WHEW

Happy Friday (mine anyway). I made it. We all made it. I'm off the next 5 days, but will be coming in to get updates from Amy and to finish of some cases. Attack that admin pile. Dust.

I asked Tina to put in a work order for Don - I'd seen him in the hall this morning while I was running to a needle in CT 4. It's the last to do decorate wise except to find a sweeping large piece of art to put in front of me in the left. That will be fun to look for. So anyway, Don, a handyman with much raw and emotional intelligence, we've known each other for six years and he did projects in my other office. He was worrying about his younger wife needing surgery - luckily not anything dire or life threatening just aging necessitates that things sag and droop. Especially on women who carry a lot of babies - they get uterine prolapse sooner. Don suggested something I hadn't thought to do - put the diplomas in chronological order of my time as an SP Fellow, AP/CP resident tenures, Chief Resident cert. and finally a fellow in cytopath. A square of four rectangles. A small sum of my past, my climb to get here.

At the end of the day I went downstairs to get more snacks and drinks from the Dr. Lounge - I'm sharing a bit with the admin assistants we made a little basket in the main area so they don't have to bug me to get a treat. Hopefully the camera that is installed to watch the doctors (I saw the Eye) and curb bad behavior will think, WOW. That girl is working out so much she can eat anything she wants and needs more to sustain her these days.There weren't enough barbecue chips left (homemade in a bowl with tongs) so I looked over at the hot food that was currently being broken down for the 3:00 lockdown. Chicken Fried Chicken. I hadn't eaten that since I was still dating my husband. I got some honey mustard sauce and put it in a styrofoam container (sorry, I'll reuse the next one). Forgetting utensils and being too hungry to wait, I ate it joyfully with my hands while releasing cases. Taking care to prevent the keyboard from getting grease on it.

Writing this blog is like an after dinner cigarette, like the ones I so brazenly enjoyed in front of everyone when I was in college and dating my first husband. We were both young and foolish then. When I started medical school I cut way back on that, and tried not to use it unless I really needed it. I try not to fault the close ones in my life their oral fixation blankets anymore either. My husband chews gum all day but oh god his breath always smells so good. I used to chew a lot of gum but after my jaw broke that didn't feel the same anymore. So now I'm addicted to altoids. And I just got some new Coconut Lime Velamints that are like a Pina Colada on a hot summer's day. That doesn't sound so good with the Cherry Coke Zero, so I'll wait until I'm done with that.

See, we are all perfect, and not so perfect in different areas of our lives so we need to cut each other all a little slack. Give ourselves grace, a pat on the back for a job well done, in parenting and in our work and our creative pursuit. Signing off with much love, E

*cross posted at my blog, www.gizabethshyder.blogspot.com. I need to relearn linking. Just did.

Coming Out of the Dark

Happy Monday - it's my Thursday I'm so excited. And I'm about done with this day.

Weekend was kind of crazy but talking to my husband and Alyssa helped me get through it. And I'm glad because I've got to support another friend this afternoon and evening.

So last Friday we were working  on some alternate means of testing. We didn't know we were getting 42 test kits and the clinicians will want to get back to doing surgeries ASAP. So we ran a couple of courier routes to a lab in Joplin and a lab in Memphis - American Esoteric Laboratories (What a great name!). Now we are no longer using Viracor - we are using AEL. We can get more than one courier up there to decrease the turn around time, and like that we are bringing the work more locally.

Friday at lunch I was commiserating about something going on with me all day - hot flashes. I asked a group of women "Do you think it could be menopause?" One micro tech said it sounded like what she experienced, another said that if you go to a male OB they will offer an antidepressant. "Oh that's freaking rich! I cannot believe it, but I can. Not that there is anything wrong with antidepressants, but to give a blanket offer, ugh." I wondered if prostate docs offered antidepressants with their prostate checks. Probably not.

The other day I went to a bathroom down by the cafeteria - hadn't been there  in a while. It is a four staller. Went to the handicapped bathroom stall. This place was usually so full it was weird having it to myself. Mid stream the lights went out. It was terrifying, to be caught in the dark with my pants down. I calmed myself down quickly - these were probably on motion detectors and I could get out of my predicament if I just moved, so I did, and I was right. Little did I know it was a premonition, but we are coming out of the woods now.

Jack won an award today! He is so happy. The 8th graders take these state-wide exams - I remember C got number one on Spanish. I was so confused - "Number one at your school hon?" "No mom, the state." "Wow." Now Jack has won the mythology award, and he didn't even have to study. I told him, "That's how it is with your passion. You could be an academic and study mythology and teach." But mom, cooking is my other passion, and I still might want to be a doctor I'm not sure." "Well you could talk to Uncle Mike and Aunt Effie. And there is this cool series on Netflix that S and I watched a little while back about the chefs with Michelin Stars, and about their journeys that would be good for you to watch. What a great mash up - cooking and mythology. I'm outta here. Much love, E

*Double posted at my blog www.gizabethshyder@gmail.com

What's Going on With You in the Pandemic

I've been blogging for about 2 weeks now. You can follow that at my blog - www. gizabethshyder.blogspot.com.

I'll continue to blog here. More tomorrow.

I've learned a lot from my close Dr. friends in LR about how different specialties are handling this crisis. I want to know more.

Please revive this blog and talk to me. This is a dear space to me. All you beautiful ladies must need an outlet, as I do, in these crazy times.

