Saturday, September 20, 2014

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension. 


My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times). 


In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months. 


So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency. 


Happy birthday to my little roaring dinosaur - Mommy loves you!

Friday, September 19, 2014

Guest post: What's your plus one?

I love the honesty of Mothers in Medicine. I feel compassion for women stretched so thin between two callings. But I’ve got to ask you this: is there more to your life than motherhood and medicine?

I know, I know. For a lot of years, it’s about sleep and survival. But at some point, you’ve got to do you, right? You’re more than a stethoscope, a uterus, and a pair of lactating breasts.

Maybe I’m not saying this right. I definitely don’t mean to act smug. But I know I always wanted to write. I just didn’t want to starve to death, and I liked helping people, so…boom. Medicine. I studied my little heart out. I loved it. Until I lost the residency match, and I had to decide, am I going to keep chasing that ever-elusive subspecialty dream as hard as I can? Or can I do emergency medicine, see my husband sometimes, start a family, and pick up my pen and write again? I chose the second one. Either road would have been fine, but I’ve built a happy life with my childhood sweetheart and two kids, I’m writing, and I want to tell you not to forget yourself, that secret self that doesn’t necessarily earn money or praise or nurture others, it just is.

Medical-wise, I’ve got privileges at four different hospitals now, and one chief of emerg told me, “No. You can’t do it. You can’t work at four different hospitals. It will kill you.” He also limits his staff’s total number of shifts because he doesn’t want them to burn out. Autocratic? Sure. But he’s the only one I know who treats other physicians like human beings instead of widgets who have to see patients faster and more cheaply every day and night and night and day. We’ve been talking about how not to lose yourself, not become suicidal, not treat each other like garbage. Thinking about yourself as an individual and not just a service—I’d say that’s the first step. Plus, I thought it would be fun to talk about our secret selves.


Melissa (aka ACLS)
Emergency doctor/writer, mother of an 8 y.o. boy and 3 y.o. girl, in Canada
http://www.melissayuaninnes.com/blog

Wednesday, September 17, 2014

MiM Mail: Getting the milk home

Hi MiM,

Avid follower of five years (you got me through training...almost! Last year of fellowship. Thank you!).

Very concrete question:
I have to leave my nursing nine month old for two days and two nights for a conference (he is currently seven months old and I am anxious about this process). I will have to bring my pump, but I need some suggestions about getting the milk home. Carry on airplane with ice (does this entail a bigger ordeal since I won't have an infant with me)? Mail with dry ice? What has worked for fellow MiMs? I really appreciate your advice. I'm worried about the separation and channelling my anxiety into figuring out this milk transportation situation!

Appreciatively,
Dedicated MiM follower

Monday, September 15, 2014

Why Is Residency So Harmful? (And What Can We Do About It?)

Genmedmom here.

I'd like to thank "J the intern" for her post on physician depression and suicide on 9/9/14, as it prompted me to read Pranay Sinha's excellent New York Times Op-Ed piece "Why Do Doctors Commit Suicide?" He discusses what may have contributed to two recent intern suicides, namely, the shock of graduating from well-supported medical student to overburdened resident drowning in the macho medical culture. He describes his early intern year as "marked by severe fatigue, numerous clinical errors [], a constant and haunting fear of hurting my patients, and an inescapable sense of inadequacy."

Ah, yes. Residency.

In the comments to J the intern's post, OMDG brings up as additional factor to consider: "the elephant in the room... sometimes doctors treat each other like garbage".

Yup, I agree with that one, too. No one is more cruel to the suffering than the suffering. Many of my own emotional injury during training was at the hands of my colleagues. But, I know that I lashed out as well. We all hurt each other. I'd like to expound on that, if I may.

I well remember being humiliated on rounds, Monday-morning quarterbacked by someone fresh and showered. I cringe as I recall snapping at my intern for waking me up to check on a patient she was worried about. I'd been snapped at in a similar way as an intern. I remember with sinking stomach the disdain and sarcasm I received when I tried to teach a medical student a very simple procedure, and then couldn't do it myself. I still get angry when I think about the patients who suffered as my residents tried to teach me paracentesis, central line insertions, lumbar puncture- and failed on their attempts. I know my anger showed then. When our colleagues rotating at a small outside hospital transferred a sick patient to us in the emergency room, and it turned out to be a case of lab error, no pathology, there was derision all-around: "They dropped us a turkey, guys." When I was worried about a sick patient and called for an ICU consult, the ICU resident came, and told me I could handle it. "Don't be a wuss. Be a real doctor."

