Doctors Make the Worst Patients

     I have always been blessed with great health. When I got my life insurance a few years ago, I got the best rates because my blood work was so good. I have always taken pride in that, kind of like getting straight A's or being number one on a test in medical school (ok, that only happened once, and in pathology, my future profession, but it happened! Out of a class of 150!). So you can imagine my despair last Fall in the midst of wedding preparation when my OB incidentally discovered I had hypertension. I'm not talking minor hypertension: my systolic would swing up in the 2 teens and diastolic would go over 100 easily. I know, because I bought a sphygmomanometer (I love that word) for home and work, and became obsessive.

     My OB recommended a family doctor and he prescribed me with metoprolol. I have been long acquainted with beta blockers - learning from a friend in med school that they are good for anxiety inducing situations such as giving talks in front of large groups of people. I applied this knowledge to many situations - that time I was interviewed about the swine flu on TV, going out on excruciating first dates on match after I was divorced. They are great for calming your physiologic response to stress without messing with your thought process. But the same bottle lasted me almost ten years and learning I had to take it daily really upset me. I have always run low, why the sudden change? I learned that I accidentally gained 26 pounds after I got engaged, and was determined to lose half before the wedding.

     That was two months of mania. It didn't seem to me that the beta blockers were doing much - I checked five or six times a day and my blood pressure was all over the map. I was religiously weighing myself every morning - something I normally stay away from doing. I managed to carve my weight gain in half before I got married. I was texting my cardiologist friend and hospitalist friend weekly with my numbers and quizzing them on how to get them down. "My systolic is way over 200! My diastolic is over 100! Should I take another beta blocker? Go to the ED? AHHH."

   About a week before the October wedding when I finally fit in my dress I had bought in June I was like ENOUGH. I made myself stop getting on the scale. I stopped checking my pressures. I was determined to enjoy my wedding and honeymoon. On a follow up appointment with my family doc in January, my pressure was fine. Not low, but systolic was 130, diastolic mid 80's. "I wouldn't treat those numbers," he said, and I breathed a sigh of relief. It was the weight gain, the wedding, the holidays, I told myself. This is over now. I'm back to perfect health.

     So you can imagine my surprise three weeks ago at my yearly OB check-up when the nurse asked to take my pressure again, "These numbers cannot be right. Are you symptomatic? Do you have a headache or anything?" No, never. My OB recommended another appointment with family doc. His nurse measured it twice too. 164/100. "Stop talking take a deep breath let me do it again." 152/90. I looked at her expectantly, "That's not very good, is it?" The doctor in me knowing it wasn't but the perfectionist in me wanting reassurance. No such luck. "No, it's not. Are you stressed?" I told her no, I was on vacation, I spent the entire weekend watching Homeland on the couch.

     Family doc decided to re-start the metoprolol daily. I told him I cannot go back to the manic numbers oriented person I was last Fall. I made him laugh describing crazy texts to mutual colleagues. I said, "This is your territory, not mine. Can we keep it that way, is that ok?" He laughed and told me to come back in six weeks for a physical and we would check it then. I asked him to review my blood work from last fall. He said it all looked great. Cholesterol was fine. Then he said something with utter surprise that filled my bruised ego with pride. "I think that is the best LDL I've ever seen. Yup, I've never seen one lower than that."

     I could think of worse things than having to take a daily beta blocker. It sure made me chill in the face of a large cooking project yesterday - not my area of expertise. I had to call my pulmonologist friend in Philly in a panic when my Instapot wasn't working, but I managed to figure it out without blowing up the kitchen or burning myself. I guess I keep going on as usual - working out a few times a week, eating as normal (my low salt diet attempt last Fall was dismal but I'll keep it in mind) and healthy as possible. Aging is tough, but I guess we all have to do it.

this little wiggly squirming miracle in my belly

I just stopped on the MiM website when it dawned on me, I haven’t posted in 3 months?!? What in THE world?

I realized it’s because I’ve been holding my breath for the last few months. Putting all of my energy into cooking up a healthy baby. Doing my dag-on best to not stress and submit to this process of life after loss.

I posted in August that we are welcoming our second child. This little baby is now about the size of a butternut squash, just shy of 29 weeks and the third trimester. It wiggles and flips, squirms and dips all of the time. I’m in love.

I’ve been holding my breath. The first 12 weeks I fretted every time I used the bathroom with a prayer of “please no blood, please no blood, please no blood”. And there wasn’t any blood! 4 early ultrasounds later I knew this one was a strong one with a heartbeat like it’s big brother Zo (many thanks to the sweet Ultrasound Tech at my hospital and at my obstetrics office who let me see the baby’s heart beat so many times and hugged me as I cried each time). It’s been strong since it made its first appearance with my linea nigra at 3 weeks.

