Wednesday, November 25, 2015

Cheers to a week of chaos

This past week was pure chaos. Our nanny of three weeks did not show up Monday morning. Nor did she show up Tuesday or Wednesday. It is now Tuesday the week after and I have yet to hear from her despite multiple calls, texts and emails. I'm not quite sure what happened. At first we were worried and imagined the worst, but a little social media sleuthing revealed she is alive and well, but decided to take a vacation and just doesn't care about coming back. I'm shocked that people act like this (I mean really, are you ever going to give my keys and carseat back?!), but I'm over it. This isn't the focus of my post, but rather, the amazing people in my life that rally and always seem to help make things work out. I am a little late to the thankful train, but I am very very thankful for...

My husband who handles chaos like a pro and always reminds me we're on the same team.
SK for being as patient as a 4 year old can possibly be while watching me stream respiratory lectures. She was very confused as to why I don't learn about mermaids in school and suggested that I bring this up to the administration.
SE for sleeping 9-10 hour stretches at 5 months (bless you) and being the happiest, smiliest baby ever.
My amazing mom who jumped on a plane as soon as she heard about our nanny nightmare.
My kind classmate who volunteered to switch spirometry labs with me so I could work out alternative childcare plans.
The timing of this chaotic least it was the week before Thanksgiving break and now we are all together celebrating with family and friends.

Happy Thanksgiving all (even you, former nanny).

Monday, November 23, 2015

MiM Mail: Making residency safer for pregnant residents

Mothers in Medicine! I am seeking your advice/expertise on the difficult subject of how to treat pregnant residents. A little background: I am a chief resident at a busy anesthesia program that takes frequent and draining 24 hour calls in the OR. Those calls are such that, most of the time, the call room is a distant fantasy. I am also a mom to an active preschooler and pregnant with #2. All was going well until after a particularly exhausting 24 hour call, when I started having frequent, regular contractions at 20 weeks. I had to take several days off work and (thankfully!) things calmed down. I'm now trying to ease myself back into the OR call rotation.

My question for all of you who have been through a resident with tough, frequent 24 hour calls or night shifts... how did your program handle pregnant residents? I've heard from friends at other programs about policies that were put in place to limit calls because so many pregnant residents were going into preterm labor. Other programs limited night shifts for the same reason. Obviously, these changes put strain on non-pregnant residents. Was there widespread resentment to enacting such restrictions?

Amazingly, I'm the first resident to be pregnant at our program in over a decade, but I know there are many women behind me hoping to do the same. I'm hoping to find some common sense changes that can be made to keep pregnant residents working, but in a safe way for mom and baby.

Thanks in advance!

Sunday, November 22, 2015

Welcome to Topic Week: Being Thankful

Welcome to our MiM Topic Week! Posts from regular contributors and readers will be spread out over the next week. We hope you will join us in reflecting on this topic as we explore being thankful from our different perspectives and experiences. Thanks for reading and being part of this community.

Scroll below to find the posts.

It Takes a Village

It’s a good day to be thinking about gratitude. I just got the results of my Pediatrics boards and, mercifully, I passed. Like many things in the life of a working mommy, the whole boards process felt fragmented, stuffed into the crevices of an already packed schedule. I studied in stolen hours, early in the morning, late at night, during E’s naps, during quiet moments on call. There existed the dream of reading the textbooks cover-to-cover, mastering the seemingly random landscape of dysmorphisms and eponymous genetic syndromes, committing to memory, not for the first time, the detailed physiology of the nephron. Instead, I did as many practice questions as I could and read all the explanations and made a stack of index cards that I only had time to review once before the test. Studying certainly helped, but what carried me through the process were my patients, the hundreds of people whose stories constitute my fund of knowledge. The symptoms they had, the way their bodies looked and felt under my hands, the labs and images I reviewed in an attempt to understand them, the medicines we prescribed, the way things turned out. All the babies whose birth weight I guessed just before putting them on the scale. All the toddlers who scribbled, babbled, stooped, and recovered during their well-child visits. How do I remember Hurler’s syndrome? I remember A, from my first year as a clinical student, and his mother who carried him everywhere in her arms even at the age of seven, because she could not afford a wheelchair. In the boards review study book, they used phrases like “coarse features” and “macroglossia,” but I just remember his face, whose beauty became more apparent to me over time, and all the grief and tenderness in his mother’s voice as she sang to him, more effective than any medication at calming his agitation. I can only hope that what I have given is somehow proportional to what I have received.

