Saturday, February 28, 2009

Just Like Mommy

Earlier this year, my daughter's class was doing a week on "healthy hearts," and her teachers asked if I could donate a stethoscope or two for the class. Since I am on my 5th or 6th stethoscope, it wasn't too hard to fish out the cast-offs from CindyLou's dress-up chest. The day we were to bring them in, CindyLou was sooooo excited. "My class is going to listen with *your* 'stefflstopes??' I'm so excited to be a doctor...just like mommy!" But instead of warming the cockles of my cold heart, these very words struck an odd chord of panic. I mean, what parent wouldn't beam with pride when their child wanted to follow in their footsteps, much less enter the medical profession?

Then, I paused a moment to think about what "being a doctor" really means to CindyLou. To her, mommy's work is hanging out at the nurse's station...checking out the new babies, coloring, eating crackers and suckers, and generally being fawned over by nurses, patients, and visitors alike. Or, perhaps she thinks about time in mommy's office, where SuperNurse plies her with her secret candy stash, she sits on her lap, and "works" on the computer. Being a doctor must seem a pretty sweet gig to a 4 (almost 5) year old. It also gives me hope that, for all my harried feelings about my job, they don't transfer to CindyLou; thus enabling her to feel like being a doctor is a pretty darn cool job. What ever the reason, I did feel grateful and humbled that my little girl was looking up to me, aspiring to be (despite my many foibles) "just like mommy.'

Tuesday, February 24, 2009

The Student

In the not too distant past, I had the good fortune of having a really great student with me for an "Office Ob/Gyn" elective. When I say "really great student," I mean exactly that. She arrived early and stayed late. She was professional and comforting to the patients. She asked appropriate questions and wrote really great notes. She had a good knowledge base, and she did it all with a smile and no 'tude. Truly, an awesome student. Unfortunately for her, we spent more time in the hospital doing surgery and deliveries than we did in the office. (I think that Whooville is having a serious baby boom. They just. keep. coming.) I do think that I was able to give her a taste of what being an Ob/Gyn is like, at least as far as being a solo practitioner, any way. She is trying to decide between Ob and a couple of other more "lifestyle friendly" specialties.

During the rotation, I really tried to let her form her own opinions about the life that she saw me living. I found myself, several times having to refrain from trying to talk her out of being an Ob/Gyn. A student that any Ob residency would be lucky to have, and I kept wanting to, I don't know, *protect* her or something. Maybe it was her sweet, un-cynical self, not yet marred by years of being beaten down by the establishment. Maybe it was because I wanted her to have a chance at a less stressful life, before it was too late to look back. Or maybe I was just trying to warn her not to make the same mistake that I made when I chose my first job out of residency (an essentially solo practice). I would like to think that it was the latter, because I truly love what I do, I just don't want to do it so, um, *often.*

I want to be able to feel confident in inspiring the best students to follow in my footsteps in a field that desperately needs good physicians. I worry that my first instinct is to tell my students to run, run, run, because I know that I wouldn't have. Even if the attending told me to run, I would have made the same choice. So at the end of the rotation, after we went over her evaluation, she asked for a letter of recommendation (which I will gladly write). When I asked whether she wanted one geared toward an Ob residency, or one for more general purposes, she chose the "more general" category. She's still making up her mind. Perhaps my feelings were telegraphed more than I had realized. I do feel hopeful, though, to know that the such bright rising stars in the future of medicine exist out there. So, to all you bright med students and would-be med students...don't let the disillusioned attendings get you down, y'all. We need you more than you know.

Saturday, February 21, 2009

The most important job in the world!

Melly has been going through her "toddler word explosion" lately, so one word we've been trying to teach her is what I do for a living.

Husband: "Melly, what is Mommy's job?"

Melly: "Diaper!"

Me: "Great, she thinks I'm a diaper."

While I am not employed as a diaper, it should be noted that:

1) Diapers and I both work at night as well as during the day.

2) Diapers are white; I wear a white coat.

3) Diapers and I both get crapped on a lot in the course of our duties. (I said DUTIES.)

So my job actually does have a lot in common with that of a diaper, but I am not, in fact, a diaper. Nice try though, honey.

Friday, February 20, 2009

Boy Perfume

“If your grandfather hadn’t worn it, you probably wouldn’t exist…”

My tween Eldest loves to use this Old Spice tag line. Like many things in his world, he’s just beginning to grasp the underlying meaning. Now youngest - age 8 - is starting to follow right behind. He came downstairs this weekend doused with his brother’s cologne.

“Whoa, Buddy. Have you been in your brother’s Old Spice?”

“Well. Maybe. “ Kind of hard to cover up an overdose of aftershave.