If you need to reach me, I'm at my personal e-mail - gizabethshyder@gmail.com. It's only accessible to me.

Wax eloquent. Much love. E

Quarantine Questions with a 4 Year Old

(Blubbering) "But WHY can't I go play with Sarah??"

The extent of our current outdoor adventures

How's everyone doing in the era of COVID and shelter-in-place? I, for one, am having a difficult time parenting my 4 year old daughter. Overall, I can't complain; we're happy together as a family, and we're all healthy. Despite changes in work volume, we're secure. Finding ways to balance our time with her needs, as well as physical exercise for all, is going alright. But explaining complex concepts to a 4 year old has been... challenging.

Being that she's 4, her world is pretty small. We've talked about the virus. Why our travel plans for the end of my sabbatical from academic anesthesia have been cancelled. Why Nana and Papa can't come visit this spring. Why we can't go to our gym or her gymnastic classes. Why only Mommy or Daddy goes to the store when we need things. But even a month into staying at home, she doesn't quite get why she can't play with other kids.

It's been easy with friends she's made through her preschool classes, since they're just not nearby. But little friends in our neighborhood are another story. We're in a condo complex, and for the most part, people are doing their best to remain active but socially distant. Dog walkers shift to the other sidewalk when passing. People wave hello, some wearing masks and some not. And as with any neighborhood, there are a few odd ducks. With kids.

Of the similar-aged children in the complex, I've seen the spectrum of parenting styles... made fully obvious now that everyone's home all the time. There's the child who's outside all the time, garage door open and toys strewn about the driveway. She's scootering up and down the roads, calling out for other children. She's wearing her pajamas and eating candy, all day. Mom is young and single, but three other men seem to be living in the home as well. Cigarette smoke wafts from the windows. On the flip side, there's the child who parts the drawn blinds and peers out the window longingly as we take our multiple daily walks. Her parents keep the house dark and quiet. Despite our previous evening chats and child exchanges, I haven't seen any of them outside for weeks - only glimpses of their silhouettes at the dining table when passing by.

My child desperately wants to play with both of these kids. The one is unavailable for even a distant hello. The other is too available. And the "family" is too tricky... When she asks why she can't see the one friend, or why I won't let her play with the other, I have a hard time coming up with what to say.

We definitely believe in authoritative vs. authoritarian parenting. I never want to say "because I said so" as a response to "why". At the same time, I want her to understand that we prescribe the boundaries. So I guess what I'm wondering is, how do I talk about these decidedly complex issues? Mamas of older kids, what have you done? What would you do differently if you could go back?

Guest post: Maternal Awakenings

I always wanted to be a perfect mother and was naïve enough to think she existed. There was so much that I did not know when I became a mother at age thirty-four, so many things to learn as I went along. My husband and I decided to have children soon after our marriage in August 1983. David was born in October 1984, Anne in June 1987, and Laura in February 1991. During the first seven of my mothering years, we lived in a small two-story house in a quiet, mixed Houston neighborhood in the Montrose area along with other yuppie families, several gay couples, and nearby apartments which housed middle-income Hispanic families. A modest, shady park with a playground was located nearby. My husband and I were busy with work those first years, but also dealt with many unexpected childhood issues. There were breastfeeding challenges and night terrors, toilet training, early discipline and temper tantrums to manage. Later there came embarrassing, immature and impulsive behaviors in kindergarten and grade school. We tried our best to sort through all our children’s needs and issues.

We did not ask our parents what they thought; after all, we were smart, educated doctors. I did not plan to pattern my mothering after my own mother. I wanted to be involved with my children’s lives, to protect, and encourage them. I was extremely lucky to have married another pediatrician. He was always calm when things went awry but did not seem as hungry for knowledge as me. I consumed stacks of books written by experts on child behavior and child development. (Thank goodness there was no internet back then, or I would be addicted.) I needed to know if all the things I observed with my children were normal. Surprisingly, there were several childhood conditions that I had neither encountered nor learned about in my own pediatric training.

Understanding why young mothers, including me, knew so little about breastfeeding was simple. The generation before us had not breastfed, as a rule, hence they were unable to inform us of the correct ways to go about it and could not support us through our breastfeeding problems. They fed formula to their infants, so it was natural, when anything went wrong, for them to say, “Why you don’t just feed him/her some formula?” My mother had a theory that David would sleep through the night at six weeks of age once she fed him a large bottle of formula. One evening, after we returned home from a date night, she had been babysitting and happily announced “He took a full bottle.” David woke up three hours later, around 2am, as usual. Sadly, he busted her theory; moreover, he didn’t sleep through the night for three more weeks. My mother did not know that sleeping through the night is a brain-thing and not a hunger-thing. A few days later, I asked my husband to hint that my mother refrain from giving me any breastfeeding advice. I remember thinking about returning to work when my newborn son was six or eight weeks old. I distinctly remember being bored. I loved caring for him, holding, rocking, and nursing him, but there was no challenge, no thought process there. About six weeks after her daughter was born, my older daughter mentioned to me that she wanted to return to her work as a nurse in the Pediatric ICU. She wondered if that was a bad thing. I tried to reassure her as I recollected how lots of working moms would rather work than stay home full-time with babies. Maybe it’s an activity thing. Maybe it’s maternal style. Some women clearly crave satisfaction and success. Your personality type may play a role: Extroverted thinkers (as opposed to introverted feelers) tend not to stay-at-home. Some of us are just not meant to be stay-at-home mothers.

