Wednesday, December 30, 2009

MiM Mailbag: Calling other/former resident moms

Recent comment to New Years Resolution:

I would like to resolve to have one day of residency when I didn't wonder if I should quit and stay home with my son. And, once I've had that one day, I'd like to move on to more days than not...Any more experienced and wisers have advice for how to accomplish this?

How did others do it? Was/Is this a constant struggle? Any regrets? Does it get better?

Sunday, December 27, 2009

New Years Resolution

I've decided my New Years Resolution this year is to spend less time online. I feel like I spend much of my day at work on the computer and I feel like I spend too much of my night on the computer. I have this crazy compulsion to check my email. It needs to stop. Now.

(And yes, I know there's irony in making such an announcement online.)

I've made one other serious New Years Resolution and that was to eat more vegetables. I totally kept that one, so I'm hoping to do as well with this one. I'm storing my laptop in the bookcase and not opening it till my daughter falls asleep for the night.

What's your New Years Resolution?

Thursday, December 24, 2009

Not Feeling It

It's Christmas Eve, and I'm not feeling it.

The house is decorated, the stockings filled. We baked and decorated sugar cookies. I made hot cocoa as a special bedtime treat. Thanks to the blizzard, there is snow on the ground for the first time in our city since 1962.

We celebrate not just Santa but also the birth of baby Jesus in our house.

But I'm not feeling it. Is it because we are so busy these days? Is it because I can't get my patients out of my brain?

God, I hope I'm able to see "it" in my son's face tomorrow.

Wednesday, December 23, 2009

Christmas Miracle

About three months ago, I got an e-mail from my lawyer friend.

"My wife and I have been trying to have a baby for a long time. We are encouraged by our friend's recent success with adoption, and have decided to go this route. We need letters of recommendation from friends, for the adoption lawyer. Would you please write one for us?"

I was awed and felt honored to do so. I didn't know the details of their fertility struggle, but it made sense. They had been married for a few years, and were lagging behind on the baby train. I took my task seriously, and wrote from my heart. When I completed the letter, and sent it to my friend for approval, ready to edit and re-write if necessary, he made me laugh out loud in his reply. "Um, these people you described sound amazing. When can I meet them?"

About a month later, I got an e-mail with a blog link. Their adoption blog. Advertising themselves, as prospective parents, and asking everyone they knew to post it on Facebook, forward it to everyone in their contacts. Apparently that is how it is done, these days. I was busy that day, but a few days later, I obliged.

My husband got a text from him last night. "We are in the NICU. Giz's father is listed as the attending. We have a baby."

My dad has been a neonatologist in the hospital I now do pathology for, for over 25 years. I remember visiting the NICU various times growing up. Having a dad as a neonatologist is a lot to live up to. I remember being in gas stations in rural Southern towns, filling out checks to pay for college essentials like gas and caffeine. We have a very rare Norweigan last name, listed on the check. "Is your dad Dr. so-and-so?" the clerk asked. I answered, "Yes. That's my dad." "He saved my little boy. I think of him every day. He is like the sun, to me. The one that hung the moon." This sentiment repeated itself, throughout my life, in restaurants and other various public venues. In medical school, when my attendings learned my maiden name. Living with my dad was like living with a celebrity. A very aloof, private one, that reserves emotion and judgment and does not seek attention. It just came, with the nature of his business. He is very good at what he does.

My dad was over for sushi last night, when my husband received the text. "I think I remember the baby I admitted last night. The one your friend is adopting. Tell him I work again on Christmas Eve, and I will be happy to talk to him."

I worked today, and couldn't contain my desire to visit and participate in their joy. I called my dad at 9:30 and asked, embarrassingly, what floor the NICU was on. I visit the SICU, MICU, CCU, the floor, radiology, and the lab, but don't have the occasion to see the NICU. "It's on the second floor. Down the long hallway off of the physician elevators. Use my physician code to get in the door."

I did, and felt apprehensive and intrusive. I went up to the desk clerk, and announced myself. "I am Dr. so-and-so's daughter. I have friends with a baby here, and they asked me to visit." She smartly replied, "Let me just check with them, and then I'll guide you to the room."

As I walked into the darkened cubicle, my lawyer friend was holding his new baby girl. His face was shiny with tears. My heart was skittering all over my chest. "Hi, Gizabeth. This is Lorelei. She's my daughter. She is coming home on Christmas Day." He told me his story. They got a call from their lawyer at noon the day before. The mom had just learned she was pregnant a few days before, and was not prepared to be a mother. Her friend, the father, was in full agreement. The mother read through dossiers of prospective parents, and chose my friends.

I sat in the dark room for 45 minutes. My friend the adoptive mom showed up eventually, from her mad dash registering at Target ("I think I probably registered for too many things twice, I couldn't concentrate!") and took the baby in her arms. She is a schoolteacher for inner city children, and worried about the fact that her kids are unprepared for her maternity leave through mid-February. But she was thrilled, and knows the kids will wait for her. She babysits my kids, occasionally, and they love her to death. She has the right combination of artistic creativity, compassion, and boundaries that will make her a wonderful mom. And her new baby girl looks a lot like her. The daughter is biracial, a mixture between Caucasian and African-American parentage. She has the olive skin and dark, wavy hair of her adoptive Caucasian mom. She is ravishing. They were all glowing.

I walked back down to my office and tried to focus on my livers, lymph nodes, SPEP's, IFE's, and peripheral smears. I kept thinking of them all day. Of their wonderful Christmas miracle. Beats the hell out of all the lights and the presents under the tree. I am so happy for them.

Tuesday, December 22, 2009

Private vs. Public School

My oldest daughter is 5 years old and her birthday is in December so she missed the cut-off to go to kindergarten this year. At first, I was disappointed that she would be 'left behind' for the year, but I soon realized this meant an extra year to be with her and one more year for her to be a kid.