The medical path – and especially the parent-in-medical-training path – has been much harder than I expected and when I reflect on this path I chose, gratitude isn’t always right there on the surface. But when I opened the Boards score report, it was right there. I looked up from the computer and the first thing I saw was my spouse. I thought to myself, “How can a person be so steadfast in the support of another?” I am in awe of it. I was the one who first brought up the idea of having a baby in my last year of medical school, before starting residency. I spelled it out to her over the Formica table in our then-kitchen – how we would have an infant while I was taking 24 hour calls and working long days, how it would be an insane juggle. She said, “That seems like it’s going to be really hard.” But it felt like the right time. We gambled and got a jewel, our daughter E, who is infinite light and delight. But it has been harder than hard. Over the last three years my spouse has done breakfast, drop-off, and pickup almost every day, dinner and bedtime too many days, whole weekends, whole weeks, whole months, sick days, unexpected call-in days, holidays. She gives our daughter what I wish I could be giving her when I’m not there, and so much more. She gracefully bolsters me in my mommy role even though I spend less time with E, when I can imagine a different person laying claim to the “parent-who-knows-more” position. She keeps us well-fed, keeps our household functioning, and through her eyes, I feel beautiful and powerful every day. She does all this while navigating her own full career as an artist and teacher. She has sacrificed some of her own creative and career advancement over the past three years so that I could forge ahead. I know it is painful for her at times – not what she signed up for, even though she did (good love isn’t as simple as they say) – but her loyalty and support just keeps shining and it lights my way and keeps our family warm.

So there are many layers to the gratitude I am feeling on this, the first day of the rest of my professional life. Gratitude to my patients, who are my teachers, who have accepted my inexperience and given me the gift of their trust and allowed me to participate in their lives in a profound way. Gratitude to my spouse, for EVERYTHING. Gratitude to my parents, which is a whole essay in its own right, the YEARS of patient attention and thoughtful decision-making, late night high school research paper crisis management and SOS babysitting saves, self-sacrifice and deep concern for my well-being. Gratitude to my friends, who have stuck with me through long silences. Gratitude to my colleagues and attendings, for saving my ass and helping me find my voice and for caring so much and taking great care of patients and teaching me by example. The African proverb “It takes a village to raise a child” has become so cliché at this point as to have almost lost meaning, but I’m thinking today about the village that raised me, and no words of gratitude are adequate. I will have to thank them by trying every day, with the best of myself, to be of service to the world.

Saturday, November 21, 2015

Not the last...the first

I am thankful for many things as I reflect on a tumultuous year.

I am thankful that a program that didn't even exist yet became available to me last year enabling me to move back to my hometown for fellowship.  I didn't know that only months after I accepted the position I would discover that my mother's breast cancer would come back all over her body.

I am thankful for a supportive fellowship program - colleagues, mentors and my mothers doctors all in one.  I am thankful that they are on my team, and on her team.

I am thankful that my daughter can go to "grandma's house" multiple times a week.  I am grateful that they are buddies now - both at a loss if they haven't seen each other for more than a day.  I am so grateful for this time.

I am grateful that my husband who has been stifled in his career by the location of my residency is now managing a large group and doing a job he loves.  This move has been good for all of us.

I am grateful for impromptu dinners with my siblings, my best friends, who I haven't been able to hang out with for years.

Most of all I am thankful that when I feel tears well up as I realize that this Thanksgiving and this Christmas may be my last with my mom, I can instead focus on the fact that it is really the first -  The first Christmas my sweet baby girl gets to spend with Grandma.  The first Christmas that I have been able to spend with my entire family in 13 years.  I am thankful for first - with a mustard seed of hope that this will be the first of many.

