Wednesday, March 31, 2010

Guest Interview with a...... Lawyer??

I know there are a lot of people who read this blog who aren't physicians or are at least considering other professions. Therefore, as a little change of pace, in this post we will be hearing from a friend of mine who is a working mother and also a LAWYER. (A mother in law, so to speak. Heh.)

Lindsey is the mother of three girls ages 3, 1.5, and 4 months. She's also a full-time attorney licensed in two states, manages a 25-person department, and has been married four years to her college sweetheart. Her loves include sci-fi, pretty shoes, red wine, and anything princess-related. She's tired pretty much constantly, but still finds time to screw around on the internet. Her blog can be found at High Heeled Mom.

Anyway, I had a few questions for Lindsey about what it's like to be a mother/lawyer:

I've spent most of the last ten years being jealous of lawyers because you go to school for only three years, then you graduate and make a billion dollars right out of school, whereas doctors have to do a grueling, low paying residency after med school. Am I right to be jealous? Tell me something awful happens when you graduate law school that is equivalent to residency.

HAHAHAHAHA. Not nearly as many of us make a zillion dollars right out as you think. Only the ones who go to big firms in big cities make what one might categorize as a zillion. And they work eighty-hour weeks, much like residents. The vast majority of us who come out and get a job at all (these days, it's not something you can count on) start in a medium or small firm, or in public service. Your average city attorney in my area, right out of law school probably starts at 45K. No lie.

That said, yes, you're right to be jealous. My sister is a doctor finishing her residency this spring and med school plus residency took way longer, was much more expensive, and seemed much more grueling than law school. We have the bar exam, which we whine about plenty, but you have boards.

I think becoming a lawyer is a walk in the park compared to becoming a doctor, and I'm shocked we're so often compared.

If you had to do a Lawyer Demo for your three year old's class (like I recently did a Doctor Demo), what would you do? No fair if you break out balloon animals.

I absolutely have no answer for this question. There is nothing I do whatsoever that a 3-year-old would find interesting. Oh, wait- the girls do like trying on my shoes, and I wear neat shoes. I'd do a "Dress Like a Lawyer" program for kids.

You have three kids three and under, and work full time. When people say to you things like "I don't know how you do it," does that make you happy or irritated? By the way, I don't know how you do it.

A bit of both. (And yes, I hear it CONSTANTLY). Happy that people find me impressive, but irritated for two reasons:

1) Usually when people say this, they aren't actually interested in how I do it, they're just sort of goggling at me like I'm a freak to want to. (Um, I don't get a choice at this point.) If they actually want to know how I do it, that's why I'm blogging.

2) I'm not impressive. The receptionist at my office who makes half my salary, has six sons between 8 and 18, , recently got divorced, and still manages to be so incredibly gorgeous that I wish I were a lesbian... SHE is impressive.

This is something that really bothers me: I've been reading a lot of chick lit lately, and there are tons of strong female protagonists who are lawyers, but none who are doctors. Doctors are allowed to solve medical mysteries, but apparently not get engaged to the wrong guy and then get lured away by another guy who initially seems like a jerk yet is ruggedly sexy. What's up with that? Why do lawyers get all the romance?

We dress better. Courtrooms are dramatic without actually being scary (as in, people rarely die). Your average chick lit reader understands what we do, or thinks she does... there are a lot of armchair lawyers out there, while doctors seem more "above it all". And one of the defining moments of chick lit came in 1997... when David E. Kelley brought us a sassy, unlucky-in-love, short-skirted, sexually active young lawyer forced to find her way through a series of dramedic misadventures featuring:

a sassy, black best friend, and a slutty, ditzy best friend
a hot, blonde rival (and later another hot, blonde rival when she won over the first hot, blonde rival)
a handsome ex married to the hot, blonde rival
a quirky, endearing fellow "drawn" to our heroine
and eventually Robert Downey, Jr.