Meanwhile, one of my goals this year was to understand the education system. I grew up in Canada where almost everyone I knew went to public schools. The school system from elementary, to junior high to high school, even including the universities in Canada are all about the same quality. There isn't the same diversity in quality of schools as there is in the US. Since moving here, I have heard all about 'magnet schools', the 'gifted track', and schools with 'bad test scores'. Until recently, I found all of these terms quite intimidating and insisted that I would blindly send my kids to public schools because I didn't want to complicate life. Trying to keep life simple is an over-arching goal I am striving for. Sometimes in contradiction, I have also been trying to make educated decisions, particularly those that affect my children. the name of getting 'educated' about the school system, I now find myself drowning in the debate of whether to send my kids to public or private school. I have researched dozens of schools online, called at least a dozen and visited a handful of schools in the area. This search has taken hours of my time and at the end of it all, I have a host of new emotions - irritated, excited, frustrated, inspired, and very, very confused.

Here are some of the highlights of my search:
- Some schools you can triage over the phone. I called one school, which is a Montessori school, and explained that I was looking for a school for my 5 year old. The lady who answered spent the next few minutes explaining why my child was now past the ability to learn in Montessori style and why all other preschools were inadequate. Montessori was the better way to learn she said but it was too late for my daughter....thanks.

- My husband and I went to one of the elite private schools in the area and spent one hour on what I thought was a tour and what turned out to be an interview. We were amazed by the grounds and the facility but not so inspired by the way the lady was sizing us up the whole time. This was early on in the process, I didn't realize that they were vetting us as well and I knew we really blew it when my husband asked after the schools finances - she answered "I'll have the development team get back to you on that...." as she rolled her eyes. Knowing that it would cost us at least 1 Million dollars if we sent all 3 of our kids to her school, I thought this was a very reasonable question...but clearly she wasn't impressed.

Here's what we've decided. While the public school system in our area is generally speaking one of the best in the country, our particular school has one of the lowest scores in the county so we won't be sending our children there. If we move in the next few years (which we might) then we will gladly reconsider as there are many advantages to the public school system.

In the meantime, I will try to send my daughter to a private school. I say 'try' because unfortunately she needs to take an IQ test. Unfortunately, because these tests are not good at predicting future cognitive ability - they only test a child's current skills which means that 70% of future gifted children would be missed when tested at the age of 5...(this fact is courtesy of Nurture Shock - a book I HIGHLY recommend).

So if she passes the IQ test, behaves well on her trial 'day at the school' and the administrators like our application, then she will go to a private school that is affordable (more than Catholic, less than the elite), on the smaller side in numbers and not a Montessori :).

We would like to send her there for at least kindergarten, maybe Grade 1 and then we'll have to see...I'm not convinced that long-term private school is the right path - there are social, financial and academic implications that I still need to think through.

Would love to hear any other thoughts on this debate that I'm sure many have considered.

Saturday, December 19, 2009

Guest Post: Leave it at the Door

I’m talking of course about all of the personal “stuff” we carry around. Those of us who work in direct patient care are not allowed to have personal stress. Right? The expectation is that when we walk into work, the stressors of our personal lives are, well, left at the door so to speak. It makes sense. In order to perform well in stressful situations, we have to be able to focus, on the moment, on what is presented in front of us. OK. I can accept that. In fact, I 100% agree. I have always been irritated by those who come into work and bemoan their personal lives, and or use it as an excuse for doing a sub -par job. PLEASE! Just leave it at the door. In a perfect world it works. But we don’t live in a perfect world. For the first few years after I had my son, I was sorely irritated by the idea that everyone else (patients) could behave poorly due to the stress of their everyday lives, (which may or may not have been anywhere as stressful as mine), but alas, I could not. I was still expected to be there, at work, focused, unfeeling of the storm that may have been taking place in my own life. I’m not typically one to roll around in the mud. I don’t like to wallow. I don’t appreciate over sharing of personal lives from the people I work with. It makes me…uncomfortable. But I am human, and from time to time, I am knocked off center by various events in my life.

Here’s a crazy secret… we all have our own lives. But… NO. We do not have the luxury of feeling, or even acknowledging it, unless we are on our own time. As a mother it is hard to disconnect. This expectation used to make me angry.

I remember one night in particular, my husband was deployed once AGAIN. I was doing the single parent thing AGAIN. My life at home was a little, ok a LOT more stressful than usual. That night, I had a patient who was deaf, and so was her spouse, I was struggling via multiple phone calls, to get an interpreter to come in and help us communicate, as I was writing everything to her for us to communicate. It was taking too long. What if there was an emergency? How would I tell her information quickly? Exactly what I didn’t want to happen, happened. (it’s Murphy’s law I guess) It was traumatic. The baby started having terrible, decels of fetal heart tones, and I could barely communicate to my very frightened patient, why I was flopping her from side to side and giving her Oxygen. I called the patient’s physician, he said he was coming in, he told me to administer terbutaline to stop contractions. I was performing all emergent response measures to improve heart tones and had another nurse come in to write out what we were doing and why we were doing it. I was stressed. My work cell phone rang, a call transferred to me by the receptionist, I figured it was my patient’s doctor but it turned out to be my children’s night time sitter calling from my house. I was irritated to have a call transferred to me at this time. I needed to Focus. On. The. Moment. “Big boy and Baby boy are both vomiting….Everywhere. I stripped all of their sheets and put Big boy in your bed, and then he vomited again. In your bed.” “Oh, fantastic” (sarcasm) “Baby boy is settling down, but he has a 102.2 fever, and Big boy feels feverish too, but I haven’t taken his temp yet” (Big boy has a history of febrile seizures) “I’m afraid to give them Tylenol and make them vomit again.” 

Times like that, are HARD to leave at the door. Our jobs are all consuming. When we are “on duty”, There is no half way. I quickly gave my sitter some instructions for cool baths. Told her to try Tylenol anyway, and told her to put a bucket next to Big Boy, and hung up. I finished the night and came home to 2 pathetic, sick children and a sitter who was worn out from her all nighter with them. My guilt over the course of the night ate at me all night long. But they were fine. My patient ended up being fine too. And the baby did well, after we got her out by caesarean section. We all survived.

