Intern Year Recap

Intern Year Recap

As my kids end school and I start power- reading to get ready to be a 2nd year resident, I want to take a chance to recap this crazy roller coaster/ transformative/ at times impossible/ at time inspirational year.

Top 10 ways to rock intern year.

1. Make friends with your co interns. Your nurses. Your seniors. Basically, anyone in the hospital. It is the place where you will spend the bulk of your time, so having people you look forward to seeing, talking to, working with, will make the tedious hours go by shorter, the hard times a bit easier, and the terrible days a little less terrible. You may even have fun.

2. If you ever are doubting your abilities, teach something, anything, to a medical student. You will be amazed at how much you actually do know. You will help them learn something. And you will feel like a better, kinder, and more capable person for it. Teaching also helps solidify information, so if there is something you struggled to know the day before, teach it to a medical student today. Believe me, it is a huge ego boost and a way to help out someone who will one day be your colleague.

3. DO NOT LIE. If you didn't order a test, or do a complete exam, or replete lytes, or order an antibiotic, DO NOT LIE. Just be honest. Admit mistakes, and work to correct them.

4. Invest in really comfortable shoes. I wore worn out tennis shoes for 6 months and my feet ached. every. single. day. When I finally bought a better pair of supportive, soft, arch-supporting shoes, I felt 100 times better at the end of a shift.

5. Check in with yourself. At some point, I realized that I (a little curvy to begin with) had gained 10 pounds during my first 6 months of residency. Check in. Run, Exercise, Eat right. Come up with a plan. Bring lunch instead of ordering in or buying cafeteria food. Skip the muffin at the free breakfast. The past month I have been committing to 2BMindset (on the Beachbody website) and I lost those 10 pounds. It was a lot of effort and commitment, but I feel better, healthier, and am inspired to keep on a weight loss track to lose the rest of the "curvy" that still has me 20 pounds over my pre-baby weight.

6. Find something you love and make time for it. I love cooking. I stalk instagram food bloggers, hoard too many cookbooks, and screenshot recipes compulsively. Cooking gives me a creative outlet and also lets me feed myself and my family in a healthy, affordable way. Having an outlet outside of the hospital is essential for your wellbeing.

7. Drink water. Being dehydrated is awful.

8. Remember your "Real life" friends. There was  period of time where I had not spoken to my best friends (non medical, live in a different state) in over 2 months. I missed the birth of their babies, kids' birthday parties, their birthdays. I felt terrible and lonely. I just wanted to go home and give up. Luckily, face time and whatsapp goes a long way and I was able to realize why I felt so lonely and make an effort to reach out. Don't forget those who loved you and supported you along the way.

9. If you have a significant other/partner remember them. Try not to come home so utterly depleted that you have "no nice left to give." Your relationship deserves it.

10. Make every day a learning day. and try to end every day with positive thinking.  When you get home, think about 1 thing you learned. Think about 1 thing that made you happy. Think about 1 think you are excited to do tomorrow. (Bonus: think of 1 thing you did to make someone ELSE happy.) Thinking positively and productively will help you sleep better and be happier overall.


* Bonus- remember that your kids will think you are the coolest person ever no matter what. Love them unconditionally, the way they love you. If you only have energy to cuddle in bed, then do that. They don't care if laundry isn't done. One thing I learned this year is that my kids are freakin awesome. Resilient. SO. Much. Fun. Way more social than I am. Adaptable. And as much as I feel like I am never home, they have taught me to appreciate the time that I am.

Off to Year 2!

Reasons to Wear Lipstick.

It's a peculiar thing being a single mom, 30, and a first year medical student. At the med school parties, I'm 8 years older than everyone. In the hospital, I'm 8 years behind on my training than physicians my own age. At my kid's daycare, I am that parent that hasn't a clue it was my turn to pay for pizza Friday, or it's the teachers birthday. The other non-traditional parents in my class live with supportive spouses, so it is hard to fully relate to anyone. I like the uniqueness of my life, and on multiple occasions do classmates and strangers tell me how inspiring I am. But, I also admit it is quite lonely.  I moved into a new apartment with my 2 and 3 year-old last year. It was the first time I had to live alone with two toddlers. My life was study, change diapers, study, take the kids to beach, study, clean, study, yell at toddlers to stop drawling on the walls, study... It was a crazy adjustment, but I rocked it, mostly, after I found a good balance between those two heavy identities of mum and med student. (Finding that balance took a lot of tears, complete break downs, sleepless nights, fits of being woken by crying toddlers at 4am before a final, lots of use of a babysitter etc. etc). After three months of nothing but late night study sessions in the library, alternating with being Mom, I wanted an escape. Something fun. Something easy. Something to take my mind off of my chaotic life and make me feel like a normal human again. So I got on Tinder. Yes, that awful addicting dating app/hook up site for people like me who are incapable of meeting someone the old fashion way through mutual friends or some serendipitous moment in a coffee shop. The swiping happened, the chatting started, and the harmless fun of it was a light and easy way to wind down at the end of the night. Like how normal people watch TV, I ask completely random attractive men about their lives. I finally got ballsy enough to meet these completely random attractive men in real life. Of course only on weekends after tests when I didn't have to study as much. My basic day to day attire was messy bun and yoga pants, so it was so nice to wear real clothes again! I went Salsa dancing on the beach with a CT surgeon, played board games at a bar with a teacher, picnicked by the water with wine and a book with an IT guy, watched a play with a lawyer, drank more wine and watched the sunset with a pediatrician. It had been 5 years since I dated, and the timing of course is terrible as being a mom and med student makes an impossible girlfriend. But the experience, fun, and connections are just what I need to take me out of my diaper/molecular biology bubble.

