Friday, October 30, 2009

Q & A with Dr. Fizzy about H1N1

Q: Dr. Fizzy, would you like to get the H1N1 vaccine?

A: Yes, I very much would. I would also like to live in a giant house and go to a spa every day. What I want and the reality differ somewhat.

Q: Is the H1N1 vaccine mandatory at your hospital?

A: No. Not only is it not mandatory, but it is not even available. I waited on line for over an hour to get my seasonal flu vaccine, but I don't even have that opportunity right now for H1N1. Someone on this very blog commented to me that I was a high priority group and it was my duty to get that vaccine ASAP. Well, my left deltoid and/or nasal passages are ready to receive it. Where is it? ("In my arm" is neither a nice nor helpful answer.)

Q: Are you worried about the impact of the H1N1 virus?

A: Uh, yeah. My own state seems to be one of the few not as hard hit, but in the blogosphere, physicians keep commenting about flu tents and all the formerly healthy kids in the PICU, which I obviously just love hearing about. This is always followed by the ominous comment, "Did you get your flu shot yet?" Apparently, in some places, it's easier to get this vaccine than in others. If I had any way of getting this vaccine, believe me, I would. Right now, you may as well criticize me for not being six feet tall. Can you tell I'm frustrated?

Q: Are you going to get the H1N1 vaccine for your child?

A: Up until a day ago, the pediatrician's office's website had a message up that said, "YOU CRAZY PARENTS STOP CALLING ABOUT THE SWINE FLU VACCINE! WE DON'T HAVE IT!!" (or some paraphrasing of that) Now it says that they have limited supplies only available for kids with less than five neutrophils in their body or something. So yes, I plan to get it for my child, but not this week, I don't think.

Q: Do you believe that the H1N1 vaccine causes autism, cancer, lupus, or HIV?

A: No, but I'm fairly sure it causes genital warts. So watch out!!

Thursday, October 29, 2009

Halloween

Halloween is fast approaching - what are you going to do with the mountains of candy that the kids bring home? (I guess that if you're Tempeh, you're smart enough to put it into the candy box.)

As health professionals, a part of our job is to counsel our patients regarding proper nutrition. So how do you translate this into something you can take home, specifically to deal with the giant pile of sugar that your kids collect on Halloween?

For right or wrong, we've settled on this approach: On Halloween night, we check the candy (ever vigilant!) that the kids have collected. We then set a kitchen timer for 10 minutes and let them eat whatever they want until the time is up. The candy is then put away, to be brought out only if asked for. Subsequent visits to the candy bag are limited to "one big or two small" pieces. I've found that my kids tend to relish the hunt of Halloween night and often forget about the goodies within a few days - over the years, I've given/thrown away pounds of the stuff a few months later.

Would love to hear how other MiMs deal with this issue!
A

photo credit: I wish I knew - this was sent to me in an email. Anyone? Bueller?

Wednesday, October 28, 2009

Live for two months!

A few weeks ago, at the end of a very trying day with the kids, I saw the Mark Twain quotation, "I can live for two months on a good compliment" at the end of a newsletter. How true it is. As I thought back over my day, the high point was a pretty random, but apparently heartfelt, compliment from a stranger. "You are so patient with your children! That is JUST WONDERFUL to see!!" said an elderly lady in passing in Michael's as I quickly picked out 50 cent treasure rewards while playing rhyming games with the two older kids to keep them from running off and attempting to stop my toddler from eating through all the packages of cupcake decorations in the cart. I'm sure she has long forgotten me and that interaction, but I have channeled her repeatedly since then.

I recently started a sticker chart for my 5 and 4 yr old kids at home in an effort to improve behavior. I used a plain piece of colored paper and wrote on it 12 things I wanted them to do (or in some cases, stop doing). Each time they do those things, they get a sticker on the chart. Ten stickers earns a trip to the candy box, twenty stickers a trip to the treasure box (see Michael's above), and thirty stickers a choice between a family trip to our local ice cream shop or to Blockbuster for a family movie night (school night or no, we honor it) with a movie of their choosing. Each time one of the kids gets to thirty, I make a new chart for him or her which may include some of the same behaviors or new things, depending on where we have made progress. It has worked AMAZINGLY well, so I have been thinking about why that is. Well, there's the obvious: Kids love candy. Kids love treasure. Kids love family trips, but especially those that involve movies or ice cream. But they got candy from time to time or little trinkets at stores or trips for ice cream or movies long before we instituted this reward system. So clearly, that's not the whole story. What they are really responding to is being acknowledged and praised, in some cases for things that I expect of them anyway (e.g. be kind to your sisters). They like the fact that my husband and I are pausing long enough to say "Great job", to stop what we are doing to go choose a sticker with them from the sticker folder, to mingle in more compliments amidst the unavoidable "no"s and redirections and scolding that go along with being a little growing human testing the boundaries of the world.