Balancing part-time work with a first grader and tenure track husband is no small feat. I am so thankful that pursuing medicine has afforded me with the ability to work part-time and still live quite comfortably. I am able to eat delicious, healthy food, attend prenatal pilates class weekly., see a chiropractor for my aching back and hips twice a week as prescribed, volunteer at Zo’s school, be the Parent Teacher Association Co-Secretary, and have days every week to myself with my favorite Netflix series (Supernatural season 4 of 28 and She’s Gotta Have It!). Though I am exhausted at the end of my office days seeing pediatric patients, I am so thankful for those days. I get to see my patient grow. They get to see me grow. And I am now getting advice from everyone about welcoming another baby into our world. I love my staff. I love my patients.

I love this little wiggly squirming miracle in my belly. Here’s to 10 more weeks of us being conjoined. Please stay healthy. Please stay healthy. Please stay healthy. You are so strong. You are so strong. We love you so much. We love you so much. We love you so much.

Kindergarten lottery

Yesterday, I saw a post on Facebook about the lottery for full day kindergarten in my town.  And suddenly, all the fear I'd felt a year ago came flooding back....

What if my kid doesn't get into full day kindergarten?  (Which only goes till 2:30pm by the way--it's just short of criminal to call that "full day".)

What will I do with her for those three extra hours when afterschool doesn't start till 2:45?

What will I dooooo??????

Fortunately, we got a spot in the lottery.  Most people did.  If I had moved to our town in February with a pre-K kid, I would have been out of luck for the next year because there were no spots left by then.  Oh, and if I didn't already have my kids enrolled in the afterschool program the year before, I would have no chance of getting in.

Sometimes it frustrates me that the school systems (at least, outside of big cities) are not set up for working parents.  Most moms I know work, yet we all have to scramble.  Holidays are always rough.  And what about that stupid week between school and camp?

I keep telling myself that someday things will change.  The powers that be will realize that with so many women in the workforce, there needs to be good childcare options.  But I'm giving up hope.  Women have been in a workforce for a long time, and it doesn't seem like there's any movement to help us, at least where I am.

I'm really glad women are coming forward in the media to discuss their experiences with sexual harassment lately and I hope some progress is made because of it.  But now maybe we can discuss the sexual oppression women face when society makes it so challenging to go back to work after having a child.

Surprises

Hello everyone! Kicks here, and happy to announce the arrival of Baby! He is doing great and we are so in love. I am sitting in my rocking chair where he fell asleep in my arms contemplating how things have gone so far

I was surprised...

L&D:
...that after signing up for an induction, my water broke in the hospital with no pitocin needed!
...that I was such a puker. I have delivered about 40 babies thus far and I haven’t seen anyone puke like I did.
...how much I HATED the nurse who wouldn’t give me an epidural at 3 cm
...how much I liked her after getting me through early active labor and getting me to 8 centimeters before my epidural
...after how nervous I was to deliver at the hospital I will soon be working at, how much I am going to enjoy working with those fabulous nurses. I always seemed to have the right nurse at the right stage of the process, and we bought them all chocolates for the nursing station on day of discharge
...how well my husband did. He feels lightheaded at the sight of blood, but stayed by my side through each yucky moment. And even watched baby be born (we had a mirror at the end of the bed) which surprised us both
...how wonderful that first hour of skin to skin was. I always counsel my mommies that we will try to get them that moment but no guarantees, as many times something happens where we’re not able to make that safely work - however it was AWESOME. Baby and I cooed at each other for so long we completely lost track of time.
..how little I have learned about breastfeeding and breast pumping despite being interested in newborn care and OB. All I knew was breastfeeding is best for baby and Mom - but the mechanics were completely new. And that pump was so intimidating. I brought it out of its box a month before delivery just to stare at the pieces. And I had no idea what people were talking about “flanges” and “membranes”. Yish.
...how many interruptions we got during our hospital stay. I wasn’t completely clueless since I am frequently one  of those interruptions myself. So I expected baby’s doctor, and my doctor, and frequent nursing checks. But then early childhood stopped by to invite us to a new parents group. The discharge planner (who said she didn’t mind that I was nursing even though I was trying to make it clear I was new at this and I happened to mind at that time). Being  offered essential oils so many times I started to think the hospital was getting  kickbacks from Big Lavender (one nurse even taped a cotton ball to my little table while I was eating breakfast so I had a lavender flavored omelette). It got to the point that my last visitor on my second day was an adorable little old lady who goes around offering blessings to the baby - I was very short with her in my declining and trying to scoot her out of the room - even though later I felt bad and really wished I would have let her as she seemed so sweet and nice and I just snapped at her to get out.
...how ready we were to go home (see above)
...how hard it is to put babies in car seats

Home:
...how natural it was to slip into the role of Mom
...how hard it is to find good advice on the internet at 3 am
...how other moms survived before internet delivery services like amazon
...how defensive I was at Baby’s first doctors appointment despite the constant praise from Baby’s doctor. Must remember to try and do that for my own patients.
..how much I question everything I do with baby. Am I holding him not enough or too much? Am I giving him enough attention or should I get out of his face for a bit? Etc.
...how much Baby sleeps. And how deep Baby sleeps, where it’s still hard to resist the urge to poke him and make sure he’s still alive.
...how much Baby grunts or makes weird noises. Seemingly all the time
...how lucky I am to have family med docs and pediatricians one text away.

