Story of My Life

Do you ever feel like your life is like a TV show, but not in a good way? More like a Seinfeld kind of way, when all you can do to keep from crying is shake your head and laugh?

Episode one. I present for a labor check at 38 weeks (determined to be false labor), and find out baby boy is BREECH when at my appointment the week prior, he was firmly declared vertex! The plan is to do an external cephalic version immediately, as I am an ideal candidate. I wait nearly 11 hours, NPO, cranky, uncomfortable, and tethered to an IV pole, and at last the Ob team assembles to do the version. AS they are putting on gloves, all their pagers go off. Oh no. No. No! It’s a gyn surgical emergency, a stabbing!! A resident returns to give me the choice to wait several more hours with no guarantee of doing the version, or to schedule it for first thing the next morning. My hangry state tells me to postpone… which in retrospect is likely the wrong choice. My “false” contractions progressively and subtly transition into excruciating ones over the next 8 hours at home (I’ve lost confidence in knowing what’s real after the false alarm earlier), and at 2:30am I find myself driving alone to the hospital, jaw clenched, sobbing, and pulling over for contractions (my husband is at home with our daughter). I am 9 cm dilated - time for emergency C section - and our perfect son makes his debut with a bang thirty minutes later.

Episode two. I find out a week after our son was born that, by some miracle, I’ve received a research grant I applied for last winter. The catch? I’m required to attend the organization’s national meeting in 4 weeks to accept the award at a formal dinner. After weighing all the options, we decide to go as a family. It’s a fun city, only a 3-hour flight, expenses are partially covered, and I‘d have the opportunity to attend an awesome conference. A two year old and a 5 week old in a small hotel room together? No problem! The reality? Every day we desperately invest hours in the possibility of achieving overlapping naptime so we, too, could sleep.

Needless to say, I don’t get to attend much of the conference. I try going to talks, I really do. It’s a lot to ask my husband to watch both of them, so I go to a few presentations with the baby strapped on, hanging out by the exit door. The night of the awards ceremony finally comes. Milk pumped, baby topped off, toddler excited, husband feeling strong. But alas, this is how the evening ultimately ends.

Episode three. The number one question I’m asked during prenatal care? By multiple people at every single appointment, from 6 weeks through the bitter end? “What method of contraception do you plan to use afterwards?” This is to the point where I can only assume they think I got pregnant on accident and are doing anything possible to prevent me from letting it happen again. Every time, without fail, I say, “IUD.” Even while being prepped for my emergency CS, crying in pain, someone manages to come around and ask me if I’d like the IUD inserted... “NOT. NOW!!!” I scream. Finally, the big day comes to do my IUD insertion, at my 6-week postpartum visit (which of course requires me to bring my newborn along). When I make the appointment, they ask again if I want an IUD inserted so they can allot enough time. Mid-way through the appointment, my Ob tells me, “I’m sorry, but the administrator who gets insurance approval for IUDs is out for the morning unexpectedly, so we actually can’t do the IUD today. But don’t worry, we’ll schedule you for next week, no problem!” CUE FOREHEAD SLAP.

The stories go on and on. I will share a few more.

Feeling the sweet warmth of a blow-out spread across my sleeve as my son, who won’t nap in the crib, sleeps in the crook of my arm as I frantically try to get through the RISE exam before he wakes up (I don't stop taking the test, by the way).

Watching cake batter overflow and drip down the oven rack gratings in a million little chocolate stalactites at 4:30am while baking a birthday cake for my mother in law.

Dropping said mother-in-law off at airport. So out of it and exhausted, I accidentally drive in the buses-only lane at departures. I have never ever done this in my life. An airport official runs over and tells me to leave immediately before I get fined ($500!!) and I get out of there… but alas, a cop is waiting for me at the very end. Sigh. (But with a wailing newborn in the backseat, I fortunately get off with only a formal warning.)

We have a few warm days last week. I smell something weird. I am fearful it is something with the sump pump or crawl space (we live in a renovated brick rowhome). Long long story short, there is a dead rat in the crawl space. Yes. A. Dead. Rat. Next door had an infestation, exterminators came, rats ate poison, and one managed to get through a crumbling brick and into our crawl space. And died. No words. This is an ongoing saga. Involving the services of a mason- I never imagined I'd need a real mason, but apparently I do. But it will be ok.

 

And the clincher. What inspires me to sit down and write this. What drives me to actually throw my head back and laugh with tears in my eyes. Baby has his 2 month immunizations this morning, and poor thing is angry and uncomfortable… he just needs to take a nice long nap. And THIS is what I come home to- view from his window.