“A little goes a long way, ya know?”

“I like to smell good.”

“Maybe we need to get you some of your own.”

“Can we?” Sure, I think. I’ve got one I can’t get into the shower but needs it. Regularly. And I’ve got one who’d bathe in dad smell if I let him.

Smells are part of my life – they’re hard to escape in medicine. The good ones: The buttery sweet smell of a newborn that makes me ovulate on cue as KC puts it, my butter cream candle that puts me in that Zen place. The mediocre: hand sanitizer foam, plastic odor from IV tubing, syringes, and emesis basins. The stomach churners: toddler poop, third hand smoke, formaldehyde based wavicide we use to clean instruments (sends me straight back to anatomy lab), and the perennial vomit tang. A well trained nose can turn off all but the strongest smells.

At home, I have to remember to turn my olfactory sense back on – make a conscientious effort to take in the yummy clean smell of my youngest’s hair and even the pubertal funk of Eldest – pre-Old Spice. Do I really want to mess with the chemistry that goes straight to my amygdala? Cover it up with some commercial pheromone?

I wonder what I smell like to my kids. Will they get a whiff in their old age and suddenly have memories of their mom? Perfume is one thing I can rarely forgo – can go without makeup, like Fizzy, but cannot go without some sort of scent. My current favorite is Philosophy’s Grace – it’s like grown-up baby powder to me – soft, a little floral, and subtle.

So at Target, I buy Youngest a bottle of Old Spice. It’s better than some of the alternatives. We keep peace in the bathroom with separate bottles for each of my fellows. A little goes a long way.

Wednesday, February 18, 2009

Guest Post: A Parent's Perspective

Whether as a promise or warning, our psychiatry clerkship director had informed us that we would be surprised to find how much we have in common with our patients. What he did not say is how much we would have in common with our patients’ parents. My first evening on call, we were told that a nineteen year old*, who had attempted suicide two days prior, would be transferred that night from a local hospital. I called medical records to have his electronic chart unlocked. As I read through the previous history and physical from a psych hospitalization back in August, I tried to picture this kid. Numerous times in the notes, they made reference to his ‘severe acne’. I conjured up pictures of the pocked, scarred faces of the skinny, loner boys in hoodies I pitied during high school. Surely this was he?

I waited for the intern to come to the floor. I did not want to interview this person by myself. What if he admitted he wanted to kill himself again? What if I didn’t show enough empathy and caused him to feel worse, more alone or more misunderstood? What if I showed too much and embarrassed him? What if I simply projected enough of my own anxiety onto him and around the room that it became more about me and not about him, alienating him even more? I sat nervously hiding in the physician workroom.

When we entered the room, my visualization had nothing in common with our patient. He was nearly a man: well developed, almost muscular and his acne had all but resolved. Wearing jeans and a tee shirt advertising a local restaurant, he was mindlessly picking at his arm hair. One leg was swung casually across the bed. His parents sat on opposite ends of the room, both perched on the edges. Dad rested on the ledge of the room’s radiator and Mom was on the hard wooden chair that matched the pine desk. His dad was wearing a suit, looking fragile and exhausted. He, too, was well-built but unlike his son, looked as though he had just gone through an ordeal. His mom had dark hair and vivid cerulean blue eyes. She glanced up as we walked in and I could feel the breath fill her lungs. She looked over at her son and gave a sad, half smile, ‘The doctors are here, Louis* she said softly. She stood up and crossed the room perching next to him on the bed. She turned to us and motioned, "They’re babies, Louis. They’re so young. They’re practically babies." She continued to attempt a smile, and it was difficult for me to tell if she was simply openly skeptical (and rightly so) of my psychiatric acumen or if she was trying to put her son at ease. I was struck with the thought that he looked infinitely more casual about the situation than they did.

I suppose one of the nice things about getting older is that I only feel pleased to be called young. There are days I feel overwhelmed and exhausted: a result of too little sleep paired the intense time required of young children and academic endeavors. Initially, I fought back the urge to reassure her that, I wasn’t young. In fact, I have four children of my own. But I didn’t say it because, unknowingly, Louis’s mom reminded me of exactly what I am: a student, fledgling in my career, allowed to ask obtuse questions and to fumble through interviews. I often feel that because I am a mother, I should be mature and accomplished enough to be good at this.