The cruelty towards women was pervasive. A pregnant resident had an early miscarriage. Still bleeding, she asked to be excused from her outpatient clinic. The chief, a woman, said no. "Just think of it like your period," she said.

A colleague went out on maternity leave six weeks early, for premature labor. Another resident was pulled from an outpatient elective to cover the rest of her rotation on the floors. The resident who was pulled was very resentful, angry to tears. "Why the f-- would anyone want to have a baby during residency? Why?" Another answered, "I'll never understand it. It's so selfish."

It's well-known that medical training erodes empathy. It took years for me to recover from residency, to feel like I could even begin to take care of people again. Literally. I did a research fellowship for three years, in large part because I couldn't imagine returning to clinical practice.

But, why did I feel this way, when my residency program was well- regarded, with many opportunities to share, reflect, even write? Why were so many of us injured and angered by our experience? So many of us recall their training with a shudder, vowing "I wouldn't revisit those years for all the money in the world."

That's just not right. How can we change it?

Open discussions confronting the cruelty of medical training may help. As a medical student, I was rotating on surgery. A rural hospital transferred a very sick patient to us, someone who had been misdiagnosed and suffered greatly. As the case was reported on rounds, there was loud derision and disgust expressed towards the rural docs. But one senior surgeon, someone so intimidating and revered that just a movement of his hand silenced the crowd, quietly admonished:

"There's no point in criticizing. Your fellow physician took the same oath you did. Assume that they tried, and that they feel terribly. We have all made mistakes, and we will all make many more. Don't waste your time on judgment."

End of that discussion, and it made an impression on me. Don't waste your time on judgment. I think, as teachers, we need to stand up and say that, and live that. Be real doctors.

We also need to dismantle that confusing paradigm of training: You are here to learn, but you should already know how to do it. Sinha also illustrates this in his essay. You were a coddled student in June, and then the doctor in July. You feel like you're supposed to know it all, because everyone is acting like they do know it all. Everyone's got a front. To ask for help is to be weak.

I remember very early in training, asking how, exactly, to write a prescription. I'd never written one before.

Oh, the rolling of eyes, the quick snappish explanation. I was so upset, I didn't catch it all. I spied on other people writing prescriptions and copied them. Seriously, how the heck are you supposed to know how to write a prescription if no one's really taught you?

How are you supposed to know how to be a doctor, if no one's really taught you?

I'm interested to hear what others' experiences have been, good and bad, with an eye towards practical suggestions. How do you think medical training be reformed?

Wednesday, September 10, 2014

Balancing parts of me

It's time to buy a new car.  Would seem a straightforward decision, but true to my planning nature, I'm trying to fulfil a number of requirements.  My eldest, HG, will apply for his learners permit in 4 more years, which falls within the lifetime of this car.  Although I want to buy a military tank in which to encase him, I realise this is not terribly practical.  So I set about looking for a safe car, the safest car if I'm honest, and find that the European (read expensive) cars have unquestionably more safety features than the locally built models.  But it comes with a big price tag, and whilst I wish to keep him safe, I also don't want him driving around in a luxury car that smacks of entitlement.  To be honest, such a car is not really me either.  I'm not sure if this fixation on ultimate safety is borne out of my work in seeing people smashed up by car accidents, and having a real appreciation for the value of life, or whether it's just me.

Of course, such dilemmas started with his birth - the safest cot, safest pram etc so this dissonance is nothing new.  A car is a much bigger investment than a pram though.  So, do I go with my cautious MiM nature and buy the European car with all the latest safety features, in case he's ever in an accident?  Or something more moderate - good enough in the safety stakes - and more in keeping with my non-flashy nature and what I'm trying to teach him about life?  Has being a MiM ever swayed your buying/life decisions?

Tuesday, September 9, 2014

MiM Mail: Physician depression and suicide

Dear Mothers in Medicine,

Long time reader here and new resident now (2 months in and there's no lookin' back). I was struck by the recent heartbreaking op-ed onphysician suicide in the New York Times. It was especially poignant to me because I'm at the same place in my training as the residents who took their lives. Each night I go home and think about my patients, but I also find myself worrying about my friends and colleagues from medical school in more grueling and less understanding specialities than my own. I know intern year is rough for us all, and I hope they are doing okay. And I'm terrified because I'm a female physician who's struggled with depression in the past (not currently) and I know the grim statistics on female physician depression and suicide rates.