This is when all you can do is laugh. And be grateful for health and for even the capacity to laugh. And embrace all of this self-inflicted chaos, the q2-3 hour wake up calls that still aren't stretching out after 8 weeks, the blow-outs, projectile vomit, and laundry. So much laundry. Laugh at the fact that your parents, who had lived just an hour away, decide to move to Asia a month before baby is born, leaving you again without family support postpartum (we tell each other it's building character). Accept the frustrating feeling of hard-earned knowledge seeping out of your brain even after a few short weeks, trying to have the will-power to study and attend resident didactics and research seminars (sometimes with a sleeping newborn hidden under your jacket), but often failing. 

But there are some TV/movie moments. When I sink my lips into the soft pillows of my son's cheeks, also becoming aware of my daughter's pudge melting away silently. The indescribable joy of seeing our daughter transform into a sibling. When my heart explodes witnessing first smiles and giggles. The sacredness of feeling the body of such a vulnerable little human relax in your arms. Awe that I can muster up secret stores of energy and patience that are fueled only by love when I have nothing left. And awe at the magnitude of this love. So it's time to celebrate- although it hasn't been pretty, we've made it through the newborn trenches once again.

Claim your space!

Equal pay, sit at the table, ask for what you're worth!

All of the above are often part of the dialog concerning women in the workplace.  Women ask for less, do not request promotions/raises, do not sit at the table.  As a big Sheryl Sandberg fan these mantras have been my mentoring rhetoric for years, starting from my own brief time in investment banking when these concepts were instilled into me through a womens group at our firm.  So, when negotiating my first contract - I asked for more and I got it, I asked for time and I got it.  I made sure to ASK ... I felt well trained.

However, just moments ago, I was chatting with one of our attendings and he was congratulating me on my job (I'm very happily staying at the place where I am doing my fellowship) and he asked why I hadn't moved into the vacant office yet. There is one vacant office in the department.  It is clearly going to be my office.  Its the small one near the bathroom that all the junior faculty get until they move up the ranks.  I walk by it longingly every day and go sit in my loud cubicle and try to work while sitting next to all the administrators constantly answering phones.  I fantasize about this office...mine in only a few short months.  Just this morning as I walked in from the garage, I was making mental plans of which pieces of my daughters art work I need to get framed to put up in my new office. I envision my name on the door.  But, NEVER had it occurred to me to "just move in."  This thought was just second nature to my male attending, meanwhile I'm sitting in the background and waiting for my turn. Maybe I'm making a mountain out of a mole hill, but I do think that we have to never stop striving to be seen and recognized and heard.  I see it in myself all the time.  I feel it. I often have to remind myself that I worked hard for this job and every job.  I walk around suppressing my impostor syndrome on an daily basis.  But, today I realized I can't be complacent.  I have to keep claiming my space.

Quality Time: What Is It, and How Can I Create More of It?

Genmedmom here.

Typical morning clinic day: I'm up at 4:50 a.m. and out the door before 6 a.m. to catch the train. The commute is prime time to skim the news/ blogs/ email/ social media, or, order groceries for delivery. I arrive at work early to prep charts. My patients are scheduled from 7:40 a.m. to 12 p.m. (and clinic usually runs over). Then, it's patient calls/ prescription refills/ results/ all kinds of paperwork/ maybe some writing until somewhere between 4 and 6 p.m. Then, I run for the train, ride back, run to my car, pick up kids at my mom's. Wrestle kids out the door, stuff them into the car, and herd them into our house. If Hubby is not working or traveling, we make a good effort to sit down to a nice dinner, usually warmed up leftovers from a weekend pot of soup. We tag-team on the evening stuff: get kids to eat if they haven't eaten, feed the cats, unpack schoolbags and yucky lunch boxes, identify any major school communications or homework, make lunches for the next day, wash dishes. The kids start getting super-silly and disobedient around this time, so I cattle-prod them up the stairs, out of their heinously dirty clothes, and into the bath; attempt to wash their hair (which usually has food in it) and yell at them for splashing water all over the place. Get kids out of tub, then chase after them as they actively evade me, giggling and taunting. Pull pajamas on, force them to brush and floss teeth, read books. Read more books. Read JUST ONE MORE BOOK PLEASE MOMMY?

Sigh. By the time the kids are asleep, I'm exhausted, and I realize with great sadness that I've spent most of our precious few hours together yelling, nagging, scolding, threatening, and counting to three about fifty times.

The few minutes we have snuggling in bed reading quietly (well, truthfully, it usually stretches into thirty minutes reading quietly) is the only real "quality time" we've got.

I know there are doctor-moms out there with busier schedules than mine (I only work four days a week).