With that, I registered that I felt much more empathy for the parents than I did for Louis. They looked anxious: a sick, what-do-we-do now expression as their fatigue mingled with wits-end. I was partially curious, floored, and anxious that two caring, highly educated people had produced a Louis, a Louis who by most accounts had a whopping drug problem tangoing with a schizoaffective disorder diagnosis. Parents, who by all appearances and written accounts, loved their son desperately, but I imagine must have also been furious and yet terrified of him. I pulled back realizing that perhaps I was afraid of him and again, vaguely aware that I could be projecting my parental panic for my own toddler son’s self injurious behavior. Panicked that one or all of my children could end up like this despite, or worse, due to my best efforts, it is little wonder I had trouble concentrating on Louis’s answers to my first question.

After the interview, I finished the write up and drove home in a daze. I recognized that somewhere during the interview my attention fixed exclusively on the patient. While agonizing over his parents’ thoughts, I initially fought to keep his story, his feelings and his concerns as the focus of the conversation. I know I am prone to identifying with the parents; yet, being excessively caught up with their anxieties could interfere with my relationship with Louis. I attempted not to illustrate his story with my own transferred feelings and hopefully, this awareness will improve the quality of care I provide him. But that seems to be the trouble with motherhood: it can be hard to separate it out from how I see and interpret the world.

*Patient's identifiers have been changed.

msm is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.

Tuesday, February 17, 2009

Seriously, I wanna know....?

This month I was going to defer to the tried and true and ask about a historical figure you'd like to have dinner with, but...I'll save that for a future SIWK.

So, I wanna know: Have you ever had your life flash before your eyes? What were the circumstances? Who was with you? Are you different as a result of the experience? Can you describe it?

Sunday, February 15, 2009

Looking fabulous

Yesterday, I cut my hair.

I've been cutting my own hair for about four years now. I was never really into fancy stylists or whatever, but I always at least went to a salon and got my hair cut by someone who could actually see the back of my head. But it never went well. Apparently, most stylists aren't good at cutting curly hair. Geez, why is it so hard?

My last haircut prior to my 4th year of med school was one of those really traumatic experiences. I'm still in therapy for it. The hairstylist cut my hair and I felt like it wasn't short enough, so I told her, "No, shorter!" Then she hacked off another five inches in one snip. I was horrified. Now I know how the surgeons used to feel when they'd tell me to cut knots for them.

The only good thing about the traumatic haircut is that I didn't need another one for over a year. Then during my intern year, I noticed my hair was getting a little long again for my taste. However, since I only got about one day off every month, I didn't want to spend that one golden day sitting in a salon. So I started to entertain the idea of doing it myself.

I think I stood in the bathroom with a pair of scissors for about 20 minutes, working up the courage to make that first cut. Then when I did, there was no turning back.

It came out better than I thought. Since my hair is so curly, it's fairly forgiving of being vastly different lengths. I decided that from then on, I would cut my own hair.

So four years later, I'm still cutting my own hair in the bathroom. Nobody at work can believe it when I tell them. I don't think it's that big a deal... I mean, it's not like I'm churning my own butter or anything. These days, being a resident and a mom, who has time to get a real haircut? Who am I trying to impress? I think it's amazing if I manage to make it to work without milk stains all over my clothing. Or manage to get my white coat in the washing machine a couple of times a year.

But yes, even though I was never the picture of style, I do think I've crossed a line by starting to cut my own hair. I also haven't worn make-up in... quite a long time. I know there are other working mamas out there (on this very blog, even) who still manage to look fabulous. I feel like I've boarded a high speed train--next stop, granny panties and eyeglasses from Sears.

Wednesday, February 11, 2009

Welcome to Topic Day on "Our Mentors"

Welome to another Topic Day on Mothers in Medicine! Today, we will be featuring posts all about our mentors: specific mentors, the difficulty of finding mentors, mentors who become friends, and more. We'll be posting regularly throughout the day.

Scroll down to find the posts...

Why I Quit

I don't have a mentor and I never did. But I did get some advice from an intern during my third year of med school that haunted me for many years after:

When I was a third year med student on my medicine clerkship, a intern named Jim saw me working on the ward at around 6PM. "What are you still doing here?" he asked, shaking his head at me.

"Huh?" I said.

"You should go home and study," Jim told me. "Or else..."

Or else I'll fail my boards? Look bad in front of the attending? Flunk out of med school and end up homeless and penniless on the street??

"...Or else you'll end up in internal medicine."

"Oh," I said, confused by Jim's ominous tone of voice. "Actually, I want to do internal medicine."

"Oh god," Jim said.

Interns typically are the most miserable and bitter people you'll meet in the hospital, but Jim was especially miserable and bitter because he wanted to match in radiology but didn't. He was stuck doing a prelim year in medicine and wasn't having much luck finding a radiology program that would take him. One day he was complaining about it and said to me:

"You know, it sucks. All this work going through med school and you can't even do the field that you want to do."

