Who blinked first?

It was a random Wednesday that I was off from work. I was thinking of the possibilities. Oh the possibilities! I could do my ever piling load of laundry. Replenish the empty fridge. Or forget all that, and keep my toddler child from daycare and spend time doing something fun with him. Since starting intern year, it feels like our time together has became ever so scarce. Today I would make up for all that missed time. We could go to the playground, do story time in the library, visit the local children's museum. Endless possibilities!

First things first, we'd eat some good healthy breakfast to get the day started right. Today I was in no rush. Instead of his usual sugary cereal breakfast, I was going to make eggs and toast. Now anyone who knows my toddler child knows food is a big struggle with him. He reacted to eggs and toast like I had handed him a plate of dog-doo. He put on a whole production. Defiant "I don't wanna". Pushing the plate away. Putting a bite in his mouth followed by gagging sounds. Finally, eating his food in infinitesimally small bites that he would take an absurdly large amount of time to swallow each bite. I was already questioning my decision to keep him home from daycare. I was now fantasizing the alternative of doing laundry in peace.

Finally after an hour or so of lingering, pleading, arguing over the table, I just had it! Out came the threat, "Child, you don't like the food here, I'll take you to school where you seem to have no problem eating the food. Forget about the museum or playground".
"Noooo"
"So you want to finish your food?"
"No"
"So which one do you want, go to school or go to playground"
"Playground"
"Then you have to eat your breakfast"
"No"
"So school then?"
"No"

Round and round in circles we went. And of course there were lots of tears involved!

"Alright then, let me break this down for you. You can go to school. Or you can finish your breakfast and we can go to the playground." Lots more tears. Then he said something shocking! "I want to go to school." I was not expecting this at all. Really!! He wanted to not eat that food so bad, that he would forgo museum and playground, something he normally loves to do! Well, I may have been bluffing a little, we were both in our PJs, not daycare ready. But it was too late to turn back now. I got dressed, got him dressed. All throughout in a shock, asking him several times, "so you want to go to school, not to playground?". Each time, "yes". Alright dear child, as you wish! 'This was incredulous', I kept thinking all the way on our tense walk to the car. Just as I was strapping him into his car seat, he said in a low voice, "I want to eat the breakfast".
In my mind, I thought, "Are you for real??? After all this, after I got dressed, got you dressed, after all those tears and drama, now you want to eat breakfast!!!"
Deep breath.
Aloud I said, "Have you decided for sure?"
"Yes", he said.

We walked back to the apartment in silence. He finished his breakfast without another complaint or tear. I'm happy to report, we had a great rest of the day in the playground and museum, of course peppered with occasional meltdowns here and there, but nothing quite so epic.

I was amazed and strangely proud of my offspring's skepticism. For not just taking my word, but for calling out my bluff with his own bluff. Keeps growing up so fast, keeps me on my toes. Teaching me that,
1. I must be fully prepared to carry out any threats I issue or rewards I promise, and,
2. Conversely, I can not make threats or promise rewards I can not execute

(Credit: Images from the hilarious Hyperbole and a Half, which can now be generated into endlessly entertaining memes)

Being The One

As a pediatrician, I got the chance to preview parenthood in more detail than many people likely do. The five-year-old little boy who clutched his mom during bedside rounds my intern year stands out even now: he buried his head in her chest as soon as we entered the room. She whispered, "Does something hurt or are you scared?" He managed to whisper that it was the latter and she held him tight, soothing and reassuring him while she listened to the plan for the day.

I carried that rosy picture along with many others as a boon of future parenthood. The chance to cuddle, to protect, to take complete care of my own little person someday - and, yes, in all honesty, the chance to be so important, to be the one. The one a child immediately turns to, relies on, needs.

Since that encounter, I have had two sons, and it thrills me to know end to be, along with my husband, their person. Nothing compares to the sound of little boy feet running toward the door with the greeting of a wide smile, a "Mama!," and eventually, "Mommy's home!" To the high-pitched voice calling your name in the middle of the night because of a scary dream or a need for water or just some extra cuddles. When in shyness they hide behind me, hugging my legs, my heart bursts with joy and wonder at the chance to be part of this classic, perhaps cliched but no less endearing, image of a child clutching his mother for comfort.