Busy doctor-moms, how do you create quality time with your kids? What does it look like? When do you fit it in?

Annual call for contributors

It's May - the month of Mother's Day and MiM's birthday (8 years old this year!). It's also time for our annual call for contributors to join MiM as writers for a one year term.  We didn't know what to expect last year, trying this for the first time, and were thrilled with the response!

If you are interested, please send a note to mothersinmedicine@gmail.com with why you would like to write for MiM and a little bit about yourself.  No blogging experience necessary - you just need to be willing to share your journey as a mother in medicine with this community on a regular basis. We are looking forward to adding some new MiMs to the roster!

Call will close one week from today - May 8.

Thanks for reading!

More Important Than Your Marriage, or Lessons from Old TV Shows

I've been re-watching The West Wing lately - my Netflix version of re-reading a favorite novel, which I also do frequently. In the episode Five Votes Down, early in the first season, Leo (the Chief of Staff to President Josiah Bartlet) forgets his anniversary and comes home at 2:00 AM in the midst of a crisis with Congress. The next day he sends his wife a pearl choker and plans a catered dinner, but it's too late. His wife has packed her bags and has a taxi waiting.

Jenny: I can't do this anymore. This is crazy. I don't want to live like this. I just can't.
Leo: I'm sorry about the anniversary. I just...
Jenny: It's not the anniversary. It's everything. It's the whole thing.
Leo: This is the most important thing I'll ever do, Jenny. I have to do it well.
Jenny: It's not more important than your marriage.

We all know what the right answer is here, don't we? We do. Leo knows, too - but instead he gives her the honest answer.

Leo: [emphatically] It is more important than my marriage right now. These few years, while I'm doing this, yes, it's more important than my marriage. 

Every time I watch it, this scene brings me to tears. This time, though, I watched it while I was doing the dishes at 10:30 at night on a day when I'd missed dinner with my family because I was at work until nearly 8:00 PM. That's not unprecedented; I'm lucky that it doesn't happen very often. One of the reasons we put off having kids was that I knew I would have a hard time leaving work at work during residency to be fully present for a small child. Sam was in graduate school at the same time and it was even more difficult for him. For many years, I was Jenny in that scene - I was afraid to ask Sam if his work was more important than our marriage. I was afraid he would say it was.

And now? Now I am almost always home for dinner, but I know I'm preoccupied with stress about work and thoughts about patients. I have to say "no" to my kid every third Saturday because I'm on call and I can't commit to whatever it is she wants me to do. There are a lot of mornings when I don't hear what's said to me because I'm in a fog from multiple overnight calls. Am I behaving as if my work is more important than my marriage? If I were answering honestly, how would I answer that question?

Overall, of course I would say my marriage is more important. Sam and Eve are the center of my life; I adore them and I want to be with them. I want them to be able to depend on me. In any one moment, though, I make choices that clearly put my work first, and those moments add up.

There's an episode of M*A*S*H in which the members of the 4077th invite their families to a party in NYC. Hawkeye assumes his dad won't leave, because he won't want to leave his patients. The elder Dr. Pierce writes back that of course he will go; "Yes, I'm attached to the patients I've brought into this world, but I'm more attached to the son I brought into this world." Hawkeye, brushing away tears, says "Funny, I always thought they came first."

I don't want my daughter to grow up thinking my patients come first. I want to show Sam and Eve now, in the moment, that they are important to me. And I want - I need - to keep the sense of myself that is only satisfied when I'm doing my work the way I know it needs to be done. Is my work more important than my marriage? No...and yes.

How Re-Taking the Pathology Boards Ruined My Year

With all due respect to the American Board of Pathology last year sucked.

I am both lucky and unlucky. I only have to re-certify every 10 years (so sad for my 6 year OB/Gyn friends and my 7 year Peds friends). Lucky. I was the first class in pathology - they were a little behind the rest of the specialties - to have to re-take my boards. Unlucky. I could combine my general and subspecialty re-certification into one test. Lucky. I think this whole process is a ridiculous money making scheme like most other doctors in the country. Unlucky.

I started studying in early 2015 on a plane on the way back from a lab inspection. I wanted to take it a year early in case I had to do it again. I was really frustrated that I would have to take it in Tampa - most other specialties could do it at a testing site in their city. I signed up to take a half a week off and fly there in August. My path bro-in-law was going to do it with me, and a friend. We learned early on that there was a study guide online, which made me so happy I took a deep breath and a couple of months off. Path boards are very comprehensive, and while I sailed through the first time, I've never studied so hard for a test in my life.

