When my divorce was finalized in September, four days after I moved into a new house, my 7-year-old daughter Cecelia started bugging me for a new pet.
Friday, December 31, 2010
Thursday, December 30, 2010
Husband: "Would you support me if I decided to go to medical school to become a surgeon?"
Me: "Yes, absolutely."
Me: "Yes, because it would be hilarious."
Husband: "You know, I might do it just to prove a point to you."
Me: "I'd love to see how far you'd take that joke. You haven't even taken any pre-med courses."
Husband: "I took a term of biology in college."
Me: "That's not quite enough. You have to take a year of biology, a year of chemistry, a year of organic chemistry, and a year of physics."
Husband: "Well, I've got the math requirement down."
Me: "There's no math requirement."
Husband: "Oh. Well, are any of those courses actually required? Aren't they just recommended?"
Husband: "Mel, do you think Daddy should become a doctor?"
Me: "Why not?"
Melly: "Because boys can't be doctors!"
Monday, December 27, 2010
Of course, I couldn't help but think of how this might apply to women in medicine. I'm sure there are tons of women who shy away from competitive fields like surgery because they don't want to spend their prime childbearing years in rigorous training. Egg storage sort of evens out the playing field between men and women, but I don't think it's very mainstream right now... I don't know of any women who have done it. I remember on Sex and the City, Miranda gets heckled by her date when she brings up the idea of storing eggs. (Although that was admittedly a decade ago and also, I don't even watch that stupid show, much less have seen each episode multiple times.)
Personally, for a risk-adverse person such as myself, I don't think if I could do it. The article said that for a woman under 35, harvesting eight eggs only gives you a 50/50 shot at pregnancy. Plus there are hormones involved, which scares me a bit. Then again, I never wanted to be a surgeon and really had no compelling reason to delay having kids.
The other issue is the cost. I have a friend whose wife is (unfortunately, unsuccessfully) going through IVF right now, and he's informed me that the cost of IVF has trumped all the daycare costs I'd been complaining about. Insurance doesn't generally cover IVF, but there are arguments why it should. Women implant more embryos when they know then only have one or two shots at success due to cost.... this results in multiple pregnancies, which ultimately results in higher medical costs.
Before I say anything (else) that will surely be construed as judgmental (smiley face), I'll throw the question out there:
Would you consider saving your eggs for the purpose of use in the future?
Sunday, December 26, 2010
Well, maybe some people do, especially if they're lonely. Certainly everyone whose deductible starts over again in January seems to. But despite the urgency patients feel to have elective surgery over the holidays, I sense that none of them is really happy about it. Neither am I, for that matter. I hate that December is always my busiest month (71 cases this time around).
So, every December, there is generally an undercurrent of "Bah, humbug!" lurking in the hospital hallways, sort of like the invisible coating of drug-resistant bacteria on the ICU surfaces. This never helps me percolate any kind of holiday spirit.
Early this month, I stopped at the drugstore to pick up some toiletries. Next to the shampoo section, my eye caught a display of silly over-the-top antler headgear festooned with blinking Christmas lights. I found myself grinning a little and thinking what my son would say if I picked him up from school wearing a set of those antlers. So I bought a set out of mischief - what are parents for if not embarrassing their preadolescent kids?!
On the way home, wearing those blinking antlers, I realized I was still grinning - and I came up with a very un-Grinch-like idea.
The next day, I arrived in preop holding wearing my white coat... and my antlers. The staff gaped, then giggled. I went to see my first patient and watched the anxiety on her face melt into laughter. She rolled back to the OR still smiling. And so it went, all day long. It was the most fun I'd had on a workday in December since - who knows?
The OR staff enjoyed it so much that on my next OR day, several of them brought in Christmas headdresses of various types: elf ears, Santa hats, snowflake crowns. I myself bought enough headgear that I wore a different set every operating day through the 23rd. My inpatients looked forward to seeing what would come next; one actually wanted to stay an extra day just to see what my head would look like. Every patient seemed a little brighter than usual this month (a lot like my head!).
I have always thought that humor is a key to communicating with patients and making them feel at ease. I use it whenever I can. My Christmas headgear experience has made me realize how big a difference it can really make, not just in the patients, but in us as physicians, too. A laugh can dispel the shadows of fear in a patient's mind; they're all afraid, each in their own way. We, too, are afraid - of the things we can't control, of the grimness of disease and death. Just as the Hogwarts students could dispel creatures resembling their greatest fears with humor ("Riddikulus!"), so do we have the power to help our patients and ourselves grapple with the dread of illness.
I wish we all could recognize this. Interesting, some of the comments I heard from my colleagues when they saw my festive antlers. Twice: "I don't know if I'd have the confidence to have someone wearing those operate on my brain!" "Do you really let your patients see you in those?!" Most telling: "I bet not many neurosurgeons would be seen wearing those..."
No, sadly, probably not. Ours is notoriously such a dignified, serious profession. The classic image of a neurosurgeon is a tall, graying man in a suit and tie with a grave expression who can burst into a tirade at the drop of a hat. No smiles, no fun, and certainly no antlers for him! After all, the patients and the world must hold him in the utmost regard! I have always secretly been pleased to look (and to be) nothing like that classic stereotype. Our field needs more laughter... and more humanity.
That's the comment (from a chaplain) that struck me most: "I am glad to see you wearing that. It lets the patients see that you are human."
Indeed. I couldn't agree more. If I learned anything from my Christmas antler experiment, it is that many physicians still take themselves too seriously. We have an important job, no question. But if we are to give our patients the best care, we must find ways to connect with them on a human level. We need to pay less attention to our dignity and more to empathy, all year round. A little laughter, sometimes directed at ourselves, would go a long way in all our relationships.
