Tuesday, March 31, 2009

Mother of the patient

I thought maybe my 14-month old son woke up on the wrong side of the crib from his afternoon nap. He wasn't acting like himself. He had no appetite. He was burning up. And he was breathing noisily. I had thought he was getting better from his cold that started several days ago but now he looked sick.

I took out my stethoscope and listened to his lungs. Coarse breath sounds, rhonchi, and wheezes. It sounded awful in there. In my little baby boy. My sweet, angel of a boy. It seemed so wrong that such sounds would be coming from his lungs.

I grabbed his sister's albuterol inhaler and spacer and gave him a couple of puffs. Which did nothing appreciable to his breathing. He also wasn't the most compliant of patients.

It was Sunday afternoon. Of course. It would be the ER. Now, or in the middle of the night, I thought.

I made the executive decision to have him be evaluated in the ER. We should go. Now.

At the front desk, I insisted to be the one to fill out the triage paperwork (as opposed to my husband, not in lieu of the nurse!) Reason for coming: wheezing, tachypnea, fever. I needed to "sell" him as someone who needed to be a priority. I needed them to know I knew.

Rectal temperature in triage: 102.9 F. Pulse 180s. O2 sat 93% (!) RR 42/min (!)

It wasn't very busy and we got into a room right away. They set up a neb for him right away and had me administer it to him, knowing that I was a physician.

JL did NOT like the nuisance mist machine all up in his business all the time and fought it sadly, crying, twisting. I watched as the nebulized mist battled his thumb that was firmly planted in his mouth. He was burning in my hands.

I told the ER physician right away that I was an internist. We needed to be on the same page. Because of that, her way of dealing with me changed, giving me a lot more power in the physician-parent relationship. She told me her thoughts, but then wanted mine, and ultimately left certain choices up to me. X-ray or not (no). Antibiotics are not (yes). I couldn't bear the thought of his little body soaking of radiation - and for what? To definitely know he had a pneumonia? Would I be satisfied if it was negative to not give him antibiotics (no)? But, I worried about some focus of bacterial infection since he was getting better from his cold and then turned for the worse. Bloodwork or not (no). Ceftriaxone IM x 1 (no).

I appreciated having the chance to weigh in so heavily, although I do wonder if I was completely clinically "on" given my duress having a sick child in my arms. Not any sick child. My sick child. But we decided this would be our management. He would be given an acute follow-up appointment in the peds clinic the next morning.

At the follow-up, the pediatrician examined his ears and saw a very clear-cut ear infection in his right ear. This was never done in the ER. I had wondered to myself if someone was going to look in his ears for the sake of completeness, and even entertained the idea of taking a look myself with the otoscope in the room, but quickly brushed the thought aside when JL had pried open the red biohazard container of the floor exposing some kind of urine hat. Plus, the ER physician didn't think it was necessary.

Perhaps I led the ER physician down a diagnostic pathway due to my own suspicions, and maybe coming from me, was persuasive enough not to veer her too far off that path. I know how to give a compelling story for whatever process I think is going on. Isn't this only natural? But, I'm wondering whether she would have done exactly the same with a parent who wasn't a physician. Would she have been more complete? Would she run more tests?

Anyway, JL is doing better, on antibiotics. He's defeveresced but still with a "junky" chest exam. His antibiotic dose was increased since apparently the dosage is higher for an ear infection than pneumonia (wow, peds was that long ago).

And I'm left wondering how much I help and how much I complicate when it comes to the health of my own children. I hope it's heavily weighted towards the former.

Sunday, March 29, 2009

No, Mom, Billy DOESN'T want to stay for dinner

While sitting at the dinner table, someone brought up maggots (I know! – but such is life with two boys of a certain age; disgusting subjects at dinner are the usual fare alongside the main course). Eldest quickly mentioned how skeeved he would be if a maggot were to touch him. Of course, I had to jump in with all of the medical uses for maggots, especially when used to treat decubitus ulcers or other poorly healing wounds. I casually discussed the role the maggots played in debriding the dead tissue and how most patients would likely consider maggot therapy rather than dismissing it out of hand, especially if faced with a potential amputation. I buttered a slice of bread as I chatted about how maggots stayed away from healthy flesh; concentrating on my broccoli, I failed to recognize how quiet my dinner companions had become. As I started in on the medical uses of leeches, I looked up from my plate to see three faces staring at me in horror. Mouths agape, eyes wide, silverware down; my family finally burst out as one: “That’s revolting!”

Er, yes, I guess some might view it as such. Apparently it’s time to brush up on my sense of acceptable dinner conversation, which has at this point been warped by too much discussion around the themes of farts, boogers, loogies and the occasion poop.

Baseball, anyone?

Thursday, March 26, 2009

Seriously, I wanna know...

Do you have a favorite season? Does your favorite have anything to do with work/school? Winter for Pediatricians is like tax season for accountants - busy! In the spring, we are starting to pull out of cough, cold, flu season, but the days in the office can be unpredictable. Having just had a run of influenza at our house, I'd say home is unpredictable, too. Fall was my perennial favorite for many years - still some daylight when I left the office, boys in the groove of school, family vacation during Fall break. Our school system changed their schedule a few years back and did away with the Fall break - shattering it into several teacher work days scattered through the semester. Vacations shifted to Spring break to compensate. I've found myself looking forward to summer more and more - the more free-form home schedule, warm weather, flip flops (wish I could be OSHA compliant in them at work!) and lighter schedule at the office even with partners on time off. So my answer: Summer!

photo credit: seseo.wordpress.com/2009/01/

Tuesday, March 24, 2009

"Match Day" book give-away follow-up

In a highly technical method of randomization (comments printed, cut into slips, and picked blindly from a bowl), ten readers of Mothers in Medicine were contacted last week to receive their prizes. Amazingly, quite possibly all of the commenters whose name is "Katie" got selected by some strange twist of bowl-drawing fate. What are the chances? (Okay. Could calculate but...)