Turns out some of my classmates are also on Tinder, so now study breaks consist of swiping and comparing baes (yes I started saying bae, I hang out with 22 year olds). Definitely no Mr. Right in the near future, but I will update y'all if anything crazy happens. Not crazy like the time my date showed up hammered after 5 shots of Whiskey. Just hoping for more wine, sunsets, good conversations, and a reason to wear lipstick.

What are y'alls reasons to wear lipstick?

Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.

Health

This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?

On Well-being

Physician burnout and mental health have been on my mind lately. Considering the many articles I’ve read recently on these topics, I’m sure it’s been on your mind too. I’m part of an initiative at my organization to address physician burnout and improve wellness among staff, both at the individual and systemic levels. I find this recent article on Kevin MD an interesting idea. Given all the metrics we tailor our system to based on patient care, safety and satisfaction, it’s an innovative twist to ask that our wellness, or lack thereof, be a goal marker as well.

Ultimately, our well-being affects how well we care for our patients and even their outcomes. The cynical part of me thinks the only way we can really get our healthcare system to change and address the epidemic of physician burnout is to tie those levels to dollar signs. There is a strong argument for the financial benefits of physician wellness and many organizations seem to be acknowledging that reality and investing more in this issue.

As mothers and physicians we’re used to putting others’ needs before our own. But I’ve realized over the years that I’m a better caregiver - to my children and to my patients - when I’m practicing good self-care. In the world of healthcare though, systems need to be in place to support that ability.

What are your thoughts? What has been successful or not so successful at your organization? Has your workplace found ways to encourage not only personal resilience but also support an organizational culture of wellness?

Here's to 10! Book Giveaway and Call for Contributors

It's hard to believe, but this month marks Mother in Medicine's 10th birthday.

Here's 10 reasons to celebrate with us:

1) Over 1500 published posts with the top all-time pageviews going to

• Day in the Life of a Neurosurgeon - SERIOUSLY? -by GCS15
• Why you absolutely need to have a baby during residency  - by Fizzy
• 10 Guidelines for Work-Life Balance - by FreshMD
• A day in the life of a part-time medical oncologist - by Tempeh

2) 1000 comments (Yes exactly. Right now.)

3) Fabulous, fearless contributors over the years, some with us from the very beginning (See Call for Contributors below)

4) One Mothers in Medicine book! (See Giveaway below)

5) 148 Heartfelt guest posts

6) MiM Mail

7) 5.2 million pageviews and counting

8) Global audience with top countries: US, Canada, Germany, Australia, UK, Ukraine, Russia, China, France, India (in that order)

9) Topic weeks (remember Childcare? How medicine changed me? Thankful? And many more)

10) Fabulous readers (you!)


It's been a great 10 years! We are honoring the occasion with a Mothers in Medicine Book Giveaway. To enter, just send an email to mothersinmedicine@gmail.com with the subject line: MiM Book and we'll select 10 random readers to receive a copy of the book. Deadline to enter is Monday, June 4.

Annual Call for Contributors
Come write with us for a year! Each year, we open up a call for new writers to join as blog contributors. It's a chance to write, reflect and help the MiM community by sharing your stories. If interested, send an email to mothersinmedicine@gmail.com with the subject line: Call for Contributors and tell us a little about yourself and why you would like to contribute. Deadline is Monday, June 4.

Thanks for reading, commenting, writing, sharing. Here's to 10!

Pink eye

Sick days are hard.

I'm on a tough couple of rotations coming up - I have 2 weeks of 24 hour shifts of my own, a week of nights, and another 2 weeks of 24 hour shifts I picked up for another resident's maternity leave, not to mention some 12 hour shifts in between all that. Future Kicks is going to be happy - less 24 hour shifts for next year - but presently I'm looking at the upcoming calendar and thinking....blegh.