In this season, we celebrate the Incarnation, the perfect divine coming to share the imperfect human experience. What a good time to put the physician "God complex" behind us and show our patients that we, too, can listen, can cry, and ... yes, can laugh.
Thursday, December 23, 2010
One woman pointed to our Christmas tree and said, "Your tree reminds me of a task we use in therapy: take two Christmas ornaments out and put them on the floor. Don't put them on the tree. Just let them sit there. See how long you can last. It's for perfectionists, you know?"
My four-year-old son had done most of the decorating while I frantically cooked French toast for dinner (using homemade bread I made with my own hands, after my husband forgot to buy bread!). This meant the tinsel was looped mostly around the bottom of the tree, he'd smashed one glass ball, and all the Christmas lights were plugged in to various sockets, some of them blaring different Christmas tunes, all of them flickering enough to potentially trigger an epileptic fit.
I cleaned up the glass, grabbed the French toast before it burned, and muted the Christmas lights before I got marooned nursing on the couch while my husband left to put our son to bed. So yeah, my tree might make Martha Stewart cry. And yes, the first book club member to arrive helped wash my dishes. But I've got pretty good work-life balance. Here are my tips.
1. I married a laid-back guy
It does drive me nuts that he'd rather have sex and play World of Warcraft than just about anything else. But on the upside, we're both on parental leave and getting a bit of sleep instead of going berserk. That'll come later, when he goes back to work in a few months. He does most of the laundry, nearly all the grocery shopping, and has taken over the school lunches. Yay.
2. Save your money so that doesn't dictate your life
My parents raised me to save like Scrooge ever since I can remember. Now our house is paid off and our expenses are relatively cheap. It's important for me to dictate the length of my own mat leave, so after the Ontario Medical Association (me) and Employment Insurance (him) are tapped out, my corporation will pay me what I need until I go back to work. I know saving money is a laughable concept while you're in school, but when the money starts coming in, remember that paying off your debts means financial freedom, which as far as I'm concerned, equals just plain freedom.
3. Get a cleaner
I'm with RH+ on this one. I felt guilty at first, but now, I think it's a good idea to pay someone who does a much better job instead of constantly singing, "Clean up, clean up..." to my family and then end up doing all the tidying up myself anyway. I don't feel as alone trying to fight the tide of toys, dirty dishes, etc. and it frees me up to do other things only I can do, like write or nurse my baby.
Of course my work-life balance isn't perfect. I cut back on my shifts during my pregnancy because I wasn't functioning well afterward. By that, I mean that I almost caused a car accident on the way home on one shift. This did not go over well during a doctor shortage and I know there will be payback when I return to work. Plus, well, you already have an idea what my house looks like in between cleaning bouts: broken glass takes priority, not artistry. But for the most part, I am happy, which is more than a lot of people can say. Now I'm going to have a nap, which will make me even more balanced. Cheers.
Tuesday, December 21, 2010
I've made sacrifices. When I was getting ready to apply for residency, my husband got into a graduate school far away from my family and friends, in a fairly competitive location. Because of this, I had no choice but to apply to internal medicine residencies to maximize my chances of matching and getting to live with him, which was the most important thing to me. When I was in med school, I loved neurology and PM&R, but there were only 6 PM&R spots in the entire area and 8 neurology spots (4 of which were at a "malignant" program). And prelim spots were impossible to come by. So I made a sacrifice and applied for medicine instead.
Amazingly, it all worked out okay in the end though.
Then when we were job hunting, I chose the general quadrant of the country where I wanted to live, and my husband job hunted first. Once he found a job, I looked within the same city for mine. It limited my choices, but I found something.
Now his sacrifices:
I hate to drive and I suck at it. I have been in four car accidents, one of which was a serious one requiring a hospitalization, so while I'm willing to have a long public transportation commute, I don't want a long drive. My husband's job is 30 miles away from mine in the Middle of NoWhere (MONW). My job is a bit in the middle of nowhere, but less so in that there is public transportation here, which allows easy access for us to get into the city and for visitors (such as our parents, who don't have cars) to visit us. So we live in the city where I work, and in exchange, I chauffeur our daughter to and from her daycare (also in the same city).
This has become a source of guilt for me though. Usually his commute is 45 minutes to an hour. But on bad days, especially now that the weather has taken a turn for the worse, his commute home has gone up from an hour to an hour and a half.... and it has twice taken him TWO HOURS to get home.
When he gets home from such a long drive, he is not a happy camper. He generally just wants to lie down and not talk to anyone, and usually says a few four letter words about the highway. And of course, I feel totally responsible and very guilty. I did look for a job near his work, but the economy sucks. It's amazing that I found a job that I like in the same general area and that pays well (more than his).
All this is further complicated by the fact that he is considering going back to school on his company's dime. All the grad schools are closer to where I work, but that won't happen for a year and a half at soonest.
I don't know what to do. I constantly feel guilty about this. I've scoured google maps but any place we moved that would shave ten minutes off his commute would add thirty minutes to mine. It doesn't make sense, especially since my days are longer than his and it takes me at least 30-40 minutes to do the childcare stuff in the morning.
Sometimes I feel like the only solution is to quit and stay home.
Sunday, December 19, 2010
Scroll down below to find the posts...
1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.
2. Be clear about your boundaries and don't apologize for them. I work Mondays, Tuesdays and Fridays. I can't start any earlier than 9AM due to school drop-off. I've had potential employers rework schedules and change clinic start times when I tell them my availability.