     Now, I am experiencing another deployment, which means more balls to juggle in the air, on my own, again. The juggling never gets any easier, but over time, “leaving it at the door” has become easier. Knowing my children are well taken care of in my absence makes it possible. In some ways, I even welcome it now. As a mother, I often feel guilty over this. But I can’t help it. “Leaving it at the door” has become an escape. I am grateful to have something else to immerse myself in and forget about the rest of that swirling storm at home. If even for a few hours. I am happy to be there, focusing on the moment, and on what is presented in front of me.


Tuesday, December 15, 2009

Lunch privileges

When I was an intern in the medical ICU, I didn't get along very well with my senior resident. There was a name I used to call her and... well, I'm too polite to say it on this blog, but it started with the letter B and rhymed with "switch."

On my first call in the ICU, my senior resident who I will call Cruella (yes, I've been watching too many Disney movies) sent me to see a patient in the ER. I saw the patient, she came down to see the patient with me, and eventually he was stabilized. It was after 1PM and at that point, Cruella said to me, "Why don't you go get lunch?"

I was quite relieved because the cafeteria was closing soon and I needed to get some food for dinner too, considering I was likely not going to have time to make another trip down there. I got a sandwich (and one for dinner), ate it in maybe five minutes (chewing a total of six times), then went back to the ICU where Cruella promptly paged me.

"Where were you?" she demanded to know.

"I was eating lunch," I stammered.

"I told you to get lunch!" Cruella said angrily. "I didn't say you should eat it!"

I swear to god, she said that.

Cruella's switchiness aside, I feel like lunch is something I've had to fight for ever since starting my clinical years and it's gotten less and less acceptable to me. On my first day of residency, I nearly fainted because I skipped lunch. I attracted quite a crowd and I ended up having to confess to my attending that I was two months pregnant because otherwise she'd think I was a wuss who fainted from removing a G-tube. I also remember there was one day when I was six months pregnant and rounds were lasting forever, well past lunch time... I told my attending I needed to eat because I was feeling faint. She said, "You really think you're going to faint? Okay, let's just round on one more floor of patients, then you can eat." I swear to god, she said that. (And she was actually pretty nice otherwise.)

Moreover, I've noticed it seems commonplace for clinics to be scheduled to go straight through lunch. When I did clinics with surgeons especially, there was never ever a lunch break planned into the day. Surgeons eat maybe one meal every two days, which they eat standing up. I've theorized they must have some sort of bear-like fat storage system to allow them to go for long periods without eating.

Recently, my morning clinics have been running past 1:30 and I feel too embarrassed to complain. I honestly feel like there must be something wrong with me because by 1PM, I am actually really hungry. In fact, I'd rather eat at noon. Am I really the only one? Am I weak for needing to eat lunch? Should people who need to eat lunch avoid medicine entirely?

I don't want to have a gigantic lunch followed by a siesta. All I want is like ten minutes built into the middle of my day when I can sit down and eat some food, preferably with a drink, and not have to apologize for it.

Monday, December 14, 2009

Pot of Gold

When I joined this community, I was thrilled and nervous, all at once. I worried about my voice, and how it would come across. I have been blogging for a year, and have a small following, consisting of mostly family and friends. I don't advertise. I just write as a stress reliever. Hopefully a positive coping mechanism. We all need those, to balance out the negative ones.

Reading "A Day in the Life" topic week has blown my mind. There are people like me out there. In my reading, I can tell that some have it together more than me. And some are struggling worse. But the quilt of voices is amazingly beautiful. Reading this week has been like soaring through a rainbow. I have enormous empathy for all these women who are facing the same issues that I am. Their voices are like teachers for the issues I have yet to encounter, and memories of those that I have already hurdled.

I was at a Christmas Party tonight, full of lawyers. A lot of old friends. As I spoke to the women, I was able to draw on the lessons I learned this week and dole out empathy and compassion. One post particularly struck a chord, and I have been telling people about it all week. I cried for her, one morning, over my coffee. We all try so hard to live up to the standards we think we should. Our boundaries get breached. We suffer the most.

But out of suffering, comes reward. If we are willing to work on it. I feel more powerful now than I have in a long time. I know I still have a lot of anger and frustration to express, a lot of issues to work on, but I am in the driver's seat. Everything will be OK, no matter what happens. I'm gonna find my pot of gold. Balance in life, time for my kids, time for creativity, and time for me. Possibility is out there. It can happen.

Sunday, December 13, 2009

Welcome to "A Day in the Life" Topic Week

Welcome to a Topic Week on Mothers in Medicine - a week where we'll be featuring posts from our regular contributors and guest posts by readers on "A Day in the Life." Different families, different specialties, different days.

Hope you enjoy reading about other mothers' days. Posts to follow below.

Premed RN mom's day in the life

A day in the life of a Mom, wife, RN, and Premed student going for a second degree in Biology.

I am a mother to 2 wonderful boys age 2 and 8. Wife to a military pilot currently deployed to the middle east, RN in a labor/delivery, postpartum unit in a rural hospital, and part time student completing my premed pre-reqs to apply to medical school for the year that my husband will FINALLY retire from the military!

My Day last Monday

0615 Alarm goes off. God I’m tired. Stumble downstairs to start coffee pot. While coffee is brewing pack oldest son’s lunch (wonder why I didn’t just do it last night before bed). Pack son’s back pack. It’s snowing today, I locate sons snow pants, boots, gloves, hat. Pack in addition to his back pack.

0620 Coffee done brewing. Poor cup (ahhh… sweet nectar of life) Sit down with books to study before I have to wake up oldest.

0715 Go upstairs to wake oldest son. Set his clothes out on his bed.

0720 Downstairs making breakfast for son.

0725 Wake oldest son again. Tell him he MUST get up NOW!

0730 Oldest stumbles down stairs holding clothes and dresses in front of fireplace (its cold today!) and sits at kitchen table to eat breakfast. I poor another cup of coffee.