Work
...how fast maternity leave went. I thought I would be itching to leave the house but I really really didn’t want to go. I cried the whole way in my car to my first day back at work.
...how much I both enjoy being back and enjoy the people I work with - but also can’t wait to get home
...how much my patients asked about Baby and how things were going. And how much I missed some of my frequent patients.
...how happy I am to go back 2 days a week only for the next month. Jumping back to full time would have been overwhelming no matter how many weeks of leave I had.
...how much more like “myself” I feel after putting real pants on and using my brain a bit more. I didn’t feel “not myself” at home with Baby, but feel a little more normal now somehow.
...how much it is going to suck to try and fit things in between work and bedtime especially once I go back full time
...how awesome my family is at stepping in to take care of Baby when I go back part time and going to extra mile to help clean and cook us dinners.
...how much I love coming home to my little peanut!

Cheers!

The good kind of pain

I seem to always forget exactly how much pain I'm in over Thanksgiving weekend, after running a 10K on Thanksgiving Day. I'll think of Thanksgiving in my mind with warmness: family, food, friends (and sometimes work) but not the stifled screams of anguish that my leg muscles dare me to emit when I get out of bed on Friday morning. Repeat that with any movement all day Friday > Saturday > Sunday.

I remember one year, I was on the consult service the week of Thanksgiving and while I had Thanksgiving Day off, I had to come in on the Friday. A nurse asked me while I was making my way down the hospital hall whether I was okay. I didn't realize exactly how debilitated I appeared. Just walking a bit slow today *shuffle, shuffle, shuffle*!

This year, it has been no different. I should be more prepared after the same sequence of events every year for the past 4 years but, no, I stepped out of bed on Friday morning and was like - WHOA: IS THIS RHABDO? HOLY CRAP IT HURTS. If I wondered whether I pushed it hard or not, there was my answer. Yet, something about the pain with every step (all day and all night) is nice in a weird way. It's proof that I did something hard.

Thursday was my fifth race this year. I've realized that training for a race keeps me motivated in a way that plain old hopes and goals don't. With my work schedule and everything going on, it used to be so easy to make excuses why I couldn't run:

• It's too late
• It's too early
• I don't want to do my hair again
• Everyone else is hungry
• I'm hungry
• I have low energy (related to the above or separate)
• or almost anything else

Also, my time on last year's Turkey Chase 10K was almost the same as the prior year.  That was kind of anticlimactic. So I asked my husband to help me work on speed over the last year. He's always designed workouts for his own bad Ironman self, so let's just say I was a little scared of what he might design for me in terms of training. Keeping in mind that he went to a military service academy and I went to a college where you could design your own major.

Turns out, I love me a training schedule! I run 4 times a week and have easy and hard runs each week to complete. (I particularly enjoy the easy runs.)  I train for the next race and have had PRs each time.  I really love that in my 40's, I can get better and better at something physical. (It's not all downhill!) Granted, I started from a very low bar of speed. But, it has channeled my previously hibernating competitive streak into something productive.

During the Turkey Chase this year, I tried to use my Fitbit Blaze to track my pace. At the starting line, as I was trying to start the app, it kept saying "Check Fitbit App." Awesome.  Last race, the display was showing me "Calories Burned" instead of my pace which was the last thing I want to know while running a race. So I felt that my contemporaneous race tracking was doomed which turned to be true as my watch kept giving me wrong distance tracking and pace estimates that were way slow. By just the time, it seemed as I was running fast, but I wasn't sure with all of the inaccurate data floating around on my display and my math skills have deteriorated a long way since college calculus.

The race results posted yesterday, and I was thrilled to see that I beat last year's time by almost 6 minutes! That felt great. Mentally, not physically, since physically I'm still decrepit. But, it's a good pain, the kind that comes from trying hard and accomplishing something. I may even miss it when it's gone.

Not pictured: heavy labored wheezing/breathing

Guest post: Mommy guilt - the struggle is real

One of the first things I did when I got a job that paid money was hire a cleaning lady. It was a given that I would, since I hate housework, and am no good at it. I actually suck pretty hard at it.

