Sunday, February 28, 2010

What's your major, baby?

For some reason, people are always shocked to find out I was a math major in college. My math ability, which was embarrassingly nerdy when I was going to competitions with the math team in high school, has amazingly become something that makes me interesting now that I'm a physician. (Which is why I bring it up as much as possible. I like to be interesting!)

My husband was a math major too, so between the two of us, we're expecting our daughter to have no less than 800 in math on the SATs. I mean, you can actually get one wrong and still get an 800. So there's no excuse!**

It's not clear to me why math majors are so rare in medical school. I think I was the only one in my class. By far the most common majors were biology, chemistry, biochemistry, and psychology. But to me, math makes sense too, at least as much as psychology. Because I was good in math, I breezed through physics and chemistry. Mathematical thinking even helped in o-chem. It was only in biology that my refusal to actually memorize anything that I couldn't work out from scratch became a liability. That and, you know, in all of medical school. (I'm kidding. Thanks to my math ability, I have a perfect understanding of acid-base status.)

People sometimes ask me if with my math background, I ever considered a career in finance. I didn't, not even for a second. The truth is, a lot of the careers that are very math-heavy (finance, actuary, engineer) seemed very boring to me.

So my question of the day is: what was your major before you ended up in med school? And if it was something crazy, like I don't know, Celtic Folklore, how did you reconcile that with your future career?

**Before the hatemail pours in, I just want to clarify that I'm joking about this. Any score above 700 would be totally fine.

Friday, February 26, 2010

The Journal Backlog

I recently experienced an epiphany. In my office I keep a stack of journals (most still in the plastic wrapping) that I plan to read. Instead of reading I cultivate this neat pile, that is about to sprout into a daughter stack.

Then I did the math:

Journal American College of Cardiology (one/week = 4/month)
Journal Heart and Lung Transplant (one/month)
Journal Cardiac Failure (one/month)
Six journals/ month or 1.5 journals per week!

Epiphany: unless I ACTUALLY read at least one journal per week the pile will continue to grow.

Despite the new clarity I have yet to read or recycle.

It true Mother in Medicine fashion, and in the spirit of full disclosure, I present another pile. In my kitchen, of parenting magazines. Nestled neatly next to my stand mixer (which I am proud to report has been used quite frequently lately).

Tuesday, February 23, 2010

Men suck too!

Dr. Whoo most recently made a post on the cattiness of females in the workplace, which I found to be very much on the mark. I applaud her for saying what a lot of us were thinking.

However, I was a little disturbed by the enthusiasm of the people who agreed that women are awful to work with and they'd rather work in an mostly-male environment. Seriously? I feel compelled to point out: men suck too.

One of the commenters mentioned watching a movie about a landmark sexual harassment lawsuit and that "after the protagonist complains to management about the fact that some guy decided to ejaculate in her work locker, the other women give her the cold shoulder and tell her what a bitch she's being." I agree the other women were awful for giving that poor woman the cold shoulder. But let's put things in perspective. At least the women didn't ejaculate in her locker. If I had a choice between working with a woman who doesn't talk to me and a man who masturbates in my locker, I'd choose the former. (Go women!)

Of all the attendings I've worked with over the years, probably the biggest ten egos have belonged to men. The biggest gunner jerk in my med school class was a guy. Men can be lazy, they can be assholes, and they often HATE being bossed around by women. A lot of men don't respect their female colleagues. The worst experience I had with a nurse was not a female nurse being catty to me, but rather a male nurse who sexually harassed me.

When I started my residency, the program was mostly men. If you think I was reveling in cattiness-free bliss, you are wrong. Let me assure you, it was not pleasant being a pregnant female in a boys club. I sat there listening to them joking about females they met while going out drinking over the weekend, knuckle-punching each other, and generally making me feel left out. It was obvious the only way I'd feel more welcome was to grow a penis. And don't even get me started on my experience in orthopedic surgery rotations during med school.

I've worked with a lot of men who have been wonderful and also with a lot of jerks. Ditto with women. But when it's a woman, I guess I feel more disappointed in them. Because I feel like we should stick together. That's part of why I love this blog. Because it's a group of mothers in medicine, supporting each other.

In summary, I 100% agree with Dr. Whoo. But I want to point out that we shouldn't go around idealizing men because they ain't so great either.