3. Don't compare your finances to others'. Recently, my six-year-old son asked me, "Where do you and Daddy get money from?" He was taken aback when I explained that we are paid for our work. All this time he had assumed we were going to work for pleasure and to help others. This pleased me no end. I don't want money to be the prime consideration in my decisions.
Every year the BC Ministry of Health puts out the "Blue Book", which lists what every physician in the province billed the Medical Services Plan. I've perused it before, but no good comes from seeing that my family physician neighbour bills more than five times what I do. I start to gauge the wrong things in terms of money; what are quiet days at home puttering in the yard with my four-year-old worth?
4. Say no. This may be the most important skill I've learned in the last five years. If I feel awkward saying no to someone's face, I say I'll consider their request. Then I say no by email. I don't bother with reasons or excuses. I came across a quote from one of Dr. Gabor Mate's books a few months ago that I think of almost daily: "Always choose guilt over resentment."
5. Write. I take ten minutes once or twice a week to document for myself what was memorable. This has a magical way of allowing what's important to rise to the top while the irritations of daily life drift away, affording perspective. Here's something lifted directly from a journal entry this summer:
Playland yesterday, Leif smiling as he soared through the air, Saskia looking non-plussed even when having a great time. It felt wonderful to give them a day of whatever they wanted, unlimited rides, mini-donuts, cotton candy, a snowie despite wasps hovering over the syrup spigots, eaten cross-legged on concrete in makeshift shade. They were good as gold. Felt strange to see legs dangling from a great height, delighted screams, ferris wheel buckets the colours of candy against the North Shore mountains, and think that the same world has refugee camps.6. Consider exhaustion the state of having given, rather than having been taken from. A few months ago, as I rounded the bend to approach the Second Narrows Bridge on my way home from work, CBC's Rich Terfry on the radio and Ariana strapped in the backseat, I thought with dismay how overwhelmingly fatigued I was. I felt drained, spent, exhausted - and reflecting on these words I realized that resenting others having taken from me was passive and inaccurate. I had given what I had by my own choice. When considering Dr. William Osler's words, "Let each day's work absorb your entire energy and satisfy your widest ambition," anything short of collapsing into bed completely spent each night feels a waste.
7. Travel lightly. I try to apply minimalism to every aspect of my life. People remark on how tidy my home is, but the truth is that we have very little stuff. I decided two years ago to leave the HIV clinic to focus my part-time work at the refugee clinic only. We eat simply. Any commitments are carefully selected and for a defined period of time.
8. Hold an AGM with your spouse. Once a year, Pete and I hire a babysitter and take an evening to take stock of where we're at in every major area of our life: his work, my work, finances, church, where we live, parenting, friendships. We identify what's working, what needs to change and when we need to reevaluate. We like to feel that our choices are deliberate; we don't want to float up to our forties to say, "Huh! So this is how we live." I have such fond memories of these evenings, full of gratitude and brainstorming and collaboration, and everything recorded in my notebook.
9. Three projects. At any given time, I have three projects on the go that require one to two weeks to complete. One relates to work, one to home and one to something creative. For example, I might apply for a research grant, order a coffee table and frame some of my photos for our front entry. No new projects can be tackled until all of the original three are completed. (See zenhabits for more.)
10. Marry well. Pete (who works full-time in a non-medical field) is supportive, a non-complainer, hands-on with the kids and flexible around gender roles. We've both made sacrifices. He is undoubtedly the linchpin to my current contented state of mother-doctor.
I've loved William Wordsworth's poem "Nuns Fret Not at Their Convent's Narrow Room" since I studied it in English 103, particularly these lines:
In truth the prison, unto which we doomI'm a mother in medicine by choice. I accept any challenges and restrictions inherent to this position, for this is exactly where I wish to be.
Ourselves, no prison is.
Saturday, December 18, 2010
These past 5 1/2 years of motherhood and living work-life balance have given me some early insights:
Work-life balance is highly personal. Set your own standards.
We were on vacation over the summer at the beach for one week. During the week, I had a monthly work-related conference call for a national committee I serve on. I decided beforehand that I would see how the week was going (the call was near the end of our week away), and that I'd call in for it if I felt like it. Well, I felt like it. After spending 24/7, all-family, all-the-time, (including an 8-9 hour car ride involving listening to 2 hours+ of straight crying), I was ready for a brief break away, if only by phone. Yet, calling in and admitting that I was on family vacation at the beach and might not stay on for the whole call made me suddenly self-conscious, much like I feel self-conscious about sending colleagues manuscript drafts on Friday nights (I have). I wondered what they were thinking and whether my "balance" was questionable.
There's no ideal "mix" or balance that fits everyone. Finding your own "groove," is key.
"Work-life balance" is a less helpful concept for me than "work-life product"
When I think about balance, I think about a see-saw, with work sitting on one side of the fulcrum and life on the other. That seems to denote that to be in balance means to have similar weighting to each side, in similar quantities. Yet, in real life, I feel that these weights are always in flux and being in a state of mental/emotional harmony depends on the work*life product to be under a certain threshold (much like the calcium-phos product). For instance, it would be okay if family needs became temporarily higher when work needs were low, or if a flurry of work demands occurred during times of quiet on the home front. But, when both of those demands become high for whatever reason, that's when things get untenable. Hopefully those times are only temporary, resulting in only a minor amount of pesky metastatic calcification (e.g. my nanny nightmare + temporary work insanity = sad me), but when they are sustained, then changes have to be made.