As time went on, I outsourced more and more stuff. Some of it was because we suddenly had things we never had before, like backyards–who’s got time to mow that? Landscaper!–and children. Oh, children. They’re outsourced more than anything else. They’ve got daycare, tutors, and a babysitter. And right now, we’re pared down, because there is only one babysitter. There was a point in time when I had two: one for drop off and one for pickup.

Apparently, getting a cleaning lady is a source of shame or guilt for some people–women, mostly–because they take it as a point of pride that they clean their own house, even if they could afford help, because it makes them a real woman. Or something. Some even insist that they [airquote] like it or even that it [airquote] relaxes them. (You should see the face I’m making right now. Hint: it’s full of skepticism) I work in a highly Portuguese area, and these women are nuts about their houses. But not me. I hate cleaning and I outsource it. And I never felt badly about it, until I was told I was supposed to, that is.

Same with being a working mommy. Everyone always worked in my family, and I never thought it was any big thing, but now that I have kids, apparently, I’m supposed to be torn apart by guilt, or so TV, BabyCenter.com, and social media tell me. And you know what, their influence is not to be ignored, because the struggle has become pretty darn real.

Any working mother knows the awful tug and pull of the mommy guilt. You’re tired and you need the help, but you also want to do things for the kids and the house because it makes you a true mom. Or something. The more you suffer, the more it shows that you’re a tough mother, so to say.

The guilt is terrible, and it has so many layers. It’s a freaking milhojas. Behold: a) you feel guilty that you’re not doing enough for and with your kids; b) you don’t want to do stuff with your kids and you feel guilty about that; c) you work and you feel guilty that you’re not home; d) you know you’d suck at being at home (because see the first paragraph. I suck really hard at all that stuff), and you feel guilty about that; e) you don’t want to stay home anyway, and… you guessed, you feel guilty about it.

And do not underestimate the power of other mommies. The good ones say, “Everyone makes the choices that are right for them and their family,” with the subtext being “the only right choice is my choice.” The mean ones straight up put you down for your choices. “Nothing like being with mommy!” vs. “Contributing nothing to society.” It’s a big deal.

Just the other day, I ran into a fellow young doc at the hospital, and via smalltalk we figured out that he had just had his third baby, and that his wife was staying home.

“And let me tell you,” he adds. “The behavior in our younger children? Huge difference.”

Now granted, I was annoyed and due to my own insecurities, so the next statement does me no credit.

“Oh,” I say. “So should I quit my job and go stay home with the kids?”

No sooner were the words out of my mouth, and Fellow Young Doc didn’t even have the chance to utter some PC comment, a random nurse, whose name I don’t know and who was not a part of the conversation, sticks her nose, literally, between the two of us, and says, emphatically:

“YES!” I kind of looked at her, open mouthed. She then elaborated, in case I didn’t get the point: “Yes! I stayed home with my kids, and let me tell you, it’s always better when mommy is around!”

She said it a couple of more times too.

Fellow Young Doc removed himself politely from the conversation, and I was left to pout and seethe.

Here’s a paradox, catch 22, predicament for the modern woman today. We’re supposed to have all this choice, but what happens when we make the choice? If we choose motherhood and family – we’re wasting female brainpower and negating years of the feminist movement. Don’t you want more for yourself? If, on the other hand, we choose career and work – we are a failed unfulfilled woman. What is a woman without a child? If we do both – we are doing a half assed job at both. What’s the point of having kids if someone else raises them? (which, by the way, is something I have heard multiple times as well from random judgmental people). And if you’re working part time, do you have the best or the worst of both worlds? Or are you just doing a half assed job half of the time?

So, here I am feeling guilty about the fact that yes, I work, but I don’t work that hard, and I still have a nanny, a cleaning service, a landscaper, and now we’ve even found a service that will deliver delicious home cooked meals twice a week. And I’m all, Oh boo hoo, I only see my kids for an hour each day….

Then, I picked up Mary Poppins to read to my son. By the way, have you ever read the actual book?? Julie Andrews has it all wrong in the movie with her sunny disposition. The real Mary Poppins from the book is very unpleasant, and I really don’t understand why the kids were so smitten with her because she’s kind of mean to them, and she’s always sniffing and paying herself compliments, and looking down her nose at everyone.

Anyway, the book starts with the old nanny leaving, and Mrs. Banks being incredibly stressed about that. Meanwhile, remember, Mr. Banks had told her that to have 4 kids they’d have to live in a shabby house because they aren’t rich. So they’re living in a shabby house with 4 kids, a nanny, a cook, a maid, a lady who does, and a gardner. And the mom presumably doesn’t work, because people didn’t back then. And she’s so stressed out about having lost one of her 5 staff, and having to spend time with her children. And not an ounce of guilt.

Yeah, so now, I feel guilty about feeling guilty. I really seriously cannot win. Can’t we all just give ourselves a break? I have no helpful advice. I just wanted to point out the struggle because I know I’m not the only one.