Monday, February 22, 2010

Own Worst Enemy

Sometimes I wonder, as a person who has very few "girlfriends" and who tends to gravitate more toward men for friendship, how I ended up in a profession where I am constantly surrounded by women. (Maybe it is because men are whiny babies when they are sick, and I have little tolerance for it. That, or prostate exams. *shudder*) I think I tend to want to avoid the drama that inevitably comes along with close female friendships. I've been burned one too many times, I guess. I've been mortally wounded time and again by women who were supposed to be my closest friends, often for nebulous reasons. We've touched many times along the same topic since the inception of this blog, yet I see the theme being returned time and again, *women* keep women down.

I see this every day in my profession (and, more recently, the blogosphere), where women judge other women's birth choices, from the kind of pain relief they choose to the kind of provider that attends them. Female physicians still don't command the same respect as male physicians, primarily from the predominantly female staff. Stay-at-home moms are aghast at working moms for "abandoning" their children; working mothers "look down" on stay-at-home mothers for not pursuing their own career. Breast-feeders sneer smugly at the bottle-feeders. Women judge other women based on their clothes, their handbags, their hairstyles, weight, and personal grooming (can you *believe* she doesn't *wax*??) It is so pervasive that we automatically apologize for not being precisely groomed. (I can't tell you how many women have apologized to *me* for not shaving their legs prior to an appointment! As an aside, I neither notice nor do I care.) As a happily married woman, I find myself angsting over letting my highlights grow out too long, or running to the hospital with no make-up on. My husband does not care about make-up, and he doesn't have a clue about highlights. I'm not looking to hook-up at the hospital, so why do I care? Because, inevitably, I will get the standard, "Oh, you look so *tired.* Are you sick?" or the snide, "Growing out your highlights, hmmm?" These comments do not come from men.

This extends to the political arena, where any woman that ascends to a position of prominence is viciously and ruthlessly attacked, scrutinized, and her family life nitpicked and torn apart (the phenomenon is bi-partisan, see Hillary Clinton or Sarah Palin). The worst perpetrators of this are not the male commentators. It is the female commentators who render the harshest blows with a glint of evil satisfaction in their eye. Even so-called "feminists" are just as inflexible and intolerant of any woman that does not share their point of view as any conservative male evangelist. I've had women, who (prior to a certain post that tweaked a nerve) proclaimed to *love* my blog, flounce noisily with a searing comment from my blog for simply expressing an opinion that differs from their own (totally within their prerogative, but baffling nonetheless). I'm not saying that I'm not just as guilty of this behavior as anyone else. I am woman, hear me snark. If you don't have anything nice to say, come sit next to me, ad infinitum. I have sinned as well.

My question is: Why?

Why do we do our best, intentionally or unintentionally, to tear other women down? Historically we are supposed to be the collaborative gender, working together for the greater good of our families, villages, etc. So why, now that we have more opportunities than ever, are we snapping at one another's heels? What exactly has feminism done for women from a sociological point of view? Are we jealous? Insecure? Afraid there isn't enough to go around or that it will be suddenly snatched away? More importantly, what can we do to change it? What do *you* think?

Thursday, February 18, 2010

Tracking Patients

This morning, I dropped my kids off to school early at 6:30 a.m. Luckily, there is a teacher available to help me out when I have to go to a more rural hospital or cover early frozens or a conference. Fortunately, I only have to do it about once or twice a month.

I was covering breast conference for my partner, who is on vacation. The last time I covered it for her was a year ago, when she went to the Rio Carnival on a cruise (jealous!) for her honeymoon. I love covering this monthly conference because it reminds me, in an attenuated version, of the hardcore weekly breast conference I covered at my training university during my fellowship year. Geneticists, medical oncologists, radiation oncologists, radiologists, mammographers, case coordinators, surgical oncologists, PET experts and oh yeah, pathologists -- all gathering in one room to pow-wow about the patients. Going over cases. Discussing new treatments. Asking questions. Challenging each other (hopefully in a tame fashion - it doesn't always work out this way depending in personalities involved).