Thanks for joining in on the fun.

(Shout out to Jenny, MS2 in NYC: claim your book! Email us with your address!)

Monday, March 23, 2009

Mom's Apple Pie

I have a confession to make - but first, a little story.

Last Friday my husband and I got to do one of our favorite things: walk our son to school, a lovely, small elementary school set amid tree-lined streets in our peaceful neighborhood.

That day we went bearing pie - home-made apple pie, to be exact, by special request, for an open house during which we would get to peruse all the kids' family history projects and enjoy culinary delights from the various cultures represented in the class.

My son had been worrying (needlessly, despite reassurance and encouragement) about this project for weeks. He was worried about getting the work done on time. Worried about messing up the illustrations. Worried about revising the final draft. Worried that I wouldn't have time to make the pie and he'd be the only little boy whose mommy was a dismal, neglectful failure.

Well, by golly, I was determined not to disappoint him, even if I had to stay up late post-call or get up early pre-call to do it. As it happened, not only was I able to make the pie at a reasonable hour, right on time for the open house, but also my call schedule was such that I didn't have to be at work till mid-afternoon on open house day, so he was able to have both parents there.

My son visited me in the kitchen while I was preparing the apples. He sometimes tries to keep me company because he's concerned I might get lonely (he hasn't quite grasped the concept of enjoying time for oneself).

"I told all my friends you make the best apple pie in the whole world," he said.

How cute is that?

"Well, that was very kind of you," I replied.

"It's the best pie ever."

"I'm so glad you like it."

Peel, peel peel.

"Is it hard to make?"

"Not especially," I said. "Once you get a feel for when to add water to the dough, and how much to add, it's not a hard recipe to follow."

Dice, dice, dice.

"Do you like making apple pie?"

Hmm. How to answer that?

"Parts of the process can be a little tedious, to be honest," I said. "But it's not bad - I don't mind," I said quickly, to reassure him.

"I love your apple pie," he said.

I never did learn in anatomy class where exactly the "cockles" of my heart might be, but they were definitely warmed.

On the day of the open house, as we approached the front lawn of the school we caught sight of other parents coming from different directions on foot with their children, carrying covered dishes and trays and plates, all heading toward the front entrance. There was something so village-like about it. A pleasing aroma of book paper and crayon drawings wafted over us as we entered the school building, making me nostalgic for my own elementary school days, when I could focus my attention, as these kids were doing, on things like "daily life in colonial times" and haiku.

The atmosphere at the open house was one of friendliness mixed with the pleased-as-punch pride of children who have done well at something. There was so much food the teacher had to set up a second table. We ate, visited the desk exhibits, mingled with parents, mingled with children; some families even visited their friends' open houses in other classrooms.

We opened our son's Family History Book and smiled as we read his tell-it-like-it-is descriptions, written in his painstaking scrawl. On the cover he had drawn a Philippine flag and a French flag, as well as maps of both countries. In the upper left corner there was a small, muffin-like item with steam rising from the top.

"That's a pie," he explained.

Several pages into the booklet it appeared again: a little pie in the margins.

My confession is this: making my husband and children happy with pie is the "accomplishment" that brings me the greatest satisfaction in life.

Even their deeply appreciative inhalations as they enter my kitchen filled with the smell of baking pie make me feel like I'm on top of the world, like I've made their day a little better. Yes, I graduated with honors from an Ivy League university. Yes, I got a medical degree. Yes, I am reasonably successful in my practice of medicine. Yes, I've had the chance to travel, learn languages, study music, get advanced degrees, receive a little recognition for things I've written, and all that. But nothing brings me greater joy than those moments when my husband and kids are eating well, savoring with relish a pie I've just made. Am I crazy? Perhaps. Crazy about them.

It's funny - cooking is, by definition, the creation of gifts that can't last. The moments we take to enjoy meals together are fleeting, as are the meals themselves. But those moments are worth the world to me. And somehow the gift does last, I think - I hope - in ways I'm sure I can't see or predict. I'm hoping that somewhere in the margins of my children's lives there will always be a little pie sketched in - an unquestioning, nourishing trust in their parents' love, a capacity for sharing and for happiness, a corner of freshness and warmth.

Sunday, March 22, 2009

I hate boys!

Sorry, I need to vent:

A resident I know recently came back from maternity leave with her second child and happened to mention to another resident (a single male resident) that she was tired.

His reply: "Why are you tired? You just had a vacation!"

Hearing that story really made my blood boil. Of course, all women who have kids know that maternity leave is not a vacation by any stretch. I still remember mine as one of the most exhausting and stressful times of my life.

But what really got my angry about this was not the thoughtlessness of the comment from a single guy who really has no idea, but it drew attention to the fact that the most unreliable residents in our program are the single guys. The female residents with 2+ kids are always on time, considerate, hard workers, etc. The punctuality and attendance issues we have at our morning lectures are 100% attributable to the single male residents. Or "the boys", as I call them.

You would think that with no family to worry about, the boys should be able to be Super-residents. They should be the first ones into work in the morning and always willing to stay late to help out. They certainly shouldn't need to whine about covering an extra clinic here or there. Yet I'm finding that the opposite is true. The boys tend to be incredibly unreliable and the first to complain about coverage issues.

Of course, I'm generalizing. I know there are a lot of single guys who are great residents. But it really makes me angry when someone who can't even show up on time in the morning belittles a working mother of two for being tired.

Wednesday, March 18, 2009

Welcome to Match Day on Mothers in Medicine

Welcome to our 5th (!) Topic Day at Mothers in Medicine: Match Day. Today, we'll be featuring posts about our experiences with the big day.