I geared back up again in the Spring until I got an e-mail from the Board at the beginning of June. They were offering for me to be a part of a pilot program to take the test online. Not in August, but probably in September. I was so excited (no flying to Tampa!) I signed up right away and took a breather. Still, having that test loom over your head is like that kid in Peanuts with the rain cloud over his head, even on a sunny day.

Even with the study guide it wasn't easy. There were three hundred topics. Some of the topics on the general re-cert were so broad - "drugs and their metabolites" and "cerebrovascular disease" - that it left a lot of material to cover (in the case of the latter - it left me wondering what the heck to cover). On the cytology subspecialty exam guide it listed topics like - "thyroid, benign nodules" and "thyroid, malignant neoplasms" - um ok, so pretty much all of thyroid. I took notes during the summer.

It is a lot easier to study for your boards when you are coming out of your residency and you are so stoked to finally be doing what you set out to do and getting a decent salary for it after years (10 in my case) of training. Stuffing tons of minutiae into your head for months is a challenge but hey! You are at the end - so close to the carrot. Ten years later you have the carrot - you are living the life. And it's hard, it's different than what you expected, there are unexpected challenges but if you are like me you also get really excited by what you do and that helps you get through the hard days. Studying ten years into your practice is hard because you know that all that minutiae is at your fingertips whenever you need it and it is so pointless to stuff it all into your head again just to spit it out and get a certificate saying you can continue to do what you are already damn good at doing. But we doctors are mostly type A by the book individuals. So we do it anyway. But it doesn't mean we are happy about it.

August came and went and I got a call from my brother-in-law, who did fly to Tampa in August. I was so jealous of him being done. "You'll do all right, but I'm sure glad I studied." When he found out he passed and elatedly called me in October, I was still waiting to get my two week window to take it online. The computer program they were using was delayed, still working out kinks. The woman in Tampa I corresponded with in frustration was very kind and empathetic, but still. Rain cloud.

October passed into November and we pilot computer people finally got a nice extended window right around the holidays. Again many apologies and an offer to let us take it in March this year because of the delays and inconvenient timing. Hell no. I was getting that monster over with. I downloaded the program with the link - can't remember now why but that process took hours. And I did it on my own mac laptop - no hospital PC would take it. My brother-in-law had a partner taking the same pilot and their group had to buy her a laptop with a camera because she did not have one.

The technology blew me away. I was able to sit at home - they recorded me taking the test and there were all these rules for bathroom breaks and such. I was sitting in the exact same room I am in now typing this blog. I did set up a desk and chair instead of sitting on the couch because it felt more official and I was so nervous. It was nice to be able to have a glass of water next to me, and being at home was a lot easier than being at a testing site. I took it in late November. I felt really good about part of it but not about others. Anyone who has ever felt like they aced a general exam I'm jealous; I always feel like crap after they are over.

Here's another beef and I know I was a pilot but come on ABP 6-8 weeks??!! My friend who took the peds boards re-cert a month before me knew she passed within that week! It's on the computer how hard can it be to grade? I waited over the holidays and finally got an e-mail in mid-January learning that I passed. I was so elated I couldn't get my work done for two hours and had to stay late.

When I look back at last year - skipping weekly lunches with my partner to squeeze studying in, ruined weekends of cramming because I refused to study on vacation or on my time with kids, and overall being more testy in general and pessimistic about life I get really angry at this whole process. I know that pathology is closely following what internal medicine does, and I hear rumors of making this process a lot more palatable (shorter intervals, smaller tests, more related to your current practice), but the nice woman at the ABP who was my phone buddy last year tells me that is years down the road. I hope not ten. I don't think I can do that ever again.

Thanks to my sweet boyfriend and wonderful kids for putting up with me last year. And congratulations to my friend Trishie who found out she passed her MOC boards today (that she took at the beginning of March!) on the way to Disneyworld. She got me thinking and inspired this rant.

Guest post: The Wandering Mind

The way my mind works as of late is akin to that of the ‘Tasmanian Devil’. I am constantly shifting focus. As a hospitalist, and probably like a lot of other types of physicians, I find myself switching my train of thought often every minute. Triggers of course are the barrage of pages, cell phone texts, acute patient care issues and the list goes on. Honestly, I was fine with this pattern because it has been going on since the beginning of my residency years, but now that I have a child….the rules to my crazy game of life have changed.

My baby girl who is now two years old is at this incredible age where every moment is of significance. She’s discovering her mind and the world that she is in. I realized I must focus and ‘be in the moment’ during the limited time that I have with her throughout the day.

So these past few weeks I’ve dived into the field of focusing. Strangely enough, after scouring the Internet and stumbling upon a TED talk about ‘happiness’, one main finding that I thought was intriguing is that the mere lack of focus or shifting of the mind can lead to unhappiness. The other activity that I’ve started are guided daily ten to fifteen minute meditations. It’s helping to drown the noise in my mind, and practice being aware of what is now.