And every one of these chick lit archetypal folks? You guessed it. LAWYERS. (Well, except for the slutty one, who was a paralegal). No wonder we're classics in the genre.

How do you divide the childcare responsibilities between you and your husband? Also, and more importantly, who makes more money? I bet it's you. Does that drive him nuts?

He gets off work earlier, picks the girls up, and brings them home, where they run rampant late-afternoon energy over him for about two-three hours until I show up. They're basically mine from then on, except when I take a bath or shower. On the weekend, we do almost everything in a group, with my focus more on the baby and his more on the older girls. Works out pretty well, especially as he doesn't really "get" babies.

He's a network security engineer and makes significantly more. Drives me nuts. I feel like I should make more. I'd LOVE to make more! (Would that drive him nuts? Not sure. Don't care. He likes money, so he'd probably get over it. Will cross that bridge when I come to it.)

Are female lawyers, especially those with kids, catty toward each other? (Like female doctors are, especially me. Meow!)

No, actually! My best friend at the firm is the other young female lawyer with a young child. She and I are sort of united against everyone else, because I think we get what it's like to have non-office priorities in a way no one else at the firm does. We both leave at 5. Female lawyers in general get along, I think, because it's such an old boy's club, especially in the South.

What would there be to be catty about?

Your three year old child wants a lollipop and dinner will be ready in fifteen minutes (TOTALLY hypothetical question, ahem). Use your lawyer skills of persuasion to convince her to wait. In your answer, you may address the child by my daughter's name.

Miss Melly, you may not have a lollipop (or as Christina would call it, "MY CANDY!")
Yes, I see you shouting.
No, I don't care that you're shouting.
Would you like a cup of water?
Yes, I hear that you want candy.
No, you may not have it.
Wow. It looks uncomfortable laying there on the floor.
Have you noticed how oddly loud this room has gotten recently?
[and similar, for fifteen minutes]
Okay, dinner ready.

It may seem I'm being facetious, but this really is what I'd do with Melly, and this is how I deal with conflicts at work with other lawyers. I don't go head-to-head very often in my sort of practice, but it does happen, and this is what I do... I just sit there (usually on the phone) and politely state the obvious and refuse to budge, until the other person either gets tired or bored.

I also have been known to compare my style of lawyering to an episode of SpongeBob SquarePants where Flats the Fish wants to kick SpongeBob's butt. He hits him- and his fist sinks right in, and SpongeBob giggles. He hits him again, and the same thing happens. He then proceeds to follow SpongeBob around for hours, trying to beat the crap out of him, and everything bounces right off SpongeBob, and SpongeBob is unfailingly pleasant. Eventually, Flats passes out from sheer exhaustion.

That's how I lawyer, and parent.

Lindsey has also interviewed me on her blog about being a doctor/mom. See the corresponding interview at High Heeled Mom.

Sunday, March 28, 2010

Welcome to Q & A Topic Week

Welcome to another topic week on Mothers in Medicine! We'll be devoting the next week to the theme of Questions and Answers. Thank you to everyone who submitted a burning question to our community --there were many! We've divvied these up so that each post will generally address one question and a MiM's answer. For those who posed multiple questions, we tried to split the questions to answer them individually. The posted response is to serve as a jumping off point for others to join in and comment. We encourage you to share your answers and experiences in the comments for a full discussion of the question at hand.

We're really excited about the response to this topic week and looking forward to seeing your comments. If any other questions come up during the week, email us, post them on our Facebook page or @motherinmed on Twitter and we'll try our best to get these up for comments this week!

Posts will be spread out throughout the week.

Thanks so much for reading and being part of this community.

Med school with kids

I am a pre-med student (planning to apply in 2011). I am married and I already have two children, who will be no younger than 3 and 5 when I start medical school. I see that most people waited until residency or after to have children, but obviously that's not an option for me. Did anyone else go through medical school and residency with children? Do you regret it? Are you glad you did it the way you did? Do you have any advice!