Your workplace "terroir" can greatly affect/encourage/stifle your sense of balance
In wine-making references, the term terroir refers to the sum effects of a local environment (the specific geography, climate, soil, farming techniques, etc) that results in the final product. At work, the organizational culture surrounding work-life issues-- managers, your boss, colleagues, inherent flexiblity of your job-- all contribute to your sense of balance. When I first started working at my job, I didn't feel it was very supportive to me as a new mother. When I announced my pregnancy, the first response was "how long will you be gone? 6 weeks?" (In my ideal world. it would have been, "Congratulations! *hug* How can I help you?") I was the only mother of my group and worked with many men who gave me a hard time for missing conferences due to pumping--I felt like a criminal trying to get out at a reasonable hour to see my child before her early bedtime. Yet, now, things have changed. Those men have left (hooray!), I've negotiated for more protected time (hooray!), and now, I have a supervisory role that allows me to create a environment that emphasizes the importance of work-life. Small gains like instituting policy and precedent for my section to take "in-lieu" days off for having to work a holiday hopefully will add up to an overall supportive culture. Finding a work environment that meshes with your own ideal of work-life balance can't be underestimated, and if not, work to change it if you can, either from within or finding a new job (like dr whoo courageously did).
Re-evaluate, re-evaluate, re-evaluate
As with any process, it helps to periodically re-evaluate to make sure things are going smoothly from everyone's perspectives. I remember one time when my husband mentioned (jokingly) something about how we both just tended to get absorbed in doing work side-by side on our laptops after the kids went to bed each night. It was totally true, and a reality check. It's so easy (for me) to get sucked into (bad) habits and not stop to reflect, or step away and see the big picture. I need to be reminded to take that time to re-evaluate and to check in with everyone.
Best of luck to all MiMs out there, finding your own work-life groove and defending it. And periodically checking in with all stakeholders (yourself, your partner, your children) to make sure nothing needs tweaking. And definitely keeping that work*life product to non-toxic levels.
Friday, December 17, 2010
Before I decided to go back to school full force, pursuing a career in medicine, I talked to several physician/mothers that I respect a great deal. Balance was always a central theme in these discussions. What I learned in talking to them is that it is definitely possible to be both a good physician and a good mother, balance is possible, but it is not always an easy thing to find that balance and balance rarely means the same thing to two people. It is more complicated than usual for our family, because KayTar has special medical needs and my husband works full time and is a full time student, too. For us, these things have been key.
1. Determine YOUR priorities, re-evaluate as necessary. My highest priorities this semester included: Never miss organic chemistry. Go to all of KayTar's medical appointments/hospital visits. Be present and active in the kids' school life. Spend time in clinic. We had several rough spots in the semester, but I never missed organic or one of KayTar's appointments, and I made sure to volunteer in the kids' library as often as possible. I also spent several days shadowing. Your priorities are probably totally different than mine, but just recognizing what they are makes it easier to stick to it.
2. Compromise where you can. I did stick to all of my priority items, but I had to compromise in other areas to do so. I missed history and music on more than one occasion to go to one of KayTar's appointments. I missed several of my son's baseball games because I was in the hospital with KayTar.We skipped KayTar's dance class at least once, because I needed to study. Last night when I was working through 228 pages of organic chemistry and KayTar kept bouncing back into my bedroom like a ping pong ball, I finally scooped her into my lap and said, "I know you reeeeeally want to play with me right now, but I'm studying for my very last test right now and it is very important. After tomorrow, I'm all your for a month!" She understood and went on her way. You can't always do it all, but you can make time for a little bit of everything.
3. Our family is a TEAM. The only way any of this works is that we are all committed to it. Laundry is usually falls under my purview and dishes belong to Josh, but if I'm drowning in orgo, he'll put on a couple of loads for me....if he's writing papers and the sink is overflowing, I'll load the dishwasher for him. I usually pick up the kids, but if I'm in clinic, Josh handles pick-up. Josh cooks dinner, but if he's busy cramming for an exam, I'll
4. Take time for yourself/family/friends. I've found that I get a lot more accomplished if I take periodic breaks and do something relaxing, than if I try to power through and do more, ignoring myself altogether. If I'm having an especially intense study session, I'll give myself 30 minutes of free time as a reward every time I finish a section. The kids understand that mom and dad have homework just like they do and for the most part, they let us work and study when we need to. When I'm drowning in coursework and need a break, I'll ask BubTar to play Wii with me or I go have a tea party with KayTar. Sometimes a little time together is all we need. We don't have a lot of time for dates or social events with friends, but when the stars align, we jump at the chance! Everything seems easier after a great date night or evening spent with good friends.
I'm sure there are other important factors, but for us, these are the biggies. As an undergrad, I know that this is probably the easiest my life will ever be...medical school, residency, and practice will take more time and effort than school currently does. Sometimes I think I must be clinically insane to be pursuing this, but I love medicine and I'm committed to making this work. I hope that as time passes and we enter into the next stages of this process, we will continue to find a way to make it all work.
And then, not one, but two of my family members were diagnosed with serious illnesses within a few days of each other. When Husband was initially diagnosed, I remember thinking "Wait a minute - this is the kind of thing that people read about and think Thank God that's not us" - except it WAS us, and I wasn't reading about it, but living it. And suddenly, my carefully constructed house of cards was crashing down around my ears. Scrambling to find coverage so that I could be at his side for two surgeries (one to remove a cancerous tumor, one absolutely unexpected correction of a bizarre bleeding complication) within 10 days strained not only my extended family, but my work relationships. As he was recovering and we had received the fabulous news from his surgeon that the margins were clear and no chemo or radiation therapy would be required, I dared to breathe a sigh of relief.