I never entered the field of medicine to work part-time. The training had been too long and arduous. Besides, I loved being a doctor. Medicine gave me a huge sense of contentment and competence. My mother had worked full-time as an elementary school librarian. In addition, she was away from home quite often doing church-related volunteer work. Back in the 1950’s, when I was growing up, mothers did not hover over their children. They certainly did not go to all their school and sporting events; at least mine didn’t. As a result, I learned independence from an early age.

Likewise, our parents had disciplined us in different ways than we planned to discipline our own children. Parents were more authoritative in the 1950s and 1960s. The other neighborhood mothers would contact your mother if you acted up in their yard or home. My parents were very strict disciplinarians. “Because I said so” was heard often, and Daddy’s rules were set without discussion. Mother went along but left the punishments to my father. My husband’s father had acted similarly in his family—he used physical punishment. Phillip and I discussed discipline, and we planned to be more lenient parents. From the outset, we both cared more about our children’s self-esteem than setting limits or strict discipline.

I recognize now that there is no such thing as a “supermom” even though we were told that she existed in the 1980’s and 1990’s. Working mothers were expected to do it all. Even TV commercials told us to “bring home the bacon and fry it up in a pan.” In fact, most of us young working mothers voluntarily chose to “do it all.” What they did not tell us was that both work and mothering were daunting, and each in different ways. They did not tell us that our children would need things from us at the most inopportune times, usually the same time that work did. I spent the first ten years of my own motherhood experience learning that there is no such thing as a “supermom.” I came to understand that I was a typical working mother—constantly trying to balance full-time work and motherhood. Sometimes things were manageable, but plenty of times everything felt totally off balance and out of whack.

There is just no way on earth that one person can be in two places at once. Maybe if you are Hermione Granger in the Prisoner of Azkaban of the Harry Potter series, but not if you are me. My favorite, yet horrible, early memory of this lesson was David’s first Mother’s Day tea held at the church preschool. He was three years old, and I was held up leaving the hospital because one of my babies took a turn for the worse. That baby needed attention. Ultimately, she needed intubation (a tube inserted into her airway), and because of my work ethic, I felt that I could not leave the situation to someone else. I paged my husband and begged him to attend the tea for me while I stayed to oversee the care and stabilization of that baby. I have the cutest picture of my husband receiving David’s hand-made Mother’s Day artwork in my stead. The art was a small, purple, left handprint inked onto cloth and Phillip is sitting in a little chair at a low, round table next to David, both drinking milk and eating a cookie. David was contented; he didn’t notice that my husband was the only father there. On the other hand, I felt miserable for days.

So, I learned early on that working mothers carry guilt. My friends all had it too. And as we compared notes on child rearing, we began to understand just how much of a trade-off working full-time actually was. I was fortunate enough to afford a stay-at-home nanny and housekeeper. We never employed a live-in helper, but lots of my doctor friends did. Without a nanny and housekeeper, I would not have been successful in practicing medicine. (The same caveat goes for my husband. When I was absent, he did everything for our children.) Mable, my elder first nanny, fussed at me when I came home around 6pm several evenings in a row. She scolded me with, “He needs you more than this.” She was probably correct, but I was busy building my academic career then. An older neonatologist, a good friend and mentor, had told me that she and her physician husband had struggled like “ships passing in the night” raising their three girls. She described one of them heading home in response to something going wrong or a sick child. And then the other one would drive home later to relieve the first one, followed by the first one returning to work. My husband and I did a pretty good rendition of “ships passing in the night” ourselves those first years.

I remember vividly one morning that David was sick with some childhood virus or ear infection. He was around two years old and had awakened with a high fever. After treating his fever and dressing for work, I called the pediatrician’s on-call service to set up an appointment. When I observed my husband straightening his tie, putting on his white coat, and heading out the front door, I said, “Wait a minute, where are you going?” He said, “I’m going to work.” I asked him “What about David, what about me?” He said, “You’ll take care of it. You always do.” He turned and walked out the door, seemingly without a care. He apparently had no guilt; he was not worried. He fully expected me to take care of everything, like I always did. This instance was my first recognition of my inability to ask for help from my husband when needed. I would continue to struggle with this and many new issues as a working mother.


Susan is a retired neonatologist, living in Austin,TX. After thirty-six years of full-time practice (fourteen in academic, and twenty-two in private practice) she is actively remembering essential moments from her medicine and mothering career, and she hopes to publish a memoir.

Should I be enjoying my bubble?

As a daughter and granddaughter of high risk loved ones, this pandemic hits close.
As a mom of elementary school kids, the homeschooling vortex hits even closer.
As a mom of a 5 week old, the unknown is just very scary.
But,
As an Emergency Medicine resident, the COVID-19 pandemic hits really hard too. Maybe even the hardest.

But yet, I'm not there. I'm not in the trenches. I'm not wearing a bandana because there are no more masks. I'm not donning and doffing. Sure, I listen to the podcasts, attend the ZOOM meetings and conferences, but with audio and video off, in pajamas, while also nursing and now virtual homeschooling, in the comfort of my home.

Friends and family reached out with different sentiments that range from " you are so lucky you are still on maternity leave" to " do you feel bad that you are missing out?" I don't know how to answer, other than "please just do your part and stay home."