Good luck and good for you. I am just finishing up a research fellowship, and I will be returning to join the class of 2012 at my medical school. I was originally in the class of 2011, the year I hope you get in!

When my classmates ask me when I think they should have kids, I tell them all "Before you get into medical school, and then wait until they're potty trained and sleep through the night." Of course, most of them don't have that option. I am mostly kidding when I say that, but it worked for me, and I hope it works for you.

I actually wrote a guest post with advice for parents in pre-med, recently (I am squeaky brand new as an official contributor! Whee!) I especially like #4 Don’t overestimate or underestimate the understanding of your classmates, professors or administrators when it comes to your kids and #5 Don’t put your education last in your house.

I was less alone than I thought I would be. There were at least half a dozen fathers in my class, and more than a few mothers. We have three single moms in our class. I sat next to a grandmother for my whole second year. We all make it work in different ways.

This research fellowship has been a blessing. It gives me an extra year to spend time with the kids, and I can learn from my classmates who are now a year ahead of me about the logistics of rotations, so I can plan as much as possible. Mornings are going to be rough.

I felt very grounded by my family and children the first year of medical school. I saw many of my childless classmates struggle with loneliness in the beginning. It can be a grueling transition, especially if you have to move to a new place. Having home and children to go home to can be a blessing, not a weakness, sometimes. It does make applying to programs, both for medical school and residency, a bit of a challenge. My first official post (coming soon) will be on having children while looking into away rotations and the residency match.

Med school and residency strategy for a high-schooler

I am a junior in high school looking to become a surgeon. What would be the best way to get to Hopkins for their MD/PhD program, and from there to CHOP for residency?
Thanks so much.
Wow. That is a specific plan you have there. I think the only thing I was sure of when I was your age was a) I wanted to go to college, b) I wanted to be a doctor. Or maybe a writer. Or  maybe some kind of unspecified star...., and c) I wanted to wear my hair in an updo for the junior prom.
I guess my first piece of advice is to be open-minded about your future. There are so many fantastic places to train --all which can help you become a wonderful physician. Having your heart set on one specific place could lead to disappointment.
You say you want to become a surgeon. That's wonderful if you know now that is what you are meant to do for a career for the rest of your life, but also be open to other possible career options. Speaking about myself, looking back at myself while in high school, to college, to medical school and now, it's hard to believe how much I've changed in every dimension.  I went to medical school thinking I would most certainly become a neurologist (neuroscience major in undergrad), then it was most certainly a neonatologist, and then it was a general pediatrician, before finally settling on internal medicine. The important thing is to always stay true to yourself and follow your heart. It's too easy to get trapped in a path that we think we should be on.
I think it's probably too early to be thinking residency strategy at this point, but if you're looking ahead to MD-PhD programs, good grades and strong research experience in undergrad probably goes without saying. But, in speaking of what makes a good med student applicant versus a so-so one, is less about the perfect 4.0 or MCATs, it's the entire package of the individual - what makes someone standout is what makes you unique.
I happened to go to Hopkins for med school. As a student there, I served as a student member of the admissions committee. What came up time and time again was that we wanted to find multi-dimensional applicants - those who clearly had outside interests and talents, unique prior experiences, and, importantly, showed a clear commitment for medicine through their application. We had the chance to mingle and talk with all of the applicants on interview day and advocated for those who were interpersonally engaging (as opposed to the clearly insincere / egomaniacs / gunners / robots / Mr.Spocks).
I'll close with this piece of advice: becoming a physician is a long road - you need to have fun and live life to its fullest on that journey. It is so not just about the destination.Your experiences outside of the classroom or lab are just as important in shaping you as the physician you will become. Live, play, love, listen. Don't let a singular focus for the future make you miss smelling the roses. The roses are key.