-Sasha Retana, MD.

Better Than An Affair: My DIY Budget Kitchen Makeover

Genmedmom here.

I'm nuts. But in a good, doctor-mom-nuts way. 

I just started a DIY budget kitchen reorganization and makeover, in the midst of Hubby's busiest time of his workyear, the kids' busiest time of the schoolyear, and my own perpetually crazy clinical/research/writing career life.

Yes, the kitchen looks like it blew up. Yes, my hands are covered with "Apollo Blue" paint. Yes, I've already gone over my $500 budget. Yes, Hubby is raising his eyebrows every time another package is delivered.

But I am having so much fun.

This has been such a delicious, decadent creative treat. The stolen time for planning and plotting, poring over colors with the Benjamin Moore guy at the local hardware store; guiltily perusing the Ikea website catalog during work hours; lying in bed after the kids are asleep sneaking peeks at Pinterest kitchen remodel pins... This is the type of affair for me!

I haven't for one second regretted tackling what is the largest household project I've ever undertaken. It's consuming every spare second of time I have, and there's not much.

I will be asking family for help, especially when it comes time to painting the walls and hanging heavy shelving, yes, that is true. Lucky for me, I'm related to several carpenters and contractors! But thus far, this project is MINE.

So, lately I've been wondering why it is that I'm so freaking happy about this craziness, and I think it's for several reasons:

One, the news cycle is so freaking depressing, this project helps me to focus on something over which I have actual control, and is actually positive.

Two, while Hubby is supportive (I did ask his opinion first), this kitchen makeover is essentially mine. It's visibly, tangibly, MINE. It's the first time in my life I've had a bit of extra cash to do something like this, and I am ecstatic. I can't go over $1000, but I'm ecstatic anyways.

Three, a large part of the undertaking is in order to get organized. Our family is so, so busy, and the kitchen is central station. Yes, it especially looks like it blew up lately, but, it always kind of looks like it blew up. My goal is to change that.

And four, I think it's a healthy doctor-mom thing to have a personal project on the side. I was reminded of an old post by Fresh, MD, a popular one titled "Ten Guidelines for Medicine-Life Balance", where she recommends having at least one non-medical creative project going on at all times. Usually I'm planning a birthday party or hosting a special meal, smaller stuff like that. This DIY thing is a bigger deal, but it is still just another personal, creative thing. I think she's totally right that we type-A intellectual overachieving dorks really need an outlet like this.

I'll definitely post about it when it's done, and let you all be the judge of my creative effort!

MiM Mail: How to ask for part-time?

I'd love for advice on the topic below. Thanks MiM!

I recently started my first attending job (anesthesiologist). I interviewed at many hospitals and ran the exhaustive lists of pros and cons with my husband before accepting a position at a large, academic tertiary care hospital near extended family. My reasons for picking this position were many, but a large part was the better work/life balance it seemed to offer over the private practice model (some private groups were regularly working 80 hours/week!).

Fast forward to now, when despite this being my best option, I'm still working 60 hours a week, my husband is still working full time, we are struggling to manage the day-to-day shuffle of having two kids. It's just as exhausting as residency! I need to cut back my hours for my own mental health and for my family, but how? I'm the newest attending. I'm the youngest attending. I'm female. I fear the "mommy track" label that will come with it, despite the fact that I will still be working more than 40 hours/week. I also resent the massive pay cut to work what any other professional would call full time.

I can get over all of my misgivings, but I'd love advice from people who have had this talk with their bosses. When is acceptable to ask? How long do I have to wait? How did you do it?

Thanks, ladies!

The Harvey Effect

I can't help weighing in on the news cycle over the past few weeks. The number of men being finally held accountable for sexual harassment and assault is making me dizzy and ecstatic (with respect to those women who are being triggered, I know from personal experience that can be pretty intense and awful). I wrote about sexual harassment in the workplace in 2011 on the blog in this post, and why it is easier to speak out when you are finished training than when you are in training. I haven't had any encounters with harassment in the workplace since then, but I can't help but think it's my professional standing and reputation that prevents me from this behavior - my word could be a lot more damning at my hospital than many women around here without as much power, at least in society's perception.

Every day a new scandal erupts. The quiet woman's network that tries, sometimes succeeding and sometimes failing to warn each other of predators finally seems to have a voice worth listening to. One day Hollywood producers, next the local legislatures, television journalists, magazine editors, the art world, movie stars - the momentum against misogyny is at an all time high. I hope it continues. No workplace on the planet should hide and condone this type of behavior yet it is ubiquitous. I like to think there are a lot of serious offenders out there shaking in their boots, waiting to be called out and fired, dare I hope also prosecuted for past misdeeds.