As promised, we are also giving away 10 (!) copies of the book "Match Day" by Brian Eule. (See reviews by myself and Fizzy earlier this week). To enter, leave a comment to this post with your email address and we'll select 10 random readers to receive a free copy sent to them! You have until midnight tonight to leave a comment, so spread the word, tell your friends, score a copy!

And, good luck to those going through the actual match who will be finding out tomorrow at noon EST!

Posts will be publishing regularly throughout the day. Scroll down to see the posts....

Match Day: Part 1 and 2

My match day was March 17, 2005.

Our match day was done in a "let all hell break loose" kind of fashion. The envelopes were at different tables organized alphabetically, and we basically trampled each other in an attempt to get our envelopes.

Inside the envelopes, was a tiny strip of paper. That 1 cm high strip of paper had our whole future on it.

I matched at my first choice on my rank list, at a primary care program close to where my husband would be working. I was so thrilled that I cried (well, a few tears) and hugged my friends. Ironic, considering I wanted to drop out of that program within two days of starting. It took me six months to get up the nerve to tell my program director that I wasn't coming back next year. No way, no way, no way.

Match #2 for me took place a year later. I didn't do it through ERAS because I was already a resident. I was on evening cross cover and as I sat in my scrubs on the couch in the empty resident lounge, waiting for the other residents to sign out to me, I got a call on my cell phone. It was the program director at the PM&R program where I had interviewed a few weeks earlier.

"We've decided to offer you a spot for next year," she told me.

No fanfare, no trampling, no hugs, no tears, no green Hawaiian leis. But there it was: a spot for me in my dream program.

Now I'm nearly three months away from graduating from this program. I feel blessed that I had the opportunity to train in a field that I love. And I don't throw around words like "blessed" very often.

Pediatric Match Day

“Should I stay or should I go now?”
The Clash

I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.

But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.

Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.

My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.

(match day) - which day was that?

Not sure why but I can hardly separate out in my mind my own match day (in the 1990's) and my husband's a few years later. Earlier today I asked him to remind me about the circumstances surrounding our opening those fateful envelopes. I don't think it's post-traumatic stress-induced amnesia, since we both were happy with each of our matches, despite the hurdles coordinating the geography and job prospects without a true couples match. Perhaps my MIM status has resulted in a loss for specific details; I now more holistically just remember that it ultimately all worked out for the best. Then again, my coffee cup is usually half full.

What's coming back to me now is how silly I felt mentioning "my boyfriend" during interviews leading up to match day, since we'd actually been (living) together for many many years prior to actually getting married. Sometimes I mixed it up by saying "significant other." We did become domestic partners so we could co-habitate in the med school dorms, us and a few thousand gay New Yorkers. In any case, most of the hard part was us figuring it out beforehand, crafting the list, and then once we met our match we planned accordingly. After all, the culture in medicine is to train for 3-4 years, and then make a decision to move or stay. Then you train for several more years and then make a decision to move or stay. And so on. Fortunately for us, the "move or stay" has always involved staying in love.

Now, it's just another day

I debated with myself for a long while about whether I wanted to post my recollections of matching. I've realized while looking back my memories of this time have become far hazier than I would have ever imagined possible. I'm sure that circumstances at the time might have had something to do with it - I was recently engaged (the prior November) with a wedding planned for early summer (when I conveniently had a few weeks off following graduation). In the midst of dress fittings and cake tastings, I waited to hear what would occur. I recall vividly who I interviewed with, and still recall the vaguely funky smell in an outer office as I waited to meet with one of the administrator/physicians who would potentially determine my fate. As it turned out, when it was time to decide, I limited my choices of where I wanted to train due to my upcoming marriage; when faced with what seemed to be starting a career versus starting a life, I chose the latter.

Now, many (many, many!) years later, I have had few (if any) regrets. OK, I wish I would have traveled more and if I knew then what I know now, would probably have structured some of my early experiences differently. But I received a very good education in my little community-based program and have never felt limited in what I could strive for.

So dear students, although today emotions run high and nerves are shot, in the long run this day will become just one of several pinnacles you'll scale. Looking back, memories of my wedding, the birth of my sons, and numerous career highlights are crowding out any recollection of the anxiety I'm sure I felt when Match Day rolled around for me. And I think that's as it should be.


Match Day Purgatory

The months that led up to Match Day were pretty stressful for me. I was in that med school relationship purgatory where my boyfriend (it makes me feel 11 to say that word) and I were in a serious relationship but we were not engaged. If we were engaged, I had imagined wistfully, submitting my rank list would have been so much easier. I would rank the program at my medical school #1 without a doubt since he would still be there, finishing up an MD-PhD. Even though I REALLY liked a couple of other programs that were in other cities. One city on the other side of the country.

But Christmas and Valentine's Day and other perfectly fine occasions for him to pop the question and appear on bended knee came and went and I was feeling a little - how shall I say - frustrated. To put it nicely. In actuality, I was going a little insane. I remember initiating serious conversations about this: where are we going? We need to do some planning. You know, all of those conversation starters that cause men to start sweating and looking for the nearest exit. But I needed to know: is this the real thing? Do I put this relationship before my real program preferences? I thought other programs might be a better fit for me and what I wanted to eventually do.

In the end, I ended up ranking the program at my school first. I also had a lot of positive feedback from the program, leading me to believe it would be pretty much of a sure thing. Yet, still, I was nervous on Match Day. What if there was a computer glitch? What if they were just telling me I was a shoo-in? What if I ended up somewhere far away?

He was with me as we gathered with all of my classmates in the big hall. I had picked up my sealed envelope from a faculty carrying the envelopes for students with my last name letter. We stood around in informal clumps, around friends and some family for the magic words at 12 noon, informing us that we could open our envelopes and find our fate.

It was time. I opened the envelope and pulled out a surprisingly small slip of paper with only the name of the program I had matched into: My school's.

It was not a surprise or an elation but a relief. A huge relief.