Saturday, March 27, 2010

The Quartet

Medicine is a tough and very competitive field and I've seen a lot of women doctors who are trying to one-up each other - not just in their work but also in how they dress, who they date, etc. Is it hard for women doctors to develop close friendships with other women doctors? I wonder about this because I'm a lawyer and all of my closest friends (and bridesmaids) are lawyers who went to the same law school but I don't know that many women doctors who are as close to their medical school or residency classmates.

I love this blog! So interesting.


A lawyer and mother of two in Seattle.

I have a quartet of women in my life who are so close to me they each deserve a blog, hell even a book, all of their own. I collected them over the course of med school and residency.

Lys - my best friend from medical school. I was the maid of honor in her wedding. Even though she ended up in a town two hours away from my own, we still talk frequently, and we are cultivating a friendship between her 3 year old and my 7 year old. She has been one of the singular most influential people in my life (well, there's mom, dad, sis, bro's - but we're talking friends here).

Mel/Mellificent - My first best friend from residency. She was two years ahead of me when I started my training, and we became fast friends. Her quick wit (I always lag behind real time - thinking of something clever to say when it is socially inappropriately late) attracted me and everyone else around her. She took me under her wing from the beginning, teaching me the tricks of autopsy and how to handle the different personalities of our all important planets - the attendings. Then she had her daughter 11 months before I did, and taught me how to pump. Showed me it was all possible: to nurse, mother, and be a resident. I don't know if I would have figured it out so well on my own. For that I am eternally grateful.

Trish-EEE! - When Mellificent left for a job in another state I was crushed. Luckily Trish had recently transplanted from Chicago and took her place. Trisha had a very different family situation from my own - she was a newlywed and I had one kid and another on the way - but we had a blast, those last few years of training. We flew together to take our Anatomic Pathology/Clinical Pathology boards in June of 2006, and had a big spa day planned back in our home town the day before she and her husband moved up MidWest to her new job. Unfortunately, our flight got delayed and we had to scramble for a room in a cheap hotel while our suitcases were stuck in Never Never Land. We begged the hotel staff for plastic Bics to shave our legs the next day and stayed up late talking. Ate a greasy breakfast in the hotel lobby and caught a mid-morning flight home. Even though we missed our spa day, I wouldn't trade that experience for the world.

Dr. Styles - My mentor and big sister. Sure, there was the faculty/trainee angst when I was a resident, most of which was created by me trying to please. I am indebted to her for all the knowledge she imparted to me, and consults she continues to help me with in my current job. I have really enjoyed cultivating our friendship in a different way over the last three years since I left training. I am no longer in a position of trying to please, and it makes us easier with each other. She is there for me now in a bigger way. Teaching me how to become a mature adult emotionally, something I was sorely lacking after a crazy few years of training and having babies. I put everyone else first, and myself last. Now I see her happiness after profound family trauma, and realize that there might be a light at the end of my tunnel.

I have a new quartet of women at my current job - ones I will write about in the future. I have always leaned on the women in my life more for emotional support, and my current practice situation is no exception.

Having said that, I have been on the wrong end of women in my job. One of my research collaborators, a non-doctor, tried to sabotage me once to a favorite faculty member. I was getting weird vibes from the faculty and wasn't sure where they were coming from. Luckily some of my co-workers saw what was happening and cleared the view of the faculty member before everything went too far South. In the end, it was tough for me to be angry with the researcher, because I could see her story, where she was coming from, and why she did it. I felt pity for her - something she probably didn't want from me - but I felt it nonetheless, and went out of my way to be kind to her in social situations. I skipped anger, and went to sympathy. One of my greatest strengths, and worst faults.

Let me digress here, and get on my soap box. There are no bad people. There are only good people who do bad things. It makes me so angry when I see mothers scolding their children for bad behavior, by saying, "That is bad. YOU are bad." Kids internalize this, and make it a part of their view of themselves and their approach to the world. They do not have the capability to isolate the situation from their own ego (I am sure I am screwing up psychological terms here - maybe JuliaInk could clarify).