A few months ago, I saw a teenage boy in my office for consultation. I'm training in pediatric hematology/oncology, so trips to my clinic can be nerve-wracking for patients and families. This young man's sheer terror at what he feared were symptoms of cancer (happily, they were not) was visible, audible, nearly palpable. When I sent him to have blood drawn and imaging done, I heard him say to his mother, who had accompanied him, "I need to call [insert girl's name here]."

His reaction startled me. I could appreciate the anxiety, but the realization that, even with his mother beside him, his instinct was to turn to someone different - presumably his girlfriend - took me by surprise. Once I reminded myself that it was, in fact, developmentally appropriate for an adolescent to be developing relationships and establishing independence from his family, I was left with sadness. Someday, far sooner than I hope, my boys will turn to someone else as their person. Someone other than me will be the one.

I sit with that sadness even now. With each milestone, it mixes in with the joy and pride. And as my children grow and I grow, my work continues to provide examples of the realities and possibilities of parenthood. So when I encountered another adolescent who, facing a challenge, had little support and no peers, romantic or platonic, to whom to turn, my apprehension and sorrow began to abate. I want my children to grow and develop, to have healthy relationships and support, even if they must eventually come from someone other than me. 

For the time being, though, I'm fortunate to have my days peppered with eager footsteps, warm hugs, and sticky kisses. And when I dropped my older son off at school yesterday, after we had said our goodbyes, he ran back for one more hug. I savor every single one.

Open or closed? How do you deal with emotions?

My whole life is organized into boxes. (ie, my blog name). I like to compartmentalize, keep work and home life separate, keep public me and private me separate, emotional me and getting-through-the-day me separate. Usually, this works. I can be the happy, relaxed, fun loving mom I want to be to my kids, efficient and professional at work, and contemplative when I'm by myself on a run or on my own. But recently,  I have not been able to figure out who I want to be or who I am when I'm with my husband. The problem, I think, is that I want to be all of me for the one I love and built a life with, but I'm having a hard time putting it all together in a cohesive, not unpredictable, way.

A lot of what we as physicians see daily gives us perspective, and makes us confront our own mortality. It's heavy stuff, if you let yourself think about too much. So I try to leave work at work, keep the danger stories or cool saves to share with my family, and  compartmentalize. With the kids, it is easy. But it is sometimes hard to explain to my partner the intensity of what I do and see daily. I want to share, but sometimes I can't begin to explain or unpack my feelings. I have never been an emotionally open person and keeping things inside and putting on a happy face is how I have been able to overcome a number of difficult periods in my life. It has worked for me before, but now it is creating an emotional void between me and my partner that I don't want to get any deeper. As I write this, I realize more that the problem is that since I can't try to explain, I don't. I simply shut it down. And then, eventually, pandora's box opens and all spills out.

For those of you with non physician partners or partners whose days look very different than yours, how do you balance? Any resources that you have read, or used, to help me feel more comfortable expressing myself and verbalizing my thoughts?

Guest post: On becoming a physician mom

While on a walk around a lake on a beautiful day with my newborn baby in the stroller, my dog, my husband, and my parents, we ran into one of my parents’ acquaintances. She congratulated me on my recent residency match, asked me where I matched to, and took a look at my baby in the stroller and congratulated me on that too. She then proceeded to tell me that through my dad, she had been hearing about my journey to and through medical school and that she too has a daughter who is in her first year of medical school at the same school I was about to graduate from. I quickly thought back to how grueling and demoralizing, at times, my first year of medical school was and I hinted at that to this woman and wished her daughter luck. She then looked at me and said something like “well it looks like it can all be done---you look great and not at all stressed!” I could feel a lump form in my throat, but of course that did not show to her. I’m not portraying my life accurately I thought.

Many people look at all of these doctor moms and think: wow they can do it all. Even as a medical student, I am frequently told by people how impressed they are with me-- that I was able to go to medical school as a “non-traditional, older, career-changer” student and have a baby during my fourth year (“perfectly timed” such that I had my baby two weeks after ending my last fourth year rotation giving me four months to stay at home before starting residency). And I suppose it is a lot to be proud of. I wish I, too, looked at it that way more often. But there is a struggle beneath the surface. To get to this point in my life, I have become a detailed oriented perfectionist and I am often driven by fear and anxiety that things won’t work out exactly how I have planned them.