Some classmates were more vocal. There were shouts of joy, a buzz of "Congratulations", there were hugs and hugs all around. It was a very emotional, joyful moment. In the beginning.

But when the dust settled a bit, and the flurry of happiness fluttered down, I started to notice that not everyone was happy. Some of my classmates were quiet, bummed. Some look like they were spun, confused, trying to be positive. And some were in tears. A good friend of mine, in fact, was in tears. It wasn't all happy.

But like that, all of us were going somewhere. Some to places they dreamed about. Some to places they wished they had never ranked. And I, was staying.

In the week to follow, my boyfriend and I took our planned student-budget trip to San Francisco, touring Napa Valley, taking mud baths in Calistoga, driving down the Pacific Coast Highway and stopping occasionally for impromptu picnics.

He proposed.

It's A Match

Match Day. It was a day that I viewed with trepidation (Will I go where I want to go?), anticipation (Where will the next chapter of my life begin?), and exhilaration (I would finally be done with medical school!) Match Day was a day that, before you entered medical school, you had no idea even existed. I hate to borrow the comparison to sororities once again, but Match Day does work almost exactly like sorority rush. Your senior year of medical school, you interview at many different programs, searching for (what you think is) your ideal fit for a training program. You have to make decisions about community programs vs. university based programs. Small programs vs. larger programs. City or rural? Academics focused or procedure focused? I'm oversimplifying for the sake of keeping the post a reasonable length, but you get the picture. Then, at the end of the interview season, you sit down and rank, first to last the programs in which you would like to train. The residency programs do the same, ranking applicants from most wanted to least wanted, and yes, they do have meetings where they put your picture up and talk about your pros and cons...just like rush. Then, all of the information from both the students and programs is plugged into some kind of nebulous computer database matrix-type-thing, where the magical "match" actually happens...each student to each program, according to mutual rankings. Thankfully, you are somewhat unaware of the gory details of the process when you are interviewing. All you know is that the decisions that you make when writing your match list will profoundly affect the rest of your professional life. No pressure.

For me, I was fortunate in the fact that I didn't have to worry about a couple's match (trying to match to the same place as your spouse or significant other). Mr. Whoo was delightfully mobile with respect to his professional life, so we didn't have the constraints of specific places that we just *had* to be. We picked a general area of the country in which we knew we would be happy, and concentrated on applying to the programs in that general area. I was also fortunate that I wasn't trying to match into a super competitive residency like dermatology or radiology (or, the "lifestyle specialties," as they are called), and I really had no interest in the rigorous academic programs. I was more concerned with learning how to be a general community Ob/Gyn, could not care less about research or academic prestige. For me, I primarily searched for community based, procedure heavy programs in a large region of the country. I looked at how the attendings and the residents interacted with one another, and I was really interested in finding a program where the residents actually seemed to *like* one another. As far as match criteria are concerned, mine were quite modest. I ranked 8 programs, 2 of which I loved enough to place them interchangeably in rank order.

Match Day itself was rather overwhelming. There was lots of pomp and circumstance, and even more nerves and jitters. There was a big ceremony outside, then we all went into the main lecture hall (where we spent the whole of our first two years as students, sort of poignant). It was there that we received the envelopes which held the direction for (did I mention?) our entire professional lives. To add extra fun, each of us was called individually up to the front of the entire room, filled with friends, students, and families to open our envelope in front of *everybody* to read aloud the program and specialty to which we had matched. The only prior knowledge that you had going up to this point was whether or not you *had* matched, so the reactions ranged from ecstatic, to barely concealed bitter disappointment. It was a little awful and a lot wonderful. On the whole, my class matched well, so many of us were rejoicing together. When it came my time to grab my envelope, I could barely squawk out the words on the paper, I was so overcome. I vaguely remember cheers and applause as I blindly made my way back to my seat. I had matched into my first choice...my path, once shrouded in mystery and doubt, was suddenly, sunnily clear.

After our class had opened the last envelope, there was a cake and punch reception (to which we brought flasks to generously spike the punch). We shared happy and sad tears, and there was a sense of relief that it was all *over,* when, in fact, it was just beginning. I found out that two other classmates had matched into residencies at the same place in which I did. This was kind of amazing, since we were coming from a big, academic med school in a location nearly a full day's drive from the smaller, community-ish program to which we all matched. It was comforting to know that there would be a couple of familiar faces in that new, unfamiliar territory. That night we all hit the town together as a class, and acted decidedly not like budding young medical professionals, but like the kids that we actually still were. For all the toil, sacrifice and tears that we had endured thus far, with even more looming on the horizon, all was right with the world on the day that we found our match.

Guest Post: A Perfect Match

I have been through this before. My husband graduated from medical school four years ago and, like everyone else, went through the match. It was one of the most terrifying and disturbing times of our lives. All the waiting for interviews and agonizing over rank lists; it was too much for me. Finally, Match Day showed up and we went to the ceremony. At his school, everyone got their envelopes with their information in it as they walked in the door. Then, exactly at noon, everyone ripped the envelopes open and exploded into some expansive emotion. Some cheered and ran around the room. Some burst into tears. Some tried to act calm but were clearly not.

It was one of the most intense experiences I have ever observed.

As we left, I clearly remember saying, “Thank God we’ll never have to do that again.” Ah, the irony.

My husband matched and we moved for his new job. I started medical school. Life hummed along nicely. Then he decided he wasn’t sure of the career he’d matched into, and needed some time to think about it. That was two years ago. And a wedding, a house, several dogs and cats, and a baby ago. We thought things were so complicated four years ago, what with the thinking and the ranking! Now, he’s moving into a different specialty and going through the match again. This time, he’s not in a class, so there is no fancy ceremony. Just an email around 1pm Thursday.