I’m starting to see the effects of some of this and I’d love to hear what the rest of you brilliant moms out there are doing to hone your focus and truly be in the moment.



I'm an academic hospitalist at SFGH/UCSF. I have a 2 year old daughter. You can follow me on twitter @psanyaldey.

MiM Mail: Pumping while on call

Dear MiM,

I am nearing the end of my glorious maternity leave. As my first day back in the OR draws near, I would love any and all advice on how to make breastfeeding work while having to do 24-28 hour calls. Obviously I will be pumping as much as possible while on call, but have been warned by all (including lactation consultant and pediatrician) of the likelihood of dwindling milk supply given the long times away from my baby.

Thanks in advance!

Dear stay at home mother...

I recently came across this article and it really struck a chord with me. As a working mom, I have often felt the divide between the working mom and the stay at home mom. This is the article and this is my own article to the stay at home mother.
http://carolynee.net/a-letter-from-a-working-mother-to-a-stay-at-home-mother-and-vice-versa/

Dear stay at home mother,

I just wanted you to know that there is absolutely no judgment from my end. In fact, I think what you do is infinitely harder than what I do. Sure there are moments such as when I have to wake up little C earlier than she would like, force feed breakfast down her throat while trying to apply sunscreen all at the same time only to be late to work once again that I might think for a millisecond that it would be great to be a stay at home mom. However, the minute I do get to work and get to enjoy my morning coffee in silence. The thought crosses my mind for much longer than a millisecond that I don't know how you do it.

I am sure you are intimidated by me but I want you to know that I am also intimidated by you. I didn't breastfeed my little C the entire year. In fact, I had to hand off the role of primary caregiver to my parents for the first 2 years of her life. I had to be okay with not being the person who knew what her cries meant at all times and I had to be okay with not being the one she wanted at all times. Even now, I try but there are times we often settle on mac and cheese for dinner and I let her watch TV one too many times just so I can finish the work that I brought home with me.

I see you at the playground. But the minute I mention my occupation, I see that look in your eyes. It's as if we no longer have anything in common. But we are both mothers. I identify myself so much more as a mom than I do as a physician. So please don't be shy. I often find motherhood to be a sorority that requires an unending pledging process. How we do it is our own personal decision but we are all linked in our role as a mom, our role to take care of these little human beings and every day we wake up a superhero because what greater power is there than caring for the next generation?

So stay at home mother, please know I have nothing but respect for what you do. I had the most incredible stay at home mother growing up and often find myself at a loss, feeling unsure of how I can provide the love and security she gave me during my childhood to my own child. I had the best childhood because I had a stay at home mother so judging you would make absolutely no sense because I had the best childhood and the best mother.

However, I chose to work for reasons that are important to me. Just as I respect and understand your decision to stay home, I hope you can do the same for me. I love my child just as much as you loves yours. I constantly struggle with the working mom guilt and every day as I tuck my little C in bed, I question whether my decision to work will be worth it in the end.

Let's support each other. We are all united in the sorority of motherhood. Most importantly, I wanted you to know I get it. I really do.

Love, this working mom

The Return From Maternity Leave: Rusty or Rested?

This article on KevinMD was published a week or so before the end of my maternity leave. As I read it, steam emanated from my ears. How dare the author insinuate that physicians lose their technical skills from taking time off equivalent to more than a mere weekend? What about those who must take prolonged time off for sick leave? And what about maternity leave? Are all physician moms, by the sheer reasoning that they had babies, now deemed incompetent?

It goes without saying that we physicians are humans who need adequate time to heal physically in order to perform well mentally. We all need vacations (longer than a weekend) to help stave off burnout, and we all become sick from time to time. During my training and career as an anesthesiologist, I have taken significant periods of time off for vacation, maternity, and sick leave, and yet I've never had a problem integrating back into the basic flow of my job. In fact, on my first day back to work after three months of maternity leave, I had a patient go into anaphylactic shock in the OR - a very rare and deadly event. End tidal CO2 dropped from 37 to 10 and blood pressure was 50/30, but once I identified it I knew exactly what to do. I counteracted the reaction and saved his life with the fortunate and timely assistance of a couple of colleagues who I immediately called into the room (having extra hands is obviously essential in these kinds of situations).