I am thankful for family and the sweet gift of each day we get to spend together.

Friday, November 20, 2015

How It Could Be, How It Is

Genmedmom here.

I was in the grocery store last week, which is rare because at this point in our crazy two-working-parents-with-two-small-children lives, we have everything that can be delivered, delivered, and this includes groceries. It's seriously saved us about three hours a week, ordering our "big shop" right from a cell phone, and having it all magically appear early Saturday mornings.

But, that week, I'd ordered on the fly and, of course, forgotten a few things, plus an item or two had been out of stock. So, in an unexpected free hour on Tuesday afternoon, I found myself wandering our local Big Food Store.

I'm so out of grocery-shopping mode that I got a little disoriented. In the old days, I'd have my list jotted down, roughly organized by aisle, and I'd zoom through the place in relative ease.

But there I was, bouncing from Snack Foods to Produce and back again because I couldn't find the damn Pea Puffs Babygirl likes. Then, way over to Dairy for the cheddar cheese sticks I absolutely have to have with my apple for lunches, and that you can't order online for some reason, and then back over to Crackers because Hubby texted that we're out of the kids' favorite crackers... et cetera.

Then I was lost, searching for the powdered instant breakfast stuff we shake into the kids' morning cup of milk to make us feel better about their nutritional intake. It wasn't with the Cereals... I saw a couple of young employees standing in an aisle, with bar code reader-things.

Oh good, I thought. People I can ask.

But just as I was rolling near, one of them started griping, loudly:

"Man, I am so ready to get off work. Get me the heck outta here!"

His buddy replied:

"Yeah, work sucks. The whole thing sucks."

I veered away, pretending I hadn't been about to ask them something. I wondered how working in a bright, overstocked first-world grocery could possibly be THAT bad. It was kind of a downer.

I never found the stupid instant breakfast, and I was almost out of free time. I aimed for a checkout line.

The man doing checkout was still scanning items for the person ahead of me, but he looked up, smiled, and acknowledged me, calling out cheerfully:

"Hello! Beautiful shopping day, isn't it?"

He turned back to the shopper and took her coupons.

"Smart lady, you're going to save some money today. You should treat yourself to something special, you deserve it!"

The woman and I exchanged smiles and chuckled. In the space of less than a minute, the atmosphere had gone from Ugh, errands to I can't help but smile!.

Now, I've seen this guy before. He's older, has a thick accent, and he's ALWAYS cheerful. Not in a fake, annoying way. I mean, he's just really genuinely cheerful. He always greets people and says nice things, makes a lighthearted joke or two. He's very efficient at checkout. He also bags items with care. He acts like someone who loves their job.

As I stood in line, I studied him. Given his appearance and accent, I guessed that he was an immigrant. I imagined that he had come from a developing country, and had known oppression, hardship and hunger. Maybe it had been difficult for him to get to the U.S., and then to get a job. He might have a family he desperately needed to support, and so, he's amazingly appreciative of the opportunity to work the checkout counter at the Big Grocery Store, and help bag groceries for harried and distracted moms like me.

Whatever Mr. Positive Attitude's story was, he cheered a couple of people up that day. I truly wish everyone was like him. Imagine that!

And whatever the Griping Employees' story was, their complaining brought me down. It's depressing to think how many people sludge through this life like they do.

I've been thinking about this a lot lately. I find that I'm sensitive to negativity, I want to run away from negativity. This regardless of whether it's expressed by my colleagues at my own job, or by friends. Examples at work might include the judging of another provider's care, complaining about some administrative issue, or griping about the electronic medical record. With friends it may be grousing about our school system, grumbling about a spouse, or sharp self-criticism.

I think some venting with a trusted confidant, in private, is okay, and even necessary sometimes. Even better if it's with a mental health provider. Emotions can be validated, and a response discussed. You know, "talking it out". This is head-housecleaning. It's therapeutic.