I'm not sure how I feel right now. Not sure how I want to feel, honestly.  I know I want to protect my nuclear family, stay safe, and keep everyone- from husband to big kids to infant- safe and exposure free. But I'm conflicted about my residency family, my colleagues on the front line. I know I need my time to rest, recover, and take care of myself and my own family right now, but my heart is torn. I'm also scared to go back.

As a physician, we dedicate our lives to helping others, hopefully saving some lives and making a difference. Throughout our training, we sacrifice time with our families, missing out on events, celebrations, quality time. Our priorities are constantly challenged; being a mother makes those challenges at times more acute.

So many thanks, and prayers of strength to all of you out there, fighting this on the daily. Please stay safe. Please know you are appreciated.

Coronavirus and being a mother

I have a confession to make.

I don't know how stressed out to be about COVID19. I'm a chief resident, so my job is to make contingency plans and sit in on big, hospital-wide policy meetings, and field questions from residents via phone all day long, but I don't know how stressed out to be about this.

In medicine: One of my doctor friends' husband works for the CDC, and she is constantly sharing tidbits with me, such as "we should cancel noon conference, or ideally space people 6' apart from each other as social distancing. And no one should eat the food." States are cancelling international work-related travel, then international personal travel (goodbye, husband + my planned trip to Portugal to go cycling while my mother watched the kids for a few days...), and now, domestic professional travel is cancelled, while domestic personal travel is recommended to be cancelled/postponed as well.

In the world, there are two perspectives:

1) Buy more bleach. "But I already have 3 jugs of bleach at home!" Nonsense, they say - the best treatment for infection hysteria is more bleach, and $50 bottles of hand sanitizer, and flats of 16 cans of black beans from Costco. This weekend at the grocery store, they were running low on tomatoes, beans, broth... and lines were out the door.

Have you ever tried to prevent two toddlers from putting their fingers in their mouths? "Wash your hands" they say, "sing happy birthday twice," they say. I say "TAKE THAT USED GUM FROM THE PLAYGROUND SLIDE OUT OF YOUR MOUTH RIGHT NOW." My daughter licked her fingers and smiled at me the whole. way. home.

I felt like I was weighing every choice this weekend when home with the toddlers. Go to the library? The children's museum? Church? Everywhere felt like a hotbed of infection, where I'm not only risking their lives (note: COVID19 is thought to be particularly less-severe in children) but risking become a vector for those around me, and almost as importantly, risking a 2 week quarantine from my job.

2) Just go anyway. At church yesterday, I asked a bunch of mothers whether they considered not coming to church. Everyone I asked said no, and I was surprised. "Really?" I asked them, not believing, "I almost made us all stay home... even as we walked out the door." (Not to mention, I emailed the pastor mid-week and asked if we could change our communion practice to minimize multiple unwashed hands touching the same loaf of bread and risking becoming "that church where everyone got Coronavirus.").

I'm trying to balance fear and risk, anxiety and trust in the world of parenting, where all choices affect them, too. Not just if they get sick, but if I get sick, but if their school is closed, but if my job changes such that the hospital can't run. And what do we do, if there are no residents to come in, and the patients balloon? No one is talking about what it's like to work in these hospitals in China, South Korea, Italy, where patients are in lines out the doors, in courtyards getting IV fluids from bags hung up in trees.

In so many parts of parenting, you weigh risks and benefits, you try to choose trust and hope over being stressed out and anxious. You pull the used gum out of their hands, the rocks out of their mouth, and prevent them from petting a strange dog and then licking their hands (toddlers = so much licking). But when it feels like the world wants you to be anxious, when the meetings all day long fuel the anxiety, then what?

It was beautiful out tonight, sunny and gold, the last flecks of yellow hitting me through the office window over the building tops as my husband put the kids to bed (#win). And I felt this sense of hope, of possibility. Of belief that sometimes you do the thing, before you believe the thing. So maybe just going to the park, just reading them a story, just telling them how much we love them - maybe that's doing the thing, before believing the hope that we will all be okay.

Guest Post from Australia

The 5th of December 2019, a beautiful sunny Thursday and a day I will never forget.

I woke up with a feeling of I-cannot-be-bothered to go to work. I was 34+1 weeks pregnant, and although the pregnancy was textbook perfect, I just felt tired that day and did not feel like seeing any patients. I was on a fantastic rotation at a medical practice attached to the private hospital. I had a few patients booked in for the day and I knew at least one of them would be a pain. But I loved being a doctor in a chilled environment with amazing supervisors. This is the rotation I had been most looking forward to.

My DH kissed me goodbye at 740am. He was off to have an amazing day on oncology ward and was savouring his last few days on a very cruisy rotation. He told me to suck it up and go to work and I would feel better once I was there. I couldnt have any sick leave because we had timed the pregnancy perfectly to finish with internship. I had to work until 38+6 weeks to be eligible for maternity leave so I did indeed "suck it up" and put on one of my favourite flattering dresses.

I sighed as I looked at where we were currently living - a granny flat with our furniture all piled up in the corner. Just a few days before, we had moved from a rental property into our own house which we were renovating and hopefully would be done before Christmas. The granny flat was old and smelly, and I couldn't wait to move into the big house which we had painstakingly considered the fine details of the renovation.

I put the leashes on my two cavoodles, who were very ready to go to doggy daycare. Doggy daycare is on the way to work and I loved sending my dogs there because they come back so happy. 

We made it around the corner when I crashed.