Today we began by discussing an incredibly rare breast cancer, and I was happily surprised that only two years out of residency I had the same experience with this type of cancer as surgeons and medical oncologists ten and twenty years my senior. So my contribution to the discussion, based on my reading, was substantial. We presented one other case, a sad one about a young girl that was just diagnosed with a high grade breast cancer - after she finished lactating she noticed a lump that didn't go away. Lactational change, to a pathologist, is usually a sight that generates a big sigh of relief when peering in the scope, because 99.9% of the time it means the lesion is benign. Then there are the exceptions. They make your gut twist. They generate nausea. Even though you know what you are looking at, you show it to a partner because you are staring at the age, and thinking about the young nursing mother and what she is about to go through, and you desperately want your partner to tell you that you are hallucinating.

I remember when I was a nursing mother I read nursing texts obsessively in attempt to prevent stories I heard from my friend who attended La Leche League. She would call me and tell me somewhat comical ones, like the girl who brought to the table her issue of being unable to find a bikini because her baby would only nurse on one side and therefore one breast was a G (do those really exist?) and the other was a C. As a new nursing mother, despite my symmetrical breasts, I was impressed (thinking of my flabby stomach) that she was even considering going out in a bikini at all that summer. Then my friend would tell me horror stories, like the girl that ignored a lump and developed an abscess and sepsis and had to have surgery and quit nursing. I went to my OB/GYN once, obsessed over something I felt in my breast that in retrospect was probably fibrocystic changes. I was convinced it was the seed of the abscess that was plotting to doom my nursing efforts. When my OB palpated my breast, she looked at me quizzically. "Um, Gizabeth, I'm not sure I really feel anything? But if you want me to pull out the ultrasound, I'll be happy too." I smiled and blushed with relief and embarrassment. "No Cindy. If you think I'm crazy, that makes me happy. I'd rather be crazy about this, than right."

There were two other patients to present in breast conference, but the radiation oncologist generated a lively discussion about a new treatment, and everyone joined in, burning up the rest of the hour. Back in fellowship when I was doing weekly conferences, I was annoyed when this happened, because I had usually spent an extra couple of hours the night before taking pictures of cases to put in a power point - other pathologist's cases (I was doing a cytology fellowship) -while my own breasts swelled up like melons, aching for the relief of going home to my nursing son. All my work seemed like such a wasted effort. But now I was the relief pathologist, no longer nursing, and the discussion meant a lot more to me with my own experience of signing out breast cases. Of course we always strive for accuracy and perfection in our reports, but it is nice to sit in the room with treating physicians and learn the direct implications of your words. The all powerful ones that you put on the patient's permanent record. Grade III. 2.5 cm. Posterior/superior margin positive for malignancy. Micrometastasis to the sentinel lymph node. Estrogen receptor positive. Progesterone receptor negative. Her-2-neu positive.

So I sat back contentedly and listened, so I might learn something. At one point, the radiation oncologist and a breast surgeon (one that I have always admired tremendously) got into a discussion about a particular patient. The radiation oncologist began discussing her, and how she treated her. She turned to the breast surgeon.

"That was your patient, right? I'm surprised she is still alive. She made it longer that I would have expected."

The breast surgeon reached into a tiny notebook in front of her and pulled out a square of newspaper, showing it to the radiation oncologist. An obituary. Everyone remained stoic.

The radiation oncologist said, "Oh. When did that happen?"

"February 3rd."

"Not that long ago, then."

The discussion moved on, and everyone slowly began to gather up their breakfast trash to throw away and head to their respective clinics, OR's, radiology caves, and lab offices. As a pathologist I have so many cases, and bounce around on so many different rotations, that I don't get follow-up unless I serendipitously come across a patient for a second time on a new case. Then I get to catch up on what has happened between then and now. I can't imagine being a treating cancer surgeon or oncologist, and keeping up with my patients by scanning the obits. Cutting them out meticulously, and keeping them in a notebook, as a reminder of how that patient ended up. Maybe to affect how you might treat a similar case differently, next time. Or maybe just to remember your patient.

Tuesday, February 16, 2010

Guest post: Advice to a mom starting her pre med

A classmate of mine introduced me to a friend of hers who is a mother of three, is starting her pre reqs to apply to medical school, and is interested in ob/gyn. She connected us via a social networking site, and I wrote down came to mind as far as advice:

I haven’t found the mom thing to be a big obstacle for me in medical school. I learned how to juggle and prioritize my time when I became a mother.