I have a lot of female friends and I've heard a lot of stories of assault and harassment over the years. Some subtly angering me, others shocking me to tears - all whispered in confidence. Every single one left scars and doubt and shame. I have a 14 year old daughter who makes me proud. She is so much more confident than I was at her age, but I still fear for her. Enough to tell her not to drink anything that is handed to her at a party - it has to be a container she opens or brought with her. I warn her about sexual abuse and harassment and talk about the buddy system. I want her to enjoy her teenage years but I also want her to be on guard and to know what actions by men are not normal, and that nothing she tells me about alcohol or drugs or men or any situation she might fall into at any point in her life will make me love her any less.

The news cycle is giving me hope that society will protect my children (I know there are female perpetrators and male victims but their numbers are much less) in a way that many generations of children and women have not been protected in the past, only hushed and shamed. Every day I breathe a sigh of relief that women are continuing to be heard. I hope having to summon bravery to report this type of behavior will someday be a thing of the past.

I read a story in the New York Times years ago by a woman from another country who was telling a story about being a victim of sexual assault. It happened to her (gang rape if I recall) and when she told her family they hugged her and cried and asked how they could help her. It happened also to a girl down the road whose family shamed her and labeled her an outcast. She became a respected professional in society with a family. The girl down the road committed suicide - she burned herself to death. That story had a profound impact on me. If we just listen to the women around us, believe them, how much higher could we lift them up?

High School

My daughter started high school this Fall.

I'm 43, I mean 44? Hard to keep track these days. So I'm old enough to have a daughter in high school but it is so surreal. Cecelia is 14, Jack is 12, and all of a sudden the physical challenges of raising small children has transformed into the higher emotional challenges of raising conscious human beings.

I have spent the past five years cultivating relationships with Cecelia's friends mothers through book clubs and trips. Thinking I had all my ducks in a row for the tough years. All of a sudden, this Spring, she upended me by deciding to attend high school at Little Rock Central High. Up until now, she has always been in small private schools. I longed to leave my small private school for Central when I was her age, and logistics prevented me, so I supported her.

As you might know, the Little Rock Nine are history. Bill Clinton was here last month for the 60 year anniversary, along with members of that brave tribe. We didn't make it, I was out of town, but I'm still super proud of my daughter for going from a class of 60 something tops to a class of over a thousand in a place steeped in history. I've been in the building exactly once. She's braving it solo. Attacking model UN and AP physics with aplomb. Making all new friends, to my carefully planning chagrin.

Last weekend I was added to two group texts - one tackling homecoming pre-party and the other a post party sleepover. I know none of the parents. It was a giant text stream of numbers. At one point, right before breakfast on Saturday, I replied to the larger pre-party text, thinking it was the smaller sleepover text. Got confused. Stepped on toes. Newcomer face plant. I was very apologetic to the one person I actually met for five minutes, and they were very kind, but UGH. I thought I had this all under control.

That's life right? You think you have it all under control and it changes. Control is a huge illusion. Life is life is life. We like to operate and mitigate it through our own interpretation but really? If we shut those eyes it would all go on without us. So you just have to sit back and roll with the punches.

I was on call last week. Friday night after the football game I dropped my daughter off at a house to socialize. All I want to do on busy call weeks in the evening is veg in front of the TV or a book (hell non call weeks too). But I've got to meet these new friends and their parents, one of whom was having an after party until midnight at her parent's house. Emboldened by wine, I marched in at 10 while the teenagers were dancing in the driveway and hung out for over an hour. I met a woman, challenged by fertility issues, who adopted two sons from Ethiopia. I met another women who is an airport engineer who travels all over the country. I became reassured that even though this is a brand new social circle, these are good people. I volunteered to do the 11:30 carpool the next night from the dance to the sleepover.

Six glamorous excited chatty girls piled into my car the next night. When your kids are teenagers, you glean much more information about their lives by listening to them talk to their friends than direct inquiry. So I relish carpooling them around. They appeared disappointed in the turnout, despite what looked like hundreds of teenagers hanging out around the venue, then started plotting basketball homecoming. They played music I have never heard of on Spotify. They took selfies with their phones. I got caught up in the moment - the excitement of youth.

I think I'm ready for high school. I'm glad it's not me. That wasn't my favorite time of life, but I'm going to try to make sure my daughter enjoys the heck out of it.

Cecelia and Jack, pre-homecoming festivities. He is dressed up to see Kinky Boots with my husband, myself, and his friend. We all wore jeans and nice tops but he surprised us with jacket and tie. I'm hoping to convince Cecelia to let me use this on the Christmas card this year.

Waiting Waiting Waiting

Baby's official due date is 4 days away.

We are as ready as we are going to be. The hospital bag is packed. The date night(s) have been had. My last day in clinic was 4 days ago.

And I am going crazy just sitting here, waiting.