An elderly couple were on their way to cardiac rehab and were picking up a friend who also was going to cardiac rehab. They were slowing down and speeding up, clearly trying to locate the house they were after. We started speeding up again (we were going about 40km/h) when one of the dogs whined and I quickly looked back to check she wasnt caught up on her lead. When I looked back at the road, the car in front had stopped abruptly. It was too late but I slammed on the breaks as I rear ended them. My breath caught and the airbags went off. Smoke started to surround us. I removed my seatbelt.

I attempted to open the door but it was caught. I had to forcefully kick it open. As I stepped out of the car, I realised I had intense abdominal pain. I pulled up my dress, right there in the middle of the road, to check if I was bleeding. I wasn't.

The driver had gotten out of the car. I said "please call an ambulance, I'm pregnant". He ignored me and called out to a bystander and said "did you witness that? She hit me!" They started talking but I did not hear what they were saying. I thought, "I need my husband here".

I kneeled down onto the pathway as the pain took my breath away. "Please baby boy be okay, please baby be okay" is what I repeated to myself. A lady who was walking on the other side of the road eventually came over and I said to her "please call an ambulance, I'm 34 weeks pregnant". Thankfully she listened to me and called them. She also retrieved my phone from the car. DH was on his way.

That's when I remembered the dogs in the back. I opened the back door and they were sitting quietly, both shaking vigorously. My heart broke. Someone offered to hold them for me.

The ambos came and assessed me to be stable - yes I had pain (which they gave me panadol and the green whistle) and was nauseous, but I was stable with a little hypertension. They painfully did not have a doppler and I had no idea for half an hour how my baby was doing. We were delayed to get going to the hospital as there was another emergency somewhere else and for some reason we were unable to get going. This was the most painful half an hour of my life, while the paramedic tried to make small talk with me, and all I could think was "shut up because my baby could be dead right now".

Casey arrived and when I saw his face full of fear and worry, I felt a wave of guilt. He took the dogs to doggy daycare and we planned to meet at the hospital - me via ambulance.

When we finally got to the hospital I was wheeled through ED and I avoided all eye contact with the doctors I knew. We went straight up to the obstetric ward where they finally put the CTG on. He was alive.

DH arrived and my heart burst seeing his concern. All I felt was guilt.

My midwife came and asked me if I had pain and that's when I realised that I was contracting. The obs reg came around and said "lets watch and wait, you're anxious and your baby is too. We are concerned about placental abruption". The consultant came around and agreed. So just like that, I calmed down and the CTG improved for about an hour. They gave me a steroid and prepared for a c section "just in case".

The sonographer came around and happily declared "I don't see any obvious placental abruption here! You do have a nice muscle haematoma here though". I was again put at ease. DH and I talked about what we would do when we got out of hospital that day.

And then I started to have late decels for about 40 minutes.

The consultant came in and looked at the CTG and said "cat 1 c section, let's go". I cried again wondering what the hell I had done.

I felt like I had failed as a mother, and he wasn't even born yet.

A flurry of people came in and just like that I was getting a spinal and they started the operation. The obstetrician (who DH knows well) asked me "do you feel this?" and I knew he was pinching my skin hard with forceps. I pretended I was somewhere else while looking at DH's face and wondering what he was thinking about.

Baby boy was born flat with apgars of 1, 6 and 7. He was immediately taken away, and DH went with him even though I could see he was so torn about leaving me.

I was left with a room full of people but felt so alone. I felt empty.

The weeks after have been the hardest of my life. My son has moderate HIE and we don't know what his future will hold.

I am trying to heal and deal with my guilt. I'm not quite there yet.

S is a junior resident in Queensland, Australia. Her son is 16 days old today.

Expectations and Realities

I will finally sign out that last autopsy that is due in 9 days so that this time I don't wait until day 60.
*I call my husband on day 60 and tell him I'll be staying really late to finish an autopsy, but I'll be home for Punky's bed time, for sure; she gets to bed 30 minutes late.

Tonight I get home from work before 6:00pm and I'm definitely going to wash my makeup sponges and re-order whatever stuff I'm low on from Sephora.
*A friend texts with a work crisis and I write back-and-forth for 45 minutes until I have to break for bath time.

For sure this time I will buy our plane tickets for our holiday travel at least three months ahead of time to save money.
*Three weeks before the trip I'm scrambling for the last three seats on the plane, surely paying at least $200 more per ticket. Again.

After Punky's bath tonight, I am definitely going to change her sheets and thin out her clothing that she's outgrown for donation.
*I spend that 25 minutes recording (for posterity) the funniest conversation that she and I had about unicorns vs. mermaids while she was in the bath.

Today will be such a good day at work; I have been off for a week and I am back and refreshed with an empty queue to start.
*43 new cases in the queue, Pedi GI calls and asks for a stat run on a liver biopsy for possible atresia, three separate colleagues come in with "sorry, I have a few quick cases that need review, and they're kinda old" and then the outlying problem hospital calls to say that a surgeon is screaming about a lost specimen and I need to call him NOW.

I will be the first one to sign up for what to bring to the next pre-K class party; I will definitely get paper plates or napkins this time!
*The list comes out when I'm on call and can't bring Punky to school or pick her up for a week; I cut an array of colorful fresh fruit for 1.7 hours at midnight and arrange them into an appealing rainbow configuration in an act of self-flagellation.