What have you done when you've seen colleagues struggling? How do you handle your own struggles in a field that often overlooks the deep mental and emotional toll this work takes on a person?

- J the intern

Saturday, September 6, 2014

Nanny Search??

My husband and I recently decided that daycare is no longer a good fit for our daughter, for many reasons.  We are now starting to look for a nanny.  I am reaching out to the MiM community to see if anyone could give any words of wisdom on finding a good nanny??  I have signed up for care.com, but there are so many nannies available and I can't figure out how to weed out the good from the bad!

Also, if anyone has used a nanny cam, can you recommend a good brand?

ALSO, if anyone has a good idea for keeping personal items safe within the home, how would they recommend I do so? (I assume get a safe? But curious if anyone has any other ideas.)

Thanks!!!

Tuesday, September 2, 2014

What's your idea of fun?

Our health centers are “medical homes” now, so I have to come to accept (but not necessarily embrace) my allotted turn or assignment to work, i.e. see pediatric patients, on an occasional Saturday. Periodically, I am able to trade these away, so they end up being few and far between. After a full day of patient care on a recent Saturday on a recent 3-day holiday weekend, my family (me included) were out to dinner and a colleague happened to be picking up dinner at the restaurant where we were dining. She came over to make small talk, and I mentioned I'd just come from working the whole day.

My young son then chimes in with, “But mom, for you, work is fun, so it’s not so bad.”

And that got me thinking about whether or not it is fun. Of course, there are all kinds of fun. Family fun is our recent amusement/water park trip, swimming in any lake, ocean, or gorge together, and family movie night. My individual "fun" is going on a long run, doing the Sunday NY Times crossword puzzle, or simply sleeping late.

But the perception that work is fun has got me thinking. Indeed, a lot of pediatrics and teaching is, when my patients giggle and the toddlers talk and my students are inspired and inspiring. And my work is gratifying. It feels meaningful. But at times it is heart-wrenching. I’m intrigued that “fun” is how I portray my work to my children, or that this is how they perceive my orientation towards what takes me from them day to day. That this one word (fun) has encapsulated their mom’s chosen career path.

Monday, September 1, 2014

Self advocacy - why is it so hard?

It’s funny how a few things collide, to suddenly make life crystal clear. It’s job application time for me, and I was lucky enough to receive three offers, strangely enough covering the gamut of work life balance from no after hours to full on subspecialty. After much deliberation, I chose the job that would best complement all my roles – mother, wife, doctor, furry friends owner, health advocate wannabe – you all know the list. I recognised I was burnt out, and at risk of leaving medicine altogether if I didn’t make an active decision to change my hours and where I was headed. Both my husband and I are in high level, full time roles, something I never felt comfortable with for the children. Here was my opportunity to make a change more in line with what I wanted for my family. I’m a firm believer in if-something-isn’t-right-fix-it, don’t just wish or whinge! Fast forward one week - past all the happiness at finally making a decision, the peace that the decision was right for me and mine, excitement of starting a new job, the daydreams and plans to incorporate fitness, walk the furry friends, spend more time with hubby and children - to today. I’m catapulted from a state of contented decision-making bliss into Guilt – guilt I now know is ‘doctor guilt’ (thank you Emily). It deserves a capital G, don’t you think, for the central place it often plays in women’s lives? So what happened?

Well a couple of things. Firstly, taking this new, wonderful job involves resigning from my current job, something that I’ve never had to do before (I’m yet to do this, because I’m waiting on a formal contract). It also means leaving a path I’d always thought I’d follow, and jumping into a reasonably unknown area for me. After making my decision, I had a conversation with the boss of the subspecialty I’d originally planned to follow, creating doubt in my mind that I’d made the correct choice. She wanted me to take her job offer, and I felt like I was letting her down in choosing not to. It was also ‘known’. After the ‘doctor guilt’ came self recrimination – in resigning, I am jumping ship, baling out, leaving colleagues in the lurch. In reality, my position is actually supernumerary at present, so in actual fact, no-one is left in the lurch, but my soon to be old hospital won’t remember that. I’m now the person I never thought I’d be – the one who leaves a post early.