The skills and traits that got me to my “perfectly planned situation” of having a baby fourth year after my Step 2s were taken and months before residency began were not helping me in motherhood. In fact, these skills and traits seem to harmful in motherhood. Crafting detailed daily schedules of when to study, what to study, what assignments to complete on rotations, and research deadlines to meet have felt necessary to me. Life schedules, when to get married (a few months before Step 1), when to conceive a baby (a couple of months before Step 2 so I was past first trimester on test day), and have the baby (a couple weeks after end of rotations) seemed to be the only way I could work things out.

As a new mother, I so badly want to make stringent schedules, check things off, and see that my hard work each day pays off. But it just doesn’t work that way here. My 10 week old baby is a wonderful baby but schedules, yeah right. Some things just don’t get done some days. And hardest of all for me, even on a day where he takes well-timed and restful naps, and I am so proud of that, he still has trouble falling asleep at night-- and that is so hard for me--seeing that all the hard work I put into the day trying to get him to do all the “things he should be doing” didn’t even pay off in terms of a timely and successful bedtime.

I am trying to teach myself how to be more flexible and go with the flow, how to not be so hard on myself, how to realize that everything really truly will be okay and that everything need not be perfect. And I luckily have so much support to achieve those things. For one, my husband is incredibly helpful, encourages me, and is much calmer and relaxed than I. And even more importantly, my child gives me the greatest smile in the morning when I first see him and sing his favorite song, regardless of how many times he awoke during the night. That is so rewarding and reinforcing that everything will be okay. However on a daily basis, I must remind myself that everything need not go as planned, I am doing an incredible job being a mom to my baby boy, I am trying my best and that is all I can do. I still have a lot of growing to do, in fact I am still meticulously keeping track of all his feeds and naps today. But I will be a physician mom. I am scared but I can do it if I let go of total control, adapt and show gratitude for all that I have.

Future PM&R Resident
Mother of 1 baby boy

Adventures in Pumping II: The rotating resident

Here is my past few months in pumping chronicled by rotation. As the weeks went by, I turned from a shy awkward pumper to a frank “I’ll do it wherever just get me a plug in” resident.

Ortho: show up to clinic struggling with clinic bag in one hand and pump in the other. Young ortho PA that I am scheduled with has kids, gets it, and finds me a private office for the day.

Cardiology: lots of older male physicians, and scheduled with a new one every half day. Rather than explain the pumping every single half day, I pump on the way to and from work and simply say I need to leave half an hour early to make my q4h schedule. I don’t say why, they shrug and say sure. I tell the younger female cardiologists I need to pump and they “remember those days” and are full of support.

Hospice: in a car with my wheelie backpack going to multiple hospice sites. At one point, I am stuck far from my pump as I misjudged how long the trip would take me and as my mentor for the day is sharing a deeply emotional story as we are ending or day together, all I can think is “gottapumpgottapunpgottapump”. Also had a mentor that went to NP school in the pre-double electric breast pump days and not-so-fondly remembers hand expressing during breaks. I’m so glad we’ve come far from that.

Night float: Sitting in my call room calling specialists with the little “whirr whirr” in the background. Eye the pagers carefully, just daring them to go off with a Code Blue while I am plugged in.

In between, check Facebook. That Willow pump that keeps haunting my news feed with ads looks wayyyy too good to be true. But cheering on the days to an better breast pump.

Psych: checking into an attending’s office for a half day. He has a no show, so I casually mention I need to pump sometime in the next two hours. Ten minute tour through the offices ensues, ending with me pumping in his private office and him waiting outside in his own lobby.

Clinic: having much more in depth conversations with my patients about pumping, supplementing, etc. Run downstairs every 3-4 hours past all the patients in the lobby past  to the pump room, stopping to briefly complain to the care coordinator about how pumping sucks literally and figuratively as we both have babies within a few weeks of each other. She made it a year with her first so we are cheering each other on.