I recently posed this question of competence to physician moms in an online discussion group. Most respondents agreed with me but cited other issues they had returning to work. Some had to regain their prowess with the EMR, others stated that they had a little trouble multitasking, but all felt confident in their abilities to do their required work tasks. I would say that the hardest part for me has been transitioning each day from Mom to MD and back to Mom again. Preparations the night before a workday seem endless, and morning routines take longer than they used to. Picking up my daughter from childcare after work increases the commute time and anxiety depending on how late my OR day has become. I have yet to be the last parent to pick up their child at night, but I'm sure there will be a day like that sometime. Evenings go by so quickly, and I feel I have barely seen my daughter before bedtime comes. Add in being a part-time physician, and suddenly I feel what some moms warned me about: not enough at work, not enough at home.

So Mothers In Medicine, I ask you: how did you feel returning to work after maternity leave? Rusty or rested? Share your experiences here.

Being On Call

When I was a kid, my dad was on call all the time. I am not exaggerating. He was in practice with my grandfather (his father-in-law.) Nat (my Popop) had been in solo practice for years and so when Dad joined him, Dad took over call. Nat was always willing to cover if my parents had plans; mostly Dad was just - on call. 24 hours a day. Seven days a week. My mother finally forced him to take an actual vacation after eight years.

Now, Dad would be the first person to remind me that this was in the 1960s. No ICU. No CCU. No tPA. No push to get patients out of the hospital - people with uncomplicated MIs (if they survived) stayed inpatient for at least ten days. You could admit people for evaluation of new diabetes. No urgent calls on abnormal labs in the  middle of the night. And he genuinely loved his work and his patients, and he didn't need all that much sleep, and of course he had no responsibilities at home because my mother did everything. But still - on call EVERY SINGLE NIGHT. I can't even imagine it.

I'm thinking about it now because last night was One Of Those Nights. I was exhausted after a long and difficult week and I went to bed at 10:00 PM. The beeper went off at 11:00 PM, 1:00 AM, 2:30 AM, 4;00 AM and 5:30 AM. The 5:30 call was from the ED about a patient who needed urgent admission to the inpatient hospice unit, which meant three more phone calls, so I had to get out of bed. I tried to go back to sleep - and then my daughter's alarm went off at 6:10. She's away for the weekend. She didn't turn her alarm off before she went.

I think I'm too old for this. And then I think of Dad and feel like a wimp. And then I remember that he was 20 years younger than I am now, so perhaps I should let myself off the hook.

Am I the only one who has grown to loathe being on call overnight?

When The Doctor Is Sick, Again

Genmedmom here. Coughing, coughing, coughing. This is the third respiratory thing to catch me in as many months. Damn germs, can't get away from them.


I'm apologizing to everyone: my husband, for waking him up all night with my uncontrollable hacking; my kids, for my medicated and exhausted attentions (or lack thereof); my patients, for spewing my droplets about the tiny exam room; my fellow commuters, for daring to get on the train sick.


I'm following all my own advice. I know I've got cough-variant asthma and I'm on top of the Albuterol. I'm taking Dayquil and Nyquil, and snarfing tea with honey and endless Ricola.


But still coughing, coughing, coughing. No fever, non-toxic, I'm eating and drinking and walking and talking and parenting and working and COUGHING.


Not sick enough to call out; miserable enough to want to.


Docs, what do you do?


Never mind, I know the answer. Suck on my inhaler, take Dayquil and Nyquil, snarf tea with honey and endless Ricola, and suck it up.

A Year of Change, and a New Sandwich

I rang in 2016 with visions of change. Change for the better. Growth. Development.

Well, 2016 is going to be full of changes alright. I’m trying to finalize my divorce, considering joining the dating world again, finding new feet after being partnered for such a long time. So, why does the tenor of this post not hold all the hope and light and optimism it should? My move mostly across the country for medical school, residency and career was not coincidental. It was therapeutic. Right now, my self created bubble is being tempered by reality.

I knew I’d be the child to take care of my parents. Neither of them have planned for golden years. Both have made poor financial decisions. I’ve tried to learn from their mistakes. Many of the decisions I’ve made in my life are a direct result of trying to exactly the opposite of what either of them have done. I’m the only child between them. Their other children, my half-siblings, are in no position to help.

I did not estimate that by trying to learn from their mistakes and deliberately making other decisions, I’d put myself in the supreme position to catch them when they fell. Of course, I love them deeply, fully. They are my parents. They supported me emotionally through my journey to get here, they brought me life, they gave me the genes to create the synapses that allow me to make the decisions I make which hopefully translate into quality patient care and contribute positively to the world. They have loved me, advised me, chastised me, praised me. They were fully responsible for me for seventeen years of my life… that means I’m responsible for them, right? Not now, right?