I will schedule a nice, easy play date with Punky's school friend that has the really nice and friendly mom to bolster my only child's social skills.
*I finally text her 14 weeks after I first committed to it in my mind, schedule them to come to our house for the upcoming Saturday, spend three hours the night before cleaning the house,  and then drink a mimosa beforehand to ease the path to small talk. It goes fine. The anxiety regarding the next play date begins immediately after the front door closes behind them.

I will work extra hard to keep up efficiency today and just work on my cases, one after another, until they are all completed before I do anything extra because I know that I'm too far behind already this week.
*I work steadily for 45 minutes, then make a doctor's appt for myself that I've been putting off for two years, make sure bills are paid, finally order Christmas gifts for my oldest friend's five kids so they get there in time (converted from birthday gifts, because I decide to face it, remembering five extra birthdays annually is essentially never going to happen), and make that rage donation to Amy McGrath (because Moscow Mitch did something heinous *again*) so I don't forget to do it later. Only half of my cases are signed out. Crap.

I really want to spend the 20 min of Punky's bath time doing color-by-number on my iPad.
*I fold two more baskets of other people's laundry and force myself to put away the clothes.

Tonight I will definitely clear off the clutter from the kitchen table that we never use for eating, because I know that my husband hates this state of affairs.
*I put approximately four pieces of paper into recycling, photograph 16 pieces of artwork for Keepy and throw them away, then realize that I need to answer my MOC quarterly questions now since the thought just popped into my head and if I don't do it I'll miss the deadline.

This year, I will wrap presents as they come in to keep caught up.
*I place gifts in reusable cloth bags on a random midnight a few days before Christmas in place of sleeping.

I will definitely complete all four of the reminders I set on my phone for internet errands today.
*At 1:23 am, I sigh and change the dates on all four phone reminders to tomorrow's date. Well, technically *today's* date.

I will work on that amazing wooden puzzle tonight after putting Punky to bed and eating something.
*I scroll thru my Facebook feed for 1.75 hours reading the news, getting angry; I see a couple of cute kids and I feel a little better.

It's been weeks since I've had a work day off with the kid in daycare, I will definitely knock out at least four of my running to-do-at-home jobs off the list I keep on my phone, including setting up the Roomba that I bought two months ago which is sitting in it's box in the corner of the utility room.
*I drop off Punky, "stop in" to World Market for 1.4 hours, then head over to Target to wander around for another two, finally getting home at 1:45 pm and folding laundry/hanging clothes in the closest while listening to podcasts and scrolling Instagram until I have to pick up Punky at 5:30pm; the Roomba remains unopened.

I will make sure that this year, we get our family photos done in October so that I can get the cards completed in November.
*I panic and realize that the weekend before Thanksgiving is the last of the semi-decent leaf color and implore my husband to check out that spot that he's been meaning to look at for photography; cards are completed on December 8th and mailed on December 15th.

I will definitely go to bed in the 12:00 hour tonight; I really need a couple extra hours of sleep this week.
*I jolt awake at 2:34am, scroll back through the Schitt's Creek episode list to figure out exactly how many episodes I missed on auto-play, and finish cleaning up the kitchen before brushing teeth and falling into bed.

I will set a recurring reminder in my phone to write a blog post for MiM at some point so they don't kick me off the site.
*I sit at my desk at work at spew this out instead of signing out cases or validating immunostains, because, well, it's just time.

Short cut

One of the biggest time saving/life hack successes our family can claim is that I cut my boys’/ husband’s hair. The fact that I do this and they are not walking around with bowl cuts or bearing deep scars of humiliation daily is a point of victory. I mean, they pass for having normal hair!

It all started when our first boy turned of age to require regular haircuts as a toddler. We quickly realized what a time suck this would be for the rest of the forseeable future. Not to mention The Husband who is not a fan of time sucks as well. In fact, spending the time to go somewhere, wait, and get his hair cut was such a loathsome, pedestrian, tiresome task for him. He’s military and his special hair needs are minimal.

I forgot whose idea it was exactly that I should try giving The Husband a clippers cut. I’m not sure it would have been me since my last experience giving anyone a clippers cut was when I gave my younger brother a trial run with a pair of clippers when I was 16 and he was 11, and it did not go well. Immediate professional rescue required. When I say it did not go well, I’m not exaggerating. Think Britney during her troubled phase. However, somehow we ended up with a home clippers set and next thing I knew, The Husband was taking a quick drink to “steady his nerves” prior to my first adult foray with the clippers. Mind you, I read the little style manual and watched some YouTube videos. The result: Passable! Not bad! I continued to cut his hair and then our son’s hair with the same basic formula and marveled at the ease and glorious time savings. Then our second son was born and for awhile, I cut all 3 of their hair every 2-3 weeks for YEARS. I’ve gotten to be decent and while I can only really do one style, it’s all that’s been needed. My biggest compliments are when someone says, "Did ____ get a hair cut? It looks nice!" and the implication is that someone other than me cut it. Oldest son, 11, has only just graduated to professionals since he has developed advanced needs involving scissors and gel.

Over the years, I've often joked about wanting to do an apprenticeship at Spiro's, the local barber shop, but only half-jokingly. I often find myself staring at the back of men's heads to appreciate the smooth tapers. I guess if this medicine thing doesn't work out, I can start training in earnest.

Acknowledging and Attending - the first few months

I'm about 3 months in into my first after-residency attending job. I really underestimated how hard this was going to be.

Logically, this shouldn't be surprising. I uprooted my family from a large metro area, plopped them down into a rural community where our nearest ties were about 2 hours away by car, and started a new job. I had a wonderful few months playing stay-at-home mom, then started my new clinic job refreshed and enthusiastic.