He has good options, was well received everywhere, and I think we will be happy wherever we end up. But that’s just it. Where will we end up? Will we stay here, where we have a house and friends and a babysitter and in-state tuition? Will we move closer to my family, where our son will grow up with his cousin and enjoy his extended family? Will we move to the great North, where we know almost no one, have no friends, but have a promising career path? And the worst of it, as you all are well aware, is that we don’t get to decide. Granted, the list that my husband submitted is of places that we would be able to live. But we don’t get to pick.

When, in all of this, do we actually grow up? Sometimes I feel very grown up. I am a mother, a wife, a homeowner, a very responsible person overall. But then, I’m also still a student, still have to request permission to use the restroom, still terrified of getting a real job. And, of course, still being told where to move and when to be there. Someday, maybe, we’ll get to decide our own fate and choose our own futures.

Of course, we still have my match to live through in a few years. And the match for fellowships, if we decide to do them. Maybe by the time I’m 40 I’ll be able to pick the city I live in. Until then, we’ll be sitting in front of the computer, chewing off our nails and clicking ‘refresh’ around 1pm Thursday.

Katie! Third year medical student, currently on maternity leave. In her free time: Mama, wife, dog-mom, sister, daughter, aunt, friend. She's probably supposed to be something else, but she's forgotten. She aspires to be a morning person, organized, and an OB/GYN. Cross-posted at You’ll Never Know Everything.

Monday, March 16, 2009

My take on "Match Day"

Like Fizzy, I received a copy of the new book Match Day by Brian Eule to review. I had heard it followed three women from Match Day through their first year of internship and was immediately interested. I mean, this was my story, too, right? On Mothers in Medicine we share, all the time, our unique stories about being women, mothers in our demanding profession. This is our story. So, I was eager to see how this translated to book form.

I had mixed feelings about the book.

What I thought the book did well was to de-mystify the process that is The Match, giving historical context, even going so far as introducing readers to the mastermind of the computer algorithm behind it. I also thought the book captured the artificial relationship deadline/pressures fairly well of the Match and particularly liked the relaying of Rakhi and Scott's down-to-the-deadline struggle of where to rank UCLA. This was a very real moment to me, full of the tensions of submitting a rank list when partners need to be considered.

I have to admit, though, that as a woman in medicine who has gone through match day and internship, I kept feeling like the voice telling the stories was an outsider; someone catching glimpses of moments but not possessing the full understanding of what it is really like. Salient moments that defined the challenges of being a woman going through these events weren't explored. Stephanie's experience as a female surgical intern would have been vastly different at a program where she was the only woman in a class of men, which is more often the case. The struggle of being "strong", letting your emotions show (nearly every woman resident has cried - dealing with those feelings), even different dynamics with other staff...all very personal, defining parts of our journey were missing.

I guess I felt that it could have been more authentic.

Overall, I was a bit unsure what the book was trying to do besides exposing the mystery behind Match Day and the pressures this can create for couples. I didn't feel it addressed women in medicine and today's challenges with full depth, but I got the sense that this was one of its goals. Still, I think the book could be very interesting to those who haven't gone through this and bringing some of these issues to light.

These were my questions for the author and his responses:

What surprised you the most while writing the book?

What probably surprised me most was how i never lost interest in the
subject. I had a friend once say that you know you have a book topic
when you have so much to write and say about a topic that a magazine
article will not do it for you. That was the case for me with this-- I
kept finding more interesting aspects to the story.

When did you decide you were going to write this?

A little less than a year before the Match Day that I describe in the
book. It was around that time that I was discovering this strange
ritual and realized so much of the world knew so little about this
process and moment that affects the whole country.

How did your relationships with [the three women you write about] change as a result of writing the book?

Well, Stephanie and I are still together, so so far so good. I still
keep in touch with the other people in the book.

How do you think your personal connections to all of the women you wrote about impacted your storytelling? Your objectivity?

This is a great question. In journalism, so often, we keep our
distance from our subjects. But actually, I found that I was so
passionate about these people and their lives, that it made for
stronger writing. I was also very lucky that none of the characters in
the book ever tried to influence what I wrote about, so I never felt
like this did anything but make me more passionate about the story.

Readers can get the chance to score a copy of Match Day on Wednesday, our Topic Day on Match Day. Mothers in Medicine received two free copies of this book for the purposes of review, but we are not not otherwise getting compensated for these reviews, nor are we obligated to provide a positive review.

Sunday, March 15, 2009

Match Day: a book review

At the heart of Mr. Eule’s novel Match Day, about three female medical students who go through the infamous residency match, is the concept of sacrifice. I think we female physicians, especially those of us with families, understand better than anyone what it means to make sacrifices. And as Match Day reminded me, so do their families. The novel describes in detail the sacrifices that women must make for the sake of their careers or for families which they might not even have started yet.

You can tell even without reading the back flap that Mr. Eule is a journalist because the novel is sprinkled with factoids about match day and residency. A lot of it was information I already knew (my class was the one that got punished by the results of the catastrophic urology match screw up), but some of it was new to me. Sometimes the book felt more like an expose on match day than a novel about three women, but either way, it was a very entertaining read. And now I can honestly say I know everything I ever wanted to know about the history of the residency match.

The scene that hit closest to home for me was when Rakhi, an intelligent young woman applying for internal medicine, is debating giving up her dream residency in order to be in a program closer to where her husband wanted to go to graduate school. Even though the rest of the book deals with more serious topics such as palliative care, this above all was the scene that brought tears to my eyes. Because when I submitted my match list for residency four years ago, it was not the one I had dreamed of. I gave up my dream residency for my other dream: to finally live with my husband. It was a sacrifice that I never regretted, but reading Rakhi’s familiar story brought back some bittersweet memories.

