...the list could go on.
But I count myself blessed to have had the support of my husband, parents, in-laws, and wonderful community of friends during this time - I know from reading this blog that many mothers in medicine are shouldering far heavier burdens with far less help. And it's largely because of those supports that I made it to Match Day. They are the ones who listened when I was frustrated, cared for me when I was exhausted, and lifted me up when I was discouraged. They are the ones who made sure that my daughter always had a safe and nurturing environment to be in (and that mama always had plenty of pictures to keep her going through the longer days and nights). My Match Day belonged to them as much as it did to me.
Even though we are staying put for residency, there are big changes on the horizon. I am thankfully finished with all of my clinical requirements for medical school, but there are all those little administrative odds and ends to take care of. And Baby #2 is due in less than 5 weeks! I still need to dig out the newborn clothes and bassinet from the first time around, maybe review our birth plan/what to expect during labor, think about preparing some food for after the birth (emphasis on think about rather than actually prepare) and pack that hospital bag. Now that the stress and excitement of the entire Match process has subsided, I'm grateful to have the time to prepare, physically and emotionally, for our transition to a family of four.
Congratulations to all the other medical students out there who matched last week - I hope that you are enjoying some well-deserved relaxation after passing this milestone in medical education! I know that Match Day is not necessarily a joyful occasion for everyone, whether it be due to an unexpected placement or not matching at all. So to anyone who is not celebrating this year, I wish you strength and courage for the discernment that lies ahead.
Please share your own stories of this Match Day and those past!
Monday, March 21, 2016
I'm a grown woman and my work bag needs to represent that
What do you do to celebrate yourself? How do you toot your own horn?
I am a part of several very lively on-line support groups for mothers. I love many of the posts and I have especially started to really enjoy the posts that talk about how busy mothers reward themselves with things like fancy purses, fabulous trips and paying off their loans. I don’t think we do as much as we should to celebrate ourselves, to be gentle with ourselves, to love up on ourselves. After the first 8 months of being an Attending, I sometimes realize that besides going to the gym I haven’t done a single good thing just for myself in a week; that’s when I schedule an eyebrow shaping or pedicure appointment (I am overdue for both by the way, uggh!). I am going to start with the purse, build my way up to a trip next year, and before turning 40 - these loans will be paid off!
Back to the bag - the work bag my mother bought me at the beginning of residency has been through a lot. It’s a nice, large personalized LL Bean bag but it has begun to look weathered and frayed. I’m too young to look sloppy and unkempt and I need an upgrade. I went out with some of my Sorority Sisters recently and I noticed how all of the Lawyers had beautifully sculpted, supple leather bags - they were gorgeous!
That’s when I decided - I’m upgrading myself as soon as I get my first check from my new position (more on that later). My budget is modest and several friends recommended Coach (my favorite is the Coach Mercer Satchel in eggplant) due to their durability and timelessness and some sister-doctors recommended the Dagne Dover (I like the roomy Charlie Tote the best). And now I’m ready for my own, not-a-hand-me-down, grown lady work bag. One that I’ll feel like singing Beyonce’s “Grown Woman” out loud as I carry it into my new office.
Any recommendations for your favorite work bag or purse? One that will not be flashy while commuting on the DC metro? One that will allow me to easily go from work to picking up Zo from kindergarten?
Thursday, March 10, 2016
Money Talks
I've been reading The Grumpy Rumblings of the (Formerly) Untenured blog lately. Their personal finance posts make me kind of uncomfortable because I don't think we've done a good job of planning or saving. We're not frugal and we haven't paid down our mortgage (although we did refinance to shorten our term) and we won't be able to retire early. Which mostly I think is fine...except when I read their posts.
But anyway, I read this post about how we communicate about money and I commented. Sam and I communicate fairly easily about money; we discuss major decisions, we have similar values, we have enough money so that we can each buy the things we want. I'm not surprised to read that money is a source of conflict for a lot of couples, or that one member of the couple manages the money. I was astonished to see how many commenters say that they give their partner an "allowance".
I give my daughter an allowance. I had an allowance when I was a child. I don't give my husband an allowance and he doesn't give me one. I understand the value of having money you can spend without accounting to your partner for every penny, and I can see the reasons for deciding ahead of time how much that will be each month. But an allowance? As an adult? That just rubs me the wrong way.
Is it just me? Do you have an allowance? Do you give your partner an allowance (if you have a partner)? Am I completely over-reacting to a perfectly reasonable word?