Of course, I only have two kids, and I heard the transition from 2 to 3 can be a little rough. How old are they? Mine are 5 and 10, so they are both potty trained (whew!) and can both understand when mommy needs to study. Not that they won’t interrupt me, but still.

I was a little nervous about doing my post bacc pre reqs as an older student and a mother. I felt a little lonely in those classes, but I was pleasantly surprised when I got to medical school. There were other mothers and other older students there – one of my closest friends is a grandmother, and she found time to work 40 hours a week while in med school (I don’t recommend it, but she did. And she still does on her rotations).

I obviously don’t have the time nor the inclination to party as hard as many of my classmates. Nor do I get my nails done or go to the gym. But, I managed to be incredibly active in extracurricular activities in medical school. I found time to be involved in things that interested me (I was president of the ob/gyn club, for example, and helped run the Vagina Monologues and ran the HIV testing clinic) because I wouldn’t enjoy medical school otherwise. And, I could always give them up if I wasn’t happy with my grades, which I was.

What helped me:

1. Juggle and balance. I would go to school, try to make and eat dinner with my family, and then study in the later evenings when the kids were in bed and on weekends after spending breakfast with the family. That schedule worked for me.

2. During my pre med, I only took part time classes, but I was also working full time. Looking back, I wish I took out loans and did the school thing full time. My life course might have been different, since I got into ob/gyn late in my premed, but still, it was a longer journey than it had to be.

3. Find friends who know what’s going on and use them. (Not use them use them, but you know what I mean.) I am not the best person when it comes to knowing what paperwork is due when, etc. So, I find an organized, friendly classmate who is good at staying on top of this stuff, and remember to ask them for help when I need it. It’s also good to have a phone number or two in case a family issue comes up and you miss something.

I did not do this enough in my pre med, and entered the application process woefully underprepared. Do your research, ask for help if you aren’t informed. I didn’t have time to do all the pre med extra curricular stuff since I was working full time and my kids were younger. I blew it my first application round, because of stupid stuff (I didn’t wear a suit to my first interview. I wore professional clothes, like I would to a business interview. Wrong. Stood out like a sore sore thumb).

4. Don’t overestimate or underestimate the understanding of your classmates, professors or administrators when it comes to your kids. Some people who you think will be understanding won’t, and may treat it like a weakness. Some people who you wouldn’t expect to be an ally at all will surprise you. Don’t be afraid to bring up the kids, but don’t act like you automatically deserve a break or special treatment. If you try as hard as you can to be as good (or even better) than the childless students, you will hopefully get the support you need when you do need an accommodation.

5. Don’t put your education last in your house. I sometimes find myself having standards for myself as a parent that may be too high. For example, I love making home made valentines with my kids, and despise the commercial ones with the cartoon characters on them. Well, this year I had a major research presentation due this past Friday, and was working on it Thursday night when I realized that my younger son had to do the Valentine’s Day exchange Friday since the holiday occurred over the weekend. My husband bought some Batman valentines, I gritted my teeth and got over it.

6. Quality time is OK sometimes, as opposed to quantity time. I ave myself permission to leave the house to study if I had to, when shutting myself in a bedroom wasn’t working. I didn’t do it too much, but one day a week or so, more during board review, with strategic kid bonding time scheduled in, worked for me.

7. Remember, it could be worse. You could be looking for a husband and trying to plan kids during your residency.

8. As for ob/gyn, I wouldn’t obsess about a specialty now, but I am a huge fan of ob/gyn. Any specialty can be challenging, time wise. Neurosurgeries take 6 hours or more a piece. I talked to an ophthalmologist who loves her practice as a mom now, but she had a grueling residency, with three babies at home (she had twins during her residency!)

Hope that was helpful. Please feel free to contact me whenever you need to.


Please feel free to add advice!

Mom TFH is one of the oldest people at her medical school. The other students learn from her various valuable life experieces: as a pizza delivery driver, a Denny's waitress, an art major, a health food store manager, a purple haired punk, a natural supplement researcher, a midwifery student, and a mother. She has two boys and a public elementary school PE coach. Going to med school just didn't keep her away from them enough, so she is doing a dual degree (D.O./M.P.H.), is the president of the ob/gyn interest club, and is now doing a preclinical research fellowship before starting rotations in July.