0745 Send oldest upstairs to brush teeth, comb hair, put on shoes. I go upstairs to put on sweats and brush teeth and put in contacts.

0755 Start car to warm up

0757 Go upstairs to wake baby (2 y/o, but he’s my baby) carry him downstairs. Get coat on him, tell oldest to put on shoes again, gather up bags, load everyone on car.

0805 Drop oldest off at school, roads are slick with the snow, wish hubby was home to help out. Contemplate the task of shoveling the driveway. Decide it can wait.

0815 Return home. Throw in load of laundry, pick up house, pack bag for myself and baby.

0845 Take baby in basement to play with train set while I run on treadmill (think about how much I miss running outside and silently curse at the military for this latest move)

0915 Upstairs from basement swap laundry, leave pile on chair in living room. Take baby upstairs with me to lock in bathroom with me while I shower. Hear doorbell, run downstairs. Nice man offers to shovel driveway for small fee. GLADLY accept and ask him to come back tomorrow.

0930 Shower. Dress. Get baby ready.

1015 Load up car and take baby to sitter. Cars off road. Slick roads scary for a southern girl in the Midwest!

1030 Drive to appt with premed advisor

1100 appointment with pre-med advisor. Review courses for next semester. He encourages me to apply to the local med school. Tells me I have a great GPA and if I have a good MCAT score I should be a competitive candidate (I inwardly smile b/c I was afraid he would be discouraging to me due to my age of 32)

1130 Drive to another campus for class

1200-12:50 study for test in class today

1300-1350 World History (I didn’t need it in the University system I got my RN degree from)

1400-1615 Chemistry, take test, feel good about test.

1630 Pick up oldest at after school care

1645 Pick up baby

1700 arrive home. Hubby calls and wants to skype (I don’t have time for this) But the kids love to see their Dad on the computer to talk to him. Even the 2 y/o will talk to Daddy on Skype

1715 finish skype and make dinner for kids, help son with homework while I run around packing bags, and lunches for tomorrow.

1730 Serve kids dinner, set out jammies for both kids, set out clothes for next morning for both kids. Set up coffee maker for next morning for baby sitter.

1735 Sitter arrives. Briefly go over homework needs with sitter and oldest son. (silently wish my husband was here to take care of them at night) Throw 2 Diet Dr. Peppers and a frozen dinner in my work bag.

1745 kiss my sweet baby tell him I love him, leave for work.

1755 Drop oldest off at Tae Kwon Do, kiss him, tell him I love him, Sitter will pick him up in 1 hr.

1800 run through Starbucks drive through (caffeine is my friend)

1830 Arrive at hospital walk in and hope for a calm night.

1835 Arrive on floor see mass chaos and have all hopes dashed.

1840 Clock in, change into hospital scrubs, chat in locker room with other nurses while waiting for assignment.

1845 Receive assignment get report.

1900-1930 See new cervical ripening pt. Check pt to get baseline of where we are starting.(1cm, 30% effaced, -2) Discuss plan for night with pt and family. Receive orders from Doc to call on call physician if she happens to go into active labor during the night.

1930 see Mom and baby that I have for the night, discuss plan of care for night. Assist with breastfeeding problems.

2230 Stat C-section for another nurse. Help out with getting everything ready.

2300 Tell on call Phys. Update on cervidil pt. (1cm, maybe 30% effaced, -2). Told by On call doc that he doesn’t want to know about said pt and I will have to call her own doc to manage her if she needs anything. (why am I the one to be telling him about this pt. Shouldn’t that have been worked out before?) Decide that it is probably a non issue because she is a Primip and Cervidil pts don’t often make a tremendous amount of change over the course of the night.

0000 Anesthesiologist calls and says he is heading home dos anyone need anything before he goes. No tell him latest exam on cervidil pt

0030 Cervidil pt calls out and wants pain medicine. Check her. She is 3cm/ 90% effaced/0 station Remove cervidil. Give her IV pain meds. Go out to call Anesthesiologist for epidural  (feeling terrible for telling him to go home 30 minutes ago) Page Dr. who sent her in for induction.

0100 Decels on fetal heart monitor. Check pt. (6cm/ 100%/ 0 station) Still no response from pts physician

0105 Anesthesiologist arrives on floor. Decels have resolved. Sit pt up for epidural. Request charge nurse to page physician again.

0107 Pt getting epidural. Phys. Calls back. Give him update. Says he will be in shortly.

0130 Pt comfy with epidural. Check her and she is 9cm. (so much for not making much change with cervidil) Turn over care of other mom and baby to another nurse.

0145 Physician comes in breaks pts water. She is complete.

0147Pt delivers beautiful HUGE baby boy who is pink and screaming.

0200-0600 Drink 5hr energy drink. Caffeine is my friend. Recover mom and baby.

0600 Baby starts grunting. Hope it goes away in a few minutes.

0615 Baby still grunting. LOUDLY. Place on Pulse ox. O2 sats highest @ 90%. (Damn)

0617 Call Pediatrician tell him about baby, receive orders for labs, x-rays etc. on baby

0630 Assist with x-ray, record report for  next shift, print off kardex for next shift.

0645 Give report, get ready to go home, supervisor says I have to go have a TB test in Occupational health TODAY on my way out the door. Seriously? I. am. So. Tired.

0800 finally on road to go home Occ health took SO LONG!

0815 traffic

0830 more traffic (darn slick roads and snow)

0900 still crawling home in traffic. Roll windows down in car to stay awake.

0915. Home. Kids at school and sitter.

0920 Shower. Fall into bed. Silently wish for husband to come home sooner. I’m so tired and I need his help. Don’t want to wake up early to study before I get oldest from school at 1500 and go back to work tonight. Know that I have to. Glad that I only work 2 days per week. Grateful not every day is as long. Look forward to the summer when I can just go to school and my hubby will be home also.


Third-year internal medicine resident, on maternity leave

I'm a third year internal medicine resident with a 3 1/2 year old son and almost 2 month old daughter. I'm still on maternity leave and have another three weeks or so left until I go back to work. I've really
enjoyed reading everyone's topic week posts so I thought I'd join in!