But pointless negativity (aka "Work sucks") is just toxic. It's just pollution. It serves no good purpose. It should be banned. And there's alot of it.

People who have known me over the years may be surprised to hear me saying this. I was kind of the Queen of Complaining in residency and fellowship. What happened? Well, to sum up: in 2006, the years of sheer physical and emotional exhaustion, unhealthy coping, poisonous relationships, and social isolation brought me to the lowest point in my life.

The struggle upwards involved hundreds of hours of therapy with an excellent provider, liberal antidepressants, formulating meaningful life goals, clean living, and meeting my husband.

Through our very different journeys, we've been touched by the pain and hardships life can offer, and we've been witnesses to some true horrors. A twist of fate, bad luck, the finger of God... bad things can happen to anyone. When they do, some people are consumed, crushed even, and yet, others transcend.

I'm thinking of my patients with devastating diagnoses who choose to stay positive. I'm thinking of our family members who have lost children, and choose to go on living and loving. I'm thinking of the people I've known in Central and South America who suffer true deprivations, but choose to hope. I'm thinking of all victims of random violence who choose to forgive. I'm thinking of the immigrants around the world who are being shunned, but choose to go on in search of better lives.

For everyone who chooses to say:"I'm going to take it day by day, and be grateful for every sunrise", I'm thinking of you.

We are so lucky, so blessed, and we acknowledge that. In our house, we joke that if we ever won the lottery, we wouldn't change much, because we've already won the lottery. We are passionate about our hard-earned careers. We've been blessed with our beautiful kids. We enjoy a place in a wonderful community.

Is everything perfect? Duh. Of course not. Read my blog.

But our eyes have been opened to what could be, and so, we're thankful for what we have. And we are truly happy.

Family bedtime

Every night before bed, our family of five gathers in our middle child's bedroom. It's dark except for the hallway light that shines in from the open doorway. We pile in somewhere in the darkened room. Maybe on our youngest's mattress that lies on the floor (and will continue to live there until our 4 year old decides his own bedroom is not haunted by The Arm). Maybe on our other son's bed. Maybe sitting on the desk chair. We settle in and start our bedtime ritual.

It's our family bedtime prayer. We start by each saying what we are thankful for that day. I'm often struck by what my children are thankful for: having a house, food, their school, our family, mom and dad. Our daughter, the oldest at 10, sets the example for her two younger brothers by being reflective and thoughtful. (That girl's natural gratitude for everything in her life is a point of immense joy for me and that perhaps somehow, during our many missteps parenting, we did something right.) I enjoy hearing what my husband is thankful for - another window into his day. And I find it therapeutic to think slowly through my day and select what stood out for me. I find that I am thankful for many things and that this reinforces my generally positive outlook on life.

Next, we each say something we are sorry for, or want to do better with next time. We emphasize that there is always something we can do better. The children's responses often involve times that day when they were annoyed or angry with the other. Never any judgment, just sharing.

Then we share one thing we are proud of doing that day. Maybe it's doing their best on a test. Or being a good friend. A piece of art. Another great insight into my husband's day for post-kids' bedtime follow-up. I love hearing what everyone is proud of.

Finally, we name who we each want to pray for. For a long time, our 4 year-old said "Santa Claus" every night and now that has seasonally transitioned to The Pope (formerly pronounced "The Hope") and Wilson, our deceased cat.  Our middle child, 7, tends to pray for large swaths of people - the homeless, people with cancer.  We finish with a prayer that we say together.

I don't know how long this family ritual will hold together. For now it works for us all. I didn't grow up saying prayers or consciously thinking about what I am thankful for. I hope supporting this daily habit gives them as much meaning as it has given us.

Thursday, November 19, 2015

Thankful for my American Dream

Isn't it crazy how verbalizing something so simple can be so challenging?  It took me almost a week to figure out how I would write this post... Yet every day, I feel so thankful for all that I have in this life!

When I was a little girl, my family didn't have a lot of money.  We always had food on the table, but I never had the clothes, toys or snacks I wanted.  I dreamed of a day when I could go to the supermarket and pick out whatever suits my mood and just buy it.