My husband is too - a few nights ago I was feeling uncomfortable/crampy, and he read to me off Google that "being uncomfortable might be a sign of early labor" - but then I took a bath and felt better and we were both disappointed.

I never understood women that were "so done" with pregnancy until I hit 38 weeks. After all, childbirth doesn't look like a whole lot of fun and I've never seen the point of trying to hurry it along. However, at 38 weeks, all of a sudden, sitting sucked, standing sucked, walking sucked, and so did laying down. My clinic patients would catch me wincing at work while waddling from room to room. One of my most complicated patients who has multiple serious concerns at each clinic visit told me I should probably go home and take it easy. Another one caught me making a face while I was auscultating his heart and told me he was afraid I was going to have the baby right then and there. No longer scheduling me in clinic was probably a good idea.

The rest of the last three weeks have been filled with research elective time. I thank my lucky stars my program director has had enough pregnant residents to know that research would be a great use of my time leading up to baby. I have probably been driving my research mentor crazy - I have nothing else to do to distract myself from the waiting and the constant discomfort, so I've been working ridiculously hard on my research project and I have a tendency to send her these long detailed emails only a day after we've met and hashed out the details on the last one.  I also find myself spending a lot of time on Google reading terrible parenting/pregnancy advice on blogposts (obviously not this blog!) and also relevant medical literature on PubMed to my situation (Fun facts: 30% of women will try some kind of non-pharmacological measure to try and start labor. And there is good evidence behind "membrane stripping" with a number needed to treat of 8 to prevent a formal induction!).

I haven't had this many nights/weekends off in a row since before med school clerkships. We've stopped making any sort of plans on the weekends. Last weekend I couldn't handle the not busy-ness any more and spent a day making 10 of those freezer meals for when we don't feel like cooking (never done that before).

I know I will want to cherish these moments of quiet, of resting, of the calm before the storm, but I still find myself silently pleading with baby to hurry up and meet us soon.

No big surprise, but…I’m still tired

I’m currently mid staycation with my daughter, and I disobeyed my own advice.  I overplanned.  As a result I set myself up for constant disappointment because, I AM TIRED.  I’m now re-grouping and re-thinking.  Just getting done what I can, hanging out with my girl and enjoying her warm little hugs - realizing it doesn’t matter if we make it to every museum and live kids music performance and puppet show imaginable.  She just wants to hang out and read Rainbow Fairy books.  I have the same bleary eyed overwhelmed tiredness of residency staycations, and it’s a little bit of a revelation.

Attending life is full of new challenges.  I have called patients and set up appointments and reviewed pathology this entire break.  I can’t emotionally separate from what is going on.  There are many good changes - I do have increased control over my schedule, autonomy, and there is a more personal sense of fulfillment.  But, I am still so tired.  I feel constantly behind at home and at work - there is always more to do.  Part of the reason we’re having a staycation is just I didn’t have the energy or time to plan a proper vacation.

So, I’m writing this post as proof that from this moment on I will close my laptop and try to unplug.  And in a few days I will be back, hopefully energized just a bit so that I can keep moving.

Mindfulness or multi-tasking as a mother in medicine

And then she said, “Wait what?”   

As a mother in medicine, are you engaging in mindfulness, or are you a multi-tasker?  Perhaps that’s too simplistic of a question, as it’s not necessarily an either/or.  The complexity may rest in which of these two are you striving for? 

My challenge is I find I’m striving for both.  I want to be more mindful and present with the people I’m with, but with things I want to multi-task.  When I’m with my family, I should be with my family.  When I’m with my students I should be with my students.  When I’m with my patients I should be with my patients.  When I'm in a meeting, I should be with the meeting members... that last one is a hard one!  What if you find yourself with people and it’s not worth your while?  When it’s not engaging.  When you have sooooooo many competing priorities and demands.  Do you exit (physically or mentally)?  Do you meditate or do you multitask or do you make your way out the door?

And, what about when the people aren’t fully present with you?  I’ll wait… And I’ll aim to make being there, being here, worthwhile. 

Maybe the key is to be mindful and fully present with people, and to multi-task effectively with things. But that may also mean you have to be around the "right" people and do the "right" things... the people and things that give your life meaning!

I guess it’s kind of a topic or conundrum for us, the busiest people.  And on that, do we agree that the busiest are the mothers in medicine?

You're a part time mom

What was the worst thing anyone has ever said to you?

I found the answer to that today. It was an eventful weekend. It's been about 2 months since I've started my new job as a first time attending (more on this on another post!) but since then, it's been non-stop with the move from San Diego to Los Angeles, getting little C adjusted to her new school, starting a new job, studying for boards (which is next month!) and furnishing a new house! I have to say we got pretty lucky and everything is going fine with of course a few bumps in the road but that's expected.