One of the things I like most about my boss is that she is a reliable complimenter. Her compliments are never insincere. They are never excessive. She just makes a point of acknowleding reliability or patience or meticulousness or creativity or kindness. It isn't that those qualities are so remarkable either--indeed, they are expected in physicians and scientists--but she still appreciates them. And that is probably what should drive a lot of compliments, appreciation of another human being, even if they are doing exactly what you expect of them and not one iota more.

I have decided to make a concerted effort to follow her model for a month and see how I feel and how my relationships with others change. So, when my husband found the dishwasher full of clean dishes and took 5 minutes to empty it before leaving for work at dawn during an awful attending month, I called him to tell him how much easier it made my morning with the kids to find it empty and ready for the breakfast dishes before we dashed out to preschool and school. It was empty the next morning too and the one after that. When my son reminded me back at home of something good his sister had done while we were out that deserved a sticker, I stopped and hugged him and said, "That is true kindness. It makes Mommy so proud when you are kind." He beamed and has been what I can only call excessively, concerningly kind to his sisters for the last 24 hrs. And when I told my clinical associate today that I appreciate how friendly she always is to the patients when taking their vitals because it sets such a nice tone for our visit, she looked at me like I was from outer space. But I couldn't help noticing that she walked off with a little spring in her step. And it was only a little smaller than the spring in my own.

Monday, October 26, 2009

please tell me more about how the heart works

The other day a fellow MIM who doesn't actually blog here (as far as I know) recounted a story to me about her child's bedtime routine that I found funny and oh so familiar. Have you found that almost all of them (those children of ours) want to stay up just a little bit later? Indeed they are oh so in tune to what enthuses mommy and/or daddy. And what would allow them a few more minutes (hours??) of wakeful banter? When they want to stay up even later than their working parents already let them, all they need to ask is just one little question...


It goes something like this, "Mommy, can you tell me again how the heart pumps the blood around the body?" Or perhaps "Daddy, will you remind me how the lungs work again?" It can happen whether we're pulmonologists or cardiologists, and even a health services researcher might succumb to a innocent query like "Can you review regression analysis one more time?" We're weak when it comes to an opportunity to explain what we love to do, our primary involvement when we are not with our precious little ones. And they know with that simple question, "How does the food get all the way from my mouth to my large intestine?" they've bought themselves more not-yet-sleeping Mommy/Daddy time.

Tuesday, October 13, 2009

NaNoWriMo

You may or may not know that November is National Novel Writing Month, also known as NaNoWriMo. The goal of NaNoWriMo is to write a 50,000 word "novel" in one month. (50,000 words may be a little short for a novel, which is why December is National Novel Finishing Month.) If you finish your 50,000 words, then you can say that you "won" NaNoWriMo and they give you a little banner you can put on your blog or facebook or wherever.

I won NaNoWriMo back in 2006. It was a lot of work, more than I thought it would be, but also a lot of fun. Then in 2007, I had a baby and between that and residency, I decided that participating in NaNoWriMo would be just short of child abuse. More of the same in 2008. I felt bad about it though, because part of the purpose of NaNoWriMo is for busy people to finally force themselves to sit down and write that novel.

Now I'm finished with residency and have more free time, so I'm going to be participating in NaNoWriMo 2009. I think my chances of winning this year are a lot lower than three years ago, but half the fun is trying.

I invite all you mothers in medicine, as well as all you non-mothers not in medicine, to join me in my overly ambitious attempt to write 50,000 words in one month.

Sunday, October 11, 2009

The post where I gush about Pauline Chen

I had the recent opportunity to listen to physician-writer and fellow mother in medicine, Pauline Chen, speak at a university function. I had read some of her columns in The New York Times (she has a weekly column, "Doctor and Patient"), and I've always been impressed by how honestly and thoughtfully she writes. Her book, Final Exam: A Surgeon's Reflections on Mortality, is a New York Times bestseller.

My colleague had helped to arrange her visit, and when I arrived to the building, I ran into him into the hallway. He introduced me to her before the talk and I got the chance to speak with her for a few minutes. What struck me about her was how she makes you feel like the most important person in the room when she talks to you. She is sincere, engaged, kind and so warm, she casts a glow. I felt gleeful to be able to connect with her, even for a short while. I even mentioned Mothers in Medicine and what we write about here.

Her talk was fabulous. The entire auditorium was captivated and hung onto her every word. She shared a couple of patient stories that were so exquisitely written and told, I had shivers. Her message was all about compassionate care, especially compassionate care at the end of life. She shared regrets and interactions she wished happened differently, but mostly, it was about hope for being the best physicians we could be. There have only been a couple times where I've listened to physicians speak and thought to myself: I would want to be her patient. Her patients are so lucky. I thought this about Pauline. (The other was Rita Charon from Columbia University. That woman rocks.)