My dad has been diabetic for about twenty plus years now. It ran in his family. He was overweight. He knew it was coming. He ignored the polydipsia, polyuria, fatigue, headaches, weight loss.  When he finally presented to his physician with the aforementioned constellation of symptoms, they confirmed the diagnosis. His response: Eat a gallon of ice cream and drink a two-liter bottle of Coke. He tows his own line and nothing is going to happen unless he’s ready for it to happen. No one knows his diabetes better than he does. He knows how it “feels” to be 245. He also knows how it “feels” to be 120. He’s got this.

Visited for my youngest brother’s graduation from high school. I was in residency at the time. That’s the first time I saw my dad have a low. Pale, diaphoretic, eyes glazed over, tremulous, almost myoclonic jerks. Orange juice spilled from the corners of his mouth as my adrenaline coursed through my veins, heart pounding. He finally came around. My ex-step-mother rolled her eyes, sighed in disgust. My brother sighed in relief. I was stunned. They had seen this before. They were well versed in dad, the brittle diabetic. I went back to residency and my life and put my dad’s hypoglycemic episode in a compartment. I went back to my other life. You might recall my compensatory compartmentalization if you read my first post,  The End... and the Beginning. 

More recently, I visited my dad’s town for a conference, took the little one and my mom (my dad’s first ex-wife) came to visit as well so as to spend time with the grand-baby. We all stayed at my dad’s house. I wake up around 3am to my mother screaming with surprise as my once again diaphoretic, hypoglycemic father, confusedly tried to crawl into bed with her. They’ve been divorced since I was two. She’s got not medical background, has no idea what’s going on. Here’s my internal monologue over the next 5 to 10 minutes:

I know he’s low. Don’t freak out or your mom’s going to freak out. Give her a task. Tell her to find his glucometer. She doesn’t know what that is. Tell her to find his shaving kit. There’s a little blue plastic machine inside. And a plastic container with strips. Tell her to look for the glucose paste. God, I hope he doesn’t wake the kid up. I’ve got no idea where his glucose paste is or whether he even has glucose paste. What’s in the fridge? Kiddo’s juice boxes. Great. Sit down dad. Sit down. Oh, super, your legs don’t work and you won’t cooperate. This is excellent. Drink the juice box. Seriously, Dad? Just swallow.Crawl into bed with mom and scare the shit out of her? Thanks for that. How much did you drink last night? How much sugar is in one of these organic reduced sugar things? How many is this going to take? What else is in the fridge? How much insulin did he take? He’s not drinking it fast enough. Shit. I’m an ER doc and I can’t fix my dad. What in the absolute fuck?!? What’s his renal function? More juice, Dad. Tell Mom to get a chair. Put it behind him. We have to make him sit so he won’t fall. Ok, Dad, you’re not sitting down… I’ll sweep the leg, just like Karate Kid. Great, now you’re sitting. This is taking too long. He’s not turning around fast enough. He’s not swallowing. He’s going to seize. Fuck it. Tell Mom to call 9-1-1. Tell them you have a diabetic who is hypoglycemic and you need help.

The paramedics arrived and by then, my dad was starting to come around. “I know exactly what happened,” he said. “I took my Humalog and forgot to have a snack. No big deal. I’m all set. No, I don’t need to go to the hospital.” Sure Dad. You know exactly what happened.

One of my dad's best friends asked me for my number that visit. He said "just in case I need to call you for something." He said there'd been times he'd supposed to meet my dad for golf and he wouldn't show. Then he'd come to my dad's house to find him in a hypoglycemic stupor, "sweaty, turning the lights on and off, not knowing where he was or what he was doing." So, it seemed this was not an infrequent occurrence. 

Ultimately, I didn’t think I’d be taking care of one of them now. My father who’s made some poor decisions has run out of options and was in financial dire straits. My dad was going to be homeless. He came to visit for my kiddo’s 4^th birthday. He’s not the picture of health. He’s stubborn and manages his diabetes between 6 packs of beer, packs of cigarettes and takeout food, often, unintentionally double dosing his insulin, or so he recalls when he comes out of a hypoglycemic episode. He finds himself in a diaphoretic, near seizure stupor which until this last year, I was mostly, blissfully unaware. Sure, I’d been to visit and he might have a low, scare the crap out of me, lead me to feel woefully ineffective as a physician, then he’d confabulate that of course he knew exactly what happened.

He asked if he can come live with my little one and I. I took a deep breath, clenched my jaw, said “of course.” He's my dad. I've got to take care of him. That's my duty as his daughter, right?

My dad's been alone for a long time. He's lived the bachelor life for a long time... probably close to 15 years or so. He doesn't take good care of himself. He doesn't eat properly. He doesn't exercise. I had this vision when I invited him to come live with us that magically some switch would flip and he'd suddenly be inspired to focus on his health and well being. I envisioned he'd start eating properly, start exercising, maybe catch up with old friends who are local, find a job, find his spirit. 