Unfortunately, as we all know, sacrifice does not end with match day. Intern year and residency, as the novel describes, is also filled with sacrifices. We give up our free time, our family life, and allow ourselves to be treated like dirt on the side of the road in order to realize our goal of becoming a physician. If you can get out of residency with your personal life intact, you can consider yourself lucky. One line that stuck in my head was about a surgery program that had a divorce rate of “over a hundred percent”, since one resident got divorced twice. You can’t make this stuff up.

The other highlight of the book was author himself. As a resident who is married to a man who isn’t in medicine, it fascinated me to get inside the head of a doctor’s husband. What’s it like to be Dr. and Mr.? How do they put up with us?? I only wish that Mr. Eule had dedicated more of the novel to himself, as the opportunities inside his own head were few and far between. But maybe that’s a topic for his next book.

I had the privilege of corresponding with Mr. Eule in the interest of asking some questions for the purpose of my review. I got a thrill out of the fact that his writing in the emails sounded exactly like his writing in the book. And what an incredibly nice guy, who clearly adores his physician wife. Here were some of the questions I asked him and his responses:

Q: You wrote a book about women who are becoming doctors. You are a man who is not a doctor. Explain.

"That's exactly the point. I was an outsider to this world, suddenly thrust into it. These key moments and decisions would affect so many lives, including my own. But I was also a journalist who knew how to dig into a story to find answers to all of the questions I had. Often, it is the outsider who sees the issue and topic most clearly. (You'll notice, for example, great books written about Presidents are often not by Presidents.)"

(There goes my dream of becoming President and writing a successful book about it.)

Q: Who do you feel is the intended audience for your book?

"I like to think that there are several audiences for the book: mainly anyone interested in doctors (anyone who has ever known a doctor); friends and family of medical students and residents, interested in this strange and demanding world they've only seen from afar; as well as those beginning their careers in medicine, beginning to make these key decisions. At a time when media stories about health-care and the quality of medical care in America are a constant, understanding the process by which doctors are selected, trained and groomed in this country seems more relevant now than ever."

Q: Since your book is called Match Day, why did you decide to include the stories from intern year in the book? Was this your intention prior to starting the book?

"Match Day is a play on words. There are multiple matches occurring in these people's lives at this time-- matches with career and matches with spouses and families, in particular. Yes this was my intention-- I was excited by this crucial turning point in all of their lives, when these people go from student to professional, and I wanted to follow these people as the first year of their career played out to show how things turned out after the Match and how they changed from student to doctor. Medical students often don't realize the impact these moments and choices will have on the rest of their lives."

Q: What are your top five tips for non-medical husbands of female physicians?

"It's hard to give tips for such a diverse group as that. I recognize people are very different. For me, a few things that have made this difficult time more bearable are: trying to remember to have patience, keeping a sense of humor, recognizing the amazing sacrifices my wife is making, realizing how many people she is helping, and reminding myself that she's human. That, and giving her some space after a 24-hour call shift!"

Q: How do I get my husband to write a book about me?

"Hahaha. Have him drop me a line and we can talk about it."

Thanks for your offer, Brian, but I don’t think it’s going to happen. He’s a mathematician, so the best I might get is a theorem named after me.

MiM Editor's note: We'll be giving away 10 free copies of this book on our Match Day Topic Day this upcoming Wednesday, so stay tuned! While we received two copies of this book for the purposes of reviewing it for our site (second review to come), we are not otherwise compensated for these reviews and are under no obligation to provide a positive review.

Wednesday, March 11, 2009

Topic Day Next Week: MATCH DAY

You may or may not know, but the official Match Day where fourth year medical students find out their residency fate is next Thursday, March 19th. In honor of this momentous occasion, we are hosting a Topic Day on "Match Day" the day before: Wednesday, March 18th. We'll be featuring posts about our own experiences on Match Day and invite you to share alongside with us. We love guest posts!

Match Day is such a unique experience for doctors-to-be: the suspense, the ceremony, the Moment, the hugs and joy and surprise and sometimes, despair. It changes our lives, that computer program.

We have some special surprises in store, too, for our readers, so stay tuned next week! Send your Match Day stories to mothersinmedicine@gmail.com.

Monday, March 9, 2009

Let me know if you need anything...ok, how about right now?

So, it's almost here. We've known it was coming for more than 6 months, but in less than 48 hours, my husband will be deploying for 5 months, leaving me to manage the madness of 3 kids under age 5, two part-time physician jobs, and a home (can someone remind me why we thought a half-acre of grass was a good idea?).

We recently had a few families over to dinner. They are dear friends--originally the parents of our kids' friends from preschool, now our close friends in their own right. They live 5 minutes away. As they were leaving after dinner, a few weeks before my husband was to deploy, one of the women said to my husband, "Well, if we don't see you, stay safe" and to me, "Let us know if you need anything." My heart sank, and my husband immediately saw it on my face.

Now, I'm not complaining...well, not that much anyway. Believe me, I know it could be waaaaay worse. He's only going for 5 months, not the 12 or 15 month deployments that Army families cope with all the time. It's pretty safe, as deployments go. We'll even be able to talk on the phone for about 20 minutes once a week. And, most of all, I fully expect him to come home to us. At some point, he won't be in the Navy anymore, and all of this will be behind us.

But the fact of the matter is that I will definitely need things. When people say, "Let me know if you need anything," the implication is that you probably won't, but just in case, you know how to find us (and we won't be finding you). The fact is that needing things is not the exception; rather it is the rule during deployment. I need things right now, and he hasn't even left yet. Like someone to babysit my kids for a few hours so that I can have a date with my husband where we finish sentences (or do our taxes), someone to help me cook and freeze a bunch of meals to decrease the evening madness, someone to invite us to dinner on the sad evening of d#1 of deployment, and most of all, someone to reassure me that I can do this, we can do this, and we will all get through it.