Wednesday, March 9, 2016
MiM Mail: Share your anecdotes about pregnancy and maternity leave
Hi fellow mothers in medicine,
I'm currently a resident and pregnant with baby #2. I must say that the attitudes I have encountered throughout this pregnancy from my attendings and peers have been discouraging. I'm working on writing an op-ed piece about attitudes toward pregnancy and maternity leave among US physicians and would love to have more quotations and anecdotes from your experiences. Positive and negative comments are welcome (please comment below)! Sadly, mine have been mostly negative.
Thanks so much!
Saturday, March 5, 2016
Conversations With My Daughter
A keeps telling me what to do. She's so mean. It's like she's my mother.
Hey. I'm not mean.
True. It's like she's the mean mother I never had. Why is she so mean, anyway?
Well, honey, you know her better than I do. It sounds to me as if she's really insecure and also pretty envious of you and C.
Why?
You both have a lot more money than A and her family. You two get to travel and buy pretty much anything you want. A doesn't.
I know. And I don't know why she's so mean to her mom. Her mom works really hard. I think she's nice.
She is nice, and she is working really hard. I can't imagine how painful it must be to have to tell your kids you can't afford things they need. And, at the same time, she seems to tolerate B being mean to her. You said once that you knew I'd never let you talk that way, and you're right. I wouldn't.
It would never even occur to me to talk you like that. Or to yell at you that way.
I know. And a lot of that is just the way you are - the way you're wired. Some of it, though, is that Daddy and I have been clear about what the limits are. And we've also treated you like a human being. We've listened to you and explained why we make our decisions and we respect you and your point of view, so you trust us to be reasonable.
Yeah. And then I expect everybody to be like that, and they're not! Other people are NOT reasonable. Like, I keep thinking people will apologize when they've done something wrong, the way you and Daddy do. And they don't!
Hey. I'm not mean.
True. It's like she's the mean mother I never had. Why is she so mean, anyway?
Well, honey, you know her better than I do. It sounds to me as if she's really insecure and also pretty envious of you and C.
Why?
You both have a lot more money than A and her family. You two get to travel and buy pretty much anything you want. A doesn't.
I know. And I don't know why she's so mean to her mom. Her mom works really hard. I think she's nice.
She is nice, and she is working really hard. I can't imagine how painful it must be to have to tell your kids you can't afford things they need. And, at the same time, she seems to tolerate B being mean to her. You said once that you knew I'd never let you talk that way, and you're right. I wouldn't.
It would never even occur to me to talk you like that. Or to yell at you that way.
I know. And a lot of that is just the way you are - the way you're wired. Some of it, though, is that Daddy and I have been clear about what the limits are. And we've also treated you like a human being. We've listened to you and explained why we make our decisions and we respect you and your point of view, so you trust us to be reasonable.
Yeah. And then I expect everybody to be like that, and they're not! Other people are NOT reasonable. Like, I keep thinking people will apologize when they've done something wrong, the way you and Daddy do. And they don't!
Tuesday, March 1, 2016
Let the Mystery Be
Our little man will hopefully make his appearance (hopefully in a much shorter and less painful way!) in the next few weeks… I hit 37 weeks a couple of days ago, and for me, this is uncharted territory as I went into labor with our daughter at 37 days on the dot. This has really felt like a milestone- as residents, we live our lives in month-long blocks, and the past two blocks have been the most intense physically and hours-wise rotations we have in our pathology program. We're all still in one piece though, and for that I am grateful. We met with our volunteer doula this past weekend, finally acquired a car seat, and took inventory of all the leftover clothes I had stashed from my daughter (mostly gender neutral, thankfully!) that we’ll be able to use again. This is finally feeling like a reality.
I wanted to share the strangest experience I had this weekend which I haven’t been able to shake. I’m sure many with multiple children relatively close together can commiserate over how different subsequent pregnancies are from the first… Beyond our work, our focus has been survival and spending as much quality time as possible with our daughter and being a family of 3. It’s been easy to forget about the pregnancy, and actually I’ve done a pretty good job at ignoring it so I don’t worry haha.. But this time, there have been no photo diaries week by week, no journal entries to my fetus, no shopping trips to buy anything special.