Barely done exhaling, the next day I received a call from my mother (yeah, I wish I was making up this timing) who lives several hours away. "Can I send you a report from a test I had done?" The report described a biopsy of an intra-abdominal mass lesion, which based on the sample received, appeared highly malignant and possibly metastatic. Um, WHAT? When did this start? You've had symptoms for how long? Back onto the patient-advocate wagon I climbed, this time trying to keep track of everything from hundreds of miles away. And now, several weeks later, Mom is beginning to recover from her surgery, with a follow-up appointment with a radiation oncologist still pending.
So what did I learn from this about balance? For one, that it was remarkably easy to jettison areas of my life that I thought were "musts". A phone call here, a brief (or not so brief) explanation there, and I was able to rearrange paperwork, lectures to residents and even days of patients. The "extra" things outside of work that I used for relaxation and ways to build friendships - gone with the blink of an eye and the click of a "send" button heralding an explanatory email. Will I restart these? Absolutely - at some point in the future. Because although it was easy to dump them now, I know I'll eventually miss doing them - and ultimately, these "extras" are part of what I use for balance.
But for now, I'm focused on making sure that the pieces of my life that I hold dearest are intact before I start juggling again.
Thursday, December 16, 2010
But back to the exercise, that is what I gave up, and I am feeling off balance about it. When I read my MIM peers who carved out that time, I am jealous, but the other thing I can’t do is get up early to do it. Love my sleep in the morning, right up until and including those little snugglers who, well snuggle in with us most mornings. I can stay up late at night, too late, easily, but other than using our brand new Wii, I don’t have exercise equipment at home to use in the wee hours. I think for my next big birthday I’ll get a treadmill for our basement. Or maybe Wii bowling will do the trick. Doubt it though. A recent development, while both kids are in non mommy-and-me swim classes I do get to use the workout machine, overlooking the pool at the Y, so that's once a week. Not enough, but have to start somewhere.
Got to get you into my life, exercise.
1) Be in a cushy residency.
It's easy to act like a big hero juggling a residency and a baby when you're in a residency that's probably less work than most attending physician jobs. I can't imagine a better residency to have a baby in than my PM&R residency. I took call from home, worked only a handful of weekends each year, and even had several rotations with built in mornings or afternoons free. Sure, it would have been nice to work parttime or not take call at all. But for a resident, I think I had an easier time obtaining the work-home balance than most.
2) Have a husband who's Awesome.
Well, we all have husbands who are awesome, right? My husband was a student when my daughter was an infant and he was able to stay home with her a lot, which was great bonding time for the two of them. My mother is still amused by the delicate care and knowledge with which he prepared her bottles. I can't say it was a perfect situation though, because childcare sometimes got in the way of his studies. Our situation is different now in that he has a full time job, and I'm curious to see how it will affect his relationship with our next child. (He's really close with our daughter.)
3) Have a nanny who used to be a cleaning woman.
When I came home from work every day, the dishes and laundry were done and the house was spotless. That helped a lot.
4) Learn to type with baby balanced on chest.
Probably my first several work presentations were composed in such a way. Very efficient.
So I guess in summary I don't really have any super secret Jedi tricks in order to survive being a resident with a baby. I survived mostly through a combination of luck and making the easiest choices.
Wednesday, December 15, 2010
I'm looking for help because, well, this teetering balancing act of physician, mother, spouse, friend, and committee member is about to fall apart!
I've cut back on committees and extracurriculars and even did a career switch (internal medicine to family medicine) in attempt to regain some equilibrium. I have in-laws that are happy to help, use money from my line of credit to have cleaners every other week, and have a fabulous daycare. And yet, I'm still barely keeping my head above water.
Hubby and I barely see each other -- this month I'm working nights in Emerg and he's on 1:4 call for the general surgery service. I think we spent less than 8 hours awake in each other’s company this week.
I never seem to have time to study or read around cases. Hubby feels like he's barely prepared for days in the OR and for exams. I feel like I could be a better doctor if only there was more time or energy.
And this beautiful child, well, he doesn't like to sleep much. And although my brain screams "No Way!", my heart is ready for another baby (or two).
How do you other MiM make it work? Everyone else seems to do it "better" than us -- they study more, are more well prepared in the OR, their dinners are home-made, and their kids are sleeping longer.
Said only very slightly tongue-in-cheek...
In residency, he was working, and I was working, and we cherished the time we had together. We hired a cleaning lady who also did laundry, and were able to spend most of our free time together nurturing our relationship and our relationship with our family and friends. Life became infinitely more complicated with one child, and we were nearly pushed to our breaking point when, in the throes of an incredibly demanding work schedule, we had our second child. We lived 14 hours away from much of our friends and family. Mr. Whoo was working 10 hour days, I was working 12 hour days (if I was lucky), and our children were in day care 10 hours a day, despite having a twice a month cleaning lady, any spare time was spent digging out from underneath mountains of laundry, and our life together was coming apart at the seams.
There was no more robbing Peter to pay Paul, and we finally had to make some very difficult decisions. The first of which was Mr. Whoo quitting his job to hold down the home front (i.e. find it under Mount Laundry and the River of Dust) and be available for our children and family. The second of which was my decision to break my contract (which cost us a bit financially) and find a more reasonable call schedule in a location closer to our family and friends. In addition to seeing more friends in person, facebook helped so much in sharing my life with my family and far away friends. I'll be the first to admit, my life is far from perfect, but compared to a year and a half ago, my life is a spa vacation. My children are still fairly young at 3 and 6, and they still have very few extra curricular activities. I know more juggling will be in order once they start, but so far we've handled Daisy Scouts and dance class fairly well. The last thing I have yet to get totally back on track is taking care of my own health. I've lost almost 30 pounds since moving here, and plan to find a way to continue to get back into good health. My *final* frontier, but a kicking body? Likely not.