He's now been living with me for about three weeks. He's had at least 3 hypoglycemic episodes so far. I say at least because those are the one's I've witnessed. He drinks too much. Thankfully, he's not a mean drunk, but I do believe he is an alcoholic. I have observed his behavior, listened to his conversations with me, watched his interactions with my kiddo and I wonder if he's actually developing some dementia of sorts. Not sure if it's from repeated hypoglycemic episodes, some sort of microangiopathy due to his health, or if he's showing signs of Wernicke-Korsakoff. There's definitely some confabulation going on.

What I believe I've learned in this short time is that I had no clue what I was getting myself into. So many of his behaviors and attitudes and coping strategies mirror those of my ex, which makes this whole thing even more challenging to swallow. I do know that I cannot be his doctor, his therapist or his best friend. I cannot control his behavior or effect the changes I believe need to be made. He is likely clinically depressed, though this is clearly complicated by his alcohol use. It was naive of me to think by some magic that he'd do a 180 by coming to live with us. I'm trying to encourage him to seek the care he needs both for his psyche and for his health. I can lead the horse to water, but I cannot make him drink... Why can't I make him drink!?!?

Permanent cohabitation is not going to be an option for me and my well-being. I have to make sure that my little one and I are taken care of and that my child's environment is safe and stable. Friends have suggested that I impose rules upon him with the threat of kicking him out. Trouble with that is I won't kick him out. I'm not going to put my father on the street. I'd rather find a way to get him his own living space so he does impinge on mine. How does one make rules for their own parent? 

The DC public school lottery struggle is real!

I will paraphrase my mommy friend C when she said “we literally have spent hundreds of hours on this”.

We moved back to DC June 2015 and since then have spent hours and hours touring and talking about schools. My husband O and I are both products of public education - we know it has many challenges and limitations but we are both committed to having our son Zo in a public school that all children have access to. We were extremely blessed in North Carolina to find our outstanding Spanish-immersion daycare. We never ever ever worried about him while he was there. We hope things will work out with public school, but thankfully being a doctor-mom, private school is a viable option.

WHAT WE ARE WORKING WITH:

Flash forward to public school in DC and we have had issues with lack of supervision in the bathroom for the preschoolers, lack of vision, organization, and communication from the administration, teachers who rely too heavily on strict discipline and quiet, homework for preschoolers, and the disorganized and understaffed aftercare that we promptly pulled him out of. What we have loved about Zo’s school - that he really likes it, the Principal Mr. L (he is truly wonderful, so committed to the students and parents), meeting wonderful families and making new friends, the beautiful playground, being a Parent-Teacher Organization parent (I feel like I’m becoming my mom every time I attend a meeting), and the overwhelming majority of his teachers.

MOVING FORWARD:

In early April we find out the results of this year’s lottery. For those who don’t know about DC public schools - there are public schools and separate public charter schools. Some participate in the common lottery and others have separate application processes. All super confusing and overwhelming unless you live in an awesome neighborhood with in-bound preference which we don’t. We based our rankings on a private session with Educational Consultant EV Downey (I still shake my head writing this cuz’ who thought you’d need to pay someone to figure out where to send your kindergartener but I quickly realized there were way too many schools I didn’t know about and I am all about tapping into my resources so we went ahead and paid her and it was well worth it), hours and hours spent touring schools in our preferred neighborhoods, countless conversations with each other, friends, and school administrators. There are so many different schools. So many different neighborhoods (drop off process and location is of prime importance in DC), school buildings with very diverse architecture, philosophies, discipline plans, and aftercare programs. So many different “vibes”.

A few of my favorites (in alphabetic order):

- Capital City, a well-established charter school with the most perfect natural outdoor space and great reputation. Too far out of our preferred neighborhoods, but if I could it would have been in my top three

- DC Bilingual, a well-established Spanish-immersion charter school. In a really nice building, but they might have to find a new site next year. Ranked low for us as not knowing where the school building will be was a deal-breaker for us.

- Mundo Verde, a Spanish-immersion charter school focused on environmental justice and study of world cultures. We love their vision.

- Two Rivers, we preferred the Young Campus as its closer to our preferred neighborhoods and O really liked the Principal

- Tyler, a public school with a Spanish-immersion and arts program that O loved

- Van Ness, newly renovated and reopened public school in Navy Yard (prettiest public school I’ve ever seen though in need of a new playground; which I hear is in the works)

Guest post: Why I can’t be Mom and Doctor to my own kids

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.