Monday, February 15, 2010

The resident/mother

In an attempt to keep my creativity from completely disintegrating and also to play with my husband's tablet PC, I've been working on a new cartoon blog. Today's cartoon is the resident/mother:

Resident Profile: The Resident/Mother

I'm not really much of an artist, so, um, please be nice?

Getting here

I was checking out this website's stats recently and clicked on a page I normally don't follow: Keyword analysis. This lists the search terms people used that resulted in landing on one of the pages of this blog. Thought the results were interesting and wanted to share.

%. Search Term
42.1% mothers in medicine OR motherinmedicine OR mothersinmedicine
7.0 % life of neurosurgeons OR life of a neurosurgeon OR day in the life of a neurosurgeon
7.0 % medical school acceptance letter OR when do medical school acceptance letter
5.3 % typical day of ob/gyn OR ob/gyn typical day
5.3% moms and medicine OR moms in medicine
5.3 % np to md OR np or md
1.75% residency match stress
1.75% medical school marriage stress
1.75% when i quit medicine
1.75% plenty of money and relaxation
1.75% marriage and medical residency
1.75% i hate residency
1.75% elitist daycares
1.75% moms and iud
1.75% qualities of a good doctor physician
1.75% emoticon hold breath
1.75% day in the life of an internal doctor
1.75% are husband jealous of gyn
1.75% time management for pre med
1.75% women neurosurgeons and mothers


Wonder if people found what they were looking for...

Thursday, February 11, 2010

Doctor's visit

Melly had her three year old doctor's check-up today and I couldn't have been more proud of her. She sat quietly while the pediatrician measured her height and weight, took her blood pressure, listened to her chest and tummy (and she told the doctor where her heart was), looked in her ears, and looked in her mouth. It got to the point where I was wondering what this obedient child had done with my daughter.

Then she had to get a fingerstick and I knew this was when the tears would surely start. But to my utter shock, she didn't even whimper when the nurse stuck her and squeezed out a tiny test tube's worth of blood. "I bet she'll cry when the bandaid comes out," a nurse said. But she didn't.

This is a kid who is routinely reduced to tears by her desire for chocolate milk. I'm kind of confused.

Back in my peds clerkship, I would have been blown away by a kid like that (little do they know what goes on behind the scenes). Looking in the ears was always a guarantee for screams. I remember I would just take out a tongue depressor and the kid would cry bloody murder.

I'd like to think part of the reason she's so good at the doctor is that she knows her mama is a doctor. She's got a doctor's kit and we play with it a lot. I look in her ears with the toy otoscope and tell her she's got a family of owls living in there. She cracks up. If she's really good, we pull out my real stethoscope and I let her listen to her own chest. There's a toy syringe in her doctor's kit and after her doctor's visit, she pretended to give us all shots.

"I shot you, Mama," she said.

Tuesday, February 9, 2010

Snowday without Children

Ode to Warm Socks

Stuck in this Blizzard, sleeping on cots
The joy of my day—a pair of warm socks.
Stuggling through blizzard from office to ward,
My job lies before me, those names on the board.
My feet feel so damp, cramped into these boots,
But a doc can’t go sockfoot, the patients would hoot.
The nurses are heros; they work shifts end to end,
While after my rounding, I’ve no one to tend.
So I slip off the boots, put the socks on the heater
Spend a few hours to make my space neater.
Still it keeps snowing, in buckets, in torrents
We’re glued to the news in a state of abhorrence.
But me, I’m contented, my children are grown
I fine where I am, don’t need to be home.
I can just watch the snow fall, all night by the clocks
And wait for the day with my pair of warm socks.

The things they ask, tell, and strive for

A few things any MIM might hear from her child at any given moment, as mine asked recently...

The question: How do the babies get out?

Different day: How do the babies get in?

A declaration: I know there are a lot of things in the body that are... pink

Overheard, to her friend, Oh, did you hurt yourself because my mother is a doctor so she can help you. And the friend responds, I know you've told me that a million times.

And aiming to serve: I'm going to be a waiter

Monday, February 8, 2010

In the other room, the laptop idled

In the darkness, his face looked like the image on the ultrasound monitor. The soft rounded closed eyes. The thumb at the mouth. I couldn’t remember the last time I held him while he was sleeping. It had been too long.