Conference: presenting a poster at a conference at a large office building. Find the pump room of dreams including sink, long counter, multiuser pump, fridge, large comfy chair. Immediately send an email to my office manager outlining this in case we ever have extra money lying around when we design our next clinic. The pump room is in use when I need it in the afternoon, so I am directed to a Breastfeeding Pod (called a Mamava) that looks like one of those party photo booths. Crawled inside, feeling slightly seasick but very private and secluded in my little cocoon.

OB: I pick up an OB shift for a resident out sick. I sit in the pump room in peace wishing I could figure out how my Spectra parts could attach to the multi user hospital Medea  pump. I get to work with the nurses who helped deliver Baby, show them pictures, and they let me eat from their potluck spread.

I mainly wanted to write this all down so I can remember both the ridiculousness and support when we’re finally ready to shelve the pump. Hopefully someday I can say “I remember when I had to haul my pump around with lots of parts from place to place in a huuuuuuge bag! You have it so much easier now!” Until then, pump and I will continue to hit the road.

Kicks

I Get To...

I had just survived one of those hyper-scheduled "days off." Early morning short work assignment at the fertility clinic, my daughter’s first gymnastics class, squeeze in a quick workout for me (as long as she agrees to stay in the gym daycare), back home for a fast lunch, then out for a mid-afternoon doctor’s appointment with babe in tow because I couldn't work out childcare. It was the kind of day that used to get me very frazzled, but I’ve been working on my organizational techniques lately, which has really been helping. I won’t lie, though, it’s hectic making that many logistical moves in a day with a two-year-old. It can be as busy or busier than a day in the OR! As the sun was going down, I pulled out my journal to reflect on all the day's events. Instead of the typical narrative you often hear from moms like us, “It was so busy today, I had to… (insert long list here)”, I decided to turn it around. I wrote at the top of the page, “I get to…”

I Get To:

• Wake up at 5 AM to provide anesthesia for two women at the same fertility clinic where I was a patient, giving them hope and reassurance that they too will someday be an IVF success story

• Take my daughter to a Mommy & Me gymnastics class on a weekday when I don't have to be in the OR

Warming up in Wednesday gym class

• Do a workout for myself, since after suffering for months with both a back and a shoulder injury, things are slowly resolving and I'm able to perform some of my favorite exercises such as the overhead press and barbell deadlift again

• Spend more time with my lovely daughter by bringing her to my doctor's appointment (she surprisingly behaved perfectly)

• Argue with my husband about what wording to use in a text to a landscaper, who we are fortunate enough to afford to pay for landscaping services, as opposed to arguing with my husband about something less frivolous (such as where our next meal will come from or how we're going to pay bills, etc.)

• Clean up potty training messes x 3 ("Oops, mama! There be poo poo on the seat/floor/etc."), including a wipe down of the whole bathroom each time, and then bathe my beautiful baby by candlelight before laying her down in her bed, where we read books and sing songs and have a cuddle-fest

• Have a few minutes of silence to myself after everyone in the house is asleep, where I prepare healthy foods for lunches the next day, and then reflect like this on my "crazy" day

What did you "get to" do today?

Stumbling Through The March For Our Lives With Little Kids

Genmedmom here.

As a primary care physician with strong public health and clinical research roots, and as a politically engaged mom with serious concerns about our kids' futures, it made perfect sense to take our kids to the March 24th March for Our Lives Boston.

One complication: Hubby and I have been shielding them from the news, especially school shootings news. Babyboy is extremely sensitive to the topic of death, dying, and violence. He'll have "bad memories" for weeks after hearing or witnessing something along gun violence lines. This may be a normal little kid thing rather than an autism thing; they're only seven and six years old, after all.

Given all of this, it was actually very difficult to explain why were marching.

The Women's March and the March for Science were so, so much easier! Yesterday, Hubby and I found ourselves searching for explanatory phrases that didn't include references to school shooting deaths or the words "being shot" or "being killed". We ended up stammering, stumbling, and not successfully conveying the point.

Many organizations have offered guidance on how to talk to little kids about tragic events and disasters, such as the American Academy of Pediatrics and the American Psychological Institution. Major news outlets regularly publish advice about talking to children specifically about school shootings (which is definitely a statement about the states of affairs in this country). Two recent articles on TODAY.com and Cnn.com are actually pretty helpful.