One experience we really treasured the first time around was going to one of those recreational 4D ultrasound places to find out the sex and see her face. We actually went twice- once around 15 weeks and once later on, maybe 25 or 26 weeks. I remember how much we stared at those photos- we even had one framed which I brought to my delivery haha. Her face was so beautiful... I still love looking at those photos in utero and seeing her face in them, her little button nose and full lips. Anyway a couple weeks ago, while feeling guilty realizing how little time was left and how little we had done, my husband and I decided to try to find a similar U/S place in the city we live in now. The place with the best reviews was far- over 30 minutes away- but we thought we owed it to our fetus to be appreciated for a morning and to let our daughter see him, haha. But it was actually disappointing… it was sort of a weird sterile office, not at all a warm fuzzy baby-friendly environment like we experienced back in California. Also, previously, we had to sign that we were receiving prenatal care and write down the name of the hospital and Ob practice in case there were any abnormalities that needed to be reported; at this place, all they took was our name and EDD. And unfortunately, our little guy was totally covering his face with both hands and feet at the session, so they invited us to come back for another look in a couple weeks.
So this weekend we went back to test our luck, and while in the waiting room, the doctor/owner of the business (radiology IMG, not practicing here; his wife seems to be the ultrasound tech) came out and asked if I could come help him with translation issues with his current Brazilian client that couldn’t speak English. He knew I had an MD, but I was caught off guard. Without thinking too hard, I shrugged and said, sure, I only had patchy Spanish and Italian to offer but maybe it could be a bridge to their Portugese. I entered the room to find a young couple with their two older sons, maybe 7 and 9. The woman looked scared. I started to feel scared. According to her LMP, she should have been around 10 weeks along. No cramping, no bleeding since. Regular periods prior. Apparently, no insurance and she hadn’t seen an Ob or PCP- only positive HPTs. The problem was that no heartbeat was detected, and she was measuring only around 5 weeks. My heart sank. It was clear they had all come to share the joyous occasion of seeing the baby for the first time as a family. I was so sad for them as I had been in the same position a year prior, the ultrasound planting the first seed in my heart of the possibility of miscarriage to follow. We tried to explain as gently as possible that time will tell whether the pregnancy will continue. But I was upset that I was in this unexpected position. I was upset that she didn’t have a doctor of her own. I was upset that she was receiving this information in this setting. I tried my best to encourage her to establish care with an Ob as soon as possible, but it seemed unlikely that it would happen.
I keep thinking about her today and wish the best. I truly hope this is a dating issue and that her pregnancy will progress. I keep thinking of my own miscarriage, the ordinariness and near universality of the experience and how isolating, unique, and devastating it still feels. I think of the miracle of our family now ready to welcome a boy just a year later. Of all the health we take for granted. I think of the fragility of our children, that this is all the beginning… by gaining so much in love we also have so much to lose. But I remind myself that the alternative, of not opening our hearts to the potential of more love and family, is also a sort of loss. I was reminded of this old song by Iris DeMent, called “Let the Mystery Be,” which expresses her coming to terms with rejecting organized religion (she grew up in a big religious family I believe) in a really beautiful way... I often sing this to myself when I feel like I need to let go and not worry... so much unexplainable mystery in life.
Here is the brief and only glimpse our little one gave us of his face in the two ultrasound sessions. He wants to stay a mystery and I accept that. I just can’t wait to kiss those chubby cheeks and lips and see what the rest of him looks like… well, maybe I can wait just a couple more weeks :)
Monday, February 29, 2016
Because I Hated Every Second of Breastfeeding
Genmedmom here.
There have been many times when I have struggled to empathize with the patient. There are certain healthcare issues, and certain patients, that I have found consistently frustrating over the years.
I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99% of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest.
My kryptonite issue has been obesity. I admit, that for many a patient encounter, I've sat there and counseled (for the millionth time) on diet, and exercise, and priorities, and wondered to myself: Why can't you do this? Why can't you just lose weight?
I know that sounds terrible. Heck, it IS terrible. My bias is based on my own experience: I gained sixty pounds in my first pregnancy, and fifty in my second. The weight didn't come off postpartum, and I found myself obese. BMI 30. I dedicated what precious little time I had as a working mom to eating healthy and exercising, and I lost it all. It took two years. It was hard. There were ups and downs. I've written endlessly about it here, and here, and here....
Of course I know that it is totally and utterly unfair to think "Well, if I could do it, why can't you?" but truth is, that's a pretty natural way to think, and many of us think like that.
So I've been making a conscientious effort to do better, to let go of the bias, and the frustration, and meet people where they are, no matter what the medical issue is.