This really forced me to choose what was important to me. I sat down and thought long and hard about my values, what I considered ethical, the life I wanted for my family, the sort of mother I wanted to be, and whether that married with my current workload (no surprises the answer is no). I pictured myself in each of the three jobs, and tried to see how I felt, what my reactions were. I read widely, trying to build a picture of my future career options. I came across an article about women failing to speak up when sexually harassed and why we are all so ingrained to be ‘good girls’, to not create waves, keep everyone else happy. I had many long chats with close medical friends, trusted senior colleagues, and my husband, who all agreed I should take this job. People who, like me, would never ordinarily leave a post early. I was told leaving a post early is common, people do it all the time. Not me though. Never me. In an ideal world, I would ask to start the new job when this one finishes, in five months time. That’s the path of least resistance.

But spending another week, let alone another month, in my current position is too long. My family needs to make a change now. As well as that, moving now saves me time at the end – possibly nearly a year of time (due to retrospectively counting some of this year, something that probably won’t happen if I don’t move until next year). The next five months in my current job is surplus to my training needs. So, for the first time in my life, I’ve chosen to do what is right for me. I’m going to take the community based, no after hours or on call job, and I’m going to start in 4 weeks. All I have to do now, is tell them. Resign. Although I’ve decided, I still question it, and probably will, until my contract arrives, and I have to make the decision final.

So I guess two questions. Has anyone else ever left a post early? Taken a leap of faith? Any advice on whether it turned out ok in the end? Fingers crossed.

Monday, August 25, 2014

Eureka Moment

I was wrapping things up at a rare early 3:30 today and filed my slides. What to do? Attack the pile of journals three months thick sitting in the far left corner of my desk. I flipped through the Journal of Arkansas Medical Society, the latest CAP Today, and the Arkansas State Medical Board newsletter. Picked up the August edition of Archives of Pathology and Laboratory Medicine. Hit an article titled "Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees."*

I'm a sucker for the latest tech tools, so I read the easy page article eagerly. I was flabbergasted. I could hold up my iphone to the left eyepiece, steady the camera, and take a microscopic pic? One that rivals my $2K microscope camera that is so complicated I get anxiety whenever I decide to use it? Without an app or anything? Unbelievable.

I practiced the image capture that the article described - they were right the steadying of the phone while taking the pic at just the right moment took a bit of practice but five minutes later I had this:


Which I found in a gallbladder. Just kidding. It's a honeybee mouth. I got it at a local science store a few years back, along with a planaria and an ant and a couple of other fun bugs for the kids to play with under my scope when they came up to the office with me occasionally on the weekends.

I used the zoom function on my phone and got rid of the shadowed vignette, just as the article recommended:



Well it is still framed by iphone bars but I imagine this can be taken care of easily. Note how little energy bars I get in my lab basement. The ease and accessibility of this is astounding. Conferences. Sharing hard cases with co-workers (HIPPA restrictions intact and observed, of course). And as the article mentions, high-quality images suitable for presentations, posters, and publications. With your phone.

I ran around in nerdy glee showing off my newfound skill to my fellow pathologists - all as excited and disbelieving as I was and practicing with varying levels of immediate success. My fraternal rival good friend partner caught on quicker than I did capturing a fantastic picture of the lung pleura he was examining (he crowed that it must be his new workout routine). I copied the article and placed it in everyone's box, and noticed that it was written by a dermpath doc I haven't met who works at the University of Arkansas at Medical Sciences - he is a recent transplant and although I spent a day last week visiting all my former attendings and fellow residents (below me!) who are now attendings I haven't met him yet. I hear he's quite good but dermpath is one area I stay away from so I hesitated outside his door and decided familiarity was more important in my limited time off. I enjoyed chatting with a former co-resident who was just hired as chief of pathology at the VA, as well as many others. Man time flies.

*Smart Phone Microscope Photography. A Novel Tool for Physicians and Trainees. Morrison, A.S. and Gardner, J.M. Archives Pathol Lab Med - Vol 138, August 2014.




Thursday, August 21, 2014

Guest post: Doctor guilt

I have been a faithful reader since sometime in med school (6 years ago?) and have so appreciated all of your posts! I haven't found a community anywhere else with as many talented, empathetic, articulate and amazing women. I'm a family practice doc in a rural town practicing full spectrum family medicine. I have been in practice for two years since residency and absolutely love my job, even when it is stressful and hectic. I am a wife to an underemployed lawyer and mom to a beautiful, sweet, developmentally delayed 11 month old girl with tuberous sclerosis. She is the joy of our lives.