So, this is something we clearly need to work on, as the kids' school runs lockdown drills and the #GunControlNow, #Enough, #Gunsense, and #MomsDemandAction movements spur debate and action.

Regardless, their taking part in a massive live social change movement is a powerful lesson. We emphasized that in many other countries, citizens aren't allowed to gather and protest, that we are very lucky to have this privilege, and we have to use it.

Overall, I'm glad that we took them and that they got to see freedom of speech, political activism, public health awareness, and social altruism, all at once and in person.

Mau Man and the Chronicles of a Low Birth Weight Mama

BIRTH:

In early March, I became a mama for the second time. We have nicknamed our new little one Mau Man. Our home birth didn’t feel all magical like the pictures I see on the Internet but maybe after continued exposure to oxytocin while nursing I’ll change my story and in a few years I’ll tell you all about how magical it was (feel free to call me out on it!). It was intense and brief (he came within 3 hours but it felt like days). Similar to our natural hospital birth with our first Zo, the details are hazy and I feel traumatized. Did a human just burst forth from my body? Yup! He did. Did I feel like I would give up. Heck yeah, I felt like throwing in the towel a few times, but I didn’t. Was I scared. You bet I was! Did I feel powerful afterward? You know what, I sure did! And super tired too, just like with Zo. I feel like no matter where you deliver, birth takes over you, it takes hold of your being and you just have to submit to the intensity of the process.

LOW BIRTH WEIGHT, THE CONTEXT: Now we find ourselves with our newest little one who is healthy in every single way except he was tiny at birth. 2360 grams (or 5 pounds 3 ounces). Under the low birth weight cut off of 2500 grams. I have read countless studies of how Black women like myself, regardless of socioeconomic status, are at a higher risk of pregnancy complications, maternal and fetal mortality, preterm labor and low birth weight. At my Baby Sprinkle a few months ago, a group of my closest friends and I spent considerable time discussing this topic. Pretty morbid but we are all Black doctors, educators, and health care professionals. But somehow I thought, I would be insulated, I would be spared. I took my vitamins, exercised, meditated, saw a chiropractor twice a week. With all of the complications and losses friends and patients have had I realize that low birth weight is manageable but it still hurts. After our own loss last year, I realize that regardless of how small he was I get to hold him and touch him and smell him and snuggle him and nurse him and I will do everything in my power to get his weight up.

LOW BIRTH WEIGHT, THE COMPLICATIONS: Flash forward to Day of Life 3. His weight loss was more than what our Pediatrician and I liked and he was at risk of hypoglycemia and dehydration. He had a good latch but he just couldn’t muster up enough energy to transfer milk out of my breasts fast enough to grow. I had to start nursing and feeding him every 1.5 hours and start pumping several times a day to provide expressed milk to supplement him with. We worked with an amazing local Lactation Consultant friend first at our home and then in her office and started using a Supplemental Nursing System or SNS. This is a little tube that you attach to a syringe to feed babies at the breast or using a finger to help train them. This helps prevent nipple confusion by delaying the introduction of a bottle. Day of Life 4 was a blur with a ton of feeding and pumping. Day of Life 5 - he had begun to gain weight and his parents were exhausted. We were allowed to space him out to every 2 hour feeds. Day of Life 9 back to birth weight. Day of life 18 weight up to 6 pounds.

And this is where we find ourselves: Nurse and reposition the SNS 10 times. Pump. O finger feeds with SNS in the early evening so that I can sleep for a few hours (this is priceless! Many thanks to Lactation and our old school Pediatrician who made this a key part of our process). Smile. Cry. Have a melt down feeling guilty that I couldn’t make him fatter. Listen to a podcast. Take a lactation supplement. Play with Zo for a few minutes. Tell Zo to be gentle and not climb on me while I’m nursing. Get a pep talk from the hubby. Repeat.

I’ll keep you posted and can’t wait until I can throw this SNS out. I pray for the day he is exclusively breast fed and that breastfeeding soothes him.

My world at night: our 30mL  syringe, the SNS premature baby feeding tube, my 2 pumps - my Spectra electric pump for daytime pumping and my NatureBond silicone manual suction pump for easy night time pumping - I pop it on the alternate breast while nursing/SNS feeding. 