My day while on maternity leave:

5:45: Husband's alarm goes off, he showers then wakes up son to bring him to preschool.
6:15: Husband finally succeeds at getting son awake and dressed, feeds him breakfast. I get to stay in bed with the baby who is likely nursing by now! A few times a week son decides he doesn't want to go to school so stays in bed until two minutes after husband has left, then decides he's ready to go.
6:45: Husband and son leave for work and school. Baby and I are still in bed lounging, or if baby has woken up by now we'll be up.
8:00: Up and about, getting breakfast for myself in between nursing  baby. Figure out what to do with myself for the day, especially if there are any errands which require leaving the house. Why is it so hard to leave the house when the baby is so small?!
9:00-12:00: Run errands, which may include grocery shopping, Christmas shopping, and on mornings when son "doesn't want to go to school", bringing him to school once he's decided he's ready to go. Start twentieth load of laundry for the week.
12:00-1:00: Sometime in here I eat lunch. Usually.
1:00-4:30: Watch some TV (have become addicted to Anthony Bourdain), check email, read blogs and Facebook, etc. Might attempt a project around the house if baby is cooperative and agrees to be put down
(often gets very sad unless she is being held, the Moby wrap is my best friend right now).
4:30: Get dinner started, enjoying having the time to cook more elaborate meals than usual right now...have been baking like a fiend and experimenting with roasting.
5:00-5:30: Husband and son get home. Noise level in the house immediately increases significantly. Finish cooking dinner among noise of dinner cooking, baby fussing, husband telling me about his day, son telling me about his day while playing with very loud firetruck toy (thank you Nana) and dancing around the kitchen.
6:00: Dinner.
6:30-7:30: Playtime with son, generally involving Matchbox cars, monster trucks, more loud toys (again, thank you Nana), and finally some books as bedtime gets closer.
7:30: Husband's time with baby, I get son ready for bed, including dramatics over brushing teeth (the torture!), peeing on the potty before bed (the horror!) and which animal to cuddle with for sleeping (Tiger Tomcat or Easter Bunny?)
8:30: Get son settled in bed, rejoin husband and baby downstairs for a little TV.
10:30-11:00: Once baby has settled down move upstairs and fall asleep in about three minutes.

Note that while on maternity leave, I do not worry about my patients, I do not miss my job except in the abstract sense of "I enjoy being a doctor and when I go back to work will find it rewarding once again".
I am so glad to be taking more than the standard 6 week maternity leave that most residents take, and so glad to have this extra time with my sweet little baby. I will be a chief resident next year so I don't particularly mind about finishing residency late because I'm not going anywhere anyway!

Once I return to work my day will start sometime around 5AM, and before leaving the house at 7:00 will need to get both children (and husband) dressed, fed, lunches and pumped milk packed, get myself dressed and fed and packed up for the day. Will have morning report first thing in the morning, then round from 8:30 to whenever we're done, pump sometime during the morning, get discharges discharged and new admissions admitted for the next three to eight hours depending on where we are in the call schedule (no overnight call for us on the general medicine service), pump at least one more time, run codes on days when we're on call, go to clinic in the afternoon once a week (which means all work on the medicine service must be done by 1pm so we can sign out), attend two hours of teaching conference during the day while teaching interns and medical students in between all of this. On the medicine service I typically get home between 5 pm and 10
pm. Not sure how this is all going to work with a brand new baby in the mix but I have faith that it somehow will!

My day last Wednesday......

A day as mom, wife and the cardiology teaching attending.

0603 Baby cries, out of bed. Husband gone to gym. Labradoodle wagging tail.

0635 Hug, kisses, clean diaper. Labradoodle pacing nursery.

0640 Oatmeal, applesauce, milk. Coffee for mom. Labradoodle watching expectantly.

0655 Wipe hands, face, high chair, floor. Labradoodle helpless, softly barks by door.

0657 Labradoodle returns from outside, excited for treat.

0700 Dad home from gym, Labradoole showers him with licks. Mom in shower.

0735 Find baby, Dad and doodle in playroom. Mom in dress and heels crouched in miniature chair to read book. Baby loses interest at page three, moves on to puzzle.

0755 Out the door. More coffee. Granola bar.

0805 Remind myself I should not be reading Blackberry while driving

0825 Park, walk past gym (boy I need to exercise), up to office

0830 Glance over desk multiple stacks of papers to beautiful view of water

0835 Sit down at desk, more coffee, sign charts, read emails, work on manuscript

0930 Don white coat, pack pockets with stethoscope, name badge, article to share with team, lip gloss

0935 Take deep breath, push metal plate button, mechanical doors open. Here we go. Heels clip, enter Cardiac Intensive Care Unit. Vents wheeze, telemetry beeps. Long coated residents and short coated students assemble. Post call team members look weary. Start rounds.

0940 Review angiograms, echocardiograms from overnight admissions. To the bedside.

0950 Find mother with 20 year old son. New diagnosis of heart failure with uncertain prognosis. Attempt to convey seriousness of situation while allowing for an element of hope. More rounds.

1020 Team met by transplant patient taking new heart out for a lap around nurses station. Supported by physical therapists and with husband in tow, she pauses to give me a high five.

1040 More rounds.

1055 Grouchy man irritated that he has not had breakfast, and is waiting to go to cath lab. Attempt to diffuse his anger and reassure.

1115 More rounds.

1130 Patient with elevated neck veins, muffled heart sounds, low blood pressure. Review clinical diagnosis of cardiac tamponade (I am genius cardiologist/teacher).

1140 Patient with large pulmonary embolism, yesterday I was certain it was left heart failure (I am idiot cardiologist/ teacher).

1200 Urine nicotine positive on patient who requests heart transplant evaluation. Confront him about smoking. He denies. Without heart he dies. Cardiology fellow asks, “Wouldn’t you lie too in his situation?” I suppose if I were stupid enough to smoke with end stage heart failure I would be stupid enough to lie.