But it was only when I was sitting with a lovely young patient of mine who was upset, grieving, actually, that she had been unable to breastfeed her infant, that I had a real breakthrough.
This poor woman had had a complicated pregnancy and delivery. Nothing had gone the way she had planned. But she held on and held it together, because she knew that if her baby survived, she would do everything right. She would take THE BEST care of this baby. She was determined to breastfeed for a full year. It had never occurred to her that that might not happen.
There were problems with the latch, with the milk supply, with pain, with baby's growth. Still, she was determined. She got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera... for weeks.
But one day when she had spent an hour and a half with the industrial-grade pump and got only about a teaspoon of breastmilk, with her nipples raw and bleeding, with her infant screaming, starving, with the pediatrician's concerns about his growth, with her consultants saying "Just push through! Keep trying!" for the gazillionth time but without any other real suggestions, and without any progress, she broke down.
She gave up.
So the baby got formula. And did fine. And grew. And she thought this burden was lifted from her.
Until the judgments came.
She was part of a social circle that especially valued breastfeeding. Friends and family would comment, say, "Don't you know breast milk is best?" or "Well, if you had only tried X, I bet it would have worked" or "If you had only HUNG ON a little bit longer" or "Those doctors pushed you towards formula, those doctors always push the formula, you shouldn't have listened" et cetera, et cetera.
It got to the point that she hid bottles and formula, or avoided socializing altogether. She felt like a freak, a failure. She worried what awful consequences there might be for her baby. She waited for some severe illness to befell her son, and for someone to blame it on her.
Oh, my heart went out to her.
Flashback. I was pregnant with Babyboy (now five and a half years old). I had a three-page birth plan outlining my natural vaginal delivery. I had a doula. I had Ina May's books on childbirth and Nancy Mohrbacher's books on breastfeeding. I had secured a highly-rated lactation consultant and booked a consult with her BEFORE the baby was born. I bought Medela breastmilk bags and a plastic organizer for the freezer. I arranged a breastfeeding room in my office.
But there were complications. The delivery- that's a story for another day. Emergency C-section for deep transverse arrest. Bradycardia. Meconium. Mayhem. I was discharged with a hematocrit of 22.
Babyboy was fine, but I grieved the loss of my dream birth. I was determined to get breastfeeding right: I wanted to breastfeed for a full year.
But. There were problems with the latch, with the milk supply, with pain, with baby's growth. I was still determined. I got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera.
Miraculously, I was able to breastfeed for a full three months.
But, I hated every single second of it.
When it got close to feeding time, I would inwardly cringe. With his latch, I would outwardly gasp, and clench my teeth in pain. The doula and the lactation consultants gave up on me. It was a nurse practitioner at Babyboy's pediatrician's office who suggested APNO (All-purpose-nipple-ointment), and it was an OB/GYN who prescribed it for me. The APNO cream helped a bit, and it got me through the three months, though nothing really helped.
Inevitably, what would come to mind with EVERY feeding were images:
Of glass-shard covered twine being pulled out of my breasts through my nipples.
Of someone pouring acid over my areolae.
Of my baby with little piranha teeth and malevolent intentions.
Oh, I hated it, and I hated myself for hating it. Wasn't breastfeeding supposed to be this wonderful bonding experience? I would rock and cry, literally cry, while stroking my baby's forehead and begging forgiveness, because I could not WAIT for this to be over.
So when it came time to go back to work, I started on a combined oral contraceptive and took Benadryl, and let that milk supply dry right up. Worked like a charm. I was done. It was such a relief.
When I told my colleagues I would not be needing that breastfeeding room, I got some eyebrow raises, but no one questioned. Many of them had made similar decisions for different reasons.
Most of my friends were understanding (very different social circle from my patient-mom) and for that I was very grateful. As a matter of fact, people came out of the woodwork with their own breastfeeding difficulty stories. I was not only NOT the only person who had struggled, I was not the only person who hadn't enjoyed it, and I was not the only person who had guilt about that.
Yes, there were a few "judgy" moments. People I didn't know well, and luckily didn't give a rat's ass about. A lady at book club gathering, a friend of a friend.
But my patient, my poor patient. Her "support network" was annihilating her. I was outraged on her behalf. I wanted to reassure her.
So I shared my own story with her, and we discussed ways to manage the hurtful comments and avoid the negative people.