Those words really haunted me. I eventually came to realize that internal medicine was not my first choice and when I matched in it two years later as a compromise (long geography-related story), I kept thinking to myself, All this work going through med school and I can't even do the field that I want to do. When I hid in the call room during my dreaded internship ICU rotation, I angrily thought to myself, All this work going through med school and I can't even do the field that I want to do.

So I quit. To do the field that I wanted to do.

Thanks, Jim!


In Homer’s epic, The Odyssey, he introduces us to Mentor, a character to whom Odysseus leaves in charge of his household while Odysseus goes off to the Trojan War. Depending on which scholar you subscribe to, Mentor is not an entirely successful guardian. He allows courtiers to woo Odysseus’s wife, Penelope in his absence. It is the appearance of Athena, goddess of wisdom and war, who disguises herself as Mentor, who shakes some sense into Telemachus, Penelope’s son.

"And yet you did not know me, Pallas Athene, Daughter of Zeus, who [will] always stand by your side and guard you through all your adventures."1

Fast forward a few thousand years. What does mentor mean today? What does a mentor look like? I have asked myself those same questions many times – and not just in the past 36 hours as I’m trying to meet our Topic Day deadline. In my mind’s eye, a mentor is someone who’s a lot like me – maybe a little older, a couple more gray hairs, and a few more life experiences under her belt. This mentor has a similar job and balances life successfully between work and home. She has the same issues with being a breadwinner or weight gain or feminism or being a leader in a predominantly male hospital culture. In lazier moments, I can be a cc or carbon copy or her and just follow in her hard won footsteps. No need to reinvent the wheel here.

But that person doesn’t exist, at least, not in my world. Like Athena, my mentors have come in many guises and where I least expect them. Like you, I had assigned advisors, and I learned plenty of pearls from those people. Those advisors were wise and understanding. For me, though, my mentors have had additional almost familial qualities and seem extra invested in their advice. My partner in my first practice was a mentor although I didn’t know it at the time. Warren's keen sense of business acumen guided me through the first three years of life as a private practice pediatrician. At the time, his work holism drove me crazy especially on the day after Christmas when we saw seventy (70) patients each. His philosophy was we’d see “em, as long as they kept calling for appointments.

When I opened my own business, I realized what production really meant. It wasn’t just some fancy word for working your ass off – production pays the overhead and coasts my practice through lean summer schedules. Some days my office feels like a spin-off of my first practice especially the days I have to prod the other staff members to hustle. Warren also taught me to honor my community. The drycleaner who brings all seven children to my office for well child care gets my dry cleaning business in return. Giving back to the same community who supported him was a tenant that he lived by and that rubbed off on me, too. He even introduced me to my future husband. He was that invested in me and my career, and while he was too young to be a father figure, the mentor role suited him perfectly.

Other mentors are not so obvious. If you gave Dr. William Wilkoff my name, he would likely say “who?” I’ve never met the man, but each column he writes in Pediatric News is filled with anecdotes and common sense about his life as a pediatrician. Some are advice to the pediatrician like this Oct. 2003 article:

“As pediatricians for the new millennium, one of the many tasks for which we haven't been formally trained is to help parents learn to say no to their children. It may not have the ring of political correctness, but the health of our nation depends on it. Simply telling parents to “just say no” isn't enough. We must convince them that setting limits can be an important health issue by giving them the facts about obesity, accidents and a sedentary lifestyle. We must support parents by telling them that we understand why saying no can be difficult but that, when done properly, it is the right thing to do.” 2

Other columns comment on the demographic shift in pediatrics:

“Here in Brunswick, I have already been challenged by and benefited from the ramifications of this nationwide gender shift. My partners, Deb and Andrea, offer a perspective that teenage girls appreciate, and they project a warm and fuzzy image that appeals to the parents who find my no-nonsense style too hard edged. ”3

I love the practicalities Dr. Wilkoff discusses monthly. These are things I didn’t grasp in residency, and his warm and self-effacing manner focus on the art of medicine. He focuses on the science, too:

“Researchers recently discovered that there are two peaks for the termination of breast-feeding during the first 4 months post partum. The first occurs during the first week, when one-quarter of mothers stop breast-feeding. The investigators observed, “This timing suggests that a 1-week postpartum visit for well-child care is too late to intervene for many breast-feeding mothers” (Pediatrics 107[3]:543-48, 2001).
It's hard to make the handwriting on the wall any clearer. If we want to protect our patients from kernicterus, and if we truly believe that breast milk is the best first food for babies, then we all should be seeing our patients 2 or 3 days after hospital discharge.”4

The last piece of wisdom I’ve learned from all of these mentors is that my life is MY LIFE. Only I can navigate the path, and to carbon copy is cheating myself out of the opportunity to be a better, more balanced person. I don’t have to see 60 or 70 patients a day to be a good physician, but I need to be available at least 3 days a weeks to give my patients (& staff) some continuity. It’s what I do with their advice that matters, but they’re here for the long haul. I hope you find or have found that kind of support system – one that won’t let you carbon copy. Like Athena, it may be disguised and where you least expect it.