So, in short, we *can* have it all, with a little help from our husbands, family, friends, and by standing up for ourselves and finding a position that allows us to fulfill our calling as a physician and still tuck the kids into bed most nights of the week. Every woman on this board has achieved so much, each of us in our own way. We've done it all, and so can you.
Tuesday, December 14, 2010
To be honest balance was a problem for me before marriage and children- well before earning my MD and before I took on the responsibility of caring for extremely sick patients.
I can remember in high school rushing home from basketball practice to work on the lay-out for the school newspaper. With copy and photos spread across the dining room table I would stay up all night long until it was perfect. In college I would sometimes sleep in the laboratory in order to run experiments, even on the weekends. Because of the fear that my work would not be good enough this super human dedication provided comfort that at least I would not fall short in effort. My extreme personality served me well in residency and fellowship, and I excelled.
This is my nature, and honestly this behavior had some consequences. Over the years I learned to accommodate or “tone down” these tendencies. In personal relationships, I realized my expecting perfection was alienating (and annoying). I learned that diversification was necessary to achieve balance, so I included exercise and relaxation in my schedule. Over the past few years I recognize that these changes are working for me. I find that I am happier and more effective through letting go, and exercise continues to be a good outlet for stress.
Fast forward to now, and although a recovering perfectionist I constantly battle feeling overwhelmed and exhausted. Right now I am not working, at home with my 6 week old son. I am determined to use my return to work as a fresh start. I have been soul searching trying to figure out what changes I need to make. This is difficult. One obvious problem- I am not working at all and still feel exhausted and overwhelmed. Not unusual for a new mom, and expected based on the irregular sleeping schedule. But as I review my spiral notebook full of lists I have created…… feeling frustrated that I am unable to make much progress on the multitude of tasks…. I wonder if this is hopeless. It is a similar feeling that I experience when working, with so much to do and unable to achieve the momentum to get to the bottom of the list.
Seriously I need help. From others I know that the first step to work life balance is learning to say no….. but why is this difficult for me? My problem is not saying no (I can be really tough when necessary), my problem is being able to discern what tasks are valuable and which are not.
Tasks that are not fun or productive but nonetheless necessary: Just because it feels like drudgery does not mean that it can be skipped.
Tasks that cannot be left undone (someone else must be found to cover): I would rather not do it, but is it worth the trouble to finding someone else? Maybe I should just get it finished already.
Tasks that are opportunities with potential strong upside: These are the easiest to say no to (many of my male colleagues would jump at the chance) but why must I pass on opportunities that I have earned?
With reflection and soul searching I realize my old tendencies are possibly still at play here. That an underlying personal expectation for perfection and fear that my work would will not be good enough still plagues me. I am afraid it is true, and despite significant personal and professional achievement I still rely on external measures of success. I now believe that this is at the heart of the matter. I hope this is the beginning of my next personal transformation…… but still at a loss for how to overcome this hurdle.
I figure that I am not alone- for the ability to withstand numerous years of training and tolerate long hours must commonly be motivated by similar ‘dysfunction’. What is the secret to better discernment? Any advice from those who already figured out how to disembark the crazy train, or from others riding along with me?
- Schedule exercise. I am sure that one of the things that keeps me sane is that I exercise 3-5 times a week. I work out my frustrations on the treadmill and lap pool instead of my coworkers. I don't however routinely train for races, because this takes too much time. I would like to do a triathlon in the next couple years, but I want to plan ahead for a time when I won't have other projects looming.
- As soon as you can possibly afford it, hire a housekeeper. This is not a luxury. I put this off way too long.
- Communication. My husband and I have our phones synced with our home calendar, so any event goes immediately on the schedule. We’ve also started a weekly “team meeting” where we talk through our schedule and expectations for the week. You can also come up with code words for naughty things to put on calendar :)
- Schedule. As my practice has gotten busier I have had to become more strict with my scheduling, for my own sanity. Previously, I would do surgeries or schedule patients during my lunch hour “if it was more convenient for the patient” or “if there were extenuating circumstances”, however these situations became more frequent over the years as my practice got busier. A few months ago, I ended up with surgery scheduled at lunch every day for 2 weeks straight. I re-evaluated my schedule. I realized that eating lunch and sitting down for 15-20 minutes a day was a necessity for my sanity.
- Prioritizing socialization. I think this is where I feel like I fail the most. I manage to over-commit myself socially and at the same time, still have trouble keeping up with my friends.
- Spend at least one day a week with the kids with no other distractions. In our house, this day is usually Saturday. Our kids are not overly scheduled. They will occasionally want to participate in activities, but not usually year round. I try to spend one day a week home with the kids, just hanging out and having fun.
Monday, December 13, 2010
OK, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don't read this, patients, because you wish even more than I do that I were perfect (especially when I'm operating on you). But it's true.
Long ago, I remember feeling that perfect was achievable. In my innocence, I pictured myself with a high-flying academic career in a big city neurosurgical teaching program. I would have a handsome husband with a powerful career of his own, 3 perfect children, and a home straight out of Southern Living. (I even subscribed to the magazine.) Of course, I would need no help taking care of the house, because I would do it all myself. I would have no surgical complications, and every patient would love me. I would be Harvey Cushing and Martha Stewart, all rolled into one!
I think it began to sink in that this was a little unrealistic just before the start of residency. My husband and I had just returned from our honeymoon. I had left myself 4 days to move halfway across the country and set up housekeeping before our first day as interns. With one night left, I found myself staring in horror at boxes still sitting implacably all over our new house. Yikes!