I left the talk feeling inspired. Inspired to write and inspired to keep striving to be the best physician, the best listener, the best patient advocate that I could be. I thought about all the family meetings I've been involved in recently - the ones where we have to break cancer diagnoses and sometimes discuss options for palliative care - about helping patients and families through the stress of chronic or end-stage illness, and feeling at least thankful to be the one to help them through this. Emotionally taxing on me, yes. But if I can make an unthinkable situation a little bit better, to be the voice of compassion and comfort, then it is all worth it. It makes a difference.

Pauline, thank you for doing what you do. Thank you for inspiring each of us sitting in that auditorium to be our best selves.

Thursday, October 8, 2009

Seriously, I wanna know...

Will you vaccinate yourself and/or your children against H1N1?

Wednesday, October 7, 2009

Contending to be Content

From the moment my first visitor came to see me in the hospital, as I was holding my brand spankin’ new baby boy, they all began to echo the same message “Enjoy every minute! They grow up so fast!” Each mom would get slightly misty eyed when they talked about how it seemed like just yesterday their ‘little one’ (who was sometimes college age) was that size. “I miss when I could just cuddle them in my arms for hours” they would say. I would smile and nod, wondering mainly when I would get some sleep. I noticed recently, I’ve fallen into giving the same advice when I round on my postpartum patients each morning.

I really have tried to relished every moment. It has not been our choice that we have an only child, and my prayer is that we will have another someday. However, I was recently thinking how this unplanned spacing between children has allowed us to truly enjoy each stage with our son. From the crawling, to the talking, to the first day of school, I have tried to soak up every second of parental joy I possibly can. We take obnoxious numbers of pictures and fill journals with stories. Ok, so potty training was not a hoot, but still it had its funny moments. I see so many of my patients with several children under the age of 5, and while I am envious of their full quivers at times, I also see so many who are just trying to survive…. If I can just get this one sleeping through the night, if I can just get this one out of diapers, if I can just get this one in school…. THEN I’ll be able to really enjoy them. There are so many people who ‘WISH” away their life.

I think the same attitudes can apply to the medical training process. With a minimum of 12 years of training, you just HAVE to try to enjoy some of it or you will go crazy and waste half your life. Yes it is grueling, yes the hours are intense but there is nothing like it. The things you see in residency are crazy. (Hopefully) You will not see near the insanity/ fun/ adrenaline filled nights when you are an attending. The lessons you learn will stick with you forever. Those crazy, on call practical jokes will make you chuckle to yourself for years to come. To this day when I see a CPR mannequin I laugh so hard I nearly pee my pants! I miss those days when all I did was surgery from sun up to sundown, interesting cases with no office follow-up. I worked with so many people who were just counting the days till the end: I wish I was a resident, I wish I was a chief, I wish I was in practice. Then once in practice, they began counting the days till they were partnered. There is always something to look forward to, but the art becomes enjoying where you’re at while you’re there.

So I’m trying to practice what I preach: enjoying my job and son to the fullest, as I somewhat patiently wait to adopt baby #2. I feel thankful and blessed, that I have gotten to spend so much precious time with my son. Obviously, there are days where life becomes all about survival, but for those many good days I pass on this same somewhat cheesy advice to all you residents and med students that I do my postpartum moms: “Enjoy every minute of it (your training) that you possibly can!”

Sunday, October 4, 2009

$$$$$$$

When someone makes a comment about rich doctors, I want to punch them.

The median med school tuition for last year according to AAMC is about $40,000. That is just tuition, not including room and board, academic expenses (some schools require laptop purchase), health insurance, or gas money. I think it's safe to tack on an extra $15,000. So that brings the grand total to $55,000 per year for four years. Doing the math: that's $220,000 in debt before you earn your MD. And that doesn't even count any debt from college.

You would think that after accumulating that kind of debt, you'd be able to go out an earn some money. Not so. My residency salary right out of medical school was $40,000 per year. Are you sick yet?

Then you do something insane like go and have a baby during residency. You need a bigger apartment and now a nanny or daycare. Once we had a child, my entire salary after taxes went directly to the nanny. But I accepted it, telling myself it was just temporary while I was in training.

I swore to myself that after I finished residency, I wouldn't worry about money anymore. Then I found a fellowship that I wanted so badly, but I knew the salary was nowhere near what I'd make in the private sector. It was a job I knew I'd love (and I really do), but part of me felt sick accepting it, considering the high cost of living around here.