My in laws, including my mother in law, father in law and two aunts came to visit for the weekend. It was a stressful but happy weekend! Moving on to the topic of this post, my brother in law (big C's brother) and his wife and I don't get along. The primary reason being that he doesn't like the fact that I'm a physician and how often I talk about it, which with him, is mainly limited to group emails and text messages amongst my husband's side of the family.

If you guys remember my story, I did not live with little C for the first 2.5 years of her life as she stayed with my parents in Irvine, an hour away form San Diego. Afterwards, I was a single mom with little C for 2 years while I did long distance with big C. During those times, we didn't have much time to visit his side of the family in northern California. I look back at these emails and I do realize I talk a lot about what I do, career wise, but often times, it was out of guilt and my way of explaining as to why I was so sorry that they aren't able to see their granddaughter that often.

Moving on, my brother in law and I had an argument today about the fact that he cancelled plans on us this weekend and he didn't offer an explanation. (Reason being--he just didn't feel the need to tell me.) But regardless, in this argument, he said that I needed to know my audience. The fact that his wife (stay at home mom) is at home with his daughter all the time with no help makes me inadequate to talk about my struggles as a working resident mom when I had help from my own mom. He said I was a "part time mother" for 2.5 years and that his wife is a "super mom" because she doesn't ever use a nanny or house cleaner. Wow. Those words really got to me. It took awhile to process. Little C is already almost 5. She's been with me over 2 years now. I an her favorite person. She is 100% sure that I am her mama so why did I feel like I couldn't breathe?

I did my best to hold it all in during the conversation but when it was done and over, I couldn't' even process it. I had to excuse myself and go the bathroom. I locked myself in a stall and I was brought back to my first week of residency after maternity leave. My boobs ached. I was still pumping and bringing milk back to C at the time. I was experiencing all the symptoms of post-partum depression but didn't even realize it. People asked how little C was doing and I could barely hold in the tears as the insurmountable guilt of leaving her with mom came back to me with every mention of her name. The mom guilt was so strong and with just that statement--it came all back to me.

It made me question am I bad mom? Is C going to be okay? Am I selfish for wanting a career and motherhood? I turned into that insecure first year radiology resident in the bathroom at the VA hospital with tears streaming down my face only to bite my tongue so hard as if the physical pain could take the emotional pain so I can back to fluoroscopy suite to do the next upper GI study that was on the schedule.

But I am not that little girl. I am not a part time mom. It takes a village to raise a child. Even as an attending, I have a wonderful village that includes a nanny who helps me with morning drop offs, a house cleaner, a dog walker, a grandmother who is willing to help out whenever she's needed and a wonderful husband, who despite his own busy work schedule, will watch little C in a heartbeat if he is free.

I will not apologize for my village. They make me the mom and physician I am today. I will not apologize for being a doctor. I will not apologize for being an example of what a woman can accomplish to my daughter. And most importantly, I will not let your words doubt my ability as a mom ever again.

I am more than a part time mother. I am her mother. And the only opinion that should matter is hers. And tonight before bed, I asked little C, do you wish mommy could stay home with you? She said, "no mama, I go to school because I'm a kid and you go to work to help sick people because you're a doctor."

Don't let people like him bring you down. As Taylor Swift will say, haters going to hate hate hate but I'm just going to shake, shake, shake, shake, shake I shake it off, I shake it off...

Mothers in Medicine: THE BOOK

I am thrilled to announce that we've been quietly working on a book that assembles the best advice, wisdom, stories, and insight shared on these pages since the blog started back in 2008. This is the heart-to-heart, girlfriend-style kind of advice and reflections that I would have loved to have when I was just starting out as a woman in medicine, with many questions about the best time to start a family, making it "work" in terms of work-life integration in my specialty, practice considerations as a mother in medicine, and even negotiation advice for landing that job and asking for what I need to be the most successful in my role.

The chapters are organized by theme and cover all of the above questions, as well as separate chapters on having children during medical school or residency, navigating life challenges such as divorce, infertility and financial hardships, the mother in medicine's village of support, and even sharing the humor of being a mother in medicine. Many of the authors are voices readers of this blog know well (T, Cutter, Fizzy, Genmedmom, Jay, m, Gizabeth, Emeducatormom, PracticeBalance, Beckster) as well as special guests who bring unique experiences to lend to their chapters. We're honored to have a foreword written by the accomplished writer, Danielle Ofri. The final chapter is a compilation of our most frequently asked questions from readers posed on the blog, with a summary of answers from our community.

Importantly, the book reflects the thoughtful, honest, supportive tone of this blog community that has featured over 1500 posts and over 14,000 comments since 2008. Our ultimate goal is to support women in medicine at all stages of training and hope it is a useful, contemporary resource for years to come.

So, stay tuned for more book announcements! We're hoping for a late 2017/early 2018 debut.

Thanks for reading!