Through our years in residency, we added a baby and a hefty dose of realism to our lives. Thoughts of Southern Living fled from my mind. Indeed, thoughts of homemade baby food, beautifully decorated nurseries, and hosting book and supper clubs also vanished. I felt lucky to keep the bills paid on time, the vaccinations on schedule, and the house clean enough to walk through (with my husband doing a lot of the work himself). Despite all this, we both somehow made it through residency with our marriage intact.
Now it is more than 15 years since that idealistic, newly married intern walked through the door of a new life.
Looking back, I'm proud of much that I've accomplished. I have a thriving practice and a family that seems pretty well-adjusted, despite all the gruesome patient stories told over the dinner table. I'm a lucky woman.
I'm not so proud of how I've balanced work and family over the years.
Anyone who goes into a demanding surgical subspecialty knows what it will be like. There will be sacrifices and long call nights. There will be stress and (yes, Fizzy) tears. There will be time away from family. Anyone who loves a surgical subspecialist knows this, too. My husband knew this when we started dating in medical school. But he also knew how much my career meant to me. He knew I wouldn't be happy without it. He married me anyway.
The decision to marry this wonderful man has been the saving grace of my life. He has done so much with so few complaints. In an culture that is still macho in many ways, he has done a lot of laundry and a lot of childcare. He takes our son to school and picks him up. He helps with homework and goes to pediatrician visits. He has been the hands-on parent where I have not. Without him, our family would have disintegrated.
Not that I haven't done anything, in my own defense. When I'm not at work, I'm all about home and family. I have made it to every band concert and the majority of my son's sporting events. I actually made it to every single football game this season, even though they were on Thursdays. For several years, when my son wasn't eating well, I made dinner from scratch almost every night. Some nights dinner was late, some dinners were frozen from earlier weekend cooking sessions, but they were done. I supported my husband when he wanted to make a radical career change, without questions or criticism. I have tried. I have tried HARD.
But I admit, I have spent long hours at work. Because I'm busy at work, I don't fully appreciate the long gaps they feel at home. And I admit, I have taken my husband for granted a lot, which is wrong. I have leaned on our marriage hard, drawing strength from it to keep doing this incredibly difficult job. I worry sometimes that I may have weakened it too much.
Almost exactly a year ago, I wrote an anguished post here about a day in my life. Seeing it in writing and hearing all the feedback made me see that I had to have better control. Since then, I have worked very hard on finding a better balance.
I have now hired a cook to come to our house and make dinner every weeknight. She does the grocery shopping and some of the cleanup. That may seem pretentious, to have a private cook, but it's worth it to me. We also have housekeepers come twice a month, but this is not new. I have hired another physician who helps me with the patient load in the office (although not in surgery). I have committed to taking a big family vacation every summer and every winter (at least a week and a half). I spearheaded hiring a new practice administrator, who has done such a good job that I no longer stress about every detail of running the office. Things are better, although the patients are no less sick, and the job is still demanding.
I now have a Facebook page that allows me to communicate with friends and family more efficiently. My husband and I had our first "date night" last month - dinner and the new Harry Potter movie. It was wonderful and relaxing. We plan to do this every month now.
I actually asked my husband and son what they thought about my work-life balance to get their perspective for this post. Those two peas in a pod both looked at me blankly and said, "What balance?" We all laughed, and I sighed.
As I have finally admitted, I am not perfect. I am, however, doing my best. They know how much I love them, and they know I am trying. We have a saying in surgery: "'Perfect' is the enemy of 'good'." I don't want to be Martha Stewart Cushing anymore. I just want us all to be content.
Monday, December 6, 2010
For our Work-Life Balance topic, anything related to the topic is fair game. How we each define/measure/struggle/negotiate it, times in our careers where it was the most/least struggle, strategies we use to achieve it, its importance to us, perhaps what we've done in the workplace to facilitate this for everyone else, etc.
Readers, please submit your posts, if so inspired, to email@example.com. These can include questions to pose to everyone else, as well.
(See sidebar links for previous Topic Days/Weeks)
Hope to see you next week!
Friday, December 3, 2010
And yet, personal and professional experience with pregnancy loss have primed me to assume nothing. I'm expecting strikes me as presumptuous. And so I am not expecting. But I am pregnant.
On discovering I had conceived, I was overwhelmed by the sense that this was obviously grand work, this close involvement with birth, and briefly, all else looked anemic. I am thrilled, at least as much as I can remember with my other children. It doesn't feel commonplace; my previous experiences - good and bad - make it that much more meaningful. It's been almost five years since Ariana was born. This me, the 36-year-old mother of three, physician to refugees, living in Deep Cove, has never been pregnant.
I first felt the baby move at sixteen weeks: a soft swipe, a sliding sensation. Then the movements changed to knocks, small thuds, bumps and turns. I often lie on the couch, pants unbuttoned, both hands on my belly, waiting for baby to buck and shift; its solid presence can take my breath away.
I'm 27 weeks, 3 days. I have a globe of a belly, a baby cardigan on the needles, three very pleased children and a non-stop pace at the office that keeps baby rocked to sleep most of the day.
I'm in no hurry to progress. Right now, everything is as it should be.
Thursday, December 2, 2010
One of mine, albeit minor, occurs whenever anyone finds out I was a cheerleader in junior high school. Whoops, there, it's out. Though I am surprised and kind of proud that my feminist mother and egalitarian father "allowed" me to be a cheerleader... cringing as they both must have been until I found tennis. I think about all this anew with my own daughter.
Oh, and future wikileaks on my horizon, when my kids find out I drink a LOT of diet pepsi.