(1) Homer, The Odyssey: 210
(2) Wilkoff, William “‘No’ Problem “Pediatric News October 2003 (Vol. 37, Issue 10, Page 33)
(3) Wilkoff, William G.” The Feminization of Pediatrics” Pediatric News August 2002 (Vol. 36, Issue 8, Page 24)
(4) Wilkoff, William G.” Neonates Can’t Wait” Pediatric News; Volume 35, issue 12, Page 43 (December 2001)

Advice from a mentor

I've been fortunate to have worked with many individuals who have sheparded me through various stages from medical school to the present; limitation of time and space doesn't allow me to describe how each of them contributed to making me the person I am today.

But as I was pondering what to share, one memory kept pushing to the front of my brain: This was a statement from a woman who I admired greatly during the early years of my career and am pleased to share a working relationship with today. At the time she told me this, she had three school-age children and a nicely balanced life. I had two very young boys and felt like every day was a struggle. I vented one afternoon about my frustrations with my morning schedule; I knew it was my choice to take my son to preschool, but when I did this (seemingly) straightforward task I was invariably late to the clinic to see patients and ran behind for the day. Her response to me was so elegant in its simplicity that even today I admire it. What were those words of wisdom? "Start your clinic day fifteen minutes later." An invisible solution until it was pointed out to me, and with those seven words my outlook changed dramatically. Yes, I could put my family first and still be an effective physician. Yes, I did have some control over my days. Yes, even I could find some balance.

Today, as young women rotate through my office I try and discuss with them how being a mother has changed me as a physician (only for the better!), and I try to emphasize that they, too, will likely be able to find the balance they need. Sometimes its just a matter of letting someone show you the simple solution that you can't see on your own.



Before residency, I doubted I would find a mentor in medicine. Who but me could have varying interests, put her family in front of her career and still be wildly successful? Surely, I thought in my typically narcissistic way, I am one of a kind.

But then I met Karen.

Karen became residency director shortly after I joined the program. She is a busy woman, and I think we all figured she would put our needs last on her agenda, but Karen proved to me that time is relative.

She has three little kids, all well-adjusted and involved in their own sports and activities. Her husband has an equally high profile career and they don't have a nanny. But somehow, she was able to meet with us whenever we needed her. She counseled, mothered and taught us until we became doctors.

After residency, Karen and I became colleagues when I joined faculty. I watched her handle departmental dramas and marveled at how she quietly but swiftly worked her projects through the bureaucracy. She spent time with her patients and they were devoted to her. She lectured, published and kept up with relevant research. She had plenty of non-medical interests and activities and kept up with non-medical friends. And she never apologized for being a devoted and attentive mom.

When I decided academia wasn't for me, Karen blessed my departure. We don't talk much anymore, but I know her office door is always open should I need to talk, cry or laugh.

The Fabulous Mentor-Friend

I got matched up with my mentor by fate. I can't even remember how I ended up meeting with the medicine division chief as a student, but there I was, telling him how I wanted to get involved with some kind of clinical research in women's health, and he gave me her name.

An unusual name. Sounded vaguely familiar.

From the moment I met Fabulous Mentor (FM), I was in awe of her fabulousness. She was junior faculty, had tons of enthusiasm and a wardrobe to drool over. FM was a star in our high-powered academic institution. Radiant energy.

We started working on a research project together, and when I say 'together', I mean she made me feel like it was mine too. She'd ask me, a lowly medical student, my opinion about things and made me feel smart and important. Her generosity of encouragement and praise helped fuel me.

FM wrote one of my letters of recommendation for residency, and one day, she let me see it. There were exclamation points!!! There were words written in ALL CAPITAL LETTERS. It was a letter like I had never seen before. A letter to frame. I got into my first choice residency, staying at my same institution, and I wondered how much of a role she played.

Throughout my residency years, she was a constant advocate for me. We worked on a couple of other projects along the way, gaining me authorship and, importantly, learning how academics worked. I always felt so lucky to have this relationship with her that others didn't.

My husband and I announced our engagement to her and her husband over dinner one spring night. A few years later, I would go to her baby shower. And her, mine. We would write or call and talk about life or babies or jobs, long after I graduated medical school and residency.

It's strange how you can wake up one day and realize you are more than mentor-student, but friends. Although, it always feels slightly lopsided. I will always partly be that awe- and admiration-filled medical student hoping to be just like her someday.