Now, his body was much bigger, stretched across mine diagonally, like a pageant sash.  My arms wrapped around him, my hands feeling the soft stubble of his blanket sleeper and his warmth. His breathing, though, was noisy. Rhonchorous, like I imagine his lungs underneath. Horns. Percussion. The music hitting all the wrong keys. His chest heaved as he breathed in and out, in discomforting noise.

I rocked.

I rocked and thought that this might be the last time I’d go through these mothering motions. Comforting an uncomfortable baby to sleep was a power I enjoyed. Is this really the last?

I didn’t want to disturb his hard-won sleep but couldn’t help but stroke the side of his face in a moment of mother adoration. To lightly brush his warm forehead, blushed with fever.

The time marched on in that rocking chair. I wondered what time it was, and what time I should get up and place him back in his crib.

Just another minute.

Instinctively, I pulled him into me a little bit tighter. Don’t grow up so fast. Be well, but don’t grow up so fast. I need these moments to slow down too.

Friday, February 5, 2010

Trying to Diagnose Disease - Med Student Style

My best friend from medical school is wickedly smart. She is currently a successful ophthalmologist, married to a great guy, and mother to an almost three-year-old girl. She's coming in town tomorrow, and we are going to see Avatar. I can't wait.

We used to stay up late studying together at Barnes & Noble, quizzing each other from old test banks after all the important solo work was done (interrupted, of course, by phone calls about the latest doings on "Days of Our Lives." I think soap operas were designed for sensory-deprived medical students - I can't imagine stomaching the repetition and inanity in my current life stage - but it was incredibly fun to dissect at the time). She is a former coffee-shop waitress, and introduced me to the flavored steamer - a nice hot pre-sleep milky drink that subsequently carried me through both pregnancies. She always made a few points higher than me on our tests - she was like the proverbial carrot that kept me studying.

On our third year clinical rotations, she developed hives. It was strange. We immediately assumed the role of medical student detective, trying to determine the source. She tried the non-latex gloves in the OR, to no avail. I remember one weekend, we decided to put all of the plants in her apartment on her back porch, to see if they were the culprit. We regarded her fish Kumar, named after the author of our second year pathology text, suspiciously - even though he was an unlikely candidate for her troubles.

The hives worsened, and became a chronic problem. She visited an allergy-immunology expert, and was loaded up on a triple-drug regimen, in order to try to gain relief on a Christmas trip with her parents to visit her brother in Italy. One night, shortly after returning from Christmas vacation, she called me frantically from the grocery store.

"I am standing in the aisles, looking at the signs for aisle content, and I can't read them. They're blurry. I've always been able to read the signs. What can this mean? I'm scared."

She went to an ophthalmologist, the next week. The ophthalmologist listened to her history, gave her an eye exam, and told her - let's look at your sugar. I am worried. It was sky high. She was diagnosed, in her early twenties, with Type 1 diabetes, about six months after her hives presented. As soon as her diabetes was treated, her hives disappeared.

I spent the next few years sharing the effects of being diagnosed with, and learning to manage, a chronic health problem. Her fears of mismanaged sugars were physically manifested in her patients at the hospital - gangrenous limbs and kidney problems. I witnessed her denial, anger, and ultimate acceptance of having to daily monitor and manage her condition by administering insulin shots. Her struggle with deciding to use an insulin pump - worries over having a constant physical reminder of her disease and ultimate relief over not having to worry so much about leaving the OR to administer her shots.

Last week, she gave a talk in the town she practices in about her experience with diabetes. We e-mailed back and forth - me reminding her of small details she had forgotten, and she sharing with me struggles I had missed - I must have been busy with a new baby or a difficult stretch of residency, and hadn't been the person she leaned on, at the time. She emphasized, at the end of her talk, that she was in charge of her illness not because she was a doctor, but because she gathered information and tools, and chose to live a healthier lifestyle. She was interviewed by a local TV station. She called me, when it was all over. I asked, "How did it go?"

"Well, a lot of the audience had Type 2 diabetes. And I think I spoke to them. But the most rewarding part was when a 14 year old girl, who had just been diagnosed with Type 1 diabetes, came up to me with her parents at the end of the talk. They were all practically in tears. They were still stuck in the overwhelming stage of new diagnosis, and so happy to find a resource, a successful one (if you can consider me a success - she is so humble), and they got my number. They want me to be her eye doctor."