1230 More rounds. Post call intern looks miserable.

1245 Patient returns for the third time in 4 weeks. Could not afford his medicine.

1300 Last patient to see, of course not on the floor. March team to echo lab. Find patient. Finish rounds.

1330 Retreat to office for salad and almonds. More coffee. Dictation and charting.

1400 To pathology lab to review heart biopsy specimens from last week. Discuss with partner immunosupression for complicated patient.

1435 See clinical research study patient for exercise test. She sets new record on treadmill after artificial heart operation.

1500 Administrative meeting with Nurse Practioner to review clinic schedules, insurance pre-authorizations, upcoming travel to conference.

1615 Back to CCU to check on sick patients. Talk to families again. Confirm plan with nurses and fellows.

1730 Back to office, already sky is dark beyond window. Unpack lab coat pockets, transfer items to purse.

1745 Walk past gym (boy I need to exercise) drive home

1815 Pull into driveway. See Dad, baby and doodle down the street in a cluster of neighbors.

1817 Tackled by doodle who escapes from leash to greet me

1820 Pre packaged dinner into oven

1830 Back to floor with baby who is already in PJs. Books, puzzles, balls. Sing if you are happy then you know it.

1855 Upstairs for diaper, rocking chair, lullaby and bed

1910 Dinner out of oven. Defrost veggies. Glass of wine.

1940 Dishes, laundry, organize house.

2030 Climb into bed. Catch up with husband.

2100 Asleep

Saturday, December 12, 2009

A day in the life of an MS1 with four kids under age 8

6:45 I wake up and get dressed.
My husband wakes up a fifteen minutes before me so he is already in the shower when I wake up.
My 7 year old and 6 year old sons wake up around the same time and get dressed in the clothes that my husband laid out for them the night before.
7:00 I make coffee and an omelet for myself while I gather my books and throw the salad my husband prepared into my lunchbox for later.
My husband leaves the house at 7 to go to synagogue for prayers.  He arranged to have a different high school girl come over every morning so that I can leave without waiting for him to come back.  The girl prepares breakfast for the boys and wakes up my four year old daughter to help her get dressed.
7:15  I put my stuff in the car and come back into the house to give kisses and hugs.  The kids are all over the place so I run upstairs to find my daughter, then I find my baby, who may or may not be awake yet.  I give them both kisses and hugs and tell them how much I love them.  The boys are waiting in the kitchen for me to come back.  My six year old doesn't let go when he hugs so I have to be the one to break him away.  My seven year old tries to imitate the six year old with his hug, but he has other things to do so always breaks away first.  The boys stand by the door as I get in the car and wave and blow kisses.
8:00 School starts - lecture for 4 hours in the medical school building.  Five minute breaks every hour.
12:00 lunch
12:30 class across campus, just this semester.  Luckily it stayed warm enough to trek there until yesterday.  Today the weather took a major drop, but luckily we just took the final today for that class and next semester all our classes will be in the medical school building so we will be safe from the cold.
2:00 optional lab  (during anatomy I stayed at school to study until midnight - but those days are over thank G-d!)
3:00 I get home and see my husband and daughter who is home from pre-school.  My husband is only working part time this year so that he can be the primary caregiver to the new baby until she is a little older.  She just turned seven months this week.  She was three months old when school started.
3:00-5:00 I study in the dining room.  It is right in between the kitchen and the living room.  This makes me feel like I am part of the family.  My husband takes care of all the parenting tasks while I study.  He makes dinner, does the laundry, and breaks up any fights.  The boys get home from school at 4:00.  They like to come into the dining room and do their homework at the table with me.    My four year old does her "homework" (coloring) with me too sometimes.  I  have been able to hold the baby on my lap while I look through the power point slides, but lately she is becoming interested in the keyboard and I can foresee from experience that she won't be able to stay on my lap much longer.
5:00 - 7:00 Dinner time with everyone.  The dining room table is filled with my school books and the kitchen table only fits four people so we don't all sit together at a table except on the weekends.  Instead we feed the kids at the kitchen table and my husband and I eat on our feet.  It seems natural that way.  Sometimes, by the time we finish serving the kids, they are filled and leave the table, and then we sit down.
7:00-11:00 My husband brings the kids upstairs for bath and bedtime while I continue to study.  He comes back downstairs to clean up supper, do some laundry, and straighten up the house.  We both take short breaks to have small conversations.
11:00 I start to lose my focus but push on with studying.  If focus is gone, I go upstairs to take a shower and get into bed with my laptop.  If I regained my focus, I continue studying with my laptop.  If not, I turn on House or something else to watch.  Meanwhile, my husband is downstairs making lunches and preparing the kids clothes for the next day.
1:00 We both go to sleep around this time and get ready for a new day

A few notes:  Many people are shocked that I am surviving medical school with four kids under age 8, but now you know my secret.  I have a great husband who really understands the time I need to put in to pass my classes.  I also have great kids that bond with me on schedule.  I take Friday night and Saturday off to spend time with the family.  I do this every week, no matter what.  Sometimes I will read a text book while they are playing or reading, but if they want me, I am there.

You may notice my baby's age and wonder if I am breastfeeding.  Well, I am not.  I breastfed the other three children until they were a year and a half but I struggled with my low milk supply and never pumped enough to fill a bottle.  Before we got pregnant with number four, I was already accepted to medical school.  We decided we wanted to have another child even though we knew it would be too hard for me to breastfeed while I was in school.  I breastfed her as long as I could, which was until anatomy started - the second week of school.  We are very comfortable with that decision, and I hope you are all comfortable with it as well.

As far as exercise, I have fallen off the wagon lately.  I have a treadmill in my house, and will sometimes use my TV time on the treadmill.  I bought the SurfShelf to assist me in this endeavor.