The day is now here, and I am living the dream.  If you read over my previous posts, you can see I struggle everyday with some aspects of my life that I'm not thrilled about.  But that in no way shapes what the overall theme is of my life:  I made it, and I'm living the American dream.  Of having a one-in-a-billion amazing husband.  Of having a daughter so sweet and smart.  Of having a positive outlook on life (mostly.)  Of having our health, and not least importantly our mental health.  Of just being happy overall.  Of not counting pennies.  Of buying my daughter the toys I want for her (and the toys she wants).  Of having a new car (seriously, sometimes I drive in my new-ish car, about 3 years old, and I marvel at how I grew up to buy myself a new car!).  Of just living this life the way I envisioned more than 20 years ago.  I may not have the dream job (right now), or a dream house quite yet, but I have a dream life, and for that I am thankful every minute of every day.

In the first Sex and the City movie, Charlotte becomes pregnant and says to Carrie, "Nobody gets everything they want! Look at you. Look at Miranda. You're good people and you two both got shafted. I'm so happy and...something bad is going to happen."  Sometimes I worry about being so overjoyed at all that I have.  But then I remember, it's not that bad things haven't happened to me recently, or that everything has just been perfect.  It's that I still have what I need to make me happy... and eternally thankful, for the health that's been given to me and my loved ones, for the ability to work hard, and for the mental prowess I possess to persevere, and look beyond the losses and negatives that come my way.

A very happy Thanksgiving to all!

Thankful for my village...

They often say it takes a village to raise a child.

As your typical OCD, type A personality, I was not one to ask for help. Before motherhood, I would say my life was quite simple. My innate desire to excel at everything I do was never challenged. I was born into a typical Korean family in America. My parents immigrated to America shortly after getting married to provide a better future for their children. I was my parent's pride and joy. I did well academically. I got accepted into a combined BS MD program in high school. My life was planned out. I would go to college followed by medical school and become a doctor.

Who knew I would meet the love of my life and get married by the end of medical school? And better yet, who knew I would get pregnant during my intern year?

I certainly did not. I lived in denial throughout my entire pregnancy that I got this. I was so wrong. My whole world turned upside down. I loved my baby girl more than life itself but for a control freak like me, having a child was the ultimate test in learning how to let go.

Fast forward 2 years and 10 months later, here I am. I cannot be more grateful. My life is a lot more complicated but I wouldn't change anything. Everything truly happens for a reason. It wasn't medical school or residency that proved to be my biggest challenge. It was the combination with motherhood.

I'm thankful that the challenges of motherhood and residency has taught me how to ask for help. It has made me a better person. Life isn't a competition. And I am constantly grateful to the people in my village that help me raise my child and pursue my career.

So here is my thank you.

Thank you to the others moms I've met during this journey whether it be a simple look of camaraderie when little C is throwing a temper tantrum in the middle of the supermarket to those who  have reached out to let me know that I am not alone in this process.

Thank you to my daughter's teachers. Thank you so much for being so understanding. Thank you for making little C love pre-school. Thank you for providing a safe environment for my daughter while I go to work. Thank you for answering all my paranoid questions.

Thank you to my pediatrician friends for answering this radiology resident's questions (whose entire medical knowledge seems to go out the window when the mommy cap is on!) from how to dose tylenol, to answer questions about little C's rash and even regarding her intense stranger anxiety (thank goodness that phase is over!)

Thank you to all my friends that stuck around. As a resident and as a mom, it doesn't leave much for a social life. Times like this has made me realize that true friends are few. Thank you to those that have been understanding and we can pick up where we left off despite the times we talk and get to see each other are few and far apart. To those who didn't want to stick around, that's okay too. Thank you for once being a part of my life but I understand that I may not be the friend you need or want. Thank you for teaching me that as we grow older, it is not possible to be friends with everyone and that it is also okay to not be liked by everybody.

Thank you to this blog for providing a sense of community. I feel grateful that I get to share my stories with other women just like me.