What took me by surprise was how unconfident I felt about everything. Once I was done seeing my first patient, I immediately went to find the nurse practitioner down the hall to run my plan by her. I knew it would feel weird not to precept as a resident, so I gave myself a break the first few days. I got some reassuring texts from other recent graduates, telling me they had done the same thing when they first started. For a while, it felt like every new patient was the first time I had ever treated that condition (insert: asthma, allergies, COPD, coronary artery disease, etc.) even if I had seen it and treated it confidently many times in residency. It's getting better, but it still feels that way more than I think it should

I had done my residency training in an urban setting treating young diverse families, and within my first couple weeks in my new job, I felt like I had met more people over the age of 90 than I had ever met before. Additionally, I was in a new system with different specialty and subspecialty resource availability and it felt like the referral patterns were completely different. I have felt like I was both under-referring and over-referring depending on the issue. I also still feel like I am over working up some problems and probably not working other problems up enough. Additionally, my husband's work has been more demanding than usual and Toddler is on his 3rd ear infection in the past two months so there has been a little more scrambling than anticipated.

Luckily, I know I'm not alone. My best friend from medical school started her new primary care job the same week I did - and we've talked at least weekly since, running our cases and insecurities by each other. I just came back from a mini-reunion dinner with my residency classmates, and I know they're all experiencing similar things.

One of my good friends moved across the country to do a primary care nurse practitioner residency and is blogging about her adventures. She recently had one tough week of both life and career difficulties and wrote about acknowledging that it has been hard. Not complaining. Just acknowledging. I don't think we give ourselves permission to simply acknowledge the difficulties of our situations. I am looking back over the past few months, and I know I have made at least some good medical decisions thus far, and people are coming back to see me which is probably a good sign.

I have decided that I am going to acknowledge that these past few months have been difficult, but I'm also going to embrace that this is a time of immense growth and I will never have a chance again to experience anything like this year. I am going to accept that I have already made mistakes, and I will make more. I'm going to also acknowledge that I am a good mom  and a good doctor, and will continue to wake up and try again the next day.

Kicks

Thank you to those who make me feel like I belong.

I just got back from a major Emergency Medicine conference, and I was absolutely blown away by the amount of female leadership- in academia, giving keynote lectures, as heads of committees, emerging true pioneers, established industry leaders,  influencers, and all- around powerhouses.  I was inspired, but had another feeling that I failed to identify all week long.

Now that the whirlwind of lectures, networking, and dinners are over, I have time to reflect. This time helped me figure out what I was feeling the past few days that buoyed my spirits and helped me immerse myself in the conference and fully engage. I felt like I belonged. Just as I am. Just as I hope to be.

Most of my mentors in medicine (except a select few, to whom I am forever grateful) have been men. Our residency leadership is mostly men. Amazing, supportive, brilliant, kind, respectful men. But the persistent image of women at the forefront, on the stage, with a wide collection of varied interests, personalities, speaking styles, and expertise, made me realize that I do belong. We all belong, simply by being there. I'm not an anomaly, an outlier, a "diversity" player. I do not have to fit into any specific "women in medicine" category. So many before me have broken glass ceilings, normalized positions at the table, and have dedicated so much time, energy, and sacrifice, for me, and this current generation of upcoming doctors, to feel like they belong.

So thank you. I'm honored to be in a specialty that is evolving, and I'm grateful to feel hopeful, not frustrated, at my future position within the house of medicine that is my calling.

When I was applying to medical school a decade ago (!!) I turned to this blog for help. I felt lonely, unsure, intimidated. I didn't know if I belonged, where I belonged, how I could continue to belong. Now, about to graduate from residency, I feel grateful. Grateful for this online community that is a source of inspiration and empathy, and grateful for the leaders who continue to show the world that we belong, in every way.

MiM Mail: Finances during medical school as a mother in medicine

Hi,

I am writing with a question that I would love to see what the MiM community has to offer for advice! My question is- while going through medical school as a parent, how did you handle the financial aspects of your day to day budget? Did you find that student loans were enough to live on for a family month to month? (Spouse and one child in my case). Did your spouse work at all? How did you afford childcare if the spouse worked? Also- how did you get health coverage? My school offers it and you can include your family on the plan- but it is so expensive!! The monthly premium would take up almost all of my monthly living loans and I would get very little left over. My school does not offer more assistance for families, just one set amount. I guess private loans are an option but I’m afraid of the high interest rates on those. I have also heard that private insurance plans might be less expensive per month but I really have no experience or knowledge about that and wonder if they provide good coverage (like if we were to have another baby, labor and delivery/prenatal care, pediatrician visits, etc)? I have heard a few families say they qualified for Medicaid but I am also not familiar with that at all. Last part of this financial question- how did you afford all of the other expenses like going on interviews, paying for step, etc? Does your school provide extra loans when the time comes or do you just have to figure it out on your own?

Thanks!
Rachael

Sharing an essay by a brave mother in medicine

I am thrilled to share this powerful essay by physician mom K. Hope Wilkinson. In "I'd Rather Be Dead", published in the October 2019 issue of the Journal of Graduate Medical Education, she writes honestly about the attitudes she encountered after the birth of her special needs daughter.