I have been giving "Let me know if you need anything" a LOT of thought since then. As far as I can tell, we only say it when it is clear that help will be needed...and a lot of it. Someone's husband dies: Let me know if you need anything. Someone's baby is born prematurely and is in the NICU: Let me know if you need anything. Someone loses his job: Let me know if you need anything. And, most relevant to us, when we are the bearer of catastrophic medical news: Let me know if you need anything.

If these words make it to the antechamber before your lips, STOP THEM RIGHT THERE! This is probably a situation where the person in front of you needs not just anything, but everything. I have decided to banish the phrase from my vocabulary and instead make a concrete offer. She can say no or barter for something different, but at least she knows I expect she will need help--it's not a sign of weakness and not an exception. If she wants to refuse it, she is free, but I won't make it easy. From here on out, I'll be saying "I'd like to bring dinner tomorrow night for you and the kids. Is 5 o'clock okay?"

Sunday, March 8, 2009

How many of you were hit on the heads with mallets last week?

My daughter's really into Donald Duck right now, so I've watched about five thousand Donald Duck cartoons on youtube in the last week or so. Believe it or not, they all seem to follow a similar formula: Donald does something to piss off some kind of woodland creature, then they get revenge on him.

In the past week, I've seen Donald fall from a 30 foot tree, plummet from several cliffs, and be exploded countless times. As I was watching him run his sled into a tree stump masked by a snowman, I couldn't help but think of my patients who ended up with serious brain or spinal cord injuries because they hit a tree on the ski slopes. As Donald made impact with the tree, I winced as I thought about broken bones, halo vests, intubation, central lines...

But none of that happens in the cartoon. Obviously. Slamming into a tree at 60 MPH definitely is an annoyance to Donald, but the only thing he appeared to damage in the accident was the winter coat he was wearing. (The winter coat was destroyed virtually beyond repair.) When a bunch of ants pushed him off a 100 foot cliff to get at his picnic basket, he yelled out in fury and climbed right back up the cliff to get revenge on those ants. When ten sticks of dynamite explode in his face, he just adjusts his beak and moves on.

Yes, I know cartoons are not supposed to be realistic, but this is really beginning to bother me. It disturbs me not just as a mother who wants my daughter to know the consequences of violence, but also as a doctor who has seen countless veterans with severe permanent brain injury from IED blasts. I need to see Donald experience the consequences of his actions in some way. I mean, they don't have to show him on a ventilator, but if he falls off a cliff, at least show him limping a little in the next scene.

And for the record, a second head bonk is NOT a cure for brain injury.

Sex in the City

Today I was finishing up the afternoon at the office. My last patient was a 40 year old mother of three there for an annual exam. After I finished the exam and reviewed the usual preventative health recommendations, I asked if she had any more questions… I’ll admit I had one hand on the door as I said this. There’s just one more thing doctor. I just have no libido.

At this point I sit back down and take a deep breath. This happens to me a least twice a day. I start with the usual questions (I’ve answered with the most common answers):
Does it hurt? No
Do you like your husband/partner? Yes
History of abuse? No
How often do you have sex? 2-3 times a month *
Do you like sex when you have it? Mostly, I’m just so tired I don’t ever feel like doing it.
Does your libido improve when you go away for the weekend with your spouse? I don’t know, we haven’t done that in 10 years

It’s at this point that I want to say, and occasionally do depending on how well I know the patient, “You mean after working full time, taking care of 3 kids, dishes and homework, you don’t suddenly feel like Samantha on Sex in the City the minutes the lights go out.?”. I don’t know it this is “normal” but I know it’s very common.

Women are multitaskers. But the one place not to be a multitasker is the bedroom. There was a recent study that showed women enjoy sex more if they are able to “live in the moment.” Well DUH!!! Honestly, it is hard to be in the moment, with so many “to do lists” floating through your head.

When I first start clinical rotations in medical school I definitely had a time of transition. After watching my first Vag Hyst as a student I couldn’t have sex for a week. Slowly, like all the other issues you some how learn to separate work from home, most of the time. The pager does occasionally go off at an inopportune time.

Although, I have become a little jaded from my profession. During a recent conversation with my husband I remarked “We have a great sex life, I mean… it doesn’t hurt, I don’t get yeast infections and I don’t have to worry about you giving me Herpes.” He gave me quite the incredulous look. I guess its all relative.

*I had a newly wed patient who was having trouble with painful intercourse. After several visits, ultrasounds, creams ect. I finally asked her how often she was able to have intercourse. When she said 5 times a day for 6 months straight…… I discovered the cause of her discomfort.

Saturday, March 7, 2009

Favorite Things

For Rinda,

To the tune of "My Favorite Things" from The Sound of Music

Four month old giggles and nine month old babbles
Dermatology cases in which I like to dabble
E-prescribing program that I am now trying
These are a few of my favorite things

A parent who stops me in Target to say thank-you
Tough diagnosis and putting together the clues
Recognition from a preteen that I am connecting
These are a few of my favorite things

Coaching new parents and caring for preemies
Referrals from OBs who bring their kids to me
Hugs at the knees and scared children now smiling
These are a few of my favorite things

Insurance pratfalls
When the ED calls
I simply remember my favorite things
And then I don’t feel so bad
Cross posted at momwithastethoscope.wordpress.com

Friday, March 6, 2009

Why I Do This

Lately, for me, all you have been hearing is bitch, bitch, bitch about how this or that sucks big hairy ones (can't wait to get the misguided google searches on that one). So why, you collectively ask me, either outright or in your minds, do you put up with all that you do? Why not quit and become a garbage collector or something? This list, my friends and frenemies, is why:

~ Bringing babies into the world is, quite simply, awe-inspiring. I love it. It is so special and intimate, that moment when a family is born (and re-born), and I feel privileged to be a part of it.

~ I love helping women. Women are way too busy taking care of every one else to worry about taking care of themselves. It is good to have 15-20 minutes to sit and listen to women, and make suggestions on how they can better care for their own needs.