Having worked my whole life, I was really looking forward to maternity leave. I thought, finally, time for a break! As any mom knows, maternity leave isn't any kind of a vacation, but it really was a much needed mental and physical break from work. However, it was also disorienting to not have a schedule and frequent social interaction. I absolutely loved maternity leave and I think part of what kept me sane was knowing that I was going back to work. When the time came closer, people warned me about how hard it would be, and that I was going to cry my first day back.

I shed a few tears the day before, but the day I went back to work I was 100% ok. I enjoyed it, actually. I felt like I was back at my second home with my second family. The first night back I assisted with a crash c-section and had a blast.

It's been 8 months and I'm still going strong. I work in clinic on Monday, Wednesday, and Friday. I do 4 to 5 24 hour ER shifts per month. I am there nearly every day rounding on patients, since I almost always have a patient in the hospital. In reality I probably average 40 hours per week even though I'm considered "part time." I love having every other day off. After a crazy clinic day it is nice to have the next day to decompress. After having a day of playing with my daughter and being at home I look forward to the fast paced environment of being at work the next day.

Strangely enough, I never experienced the mommy guilt that is so prevalent among working moms of every profession. I love both of my jobs. I know my daughter is in good hands. (My husband is with her most of the time when I'm at work, and we have a wonderful neighbor who helps). I miss her when I'm working a 24 hour shift but that's not the same thing as feeling guilty that I'm not there. I don't know if it's because I'm the primary breadwinner or some other reason. I am 100% at peace with my decision to work. How many men who are breadwinners feel daddy guilt? Is mommy guilt something that is part of our genetic makeup or something that we are told culturally we are supposed to experience?

What I have felt sometimes is doctor guilt. I think part of this is because I was 32 when I gave birth so working is what I've known my whole life. I wonder if I should be working when I'm playing with my girl. I wonder if my colleagues are jealous that they don't get more time off to spend with their kids. (They never say anything - I just wonder). Maybe we'd all be better off as doctors, moms and dads, if we had the flexibility to have more time with our families.

Anybody else have doctor guilt, rather than mommy guilt?

Tuesday, August 19, 2014

MiM Mail: Two parents in residency possible?

Hello! I am a pre-medical student and wanted to share with you how much your blog has comforted me about my future in medicine with a family. Although I do not see kids in my near future, I have been with my boyfriend since freshmen year of high school and am confident that we will end up married (side note- he is also pre-med). I am one of those people who needs to have all their ducks in a row, so to say. I obsess over the future and planning, which I know is not always convenient when it comes to both motherhood and medicine. Upon looking for advice about when the best time to have children was in the medical career, I found many people who said that it was best to give birth during medical school. This just seemed extremely difficult to me because there is so much studying that needs to be done, and I don't want to add years to my training as I plan to do a general surgery residency and then continue to specialize for about another 4-5 years afterwards. I went on to search for advice/experience from women who were juggling babies and residency, and that's when I found your blog! It has been immensely comforting to read from women who have made it through and to not have to read comments from male doctors that "a woman should either be a mother or a doctor, because each one requires 100%" (seriously, one doctor ranted about this on a discussion board, but failed to explain why it was okay for him to work full-time and barely see his kids just because he was a male...)

My boyfriend and I are the same age, so we would be in the stages of our training at the same time....is it possible to manage children with 2 parents working in residency? (if it helps, he is interested in a radiology residency, although I know that both our choices could change over time). I know many of you have had such difficulties when only one parent is in medicine, so it scares me that my situation may be impossible.

Thank you again for writing such a wonderful blog for anyone interested in the medical field to turn to. I believe that as women we shouldn't have to give up what we love to do for our children, but I still want to be able to have a good relationship with my children. I realize my questions might seem premature considering I'm only pre-med, but the ducks must be in a row for me...... :-)

Thursday, August 14, 2014

All Holidays

A friend of mine came to me with a dilemma I thought this community could be helpful in solving.

She is a nontraditional student who is midway through medical school. She is going through a divorce and about to become a single parent. For that reason, she asked me if it's possible to have a career in medicine where she could be off during all the school holidays. Not the entire summer, obviously, but during the Christmas break, the winter break, Easter vacation, all the major holidays, and the weeks between camp and school starting.

I told her probably not.

Considering in an earlier post years ago, I was skewered for suggesting that people with young children have some priority in getting to choose which holidays they needed off, I figured she would be burned at the stake for asking for every single holiday off every year. But maybe I'm wrong. Maybe there is some job for physicians that allows you that kind of schedule.

Wednesday, August 13, 2014

Taking Care Of Ourselves

Genmedmom here.