So here I am, in my 9th year of medical training, still pinching pennies, making less than some of my friends made right out of college. Everyone asks me when I'm going to have a second child, but when I do the math, I simply can't afford it without having a negative monthly balance. I'm a doctor and I can only afford to have one child. Something about that seems a little off to me. People look at me weird when I say it.

I think to myself, "Did I do something wrong? Why am I still struggling to make ends meet?" I could moonlight, but that would involve working extra weekends, when I had vowed to spend more time with my daughter when residency finally ended.

I was at the ice cream store yesterday with my daughter. I was staring at the menu, struggling to decide if I wanted to pay an extra dollar to get the medium instead of the small. The small will be enough, I told myself, it's not worth the extra money. The ice cream is such a rip off. And as I contemplate this, I think to myself, "This is crazy, this is ridiculous, I shouldn't be worried about spending an extra dollar on ice cream... I'm a DOCTOR."

And then I get the small ice cream.

Saturday, October 3, 2009

Looking to History for Mothers in Medicine

Here are few remarks excerpted from a talk I gave about a travelling National Library of Medicine exhibit on women in medicine that is currently at my school and may come to others. The exhibit is very worth a visit, even from an overbusy motherdoc. The students in the audience seemed to share my thoughts--many are struggling with the same concerns we have all had about integrating our many roles:

"I graduated from medical school in 1977. A picture of my class could have found a place on one of the panels of a history of medicine exhibit, as it was, I believe, the very first class at my medical school to have more than a token number of women—30% rather than 10% or fewer. What that meant to me concretely was that my male classmates could look around at their peers and professors themselves for models, inspiration on how to build a life and a career in medicine. In school, I could look to my peers for ideas on how to remove the smell of formaldehyde from my hands. Later they showed me how a woman can be an effective teacher or begin a research career, but for inspiration, I had to look backwards in time to the women sporadically flung up by the tides of history. Reading about the checkered history of strange and sometimes misguided study and treatment of disease by strange and sometimes misguided practitioners helped me form a realistic view of medicine, to lose the na├»ve assumption that one had to be a genius to enter this profession and that once in, one could never make a mistake.

Elizabeth Blackwell, of course, was the subject of various biographies for children that I read in elementary school and every other book about women in medicine that I read after that. I admired her determination and commitment, but I was always troubled by her detour away from what was called allopathic medicine into homeopathy, as well as by her unmarried and apparently unmarriageable state. In my college, which had originally been an all women’s school, I stumbled across Dr. Edward H. Clarke's publication Sex in Education; or, A Fair Chance for the Girls (1873). Clarke was a professor at the Harvard Medical School, and seems to have been panicked at the sight of blood. Aside from unbending prejudice, that was the only way I understand his argument that women were so weakened by the menstrual blood loss that they could not possibly tolerate the rigors of secondary education, much less enter any of the professions. He suggested all women should lie in a quiet room for a week every month, to conserve their strength to bear healthy children. Clarke’s contemporary on the faculty, Oliver Wendell Holmes Sr, clearly knew this was nonsense, but all he ever did to counter it was to state in his eulogy for Clarke that he knew Clarke sincerely believed in his own thesis. I was thrilled when I learned that Mary Putnam, another early woman physician, had demolished Clarke’s work by rigorous research conducted during her post graduate training in Paris. Her complete and influential refutation of Clarke in fact laid the groundwork for the creation of elite women’s colleges around the country, and accounts for the emphasis they placed on athletics as well as scholarship.

Still looking for models for myself, I was also very relieved to read that Putnam not only succeeded in influencing the whole of her profession, she also married and was the mother of two children. Still seeking a guide on my own path into medicine, I found her story a bit intimidating, given that I could not imagine having her commitment to science, or her critical intelligence. She saw clearly the inadequacies of her own training in the US, and went off to remedy that in nearly complete isolation from friends and family, not to mention other women physicians.

Regina Markel Morantz’ article comparing Elizabeth Blackwell and Mary Putnam Jacobi clarified a lot for me. These two women represented different poles of feminism—ones still relevant in my era in college in the 1970s and even today. Blackwell was a “difference” feminist who believed that women’s unique nature would lead them to be more understanding, more gentle and feminine in their professional practice. Ironically, since Blackwell herself was never a wife or mother, it was Putnam (Jacobi) who was what has been termed an “equity” feminist. Despite (or perhaps because) of her personal adoption of the conventional roles of wife and mother, she successfully argued and demonstrated that women deserved the same opportunities to achieve as men, given their equal abilities. I could only sit on the sidelines of history chanting the “right on!”, the 70s equivalent of “You go, girl!’, though I did become convinced that I could handle being in medicine, and would not have to abandon my hopes for a family as well."

I wonder if other bloggers find history as important as I do as a way of understanding the way our current context influences how we feel about ourselves and our choices?