So in my opinion, yes. Female doctors can cultivate wonderful friendships with their female peers. A former blog contributor who is now taking a break wrote a very different take on being a female doctor and making friends - one that KC (an incredible, laid back, capable and helpful ring-leader that I joke about being a slave driver in complete fun) shared with me at lunch yesterday. Anesthesiobiologist wrote this post, one that I encourage you to read. She is a great writer, and I empathized with her thoughts on some level.

I hope this wasn't too all over the map. I feel a little scattered, these days. Thanks very much for your question - lawyer and mother of two in Seattle - it made me think a lot and this was much harder for me to write than the breast pumping post. It is tough to condense the gratitude I feel toward all of my female colleagues for helping shape who I am as a woman, mother, and doctor.

Friday, March 26, 2010

Time with Kids

During residency, what are/were your favorite ways to spend time with your children in the 3-5 hours/week when you were not working or sleeping?

Playing with them. On the floor, TV off, giving them my undivided attention.

That being said there are a bunch of my son's baby pictures that include a William's Textbook laying beside him! I think the key is to maximize the amount of time you can spend with them at home. Also, if possible, to have your spouse bring them up for visits when you are on-call.

I planned to have a child when I was a resident, so I decided early on try to learn everything I could in my first 2 years of residency. My theory was to learn everything in 2 years, so I wouldn't have to study as much when I had a baby. I constant carried notes, photocopies of text book chapters, and notecards with me. All those little moments of down time: waiting for a case to start in the OR; waiting on L&D for a patient to deliver; waiting for your attending to arrive for rounds, these were all my extra study times. And I didn't even have an iphone back then!

This allowed me to rock as a resident and also take time management to a new level. Of course I didn't learn everything in my first 2 years, but I did learn a lot more some of the other residents and I didn't have to study as much at home. Which gave me more time with my souse AND my son when he was born.

Subject: How to pursue pre-med studies

NOTE: This is a very long question, and subsequently a long answer. I decided not to edit down the question, as all of the parts seem to be equally important to the questioner.

I have a B. Mus. in classical music performance from Oberlin. When I was wrapping up my degree, my desire to learn more about the human body trumped all my plans -- grad school, a performance career. For the past three years I have been employed in healthcare, first in a nursing home as a caregiver, and then as an EKG tech at my local hospital. I needed to spend this time working in the field to confirm my desire to become a physician and to develop accurate perceptions about healthcare.
My son is only eighteen months old, but I feel like I can't put off post-bac studies any longer. It makes me miserable to continue to put my education on hold, and it's becoming increasingly difficult to be enthusiastic about a job where I'm completely underutilized. I just accepted a new job working overnights in the ICU so that I can take classes during the day. My husband is a nurse and we work opposite schedules.
Meanwhile, I have been accepted to several programs as a transfer student to obtain a second bachelor's degree (in biology) and two post-baccalaureate pre-medical programs. Although I would love to attend one of the post-bac programs, they are all through private institutions and I'm just not sure if we can afford it or even secure adequate loans. Some of the B.S. programs are through state schools, and very, very affordable ($3000/year after grants), but not many of my credits from Oberlin will transfer and it would probably take 3-4 years to complete the degree.
Should I just take courses a la carte? It seems like a more direct route in some ways. I could afford to do this at a state school, but I hate that I wouldn't have an advisor, that I wouldn't have the opportunity to be involved with research, that it would be difficult to get to know my professors and that it would be hard to build the rapport that I would later need for recommendations. Some of the physicians I work with are willing to write recommendations, but I feel like I will still need someone to comment on my academic ability.
Should I try to complete a masters program instead? Could I tack on pre-med courses while completing an MPH? Are there other graduate programs that I should consider? I didn't apply to any graduate programs, but in retrospect, I sort of wish I had.
Did any of you work full-time overnights while being a full-time student? How did you do it? Did you ever sleep? If so, when? Were you scary or silly? I'm feeling desperate and crazed and I would be so grateful for some outside perspectives. -E.G.
(E.G. is a 24 year-old EKG technician living in Upstate NY.)