REFERENCES:

Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. https://www.ncbi.nlm.nih.gov/pubmed/21213184

Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It. https://www.propublica.org/article/black-women-disproportionately-suffer-complications-of-pregnancy-and-childbirth-lets-talk-about-it

Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206968/

What’s Killing America’s Black Infants? Racism is fueling a national health crisis. https://www.thenation.com/article/whats-killing-americas-black-infants/

Mommy time/ whenever I can get it

How do you fit your "mommy time" in?

I love residency. I love what I do, love my work colleagues, and am so thankful for my attendings and program director. I could not have imagined a more supportive community. 

One thing I'm grappling with right now is keeping any sort of structure for my kids when I am at home. When I am at work, the house runs like clockwork. My husband gets them to school on time, the nanny has them fed, brushed, bathed, and in bed by 7:30. No fuss, no problem. 

But when I'm around, it's chaos. And not the controlled choreographed chaos of the ED. It's pure, unpredictable, chaos. For example, this morning, all before getting to school by 845 (very late- they start 745), my daughter "ran away" from home down the block, the kids put on a puppet show, everyone ate pancakes, and only then did we start getting ready for school. 

As an EM resident, my schedule is varied. I work a lot of later day shifts (10-10) or mid shifts (2-2) and at least 2 full weekends a month. I usually average about 1 dinner/bedtime/bathtime home a week. During that night, we try to fit in all the homework for the week, I try to hear all the stories about their friends, cuddle time, book time, story time, song time, just-be-with-mommy time. Needlessly to say, bedtime gets substantially pushed off. On the mornings when I'm home before shift, I'm usually exhausted, but, as I have not seen them for 2 or 3 nights already, we morning cuddle, make pancakes, read books, play dress up, etc. Trying to fit all this "mommy" time into the 1 hour or so between wake up and school is impossible. So we are late. Consistently. 

I know that once they are older, getting to school on time will be more important, but it's been a challenge to balance between maximizing every second I get to be home with them with sticking to a routine. Some days are better than others, but I'd love any tips! 

How do you maximize quality time when you don't have the quantity time to give? How do you balance discipline/structure with just enjoying their company?

Financial Wellness?

Do you know how social security works? Are you maximizing contributions to your retirement accounts? Have you ever heard of a 529 account, or a backdoor Roth IRA?

I combed the archives of this blog, and while there are a smattering of posts on money and costs of being in the field of medicine, I didn't see much about money management and financial planning. It's not a topic people commonly like to discuss, and yet it's so important to our overall well being. Physicians are notoriously horrible at managing money, and yet many in our profession shoulder a huge debt burden, one that can amount to hundreds of thousands of dollars by the time all the training is over. And at that point, the last thing most people want to do is continue "living like a resident", so they commence with lifestyle inflation and remedies for their delayed gratification.

                             

Last weekend I had the pleasure and opportunity to attend the first Physician Wellness and Financial Literacy Conference, aka the White Coat Investor Conference. It took place in beautiful Park City, UT with two days of CME talks, broken up by mid-day skiing time. The conference featured valuable information presented by physician experts in the areas of finance, financial independence, and burnout, along with some financial professionals (who did not have an interest in charging huge fees to physicians for their services, an issue common to many physician-targeted financial advisors). There was even a talk by one of the only female physician financial bloggers, Miss Bonnie MD, who also happens to run the very active informational goldmine Women Physicians Personal Finance Facebook group.

On day two of the conference, I represented both PracticeBalance.com and Mothers in Medicine on a panel of six bloggers for a Q&A session. Despite being the only blogger there who does not primarily blog about finance, it was a lively discussion with lots of inquisitive attendees. It left me with inspiration to blog more, and blog more about financial issues that I deal with!

Over the course of the weekend, I met so many inspiring people - especially women - who are taking control of their finances so as to not become an "underwater doctor" statistic. We often say in my household that debt = slavery, and that sense of lost control is what often leads to burnout for many professionals. While debt is for most people unavoidable on some level during medical training, we physicians have the power to manage it and at the same time plan sensibly for the future. I felt so much more empowered after attending this conference, and I highly recommend that you all check it out the next time it comes around. At the very least, take a look at the blogs (linked above) by the White Coat Investor, Physician on Fire, and Miss Bonnie MD. They are a great starting point on the path to proactively managing your money.