Thank you to my attendings. I've had my share of attendings who seem to forget how hard it is to be a resident let alone a resident and mom. However, I've also had my share my attendings that do remember and this is my thank you to the ones that tell me to go pick my little C early when things start to slow down at the end of the day.

Thank you to my husband for always listening to me and making the best out of the situation. Despite the entire country between us, you try your best to make sure I don't feel alone this year.

Thank you to my in laws for being understanding and patient. Thank you for not complaining about not being able to see little C or us that often. Thank you for supporting our careers and our journey to parenthood.

Thank you to my dad and brother for sharing your wife and mother with me. I know me and little C have taken her away from you two during the past 3 years. But neither one of you ever complain and love little C just as much as I do.

And my biggest thank you goes to my mom. Thank you for raising little C for 2 and a half years as her primary caregiver and now that she's in pre-school, thank you for spending your weekends with us, thank you for always packing us food for the week, thank you for watching little C when I'm on call and thank you for always being available when little C is sick and can't go to pre-school. You are the main reason I've made it this year.

Thank you, my wonderful village. I couldn't and can't do it without you all. Here's to 38 more weeks of long distance and to 30 more weeks of residency! I can see the light at the end of the tunnel.

Dear beautiful people in my village, my success is just as much yours as mine.

Wednesday, November 18, 2015

Guest post: No longer twenty-two and thankful

This has been a reflective week for me. My two-year old, the fourth and last of our kid posse, ditched the diapers. My husband and I are on the verge of making the decision to repatriate our family to the US after five years of living in South America. And I received my first-ever acceptance to medical school.

It's been a long and non-traditional road. When my husband and I met in organic chemistry many years ago, he had already switched his major to English and I was an enthusiastic pre-medical student. After college he took a job that required him to stay in our alma mater's location. I had a track injury that kept me in school for a fifth year. After my graduation, we decided I would take a deep breath from the hamster wheel of school, athletics, research, thesis, more school, and the insular world of which a 22-year-old college student is the center.

As often happens when one takes the opportunity to step back, my horizons broadened. A Masters degree. Marriage. My first year teaching high school with 153 teenagers. A surprise pregnancy. My mother-in-law with terminal cancer. And I hadn't yet reached my twenty-fifth birthday. Sometimes I felt like taking the deep breath was more like having the wind knocked out of me.

Fast forward a few years. My husband's parents have both passed away. We have four lively, enthusiastic children. Our career paths have been eclectic, and we are considering returning to the States, where we will find ourselves at another life junction.

"What do you want to do?" my husband had asked me a couple years ago.

"Well, the same thing I've wanted to do for a long time. Go to medical school."

He smiled, chuckling at the roundabout trajectory we had taken to get to this point from our chemistry classes way back in the day. "Well, let's go for it and see what happens."

I flew back to the States and took the MCAT seven months pregnant. I asked my thesis advisor if she could dig up the letter of recommendation she wrote for me over a decade ago. I finally filled out the tedious AMCAS application. I went to my first interview wearing a green suit (slate green at least!), and quickly realized that everyone else was wearing black, with a dark navy or two thrown into the group. But I am okay with being non-traditional.

I am no longer twenty-two, and I am thankful. Thankful for the crazy road of life, that has left me with unexpected joys, scars of sorrow, and varicose veins. Thankful for a family that has encouraged me through multiple moves and international transitions with uncertain futures. Thankful for the medical admissions committee members who decided to give me a shot.

And thankful for all the Mothers in Medicine, who have shared their stories and their journeys. Many blessings to you as we finish another year celebrating all the lives with which we are intertwined.

A soon-to-be MS1

Thankful For That Creepy Wiggle

Every year, there is always so much to be thankful for. As physicians, I don't think this idea is usually lost on us; we see patients suffering with difficult health challenges or even life-and-death situations on a daily basis. But what is sticking out this year as the thing I'm most grateful for?