For doctors, sharing our own stories and feelings about medical issues with patients is a tricky thing. Sometimes it's appropriate, sometimes it's not, and sometimes it's a mixed bag. In this case, the patient expressed relief and gratitude. She had been initially expecting me to judge her, too, she said. She was so glad to have found validation, reassurance and open discussion instead.
That's when I had my breakthrough: The patient had been expecting me to judge her, and had instead found validation and reassurance.
Wow. THAT is what I need to bring to EVERY patient encounter. Validation, reassurance, open discussion. Because that is what I would want for me, as well. It's what I want to be able to provide for everyone, especially my patients.
There have been many times when I have struggled to empathize with the patient. There are certain healthcare issues, and certain patients, that I have found consistently frustrating over the years.
I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99% of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest.
My kryptonite issue has been obesity. I admit, that for many a patient encounter, I've sat there and counseled (for the millionth time) on diet, and exercise, and priorities, and wondered to myself: Why can't you do this? Why can't you just lose weight?
I know that sounds terrible. Heck, it IS terrible. My bias is based on my own experience: I gained sixty pounds in my first pregnancy, and fifty in my second. The weight didn't come off postpartum, and I found myself obese. BMI 30. I dedicated what precious little time I had as a working mom to eating healthy and exercising, and I lost it all. It took two years. It was hard. There were ups and downs. I've written endlessly about it here, and here, and here....
Of course I know that it is totally and utterly unfair to think "Well, if I could do it, why can't you?" but truth is, that's a pretty natural way to think, and many of us think like that.
So I've been making a conscientious effort to do better, to let go of the bias, and the frustration, and meet people where they are, no matter what the medical issue is.
But it was only when I was sitting with a lovely young patient of mine who was upset, grieving, actually, that she had been unable to breastfeed her infant, that I had a real breakthrough.
This poor woman had had a complicated pregnancy and delivery. Nothing had gone the way she had planned. But she held on and held it together, because she knew that if her baby survived, she would do everything right. She would take THE BEST care of this baby. She was determined to breastfeed for a full year. It had never occurred to her that that might not happen.
There were problems with the latch, with the milk supply, with pain, with baby's growth. Still, she was determined. She got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera... for weeks.
But one day when she had spent an hour and a half with the industrial-grade pump and got only about a teaspoon of breastmilk, with her nipples raw and bleeding, with her infant screaming, starving, with the pediatrician's concerns about his growth, with her consultants saying "Just push through! Keep trying!" for the gazillionth time but without any other real suggestions, and without any progress, she broke down.
She gave up.
So the baby got formula. And did fine. And grew. And she thought this burden was lifted from her.
Until the judgments came.
She was part of a social circle that especially valued breastfeeding. Friends and family would comment, say, "Don't you know breast milk is best?" or "Well, if you had only tried X, I bet it would have worked" or "If you had only HUNG ON a little bit longer" or "Those doctors pushed you towards formula, those doctors always push the formula, you shouldn't have listened" et cetera, et cetera.
It got to the point that she hid bottles and formula, or avoided socializing altogether. She felt like a freak, a failure. She worried what awful consequences there might be for her baby. She waited for some severe illness to befell her son, and for someone to blame it on her.
Oh, my heart went out to her.
Flashback. I was pregnant with Babyboy (now five and a half years old). I had a three-page birth plan outlining my natural vaginal delivery. I had a doula. I had Ina May's books on childbirth and Nancy Mohrbacher's books on breastfeeding. I had secured a highly-rated lactation consultant and booked a consult with her BEFORE the baby was born. I bought Medela breastmilk bags and a plastic organizer for the freezer. I arranged a breastfeeding room in my office.
But there were complications. The delivery- that's a story for another day. Emergency C-section for deep transverse arrest. Bradycardia. Meconium. Mayhem. I was discharged with a hematocrit of 22.
Babyboy was fine, but I grieved the loss of my dream birth. I was determined to get breastfeeding right: I wanted to breastfeed for a full year.
But. There were problems with the latch, with the milk supply, with pain, with baby's growth. I was still determined. I got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera.
Miraculously, I was able to breastfeed for a full three months.
But, I hated every single second of it.
When it got close to feeding time, I would inwardly cringe. With his latch, I would outwardly gasp, and clench my teeth in pain. The doula and the lactation consultants gave up on me. It was a nurse practitioner at Babyboy's pediatrician's office who suggested APNO (All-purpose-nipple-ointment), and it was an OB/GYN who prescribed it for me. The APNO cream helped a bit, and it got me through the three months, though nothing really helped.