Adventures in Pumping

Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

Are residents worse post-pregnancy?

This is an interesting article about how peer evaluations of female residents go down after pregnancy, while evaluations of men who have children during residency do not go down.

I was wondering why this might be the case. I thought of a few possibilities:

1) resentment towards pregnant residents who took a leave and everyone had to do extra work to cover. I wonder how evaluations might be affected in other residents who took leave for other reasons. Of course, people generally think of pregnancy as “a choice“ so leaves for other medical reasons might be looked at more sympathetically.

2) performance may actually decline after having a baby. I don’t know about you, but if I am awake breast-feeding two or three times per night, I’m probably not going to perform at the same level as I was when I was well rested. Also, once you have a baby, no matter how good your support system is, you’re still somewhat at the mercy of your child’s health. Even if you have someone to watch them when they are sick, you probably aren’t going to be able to work when you are actively vomiting from the G.I. bug that they gave you. (I tried.  I was sent home.) again, this is something where man should theoretically be affected as much as women, but there is probably more of a tendency for men who decide to have a baby during residency to have a spouse with a more flexible career. And also, they don’t have to breast-feed.

3) Other residents might not take you as seriously when you become a parent. They may feel your priorities are shifted, even if that’s not actually the case.

What do you think?  If you had a baby during residency, do you think it changed what the other residents thought of you? Did you change your opinion of female residents that you worked with after they had a baby?

My almost-teen

“I saw J do the reading the other day at church, and at first, I thought it was you. She is becoming a young lady,” Maureen said to me on the sidelines of a soccer game.

My daughter is 12, soon to be 13, but has recently passed me in height. She is never far from a book – goes through them like that – and can’t help but blurt out her responses and reactions to the plot twists in real time to anyone around. “Anna betrayed her!” “I can’t believe he did that! They have the twins!”

She confides in me still, and each time we are there with the door closed to her room, and I am consulted in critical matters of friendship or fashion decisions, I try to proceed gently as if I’ve been let in to a secret society and don’t want to blow my cover. She recently cried into my arms over a friendship disappointment. I felt the same mixture of calm, responsibility, and honor I feel to be let into that moment as I do when a medical student starts crying in my office in my role as a student affairs dean. Or when a patient breaks down in front of me under the weight of a diagnosis.

She started taking martial arts recently since she wanted to learn self-defense. We found a low-key place that offers all types of classes for kids and adults. She does the kids Muay Thai and immediately following is the self-defense class for ages 13 and up; they allowed her to trial it to see how she would do. She texted me before the self-defense class and wrote “I don’t think I’ll do it,” and inserted a chicken emoji. I called her immediately. There were adults and older teenagers taking the class and she felt very intimidated.

“You should do it,” I said.
“But I’m scared.”
“Just try it! I can’t pick you up until after the class anyway.”
“Okay…” she said reluctantly.

I came to pick her up ten minutes before the end of the class and sat down on the viewing benches in the waiting room. There she was, practicing with her partner, a woman in her 30s in a pink hoodie. She was there among older teens and men and women—she seemed so grown up! She was clearly comfortable, holding her own, and loving it. The group huddled in closure and then started clapping and looking at J. She practically skipped out to me at the end of the class, face aglow.

“I want to come twice a week to this from now on. I’m thinking it might be hard in the fall with my two soccer teams, but I want to figure a way to do it!” She was breathless with excitement. “Can we get the gear? I’ll need the punching gloves and shin guards.”

My almost-teen is growing up. I love that she allows me to be there for her. Mothering now is more coaching, guiding, discussing. It’s confiding and listening. It seems like just yesterday she was an exuberant 3-year old who loved Dora the Explorer and would grab my keys, throw them under the couch and say, “Swiper, no swiping!”

I’m amazed by the person – the woman- she’s becoming. She is still that exuberant child, but now with a playful sarcasm, insight, a deepened faith, and strong sense of morality. I’m navigating my new role: sensing, adjusting, responding, and still gently pushing her to keep growing.

We’re both growing, and I wonder how long I'll be a secret society member. Is it life long? Since that seems pretty amazing.

Going part-time

I have been a little MIA here since I've joined the chaos that is being an attending!