That is a day in my life.   I hope that if you have a family and are considering med school that my day has been useful information to you.  First year medical school is hard for everyone.  Set your family up with real expectations.  If you are a single mom (or dad), make sure you have a support system.  Find a relative or a friend who you can lean on during first year.  Don't expect to be balanced until summer comes around.  Things will get better - I can tell by reading the blogs of other mothers on this site.  Good luck!


Day in the Life: Conference with cub #2

This is not a typical day in my life, but a recent, busy, and good one.
I have been at a wonderful conference this week and brought cub #2.
I love the chance for one on one time with a kid as well as the chance to parent an only. But there was the conference to attend and people with whom I wanted to connect. So attending a conference with a kid puts front and center the work/family balance challenges/guilt/dance.

So I came with my parents as well. We tag teamed the child time, had some family time, and also had good time with family friends attending the conference. And many of the attendees were mothers in medicine from my brick and mortar life.

Here was a look at yesterday:

7 AM up with the bright meeting venue sunshine

8 AM arrived at meeting hotel (we stayed in the farther flung hotel) with cub

8:15 Met parents in lobby for breakfast

9 AM I dashed off to morning sessions and cub went for a swim with grandparent

9-11 AM I felt somewhat drowned in advanced science talk about my favorite disorders. Answered many emails from other care providers about urgent patient issues - all for the same patient. Took notes on talks. Fidgeted. A lot.

11 AM bolted from the session to meet cub by the pool.

11-11:45 felt usual pull about being with cub or having nice connecting conversation with my mother. Chose conversation with mother while a great female colleague swam laps with my cub and discussed the meeting findings with her.

11:45 Family reconvened with grandfather for lunch

1-3 Another session

3 PM Grandparents left to return home. I brought cub with me fortified with a laptop and homework to do. Momentary concern about professional impact of having cub with me in session. Momentary concern quickly dispelled with thought that mom has to learn and kid has to do homework. Mental contortion about which session to attend, learn about something new or learn more deeply about something more familiar. Went with learning more about something familiar.

3-5:45 Superb session in which I learned a lot more about a familiar topic. Everyone stayed over to hear the questions and answers and debate friendly differences. Cub finished writing assignment and watched an episode of favorite show on iTunes with earbuds. Only comment made was, "What a great idea. She is so lucky to learn about what mommy does for work."

6-7:30 Poster session with cub. Lots of other kids there for free cheese and crackers, ginger ale, and wine. Ran into favorite old friend and colleague there with her spouse, two little ones, and grandparents. I felt happy to have an older cub who whines instead of tugging on my skirt and can get more cheese on her own without an escort. After the posters, cub and I spent time with my friend and her family out on the porch with her crawling one crawling all over. My cub played cards with her pre-schooler, and she and I shared true confessions about the challenges of early parenting and work joys and balancing. I felt like I gave her the gift of knowing that someone else has been there too and come out the other end smiling.

7:30 cub and I returned to our room. Ate chicken nuggets, shrimp cocktail, and cookies. Watched a Disney movie while snuggled in bed together.

9 PM Cub and I fell asleep in bed together.

9 AM We woke up, packed, and dashed to the airport.


Friday, December 11, 2009

Another Day: The Life of a Clinical Neurologist

What a week this has been! I was going to post about a really lousy day I had earlier in the week (arising at 4:30A after having been kept up until after 11:30P the night before was the start of it all). In my sleep-deprived state I was feeling really bad for myself - and then I read GCS15's post. I've been there in the past; I remember coming home (too many times!) well after the kids were in bed, realizing that I was too tired to eat the great dinner that Husband had saved for me and making do with a bowl of Cheerios, and then falling into bed - only to do the same thing the next day (with a few stolen moments of sticky hugs and kisses prior to starting, which served only minimally to tide me over). After doing this for too many years, missing too many class events, too many birthday parties, too many competitions that I had promised to attend, I realized that I needed to make a change. It took a long time to find the right fit, but now I am fortunate enough to work only 4 days per week; while I have an occasional day that stretches beyond its boundaries, I've managed to limit my practice to mostly office work - which is far more predictable than hospital coverage. Less lucrative? Without question. But ultimately far more satisfying due to the time I can spend with my family. I admire any female physician who can routinely execute the rigors of a surgical career - and challenge those chauvinists who throw any derogatory phrases at their female colleagues to keep up with the double duty that the majority of working mothers perform on a regular basis - but I know that I cannot be successful at such a life at this point. So here's my day:

4:30A Fall out of bed (yes, really - I got caught in the covers after turning off the alarm. At least that doesn't happen daily); awaken Eldest for breakfast before [sports] practice - he's got to be there and ready to go at 5:15A. While he's eating, pack a second breakfast for him; pack lunches for Eldest and Youngest.

4:50A Eldest is safely on his way. In an Ideal World, I'd have been to bed by 9:30 and be rested enough to head out to the gym myself. Not today. Climb back into bed; try not to awaken Husband with my feet (which have turned into blocks of ice despite my slippers). Reset the alarm for 5:45.

5:45A Turn off alarm for second time; manage to get out of bed safely this time around. Ignore slippers at this point and head into kitchen to put on coffee. Realize that we only have enough left in our canister for about 3 cups - not the 8 that the pot is set up for. Figure out a way to get most of the water out of the coffee brewer so that I can have at least a sip of needed caffeine prior.

5:50A Start a load of laundry.

6:50A Showered, dressed, ready to go. Awaken Husband and remind him that I'm leaving early because I'm scheduled to give a lecture to the residents. Check on Youngest - remind him of his school obligations for the day. He wants to know why I'm leaving so early (usually I'm not out the door until he's left for school).

6:55A Reawaken Husband.

7:00A Get out the door and on the road. Realize that I've forgotten to pack the cord for my laptop and hope that the battery will last through my lecture. Further realize I've forgotten my watch. Stop at a local coffee shop and grab a large cup to go. Would love to get a pound to go, but don't have time to wait for it.

9:10A Finish lecture - 30 minutes later than expected, but it was a really good group with a lot of questions. Start drive to office - remember the coffee situation and pull into a Target. Run into the coffee aisle and realize that there are about 900 varieties of coffee - where's the one we like? Finally find it and grab three bags. Do I have time to buy drain cleaner for the slow drain in the upstairs bathroom, too? I'm here now, so I decide I'd better get it.