FM is fabulously successful in her career now, of course. And I'm still looking to her for career advice, in between talking about babies and life.
Meanwhile, I find myself in the mentoring position with my own student mentees. Students whom I hope I can adequately guide, counsel, and, hopefully, inspire. They have been mainly women (by chance? by purpose?), women whom I hope will become friends, talking about life or babies or jobs one day, years from now. I'm paying it forward. I'm shooting for fabulousness.


I went through medical school at the edge of the first large wave of women admitted since the forties. In the 1970s, the whole concept of mentoring was murky. Daniel Levinson’s book on adult male development had highlighted the importance of mentorship, mostly in the business context and mostly from the point of view of the value of being a mentor. We called our mentors advisors. In college, my relation to my advisor was distant—I doubt she could have picked me from a police lineup—and medical schools had not yet recognized the need.

Beyond the deficits of the system, being a young woman in an environment where all the potential mentors were older men, I felt uneasy about seeking a mentor. The boundary between mentor and puppetmaster was too thin. Though I aspired to an academic career, I knew that the careers of my possible mentors were not for me. I wanted a family, and I was not prepared to work evenings and weekends on articles that might add weight to my resume but only add burden to what others were expected to read. How to be creative, individual, and sane were my goals, and the few senior faculty who reached out to me, or who I approached, could not really speak to my condition. The best one of them came up with was that I was promising but an underachiever.

Fortunately, though I lacked mentors, I had models aplenty. I admired extravagantly the men who taught me, mainly by example, how to be a teaching doctor. I remember seeing my physical diagnosis tutor examining a patient’s abdomen. He was a big guy with huge hands, and the gentleness with which he showed us the liver edge moved me almost to tears. I knew my hands would never look like that, and that I would have to struggle not to seem sharp and small touching people, but I did learn that a doctor’s touch could warm and heal as well as probe. Another tutor took us to see a man (whom he did not previously know) who was recovering from a stroke. The man’s worried wife was standing behind him. My tutor managed to demonstrate the extent of the patient’s continued paralysis, while his words to the patient and his wife conveyed how much he seemed to improving. Neither of these men will ever know the impact that observing their blended skill and compassion had on me, but neither will I ever forget those or other moments that so nourished my growth from student to doctor.

Now I am in a position to mentor students myself, and I find it tough going. They are so silent, so fearful of expressing themselves, of making errors or seeming uncertain. I can only hope that they see me the way I saw the people I admired. Perhaps someday something I did or said will be communicated to other students as an example of what good mentoring can be about.

Guest Post: Jane

Lucky to have had many mentors and stand on the shoulders of those who have gone before me. Mom, Dad, and others too in many ways.

But I want to tell you about my third year medicine intern. I entered that rotation totally confident and blissfully unaware of the challenges of combining motherhood and medicine.

Jane (not her real name) was married and mother of a young toddler. Her husband also worked for pay and they had a nanny watching the kid. This was in 1992. Jane knew I was newly married and told me how they work their family system. Jane had a code worked out with the nanny to use with her beeper.

Remember beepers with the one row of numbers that would appear after the caller typed them into their phone? No words, no keypads, no cell phones. Jane had gotten her nanny a beeper as well. If Jane was going to be home at the usual time, she did not call in. If Jane was going to be home in one hour, she typed in '1'. If nanny wanted to Jane to call home to talk, she typed in another code.

And, of course, if there were an emergency, either one would type in '911.'

This let Jane get messages of all sorts from the nanny and stay connected in real time while rushing throughout the hospital doing intern things.

While I had no clue about the variety of issues on the horizon for myself, I always appreciated the earnest and urgent need Jane had to impart her wisdom and experience and sisterhood.

I have not kept in touch with Jane, but hope we do reconnect some day.

Jane, if you are out there reading THANK YOU!

post by Tigermom

What is a Mentor, and Where Can I Find One?

I used to think that the word "mentor" was derived from mens, the Latin word for "mind," or men, the Indo-European root for "thinking," and the suffix -or, meaning "one who does or creates" the thing described by the root of the word. Thus a mentor would be one who uses the mind or forms a person's thinking.

But of course the word mentor doesn't come from such a derivation at all. Mentor was the guardian of Telemachus, son of Odysseus, and in The Odyssey the goddess of wisdom assumed Mentor's form to aid Telemachus, one of her favorites among mortals (as well as to escape notice by Penelope's suitors).