I was once told that the first year of being an attending would be the hardest. That is quite the understatement.

I was going through so many changes this past summer. I moved out of San Diego, a place that has been home for 14 years. I joined my husband in Los Angeles and after 2 years of long distance, we are finally under the same roof! Little C started her new school. It was basically a lot of change. It was all good but with any transition, it is never smooth sailing.

Fortunately, all that stuff mentioned above went pretty smooth. Kids are so resilient. Little C had a best friend by week 2 and by the second month, she was completely adjusted. It is definitely nice seeing my husband's face in person and not via FaceTime! But it turned out, the hardest transition was my new role as an attending.

I joined a private group. I remember posting on this website about what to ask in a job interview. To sum it up, I was way too excited that I was actually getting a job that I forgot majority of the advice given to me and signed a contract without really knowing what I was getting myself into. I had a sense of what the group would be like but I went along with their assumption that as my first year out of training that I would want to jump right in, make a lot of money and be on the full-time schedule, which included a lot of weekend call and evening shifts.

Initially, it didn't seem horrible compared to residency and fellowship. But my biggest dilemma now was how do I juggle being an attending and a mom without my own mom? My mom has been more than a grandma the past 4.5 years since little C was born. She was her primary caregiver for 2.5 years and the following 2 years of my long distance with my husband, she was available for every single sick day, call, evening shifts and weekend obligations. But I wanted to hold true to my promise that she would be a grandma once I became an attending. I think I really burnt her out the past almost 5 years and I think it was starting to put a dent in our relationship so this was new territory for me.

I found an incredible nanny to help with picks ups and drop offs but I was often very frustrated as to why I was working this hard and still not getting the work life balance that I thought I would ultimately have once I became an attending. I grew very unhappy, bottled it all up inside and did something I never thought I would do.

I quit.

But the most surprising twist of all was that my resignation wasn't taken and instead I was asked what would be my ideal schedule. I was shocked. I didn't expect such encouragement and flexibility. It took some convincing because I didn't think I deserved this kind of special treatment being so fresh out of training but it turns out, there were many people in the group who had different contracts that accommodated their lifestyles.

I thought I would let the group down if I didn't work the regular full-time schedule. I thought I was selfish asking to be taken out of the call pool and to only work from the hours of 8-5. But trying to quit ended up being the best decision ever. I got my dream schedule. I finally have time to work out for the first time in 5 years. I have the luxury of dropping off and picking up little C from school on Tuesdays and Thursdays. And the idea of second child is exciting now, rather than terrifying!

I feel like I can finally breathe now after 6 years of holding my breath and just trying to survive during residency and fellowship. I finally did it. I got my work-life balance. It's never perfect but I can work with this. So my take away lesson from all of this is don't be scared to ask for what you want, preferably without having to go through an almost resignation like myself!

The MiM Book is out!

Available through Springer, Amazon, and Google Play

We are thrilled to announce that our MiM book "Mothers in Medicine: Career, Practice and Life Lessons Learned" is out! Written in the same conversational style of the blog, our authors address issues such as having children during training, practice considerations for the mother in medicine, negotiation skills, work-life integration, and challenges including divorce, financial hardship, and infertility, and more. We capture some of the wisdom "gold" mined from the blog over the past 9 years. We hope this can serve as a valuable guide for women at all stages of their career: from the premedical student wondering if she should go to medical school, to the practicing physician looking for support in balancing their multiple roles.

Chapter authors include MiM contributors T, Cutter, Genmedmom, Fizzy, Jay, m, Gizabeth, PracticeBalance, Emeducatormom, and Beckster. We also were fortunate to have authors with expertise in their areas write other chapters (e.g. an amazing student affairs dean writing with one of her former students, a thoughtful internist who chose to leave her job, private practice partners who learned to negotiate the hard way). Physician writer mom Danielle Ofri writes a lovely Foreword.

Sprinkled throughout the chapters, we feature blog excerpts and comments - some of you faithful readers and commenters might find your comment included! You all helped make this book a reality. Thanks, as always, for being part of our community.

Happy reading!

*Springer, our publisher, has offered a 30% discount through a discount flyer that you can access through the tab "The Book" above. (They don't do discount codes apparently.) The discount is good through June 1, 2018.