Inevitably, what would come to mind with EVERY feeding were images:
Of glass-shard covered twine being pulled out of my breasts through my nipples.
Of someone pouring acid over my areolae.
Of my baby with little piranha teeth and malevolent intentions.
Oh, I hated it, and I hated myself for hating it. Wasn't breastfeeding supposed to be this wonderful bonding experience? I would rock and cry, literally cry, while stroking my baby's forehead and begging forgiveness, because I could not WAIT for this to be over.
So when it came time to go back to work, I started on a combined oral contraceptive and took Benadryl, and let that milk supply dry right up. Worked like a charm. I was done. It was such a relief.
When I told my colleagues I would not be needing that breastfeeding room, I got some eyebrow raises, but no one questioned. Many of them had made similar decisions for different reasons.
Most of my friends were understanding (very different social circle from my patient-mom) and for that I was very grateful. As a matter of fact, people came out of the woodwork with their own breastfeeding difficulty stories. I was not only NOT the only person who had struggled, I was not the only person who hadn't enjoyed it, and I was not the only person who had guilt about that.
Yes, there were a few "judgy" moments. People I didn't know well, and luckily didn't give a rat's ass about. A lady at book club gathering, a friend of a friend.
But my patient, my poor patient. Her "support network" was annihilating her. I was outraged on her behalf. I wanted to reassure her.
So I shared my own story with her, and we discussed ways to manage the hurtful comments and avoid the negative people.
For doctors, sharing our own stories and feelings about medical issues with patients is a tricky thing. Sometimes it's appropriate, sometimes it's not, and sometimes it's a mixed bag. In this case, the patient expressed relief and gratitude. She had been initially expecting me to judge her, too, she said. She was so glad to have found validation, reassurance and open discussion instead.
That's when I had my breakthrough: The patient had been expecting me to judge her, and had instead found validation and reassurance.
Wow. THAT is what I need to bring to EVERY patient encounter. Validation, reassurance, open discussion. Because that is what I would want for me, as well. It's what I want to be able to provide for everyone, especially my patients.
Sunday, February 28, 2016
That One Time When You Unknowingly Insulted Me
It was normal Wednesday and I was staring absentmindedly at the surgery white board. I searched its unending list of procedures and "ectomies" that stretched the entire length of the wall, until I was finally able to locate my string of minor surgeries. Lost deep in thought, I wondered if there was any feasible way the labor gods would be kind to me. What were the odds my labor patient would deliver while I was scrubbed in one of my many hysteroscopies? As I came to the conclusion that once again my day was hopelessly overbooked, I sighed only to feel a hand on my back.
Turning around I saw the familiar friendly face of a charge nurse. She looked concerned.
"Dr. RH+, poor thing, were you on call last night?" she asked.
"Actually, no. I slept all night." I chirped.
"Oh....." she said as we stared at each other, slowly realizing that she had just accused me of looking like total crap.
When the awkward silence became too much to bear, I faked a page and make a dash for the locker room, where I stat ordered eye cream from one of the 200 people on my Facebook feed who try to sell me overpriced fancy products endorsed by celebrity dermatologist. Maybe I can be the next before and after picture on their web site.
Asking a doctor if they are post call is like asking a woman if she's pregnant: Just don't do it, unless you already know the answer, then think twice. The "post call" look for me often means no sleep, no shower, puffy eyes and hair style that can only be described as "Beetlejuice"-esque.
Time, stress and life itself have had their naughty way with my appearance. My running addiction is great for my legs, but my crows feet have deepened without the extra layer of fat to cushion them.
While I can't remember the last time a patient asked if I was "really old enough" to be a doctor, I also haven't had anyone question my abilities in an equally long time. At 40, I am enjoying the comfort of my own skin. My patients confidence and my colleagues respect are far more important to me than a few fine lines. I look socially acceptable most of the time (at least I hope so). I wouldn't consider trading the peace and maturity of age for a baby smooth face, but also still it's not nice to tell me I look like a tired old bag either.
Turning around I saw the familiar friendly face of a charge nurse. She looked concerned.
"Dr. RH+, poor thing, were you on call last night?" she asked.
"Actually, no. I slept all night." I chirped.
"Oh....." she said as we stared at each other, slowly realizing that she had just accused me of looking like total crap.