Homer's Mentor is a mere minor character, however, without all the attributes of the "experienced and trusted advisor" the Oxford English Dictionary leads us to believe such a figure should have. Where do we get the archetype of a wise teacher who cares about, nurtures, and encourages the learner - who builds up the learner's intellect rather than doing the opposite, sucking out the student's soul, as J.K. Rowling's DE-mentors do?

For that sort of character we have François Fénelon to thank, whose enormously popular book Les Aventures de Télémaque, published in 1699, was "a continuation of The Odyssey from an educational vista," according to author Andy Roberts. It brought Mentor to the forefront as a major character with tremendous influence over the story's hero. "It is Fénelon," Roberts continues, "not Homer, who endows his Mentor with the qualities, abilities, and attributes that have come to be incorporated into the action of modern day mentoring." The word mentor came into modern usage in English in 1750.

I am rambling on about these literary and historic niceties because I enjoy them. But I am also having a hard time writing about an actual mentor. From what I can gather from my own experience and from other people, finding a mentor in medicine usually happens by a great stroke of luck; it's not automatic. You'd think that in a profession supposedly built on compassion and learning, mentors would abound. The word doctor, in fact, means teacher in Latin. But it's not that easy to find good mentors. It may be harder still for those who long for a mentor who is a woman.

There were many teachers, of course, who gave me terrific lessons I carry with me to this day; but a mentor is more than a good teacher or role model. A mentor is someone with whom you have a relationship - someone who truly cares about your formation and expends energy, real work, to help you through it, and wants to do so. A mentor believes in you and communicates that faith; a mentor listens, and can be trusted with your struggles and your successes; a mentor teaches and guides without resorting to a power differential to exert influence; a mentor has a personal stake in the education of the whole learner - intellectual, moral, physical, spiritual - and, therefore, cares deeply about the learner's character and responses to the world as well as his or her knowledge.

I do have a couple of people who always come to mind whenever I hear the word mentor: my med school anatomy professor, Dr. Matthew Pravetz, who also baptized my youngest child; and from my days in pediatrics, Dr. Indira Dasgupta, a woman whose dignity, intelligence, compassion, and humor I hold in my heart to this day. There have been few people in my career who have helped me believe - as they did and as every mentor should help his or her "telemachus" believe - "You can do this. You are good. Your work will make a difference. I'll be there for you if you need me." Even the most independent-minded and confident person needs guidance at one point or another, or loses faith, or needs help. Mentors ultimately stoke the fire and help keep the faith. Happy are those who are blessed with some good ones

Sunday, February 8, 2009

to a pediatrician, blue is not good

Well he's either cyanotic or it's really that cold out. That's what his preschool teacher, whom I respect and admire, asked me about at drop-off one recent 20 degree day. She didn't explicitly mention cyanosis, just a concerned question about whether it's really that cold out. An innocent, "why are his lips blue?" And his fingers too, upon closer inspection.

Am I stressed? Is this a tet spell?

Why are his lips blue?

Check pulses and the other ABC's (of resuscitation, not of the alphabet)? Stat EKG? Pulse ox? Echo? He's a healthy 2 year old. My healthy 2 year old. Not known to be short of breath while rocking out with his Daddy's guitar, not known to tire easily, might miss a nap but not a heartbeat. What to do? Is he blue?

Well, blue berry.

That's his breakfast. Frozen blueberries in warm oatmeal. Today more on his lips (and fingers) than in his mouth. I've heard they're pretty good for you, too.

Friday, February 6, 2009

Could I get a little Zen here?

My kids have a book I love. It's called Zen Shorts, and it's just that: a series of short stories, each with a Zen message. (Note: we are not particularly religious in general and completely non-Buddhist, in case that matters to anyone.) One of these short stories includes a well-known parable from Zen Buddhism. It goes like this. A young monk and an elderly monk are walking along. They encounter a high-class woman stuck at one side of a big mud pit fretting about how she will get across. The elder monk picks her up, carries her across, and gently puts her down on the other side. She is quite unpleasant to both of them, complaining all the while, and never says a word of thanks. The elder monk walks on silently as he did before. The younger monk ruminates on what happened for the remainder of the afternoon as the two monks continue their journey, marveling at how the woman could be so rude and disrespectful and asking why the elder monk didn't just put her down. Finally the elder monk says, "I put her down hours ago. Why are you still carrying her?"

My kids love the book, so we read the story often, and I have a Eureka! moment every time. THAT is how I want to be, like the elder monk. I have to cultivate this Zen thing. No, wait, I know, even better: maybe I'll even BECOME A BUDDHIST!!!

But the sad reality is that I am SOOOO not Zen. I am the young monk. No...worse. I am the anti-Buddha.