A patient of mine recently asked me how my kids are, and what cute things were they doing nowadays? I'm very open about my family with all of my patients. They've seen me huge and pregnant, and they've seen my colleagues during my maternity leaves. My kids' photos hang in my exam room. We often trade parenting experiences as part of the visit.

So, I was not at all put off by her asking about my kids. Her visit was over anyways, and we were only making small talk as we wrapped it up. I described how Babyboy is a little engineer, always building and figuring things out, and that Babygirl is full of sass and song, teasting and challenging and singing all day long. She laughed and said a few things about her kids, how they were all grown up, how she missed their little days, but didn't miss how hard it had been.

"Make sure you take care of yourself," she said, suddenly not laughing anymore. It was a bit abrupt, this serious turn of mood.

"I mean you need to take the time for care for you, because you need to replenish your strength, to be able to care for your kids. Exercise, salon time, friends time, it's really important. You need to do that." She was beseeching me.

"Uh, okay, yes, I know what you mean, absolutely..." We were moving towards the door.

She stopped, and said, quietly: "No, really, I can see how tired you are. You're really, really tired. Remember to take care of you. I need you to, too!" Here she smiled, and the door opened and she was gone, leaving me unusually flustered, standing there for a few seconds, wondering what next.

I know I carried on with my clinic, and then went home, and did the dinner/ bathtime/ bedtime routine with my kids. I know I crammed in some mail opening, bill pay, and reading. I know that sleep was likely disrupted by something... If not one of the kids (usually Babygirl) then the cats, or this nagging cough I've had. I know I am really, really tired.

Now, I have alot of help from a wonderful husband and my untiring mother. I do get to exercise twice a week. I write, which is therapeutic. Hubby and I sit down for dinner every night that he's not traveling, and we have family dinners every week. I don't shop much, or see friends that often, and I can't remember the last time I went to a salon.

I honestly can't tell if I'm taking care of myself enough or not. I think I am. But if patients see me as exhausted, drained, that's not good. I'm not sure how much more time I can carve out for "down time" things, and I'm not sure I feel that strongly about making that happen.

What do others do to take care of themselves? How much down time do you need?

Friday, August 8, 2014

(Don't) Hide your kids!

The first year after my daughter was born, my end of year evaluations digressed into a lot of talk about whether or not I was mommy tracking myself.  The criticism was not about my work ethic or my skills. Apparently, there was an extensive discussion about how overly preoccupied I seemed to be about my daughter.  I mentioned her too often.  The suggestion of part-time residency came up and the sentiment was that I would no longer reach my full potential.  These meetings are supposed to be confidential-ish but I was told afterwards that perhaps I should try to hide my kid.

The instructions to hide my daughter came from a good place.  It came from an attending who had my best interest in mind.  He mentioned that in this world even though I was working just as hard, family issues were going to be looked down upon.  I would be stereotyped.  People aren't used to mom surgeons, especially not as residents.  He told me a story about sneaking off from work as a fellow to pick up his sick son by making up some elaborate story to hide the reason that he had to leave.  “It is more respectable to meet friends for beer than try and pick up your child from daycare,”  he told me.  My response…I would talk about my child incessantly!

So, I did.  I figured, if the world wasn't ready for women to be both surgeons and moms, than I would help to make them ready.  The end result is that I feel this has brought me a lot closer to the other hospital staff who are sometimes more open about recognizing the importance of family.  Being closer to the hospital staff makes my job easier.  I chat with the nurses, scrub techs, office managers about our families.  I feel like it gives me a sense of legitimacy and realness which means we are all on the same team.  Also, an unexpected result was that I became the “mama hen” of the residents.  There are a few more junior residents with kids or husbands and the associated stress.  I try to keep an open door policy for them.  And we have real and frank conversations about how hard this can be.  The supportiveness of being able to have this dialog goes both ways!  Also, I find that many of my attendings take an interest in my family life as well as my surgical development.

This past year’s evaluations had no mention of mommy tracking.  In fact, I was made chief resident.  Last night, as I sat finishing up work in the chief’s office while my baby girl bounced around watching Dora and coloring, I felt I made the right decision.  She knows all the names of the other chiefs and incorporates them into her world.  She loves coming to the office and is well known throughout the department.  She chats with me at night about her day and asks about my day.  She tells me she wants to be a doctor like me when she grows up (well, a doctor and a cowgirl of course).  I’ll never hide this beautiful girl!