9:35A Get into the office. The 9AM patient showed up despite his phone call two days prior stating he had the flu and wouldn't be in. He's only a little grumpy, and his mood elevates when I mention that I was giving a lecture to a group of residents. "Teaching, eh? Good for you!"

11:30A Meet with a patient that hasn't been to the office in more than a year. She's in with her family; she's not doing well. Son is with her, as are other family members. Long discussion about transition to hospice care. End up spending more than an hour with patient and family.

12:40P "Lunch break" - optimistically penciled into the schedule as a 60 minute time without patients; due to add-ins, unexpected lengthy visits, and phone calls, this rarely happens as scheduled.

1P Start the afternoon schedule. Remind MA that I want to be out the door early for Youngest's sporting event. I missed his competition last week and still feel bad about it.

3:30P The gods are smiling on me; the last patient of the day didn't show, so not only am I done with physically seeing scheduled patients, I managed to get my paperwork done, too!

3:40P Out the door (this is usually 5:30 or 6)

3:43P Office manager calls to discuss a few issues that she didn't have a chance to speak with me about - our conversation lasts the entire drive time, as well as some time in the parking lot.

4:10P Find a seat in the stands. Another working mom sees me and moves to sit closer. "I don't know how you manage to do everything you do." I'll take this as a compliment.

4:25P Cell phone rings; RN from office with questions about patients. Answer as best I can despite noise from stands.

4:45P Cell phone rings again; RN from office with more questions about patients.

5:15P Look at cell phone to check time; realize I've missed another (!) call from office. Call back to address issues.

6:00P Sporting event over; have given permission for Youngest to be driven home (so he doesn't have to take bus) and wait for him to appear in the hallway. Take a call from a physician that I've been trying to reach for two days; the call lasts most of the drive home. I pout a little - this is usually the time I can really catch up with my child's life.

6:3oP Finish a really quick dinner so that Youngest doesn't start eating his own hand. Husband runs out the door to Eldest's sporting event; we've previously decided that we would not make Youngest attend all of Eldest's competitions, so we knew that one of us would stay at home.

6:45P Youngest reminds me that his science fair project proposal is due. I question him about the project, and he tells me that his partner was going to write it up. He calls the partner to have the proposal emailed over - only to find out that the partner has been unexpectedly kept after school and is just getting home. Nothing has been done.

6:55P Put laundry from AM into dryer.

7 - 8P Help Youngest and Science Fair Partner through the requirements of the project proposal; remind Youngest about other homework due the next day.

8P Realize that an early bedtime isn't going to happen....but am content in the fact that I'm at least at home.

9:30P Get Eldest and Youngest tucked into bed. Snuggle them an extra long time.

10P Crawl into bed. Find a crossword puzzle (I used to do them nightly - this one is from last week); fill in about six responses and

11:30P ...wake up to a line trailing across the puzzle. Finally turn off light and end day.


Day in the Life of an Orthodonist

I'm actually a dentist, not a doctor. I practice orthodontics in the hospital and am a mother to a 20 month old girl. and I'm in Singapore, half a globe away from you gals in America. but hey, life are surprisingly similar between mothers in US and mothers here! 

Me – 32 year-old hospital based orthodontist in Singapore, who just finished her residency not too long ago.
Husband – 34 year-old general dentist who has his own clinic and works full time.
Daughter – 20 month-old toddler who spends her days playing, eating and sleeping.

7:30am IPhone vibrates under pillow, telling me it’s 7:30 and time to wake up.  No alarm clock allowed in the bedroom because daughter co-sleeps with us. (Can you tell that I am a fan of Dr Sears?) Shower and get ready for work while husband and daughter are still sleeping.
8:00am Tell the nanny what to cook for lunch. Daughter wakes up and wants to play with me. Tell her mommy needs to work. Daughter cries when I leave the house. Serious mommy guilt.
8:15am Reach the hospital. Change into scrub. First patient is already waiting for me.  We usually schedule the long cases in the morning – first consultation, surgical consult, setting up the braces, taking out the braces. In between patients, I check my email, review some xrays, and prepare the powerpoint presentation for my orthognathic surgical case.
10:00am Coffee break. On the way to the 7-11, see a toddler crying and shouting in the patient waiting area  – “No dentist! Want go home!” (I am sure at least half of the grown-up patients there feel the same way too.)
10:15am See more patients.
11:30am Case conference where the orthodontists, oral maxillo facial surgeons, plastic surgeons and sometimes speech therapists, social workers meet to discuss and treatment plan complex dentofacial deformity cases like cleft or syndromic cases. Usually the residents will present their cases first – to allow ample time for pimping.  Ah, those were the days. I present my case near the end of the conference when everyone just want to finish up and go for lunch.
12:30am Lunch time.  Drive home to have lunch with daughter. (I live very near to the hospital – 3 minutes drive to be exact.) Play with her, breastfeed her (Attachment parenting, remember?) and put her down for her nap.
1:30pm Back to work.  Afternoon are reserved for short reviews for routine cases. Most teenagers prefer to come around this time (after school and before dinner) to have their braces adjusted.  Each patient is only allocated a 15 minutes slot so I have to work really fast.
4:30pm Leave the hospital for husband’s clinic. I moonlight there three times a week to earn some extra moola – we have a mortgage to think of and the hospital does not pay me very well. 
6:00pm Dinner with husband at some cafĂ© near his clinic. Catch up on each other’s day. Call home to make sure daughter is eating her dinner.  (Don’t worry – we still have family dinner altogether on those days when we don’t have evening clinics. I read this article. )
8:30pm Finally home. Shower with daughter and read her bedtime story.  One fish two fish by Dr Seuss. Put daughter to bed with more breastfeeding. I fall asleep next to her (the beauty of co-sleeping) with my iphone under my pillow – so it will wake me up again the next day.