Wednesday, December 1, 2010
Tuesday, November 30, 2010
We recently retrieved the movie from the jaws of the Disney Vault. I think I liked it the first time I saw it, when I was a kid, but this time it just left a bad taste in my mouth. The music is good, I suppose. But Belle is so annoying. What a horrible role model for girls. Here is a woman who is "smart" because she reads books about princesses falling in love, and has absolutely no aspirations of her own to accomplish anything.
Yes, she wants to leave the town she lives in. And true, she doesn't want to marry the arrogant jackass. But the joyous ending for her is just falling in love with some guy who isn't an arrogant jackass (anymore). Who appears to only like her because she's pretty. Plus she does nothing to help him when he's fighting the bad guy... aside from loving him, I guess.
My daughter has a bit of an obsession with the Disney princesses, as evidenced by the drawings on her underwear, so I can't help but notice that all the movies are like that. Ariel and Jasmine are spoiled little brats. Cinderella falls in love with a guy so generic that he doesn't even have a name and is merely defined by being "charming." It's kind of sickening.
That said, I love Mulan.
We just rewatched it as travel entertainment, and each time, I like Mulan better. If you've never seen the movie, it's about a Chinese girl who poses as a male soldier so that her ailing father is spared joining the army. She completely kicks ass as a soldier and there is only passing mention of her romantic interest in her commander.
But you know what I really love about that movie? Not that Mulan kicks ass, but I love how in the beginning, she sucks at everything. She is terrible at every part of training, and her only comfort is that everyone else is equally terrible. I totally relate to Mulan! Granted, she gets really good within the span of a two minute training montage, but I still like her for it. And I love that she continues to doubt herself until she finally gains confidence in the last sequence.
I think it's such a great movie to show to young girls. Every time my daughter watches it, I want to yell, "Isn't she awesome??!"
Does anyone have any other examples of movies we can show our daughters to inspire them not to turn into whiny brats ogling some handsome prince?
Saturday, November 27, 2010
I started medical school at 28 with 3 little kids who were 5, 3, and 10 months at that time. I had energy to take care of home, husband, kids and study. I made it through residency with a few more gray hairs but was for the most part enjoyable. I had avoided the more strenuous and time consuming residencies because I wanted a family life, which I have truly loved. Then I paid back my time to the US Air Force and life got a little more stressful.
I am not sure if it was the lovely combat boots, the ever changing rules, the fact that I did not have control of my time or travels or the facing a young mother who was about to leave her young infant for a year long deployment. This takes a lot of “brain and heart” energy that I sometimes do not want to expend. I find myself feeling guilty over this but my husband, kids, family and friends need me to be “fully there” also and at times I am just emotionally and mentally spent.
Now as a civilian a typical day may consist of dealing with a depressed cancer patient and their stressed family members, a concerned mother worrying about her obese child, a middle aged woman with vaginal bleeding after menopause, a hypertensive diabetic patient with an oh by the way I have chest pain, or the patient who has lost their job and will soon be homeless and the list goes on and on. Between discussing odd symptoms, rashes, patient comments with colleagues, pouring through online and print resources and cramming the newest medications in my brain…guess what…I am worried about my patients and exhausted at the end of the day.
My weekends take me away to a place without the stresses of patients’ needs but amazingly enough my thoughts always go back to a patient or two. I find myself thinking of a new strategy to combat their hypertension, a positive word I can say to the worried mom, or make a mental note to call a patient on Monday morning to see what the specialist said. So, even though I am tired I cannot pull myself away from the things I love…family, friends and medicine.
I have yet to decide if this line of work is healthy for me but it certainly is addicting and for the most part enjoyable. I certainly pray a lot more these days than I did when I was younger with fewer responsibilities and more energy. I have learned and changed so much from my patients I can’t imagine who I would be otherwise. So as I walk through my day I must remember to take a deep breath, and enjoy these patient doctor moments because I will never be the same.
Thursday, November 25, 2010
Tuesday, November 23, 2010
--My senior resident telling me at the end of my 30 hour call that even though I was off duty, she expected me to go watch my patient get a colonoscopy. ("It might be painful, but you better go because it's worth it for your education!")
--Spending 14 straight hours rounding on 70 patients on a Saturday and finally getting home, only to immediately get called back to the hospital for chest pain the patient had been having all day and decided not to tell me about.
--After an entire afternoon of coding a patient multiple times and finally agreeing it was hopeless, when the nurse said, "The patient's daughter wants to hold his hand as he goes."
After a while, I got a little better at holding it in till I got to my car, where I'd really let loose.
When I mentioned my frequent tears in a previous post, I think a few people may have called me "emotionally unstable" in the comments or something along those lines. All I have to say to that if that's the case, there are a hell of a lot of emotionally unstable med students and residents out there.
Of the residents and med students I've worked with, I've gotten to see a lot of them cry. In my intern year ICU rotation, I saw practically every female resident working there cry at some point. My senior resident cried when she realized the next morning that she missed a pneumothorax (wouldn't have mattered). She also cried when the coroner yelled at her post-call for incorrectly declaring a patient. I even saw the "badass" senior resident on the team crying one afternoon.
In med school... wow, it happened a lot. After exams, before exams, just randomly in the locker room. I remember during my surgery clerkship, we were having a workshop on tying knots, and one student was having trouble with her knots and burst into tears. I still remember what she said: "I don't even feel that sad. I'm just SO TIRED."
I guess my point is that you shouldn't be made to feel like an emotionally screwed up freak if you cry at some point (or multiple points) in your medical training (or beyond). Unless, of course, you're a man and you cry. Then you're weird.
(I have never once seen a male resident or med student cry before. I wonder why that is. Do they just not feel it or are they better at holding it in?)