I have an extraordinarily hard time letting anything and anyone go. I have a lifelong tendency to accumulate clutter in my house and office--not DSM-qualified hoarding or anything, but real clutter--and in my mind. The sad fact of life as an oncologist is that yes, there are many people we save, and yes, we've come a long way, especially in breast cancer which is my specialty, compared to 10 or 20 years ago, but we still lose a lot of people. I remember the name of every single patient who has ever died in my care--all of them, even my patients in the ICU as an intern--and, in most cases, the names of their spouse and kids and various random facts about them, too. I don't know if this is because I doubt myself and wonder whether I could or should have done something differently that might have saved them. Or if I actually have too much empathy for patients and families. Or if that's even possible. All I know is that I take every death very much to heart. And, as an oncologist, if you're still carrying patients long after you should have put them down, you are in for real trouble.

Although I suspect that most of the readers of this blog are in fields other than oncology where death is fortunately not a regular occurrence, I wonder if and how you put patients down once you have done your job of carrying them across. When you have made mistakes, do you let them go? If you have lost patients, can you put it behind you? And if so, how do you do it? I know we don't have a doctor-patient relationship, but, please, can someone prescribe me a little Zen?

Wednesday, February 4, 2009

After the tantrum

I go to lie down after dinner, not feeling so well. So, JP goes about the business of putting Jolie to bed alone.

I hear them in the bathroom right next to our room. The step stool dragging. Doors loudly shutting. (The baby!) Whining overtones drifting to my ears. Sounds of impending mutiny.

Crying. Her loud crying.

The sound of JP walking out into the hall and shutting the door, the momentary magnified cries suddenly muted several notches. I hear his voice, strained. His limit, reached.

I drag myself out of bed and into the harsh bathroom light where Jolie stands half-undressed and suddenly more pliant. I get her dressed, brushed and into bed. She is tired, I decide. Maybe it was that popsicle after dinner. Maybe it was JP and I, mostly talking to each other during dinner, hungrily catching up on each other's work day. Multifactorial, I conclude.

Our fault, probably.

So, I decide that tonight, for the "5 minutes" that I'll linger in her room with the lights out, I will curl up beside her. I rest my head on her pillow, 6 inches from her face. I drape my arm around her and she does the same. I observe my daughter, 6 inches away, taking in the half of her face not sunk into the pillow. It is a beautiful, less in focus half-face. She loves this closeness, I can tell. Repositioning her arm around me, touching my face. She is wildly in love with this closeness. At one point, she lifts up her head to touch me with her nose, then back down.

I am taken aback. I am taking it all in.

"Is it two minutes yet?"

I wait for the question.

"I love you."

"I love you too."
"I love you too."

She takes her ring finger and rubs it gently into her pillow. Then uses her finger to touch her lips gently tracing them with a familiar pattern. Back and forth. Top and bottom. Dabs pillow. Trace. She does this without words, as if by habit, and I see it. It's me. Putting on my lip balm from my tin. It's me.
I laugh.
"Are you putting on lip balm?"
She giggles.
We're both laughing now, one turn after another. She keeps tracing her lips. Back and forth. Top and bottom.
It is five minutes or six or seven and she hugs me with all of her might.

And, I think: I need to do this more. Yes, she needs it too.

Tuesday, February 3, 2009

Why is the sky blue?

I'm fortunate in that my daughter is not yet old enough to ask me any tough questions. The most complex interaction we have goes a little something like this:

Melly: "What's this?"

Me: "A butterfly."

Melly: "OH!"

Yes, I am the All Knowing All Powerful Mama.

My husband, however, is (unintentionally?) training me for the more complicated questions she might ask someday. He seems to go under the assumption that I know everything about the physiology of every animal. Some questions he's asked me recently:

"How long does a mouse live?"

"Where does lymph come from?"

"Would you still create poop if you didn't eat any food?"

(Yes, you read that right. My husband asked me this.)

He also has some very pointed questions about being a doctor, including:

"Why do you have to work 30 hours in a row?"

"Aren't you too tired to take care of patients after being up all night?"

"Why don't they just hire more residents and then you wouldn't have to work as many hours, right?"

Recently, he came across an article about how some huge percentage of doctors are unhappy with their careers and regret having gone to med school.

Husband: "If they regret it, why don't they just quit?"

Me: "It's not that simple."

Husband: "Why not?"

Me: "Well, the average med school tuition is more than $30,000 per year. With housing and other costs, you can end up borrowing at least $50,000 per year. So at the end of med school, when you're nearly a quarter of a million dollars in debt, you can't just quit right before your salary goes up. You're forced to continue, even if you're unhappy. You're locked in."

Husband: "My god, do people know about this?? You have to tell them!!"

Me: "I think they know."

Man, I am so much better at fielding questions about butterflies.