The opening paragraph draws in the reader:

When my daughter was born, something was clearly wrong. She was just shy of term, but she weighed only 3.5 pounds. Her initial Apgar score was 0, and she was coded, intubated, and resuscitated. On her fifth day, the neonatologist did brain magnetic resonance imaging (MRI) “for prognosis.” Specialists pointed out to us everything that was wrong: the way she flapped her hands, the tilt of her ears, the size of her chin, the crease of her palm. They constantly reminded us what most babies do: smile, lift their heads, not just be little lumps. Eventually they diagnosed her with a rare chromosomal disorder, one that is barely described in a few publications. The kind pediatrician told us we would sing to her, we would read her stories, and she would go to school because we do those things for all children, but they didn't know what else her future held...

We want to read the rest, we want to know what happens. And, we need to read the rest, because her message to us as healthcare providers is very important. I know that the author made a considerable effort to craft this piece, and that it was not easy for her to share her story. Please check out the essay and let this brave mother in medicine know that we appreciate her hard work and perspective!

5 Ways to Reconnect with your Purpose

FIRST STEP: YOU HAVE TO WANT TO BE WELL TO DO WELL.

“I had to think out of the box...” I did all the “right” things: went to college, graduate school and medical school, got married, had children. Still, when I looked at my career, things just didn’t sit well. 

I was a successful and young pediatrician working for one of the top academic medical centers in the country, and I loved my patients, but I was miserable. When I looked around, my colleagues were overworked, tired, and burnt out, too. It was the end of training: Wasn’t I supposed to have found happiness and my dream job? 

I read books like Paulo Coelho’s The Alchemist, listened to self-help podcasts like Dreams in Drive and Therapy for Black Girls, subscribed to the best blogs, you name it.

I had some serious sit-downs with my husband and friends, ones where we spoke frankly about how our happiness was our responsibility. A quote from Toni Cade Bambara’s The Salt Eaters replayed in my mind. In one scene a healer is talking to a woman with severe pain and disfigurement. She asks the woman, “Do you want to be well?” and goes on to share that there is a lot of responsibility in being well. 

I took heed and began forging my path to wellness in my career—to harmony and balance in my life—so that I could be a better me to myself, a better partner to my spouse, a better mother, and a better pediatrician. 

Here are some of the things that resonated with me on this journey:

1. COMMIT TO GREATNESS.

Reset your vision of what could have been and what should be. 

I had spent a decade thinking about what my dream job would be. But when I distilled it down to its essence, I realized I wanted to do great work with children and families. I didn’t need a big hospital system or a fancy clinic to do that—in fact, they were getting in the way of my real, authentic work. 

I now do house calls and telemedicine for children and families in my area and it feels great meeting families where they are. In order to do the work I was called to do, I had to think out of the box and get out of the suffocating systems of old-school medicine. 

2. TAP INTO YOUR NETWORK. 

I have been with Mocha Moms, a support group for mothers of color, since my oldest was born in 2011. Over the years the group has shared so many stories of how other Mochas used entrepreneurship to orchestrate the lives that they and their families needed. 

I let these stories inspire and encourage me. I reached out to other physicians in my area and nationally, and learned that my story was not unique and that I was not alone. I forged great collaborations with other house-call doctors, local midwives, and other small-business owners, and now have a thriving network that I check in with regularly. 

3. KNOW THAT FINDING HARMONY IN CAREER AND LIFE IS AN ITERATIVE PROCESS WITH MANY STARTS AND STOPS. 

I am living this now. Forging a nontraditional path means experiencing things you never imagined. Sure, I don’t have a boss breathing down my neck telling me to check off a box on the computer system, but I still have a ton of paperwork. I remind myself daily that even when doing administrative tasks, I am working toward my vision and am improving children’s lives one home at a time. 

This process also requires you to let go of many of the harmful habits that have shaped who you are. Just like the woman in The Salt Eaters who for so long had been defined by her severe pain and disfigurement—to truly be well, she had to redefine herself. 

For those of us in high-stress fields and jobs, we have to redefine ourselves in a way that doesn’t use being exploited and constantly overworked as part of our defining characteristics. For me, that required and still requires self-reflection on what it means to be in service to others. Serving others does not mean being exploited or working crazy, unsustainable hours. It means being unwavering in my commitment to a life that allows me to serve sustainably and passionately for years to come. 

4. ALWAYS KEEP A PAYING SIDE HUSTLE. 

Entrepreneurship is ever-changing, but your rent, mortgage, and bills are not. 

Even though your work is fulfilling and exciting, until you are getting a regular and sustainable paycheck, you will need to keep some side hustles in rotation. 

5. FIND ALL OF THE WAYS TO BRING JOY INTO YOUR LIFE THAT YOU CAN. 

Check in with your sisterhood circle regularly. (I do that on my parenting group’s ladies-only GroupMe.) 

Check in and make time for loving relationships with your spouse or partner and commit to prioritizing your relationship with time and attention whenever you can. Try not to talk about your stressors for too long and also don’t talk about the kids on date night if you can! 

Spend time out in nature. Research shows that time spent outside improves health. 

Play outside with your kids. We try to take a family walk around the block every day and we use our local national parks for hiking as much as possible. 

As the healer in The Salt Eaters said, there is so much responsibility in being well and it ultimately rests with each one of us. Let’s be well!

Originally posted at: https://www.matermea.com/blog/5-ways-to-reconnect-with-your-purpose
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Photos courtesy of Leslie Kershaw: http://www.lesliekershaw.com/