We've been pretty lucky when it comes to Baby's health though. We've walked through the day care door for the past 4 months despite the warning signs of RSV, pneumonia, and strep and come out with multiple runny noses but nothing else. 

Yesterday he was a bit crabby but hadn't slept much and was. not. having. the peas we were trying to introduce. I thought he had a booger in his eye, but didn't think much of it as he pretty much has boogers everywhere all the time. However, this morning one of his eyes was matted shut and it took multiple wipes to get the goo off. Was it pink? I thought so, but the lighting in our house isn't great so I couldn't be sure. I just kept staring at him for a few minutes trying to decide. It definitely wasn't clear cut pinkeye but I wasn't sure. 

I took a minute to evaluate the week's schedule. It was about 6:15. I had a meeting at 7:30 with my PD, I was the walk in clinic resident this AM, and I had block ed this afternoon. Nothing that couldn't be rescheduled or easy to fill. Tomorrow and the next day were 12 hour shifts at the hospital that could be much harder to fill and impossible to leave mid-shift. I knew I had two options and I had to make the choice quick.

1) Take him to daycare and roll the dice that it wouldn't get more pink. 

2) Call in sick today even though it was a soft call on pink eye with the hope of nipping it in the bud today and having a doctor's note to return to daycare tomorrow

I opted for #2 because it's much more difficult to leave mid-clinic shift than to not go in at all. Took him in right away this AM. Of course under the bright lights of the office, those eyes looked clean and white. The FP there recommended I stay home with him today and gave me a note saying safe to go back to daycare tomorrow. 

Now I'm home. I feel really guilty about calling into work, but trying not to. The meeting will be easy to reschedule, it's generally easy to fill walk in clinic, and the only one who loses if I miss out on block education is me. I still think I made the right choice and I am going to finish out the day at home (doctor's orders as above :)) 

I'm reflecting today on how utterly hopeless it is to try and schedule a sick day. 

I also feel somewhat stupid for bringing him in to clinic. After all, I am a family doctor who diagnoses pink eye in kids all the time. As soon as I brought him in, I knew that his eyes would be clean. I remember looking at him on the table early this morning thinking "I am a mother-effing doctor. How am I not able to tell if it's pink eye or not?". I've read about the fallacies of trying to diagnose your own kid and the scary stories of doctor parents never bringing their kids in, so I'm probably overcompensating the other way. 

How do you guys feel about bringing your kiddos into the doctor? Do you think you do it too much or not enough?

In the end - I'm going to enjoy our day off together, put the guilt aside, and rejoice that it's not pinkeye (yet). 

Supporting parent learners in medicine

I recently put together a panel for the AAMC Continuum Connections conference (a joint meeting of student affairs, GME, medical students, and residents) on Supporting Parent Learners Throughout the Continuum. The goal was to discuss the unique needs of our parent learners, identify gaps in support, and share best practices. We had a fantastic panel including a medical student dad, an OB/GYN fellow mom, a student affairs dean, and a former PD/central GME leader.

The 1 hour 15 minute session was clearly not enough time. We could have filled 2 days with the discussion. I loved that so many people had chosen to come and think about these issues and the panelists' personal experience and perspectives were insightful. 

Some key areas that were brought up:

• communities of support for parent learners to connect with each other
• childcare
• stigma/bias
• parental leave
• breastfeeding (particularly with regards to culture/time and certain rotations)
• parental leave

One institution holds spots in a local daycare for incoming PGY-1s since the process can take so long and there can be too little time to secure ones after Match Day. Love this idea. One school holds a welcoming event for medical student parents and their families to get to know each other right from orientation.

And I shared the upcoming event at my house: babysitting for medical student parents so they could have a nice night out together --Parents' Night Out. It was so difficult for my husband and me to share any alone time without a baby on our lap, and it's expensive to hire babysitters, so I wanted to give our student parents some wellness. 

We had it this past weekend and it was a ton of fun. Students dropped off their kids at our house and I had a small crew of student volunteers who wanted to help. There were five kids total, ages 3 months to 3 years old. We adults outnumbered them -which turned out to be a very helpful ratio to trade-off and allow helpers to eat and take a break. I loved loved loved seeing our medical student parents and their kids. When one couple came to drop-off wearing nice going out clothes and mentioned it was their first date since the baby was born, I think my heart grew two sizes. I also enjoyed getting to know the students who volunteered their time to help on a Saturday night.

At the AAMC panel, the former PD/central GME speaker said to the audience: to the younger generations, I'm sorry my generation could not figure it out (in terms of parental leave). It's still an issue after all of these years. But, what I would add to that is that we have certainly made progress. More of us are thinking about how to support our parent learners better, as well as all of our learners. Just having a dedicated session to that during a conference is a start.

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/