I am so proud of my friend. She is a success. I can't imagine having to grapple with a chronic illness in medical school, but I have encountered many others who have, in med school and in my residency and attending career. Testicular cancer. Breast cancer. Heart transplants. It amazes me. Makes being a mother in medicine seem not so tough, after all.

Wednesday, February 3, 2010

“Lack of Patient Preparation for the Postpartum Period and Patient’s Satisfaction With Their Obstetric Clinicians”

When I read the title of this article in this month’s Journal of OB/GYN (the ‘green’ journal), I literally laughed out loud. This could be because, at the time I was holding a fussy 2 month in my left arm while holding my green journal in my right hand, walking the room. I was trying to read, console baby and keep 6 year old entertained, all at the same time, so husband could finish working on a project upstairs. How can I prepare my patients better for their ‘postpartum experience’ when I can’t prepare myself, I thought?

As I read the article further, it mainly discussed the physical symptoms associated with post partum such as bleeding, hemorrhoids and breast tenderness, with just a small aside on anxiety and mood swings, written blandly in technical writing. I laughed again. Seeing someone try to quantify the emotions that go along with having a baby in a ‘prospective longitudinal cohort study’ seemed absurd.

There is nothing that can fully prepare you for having a baby. No amount of books or advice. Not even being board certified in OB/GYN. When my oldest was born I was a 3rd year resident. I could rattle of the top of my head the physiology of delivery, risk factors for postpartum depression and I could have resuscitated/intubated my newborn if needed. I thought I knew what I was doing. I had read books on baby care and breast feeding. Then after a difficult delivery, I was home with a newborn, who did not ,in fact, read the same books that I had read on how he was supposed to act! I remember being so sleep deprived I literally couldn’t see straight. I had reasoned before delivery that if ANYTHING could prepare you for postpartum, then it was residency, but the truth is that NOTHING can truly prepare you. I finally let him occasionally take a bottle so I could sleep and recover from my cesarean section. After a couple weeks I got into a flow and he did eventually get on a schedule…. Sort of. I learned to be less anxious and just enjoy every minute with him.

We recently adopted baby #2 and the ‘postpartum’ time has been significantly better. Some of this is the lack of physical recovery of course, but I think a lot of it is just knowing what to expect. Additionally I now live closer to family and have more social support.

In my practice I think the people who have the hardest transition to postpartum are the women who have it the most “together.” The executives with their blackberries who have everything all planned out and the nurses who know it all already and won’t ask for help. These are the patients that I try to take the extra time with to prepare for postpartum. Usually they smile and nod patting their baby books on their lap, thinking NO not me! But at their postpartum visits they almost always say you know, you were right! This is the hardest thing I’ve ever done.

I’m not sure that being a mom makes me a better doctor, but it definitely helps me understand/ counsel the postpartum patient. When my staff asks if I’ll see a postpartum patient that has shown up late for their appointment, I ALWAYS say yes. Just making it out of the house with a baby is difficult, let alone making it on time. Actually, I usually even will see them first, even if others have been waiting longer.

No offense to the author of the article. It was a well done study and she's right we do need to better prepare our patients for postpartum issues. I just don't think an extra brochure is going to do the trick.

I would love to hear our readers input on their personal “preparation” for their postpartum recovery (especially any OB/GYN’s out there).

Monday, February 1, 2010

Planning for the future

My daughter is very into birds and ducks. She has this game where the baby duck is looking for its mama, which she makes us play with her over and over again until we want to vomit. Anyway, yesterday we were playing this game with her and my husband (a.k.a. Captain Obvious) commented, "She sure likes birds."

Me: "Yeah, she really does."

Husband: "Hey, maybe someday she'll be an ornithologist."

Me: "..."

Husband: "You know, someone who studies birds."

Me: "Um, yeah, maybe..."

It seems like we spend an awful lot of time trying to figure out what her future career is going to be. I have to wonder if anyone can predict such a thing at age three.

As for me, my mother wanted me to be a doctor, so I was trained to name "physician" as my chosen career as early as age four or five. But I went through a few other career options in my mind before I took the MCATs at age 20 and got my first med school acceptance at age 21. I don't think the idea of going to med school really solidified until the latter happened. (Sometimes I think I'm still not 100% sure.)

So my question to the masses is: When did you decide that you wanted to be a doctor? Or else, when did you decide you wanted to be a [insert chosen career]?