~ I like to *fix* things. I am, at heart, a fixer. I want to change things for the better, and being an Ob/Gyn allows me to do this more often than not. I find this infinitely satisfying when I can make things better through surgery or medical treatment.

~ I enjoy the continuity of care that being an Ob/Gyn affords. I love being able to deliver multiple babies for the same patient, and then be able to take care of their Gyn needs once childbearing is over. I like the lasting relationships the field can foster.

~ I like to do Gyn surgery. General surgery, to me, was overwhelming, but Gyn surgery affords me the ability to do a variety of cases in a limited area of the anatomy. The perfectionist in me enjoys the focus on one organ system, but there is always good enough variety to keep it interesting.

~ Procedures are fun. Not just surgeries, but colposcopies, LEEPs, IUD insertions, polyp removals, and endometrial biopsies are all very enjoyable, and the results are often immediately evident. Highly satisfactory.

~ There is a limited amount of pharmacology. For me, it is pretty much antibiotics, hormone replacement or suppression, birth control, anti-inflammatory meds, the occasional hypertension or diabetes med, and some anti-depressants. I loathe polypharmacy, so I enjoy the clean and simple pharmaceutical profiles that Ob/Gyn provides.

~ The patients. That's right, for all that they do to drive me crazy, it's the patients that keep me coming back for more. Be it the infertile woman that I helped to conceive, or the anemic, miserable woman whose ills were cured by a simple procedure or surgery, or even the chronic pain patient who got the correct diagnosis, treatment, and subsequent improved quality of life. I do this for the patients, plain and simple.

~ At the end of an exhausting day, I feel that I am making a difference and an impact for good in people's lives. That fact makes the unbearable actually bearable.

So, look, I love my job. I love it. For all of my whining, I wouldn't do anything else. I hope this answers the questions out there. Thank you for listening.

**Cross posted at Ob/Gyn Kenobi

Thursday, March 5, 2009

a gray area

Just read a NY Times article about our presidents going gray. Every now and then I see a stray gray of my own pop up (surprise!). In terms of how I feel, well, you know, it's a gray area. I'm in the early stages of seeing one or two here and there, so I usually feel somewhat amused and am proudly reminded of all my accomplishments. These include first and foremost, being married with children. That is, having met my life partner and our shared attempts at raising two strong and silly kids together. Despite their (all) contributing from time to time to yet another gray hair. I still feel young (except for the occasional hip pains) and think I look fairly young (delusion or reality, I'll never know), so for me I actually welcome the few grays to help on the job, where I am supposed to have the authority to guide patients and families through important decisions about their health and well being. Where I work to educate and advise medical trainees (a few grays among them). Certainly, it's just hair, but it's aging and stress and experience and evolving self-concept as well. No need to pull them out gray by gray, I'll just let them blend in and go with the flow (tucked away in a pony tail, of course).

Wednesday, March 4, 2009


It was 7:30 AM, the front door was open in readiness for the five of us to brave the morning chill and head for the van, and I was crouching in the front entrance hurriedly attaching boots and mittens to my dawdling four-year-old.

I ushered him out the door, entreating him to pick up the pace as he ambled down the walkway, stuffing pinecones into his hoodie pockets. Once in the van, I had to remind him several times to climb into his car seat, as I strapped in his sister and deposited backpacks in the trunk.

I read once that children have no sense of urgency, that it's a waste of time to try to make them hurry, and I must say that in my seven years of parenting, truer words have never been spoken.

However, from time to time I can't resist trying to instill the importance of efficient house-departing routines into their little heads, and so this morning I told him earnestly, "Mommy and Daddy can't be late for work. If we are, we could be fired!" Unlikely though that scenario is, against the backdrop of today's economy the statement sounded sufficiently grim.

My words seemed to have an effect. I had his full attention. "They would set you on fire?" he asked with real interest.

Sunday, March 1, 2009

All the sweeter

Today, a patient's family member hugged me. When I saw her standing in the hallway, by the room her father was in when he passed away peacefully last week, I wondered who she had come to see. Her father, a patient who was "comfort care," was now gone. The room held someone else.

I smiled at her and the next thing I knew, she was throwing her arms around me in the middle of the hallway.

She was here with the rest of the family, wanting to thank the staff, wanting to tell us of the funeral arrangements. She had told us last week that if she ever had cancer, this was the way she wanted it to be. This was the care she would have wanted.

My team has taken care of many, many patients with cancer these past few weeks. In a way, it's been depressing. There's just so much cancer. But in ways like this, it has been deeply fulfilling to be able to make a difference in the lives (or end of life) of patients and families.

I'm reaching the end of a particularly long stint of attending on the medicine wards. I thought that I would be ravaged by working the weekends, of not being able to spend as much time with my children as I wanted. I thought I would be impatient, tired, and annoyed.

Yet, today, coming home after a day of weekend rounding, I feel renewed.

Several patients expressed how much they appreciated me taking care of them. One grandfatherly figure said that he felt better just by me coming to talk to him and joked that even his gouty ankles were smiling at me. One, despite being frustrated at still not feeling completely better, told me how much he felt I made a difference. One, slowly getting better, said thank you in a way that made me humble. One, confused about what was going on, shook my hand with both of his after I gave him the diagram I drew of where in the biliary system we thought his obstruction was.

I don't know whether, with time, I'm getting better at interacting interpersonally with my patients, or that I just happen to be taking care of an appreciative bunch, but I can tell you I feel like each conversation I have with a patient lately has been therapeutic. I feel like I am personally making a difference in their hospitalization, that my joking with them, or trying to make their illness experience better in small, tangible ways, is making a difference.

Today, I came home, picked up, and twirled my 13-month old son, delighting in feeling his weight, his sweetness.

All the more sweeter from having such a fulfilling day in the hospital.

And, I thought to myself: I am good at this. This is my calling. I can't imagine doing anything else.