When the awkward silence became too much to bear, I faked a page and make a dash for the locker room, where I stat ordered eye cream from one of the 200 people on my Facebook feed who try to sell me overpriced fancy products endorsed by celebrity dermatologist. Maybe I can be the next before and after picture on their web site.
Asking a doctor if they are post call is like asking a woman if she's pregnant: Just don't do it, unless you already know the answer, then think twice. The "post call" look for me often means no sleep, no shower, puffy eyes and hair style that can only be described as "Beetlejuice"-esque.
Time, stress and life itself have had their naughty way with my appearance. My running addiction is great for my legs, but my crows feet have deepened without the extra layer of fat to cushion them.
While I can't remember the last time a patient asked if I was "really old enough" to be a doctor, I also haven't had anyone question my abilities in an equally long time. At 40, I am enjoying the comfort of my own skin. My patients confidence and my colleagues respect are far more important to me than a few fine lines. I look socially acceptable most of the time (at least I hope so). I wouldn't consider trading the peace and maturity of age for a baby smooth face, but also still it's not nice to tell me I look like a tired old bag either.
Monday, February 22, 2016
The other mothers of medicine...
The greats we learn about. Often men. Many of us have heard and read the stories of the "Fathers" of modern medicine.
But let's know and share and never forget the story of these women, Anarcha, Lucy, and Betsey. We might call them the "mothers" of medicine, of modern gynecology. Alas, these enslaved women whose bodies were used for physician's research. Without anesthesia. Consent unknown.
Take a moment to listen to this moving podcast at NPR's Hidden Brain with historian and physician Vanessa Northington Gamble, and artist and author Bettina Judd, telling these stories that need to be told.
#blacklivesmatter
But let's know and share and never forget the story of these women, Anarcha, Lucy, and Betsey. We might call them the "mothers" of medicine, of modern gynecology. Alas, these enslaved women whose bodies were used for physician's research. Without anesthesia. Consent unknown.
Take a moment to listen to this moving podcast at NPR's Hidden Brain with historian and physician Vanessa Northington Gamble, and artist and author Bettina Judd, telling these stories that need to be told.
#blacklivesmatter
Thursday, February 18, 2016
35 pounds
I have lost 35 pounds. 5 pounds at time. Over the last 3 years.
Unfortunately, I have also gained 35 pounds over that same time frame.
3 years ago, when Hubby and I decided to have a second kid, I knew it would be better for my health if I lost 20-35 pounds. I also thought it would take a year to get pregnant because it did the first time around. So I began to exercise and diet. 2 months later and 5 pounds down, I was pregnant. And terrified because I had gained 45 pounds during my first pregnancy.
Then the miserable pregnancy began. Horrible morning sickness for the first trimester. I had expected some because I had it in my first pregnancy but by week 14, it had stopped. I got two blissful weeks in my second pregnancy where I could eat normally at the beginning of my second trimester. Then came feeling lightheaded after eating or abdominal pain that would prevent me from finishing meal. I rarely ate. I wasn't even hungry. At work, I would vomit in empty patient rooms' trash cans. I had to take 4-8 mg of zofran and 1000 mg of acetaminophen before each shift. I never had less than 3+ ketones in my urine. I felt miserable all the time. By week 28, I had gained zero weight, but had not lost any either, and ultrasounds proved Blur2 was growing fine. I passed out week 32 and was diagnosed with gestational diabetes (had passed my 3hr glucose test with flying colors weeks before). On the carb restricted diet, I lost 10 pounds in 9 days. Off the carb restricted diet, my sugars were never higher than 130, even after eating cinnamon rolls and drinking orange juice, and most of the time they were 100-110. Somehow, despite not eating, I gained back the 10 pounds and delivered Blur2 weighing the same as I did when I conceived him.
At my 6 week post-partum checkup, I weighed 15 pounds less. No diet. No exercise. Just baby and placenta and fluids. I was also able to eat normally. I was happy and thought it would be a great jumpstart to my original goal a year prior. Except, I was exhausted with new baby and a toddler and headed back to full-time at 12 weeks of maternity leave. Slowly, I regained the 15 pounds, but not more, as if my body wanted to be this weight.
1 year of adjusting my diet - less carbs, less fluid calories, more protein, used myfitnesspal - and my weight go down 5 pounds with each change and then creep back up.
I intermittently work out. I view exercise as a necessary form of torture. During periods of working out, my diet would get even better and 5 pounds would come off. Of course, I would stop exercising because I hate it and then the 5 pounds came back.