Fetal movement. Yes, that weird sensation inside of my own body. My first child is due December 11, right between Thanksgiving and Christmas - the time that we most contemplate gratitude. This is not my first pregnancy, but I have never gotten far enough in the process to experience fetal movement before. I started feeling the movements around 20 weeks gestation, which began as little "pat pats" in my low abdomen that were easily confused with gas bubbles. They have now transformed into squirmy, distinctive wiggles several times throughout the day.

Overall, I have had a pretty easy pregnancy. My early nausea was fairly mild, I was able to continue with moderate exercise and work throughout my first and second trimester, and I have had no major complications as of yet. My tall stature has blessed me with a long torso within which baby can stretch, and I haven't been confined to maternity clothes. However, in my third trimester I have developed severe leg swelling that has significantly limited my activity (and my work, which usually involves being on my feet most of the day). It is very uncomfortable with constant itching and pain throughout my legs. To keep my mind off of it, I have been trying to focus on the good things... like the consistent blessing of fetal movement, a reminder of why I am going through all of this.

Many have described the sensation of fetal movement as "creepy", "surprising", "uncomfortable", etc. Expectant parents jokingly refer to their growing fetus as a "parasite". To me, the squirmy turns of my belly, the head-butting of my cervix and the kicking of my diaphragm are welcome reminders every day (every hour, really) of how hard I've tried to become a mother: the months of IVF cycles, shots, staying home instead of traveling, rearranging work schedules, waiting, hoping... And about how after all this time, it's finally going to happen!

Tuesday, November 17, 2015

Ten reasons this primary care pediatrician is thankful to her patients and families

1. Thank you for asking me questions, listening to my answers, discussing options together.
And for answering the many questions I ask of you.

2. Thank you for brushing your teeth in the mornings.
And in the evenings.

3. Thank you parents, for letting your teens talk with me in private.
I always encourage them to share with you what we discuss.

4. Thank you for asking for refills before your medications run out.
And for using your inhalers with spacers.

5. Thank you for understanding how important vaccinations are for your children.
And for getting your own influenza and pertussis vaccines, as parents.

6. Thank you for modeling healthy behaviors.
Reading, drinking water, minimizing inattentive screen time, and getting exercise every day. Together.

7. Thank you for letting medical students and residents learn pediatrics.
You are their teachers too.

8. Thank you for working on quitting smoking.
Call 1 800 QUIT NOW.

9. Thank you mothers, fathers, aunts, uncles, grandparents, great grandparents, neighbors, and cousins for caring about the children you bring to the pediatrician.
It takes a village.

10. Thank you for sharing your stories, and inspiring me to grow and learn with you.  So we can all be as healthy as possible on this journey.  
I'm listening. 

(an earlier version was posted previously by me at and I'm still thankful)

To my patient

I had started a thankful list, a real one from the heart. And yes, I am thankful for those things. But then the precarious balance of my life got upset, so new post.

I got shingles - it’s the thing that has upset my life balance. Stupid, burning shingles. My pain isn’t too bad but the burning isn’t affected by pain medications. Occupational health cleared me to work as long as the rash was covered. So to my next shift I went.

It was the shittiest shift I have had in a long time. By the end, I was hating everyone and everything but especially myself and my job. It was a shift where I felt like I couldn’t or didn’t help anyone. Most of my patients didn’t need a doctor, they needed better coping skills and over-the-counter remedies and time. 

But my last patient, I need to thank him. He needed an Emergency Doctor for his problem. He changed my whole day for the better. His sense of humor about why he was there and interaction with his wife reset my outlook for the day. And I could and did fix his problem too. Spiritually and doctorly, I was better. 

That patient refilled my compassion cup. Usually that’s the job of a million little things: bad television and sports, beer and coffee, my Sleep Number bed, Mirena, goofy t-shirts under scrubs, nail polish of extraordinary colors, my Chuck Taylors, t-shirts and jeans on off-days, Twitter, my KitchenAid mixer, and the color orange. Or the job of some big things: Hubby and The Blurs.

So thank you, sir and your lovely wife, my next shift was much better because of you. My balance is restored (mostly, because stupid burning shingles are still here).

Monday, November 16, 2015

Guest post: Unexpected gratitude

I love Raymond Carver's poem "What the Doctor Said." The doctor tells the poet he has widespread metastatic lung cancer. The poem ends with this:

I jumped up and shook hands with this man who'd just given me
Something no one else on earth had ever given me
I may have even thanked him habit being so strong

I may even have thanked him. 

I don't have to tell people they are dying. I'm a hospice doc. My patients know they are dying before they meet me. Everyone knows they are dying. They may not want to say it out loud, and they may use a variety of euphemisms, but everyone knows. I don't have to say it. I do have to find a way to answer the question "How long?" I always start and finish my answer by saying "I don't know." We never know for sure. I am frequently surprised - I am surprised how quickly some people die and how long some others linger. I am surprised by so much about this work. I am surprised by the peace that I feel at the bedsides of the dying, and how comfortable it can be in our inpatient hospice unit. I am surprised at the laughter I find when I make home visits. I am surprised by the capacity of family members to do the hard, dirty, physical work of caring for their loved ones.

And I am surprised when they thank me.

Patients thank me for coming to their homes. "A doctor who makes house calls! In this day and age"! Caregivers thank me for the medication that eases the symptoms and makes their job easier (even though it's the nurse who tells me what they need). Family members thank me for clear explanations of the medical system and for signing forms (although most of that credit should go to the social workers who do all the actual work). All of that makes sense. I have done something, given them something, provided an answer or solved a problem.

Then there's the question no on ever wants to ask: "How much longer, Doc?" It's often asked in the hallway of our inpatient hospice unit. Someone is usually crying. Sometimes the someone is me. I am as honest as I can be when I don't really know. I say "I don't see anything that suggests it will be the next few hours...", but I know the patient might be gone when we walk back into the room. I ask what the family needs - what decisions are they wrestling with? Who needs to come in from out of state? Who are they trying to protect? And at the end of the conversation, they say "Thank you." I am always surprised.

I don't really know why they are thanking me. Perhaps it's for some clarity and honesty after the muddle of modern medical care. Perhaps it's for the moment of connection and the respect I hope I'm communicating. And perhaps it's what Raymond Carver wrote about - that I have given them something no one else ever has.

Those moments will continue to confound and humble and amaze me, and for that, I am thankful.

Jay is an internist working full-time in hospice and palliative care and mom to a 15-year-old daughter.

Thankful in this moment

I am thankful for this hour of quiet. My father is in town helping us for 4 weeks while my husband is away doing research. I signed up to take Zo trick or treating but the greater than 50 notes I have to finish from the last 2 weeks are weighing on me and I have vowed to finish them this weekend.

I am thankful for the opportunity to care for my patients and their families. There isn’t a day that goes by that I don’t laugh and smile and sing and dance with my patients and think to myself or say out loud how wonderful they are. From the teenagers affected by gun violence who are working so hard to graduate high school and stay out of trouble to the school aged children who get so excited telling me about their dreams. To the new parents whose babies are growing and thriving. There cannot be another job like this!

And I am thankful that my position has just the right amount of joy coupled with dysfunction to keep me motivated but to also remain committed to finding solutions to enhance the work experience of community pediatricians. I cannot imagine how folks continue with this schedule for years and years. I have been practicing full time for less than 6 months and I seriously need a scribe, personal/house assistant, cleaning person, and driver for our son. Out of discomfort comes great things so I will work hard to building a better future for myself and future providers as well. It has to get better. And I have some ideas on how to make it happen.

I am thankful for being given the opportunity to raise my beautiful, outgoing, silly, passionate 4 year old with my extroverted introvert of a husband. I am thankful that my husband’s schedule is flexible enough to accommodate random days off from school. I am thankful that my new salary allows my husband the ability to pursue his research interests. And I am so freaking thankful that at this time next year he will likely have a full time job with benefits so that I can work on a schedule that gives me more freedom to pursue my research and advocacy interests.

In this moment I am thankful. And that’s all that really matters.