I got diagnosed with arthritis (subtype unknown) and worsening reactive airway disease. Stiffness all the time doesn’t help the working out motivation. Every little cold turns into weeks of inhalers. Steroids (for both), don’t help my weight.
I work evening and nights. I eat on the run or just before shift. I never liked breakfast, still don’t, and often catching up on sleep then. I am the cook for my home and I make healthy foods.
I am sick of the plateaus, the stopping-starting, this weight that my body wants to be, this relative out-of-shapeness. I am also sick of not being able to keep up with my kids and worrying about my future health.
Excuses are easier than losing weight and being healthy.
So I'll restart on Monday. Again.
Maybe this time I'll get to 35 pounds.
Tuesday, February 16, 2016
I Wish I'd Said Thanks
One of my mother's cousins died yesterday.
I hadn't seen in her a long time - there's a fair amount of distance in my family, literally and figuratively. Miriam was married to my mother's first cousin. He's an internist (that runs in my family) and she initially trained as a pediatrician and then did a psych residency so she could practice pediatric psych. Which she did; she was still working part-time when she took ill, just a month or so ago.
According to her obituary, Miriam graduated from medical school in 1971, shortly before I turned 11. I didn't remember the exact dates. I do remember - quite clearly - that she was the first woman physician I'd known. There were lots and lots of doctors in my family. They were all men. At that age, I planned to be a nurse. It had never occurred to me that I could be a doctor. And then I met Miriam.
I made up my mind when I was 14 - I was going to medical school. Miriam started sending me occasional articles from JAMA about women in medicine. It was one of those articles that I learned that there was a first wave of women in medicine in the early 20th century; I asked my grandfather and he told me that his med school class was about 30% women (he graduated in 1927). The Great Depression, the rampant discrimination that made it impossible for women to join hospital staffs and the post-WWII pressure for women to leave the workplace changed all that. My father graduated from the same medical school in 1958 and there were six women in his class. Miriam was part of the second wave, the women who went to med school when the OR changing rooms still said "Doctors" and "Nurses" instead of "Men" and "Women" and when women were still routinely asked why they were taking a spot away from a man, since they were just going to quit and have babies anyway. Miriam had babies - two of them - and never quit. She was the first Mother in Medicine in my life.
I don't know what my life's path would have been if I hadn't watched Miriam walk hers. Even from a distance, she was an inspiration to me, and in many ways my first mentor. I just sent a condolence note to her husband telling him that. I will always regret that I never told her.
When we are touched by death, we often want to hold our loved ones closer, and I will do that. I will also think about the other mentors who have touched my life, and start thanking them today, while I have time.
I hadn't seen in her a long time - there's a fair amount of distance in my family, literally and figuratively. Miriam was married to my mother's first cousin. He's an internist (that runs in my family) and she initially trained as a pediatrician and then did a psych residency so she could practice pediatric psych. Which she did; she was still working part-time when she took ill, just a month or so ago.
According to her obituary, Miriam graduated from medical school in 1971, shortly before I turned 11. I didn't remember the exact dates. I do remember - quite clearly - that she was the first woman physician I'd known. There were lots and lots of doctors in my family. They were all men. At that age, I planned to be a nurse. It had never occurred to me that I could be a doctor. And then I met Miriam.
I made up my mind when I was 14 - I was going to medical school. Miriam started sending me occasional articles from JAMA about women in medicine. It was one of those articles that I learned that there was a first wave of women in medicine in the early 20th century; I asked my grandfather and he told me that his med school class was about 30% women (he graduated in 1927). The Great Depression, the rampant discrimination that made it impossible for women to join hospital staffs and the post-WWII pressure for women to leave the workplace changed all that. My father graduated from the same medical school in 1958 and there were six women in his class. Miriam was part of the second wave, the women who went to med school when the OR changing rooms still said "Doctors" and "Nurses" instead of "Men" and "Women" and when women were still routinely asked why they were taking a spot away from a man, since they were just going to quit and have babies anyway. Miriam had babies - two of them - and never quit. She was the first Mother in Medicine in my life.
I don't know what my life's path would have been if I hadn't watched Miriam walk hers. Even from a distance, she was an inspiration to me, and in many ways my first mentor. I just sent a condolence note to her husband telling him that. I will always regret that I never told her.
When we are touched by death, we often want to hold our loved ones closer, and I will do that. I will also think about the other mentors who have touched my life, and start thanking them today, while I have time.
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