I’ll attempt to answer this as best I can, E.G. It sounds as though you’re already quite accomplished, and I understand your frustrations with feeling as though your life is “on hold” – but there are many things that you may not be aware of as you look toward your goal of becoming a physician. First, there’s no rule that says you need to have majored in the sciences to become a doctor, so looking at obtaining a second bachelor’s degree in biology may be overkill. What you do need to look at are the classes that you’ll need to succeed at the MCAT, as well as the pre-requisites for medical school. As such, the “a la carte” approach might be the most reasonable path to pursue. I wouldn’t be afraid of not being a full-time student in that scenario, and I wouldn’t worry about not having an advisor – I think that most professors would be willing to work with someone in your position in such a capacity. Even though you wouldn’t be a full-time student, you’ll still get to know your professors. In fact, you’ll likely have the same professor for several of your courses, and they’ll be able to easily comment on your academic abilities when needed. And why are you even considering an MPH? Is it something you think you’ll ultimately use? If not, at this stage of the game, it’s likely to be more of a burden than a benefit.

Now, let’s consider how realistic it will be to work full-time nights and attempt to be a student during the day. Something’s going to give, and it’s likely to be your sanity. For most of us, balancing a full-time job and a family is a stretch; adding a full load of college classes seems to be a recipe for disaster. Sleep deprivation will impair your memory, impact your grades, and potentially injure some of your relationships. To address the specific question you asked, most of us become very scary when we’re chronically sleep deprived.

I haven’t even begun to discuss the economic impact that this will have on you and your family. There’s no getting around it - medical school is expensive. It will be very difficult to work through your first few years due to the course load, so to be practical, you’ll want to have as little debt as possible prior to entering med school.

Lastly, your son is only eighteen months old. While it seems like he’ll be tiny forever, wait another three seconds and see how old he’s suddenly become. Don’t miss out on your time with him in your desire to finish your schooling. What about other children? Two kids are exponentially more difficult than one, especially if you’re working – let alone going to school.

Ultimately, although it seems that you must complete everything now, in reality you’ve got lots of time. You’re way off the path of being a traditional student at this point, so revel in your non-traditional status. Enjoy your job – use it to hone your bedside manner with the patients you see on a daily basis. Share your ambitions with the physicians you work with – you may find that they go out of their way to share some interesting findings with you. Do the best you can in the classes you take, even if it’s only one per term – professors are much more likely to write letters for students who have genuinely enjoyed and subsequently succeeded in their classes. And realize that there’s no reason to be desperate and crazed now – save those emotions for later (like when you’re post-call, your husband is out of town and your son won’t stop barfing….).

I hope this helps –

Thursday, March 25, 2010

Why Would You Quit?

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder - why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but of course, I don't want to be so rude as to ask that question to them.

A lawyer and mother of two in Seattle.

I am going to try to tackle this question, even though it is not my current personal experience or decision. I actually went through residency with a woman who did this very thing. She went through medical school, a strenuous Ob/Gyn residency, and then worked in private practice for a couple of years. She was married to another physician who eventually completed an interventional radiology fellowship. During residency, she had two children, and then had a third when she was out in private practice. Once her husband finished his training, she quit practice to be a mother full-time. When people would ask her why, her answer was simple..."because I want to, and financially, we can do this, so why not?"

I know she loved her career, and she was a very skilled, caring, and compassionate physician, but she just wanted that time with her family more, and they were in a position to swing it. She didn't think of her choice as "quitting medicine," she viewed it as choosing her family. It is no different than the other career women (lawyers, executives, teachers, bankers) who make the very same choice. She always planned to return to a GYN-only practice once her children were school aged, and she became board-certified, and kept up with the field via conferences and CME (she had lots more time to read!!) I have since lost touch with her, but I have no doubt that she was very happy with her choice. While most physician-mothers are not as extreme, I see varying degrees of women choosing "lifestyle" specialties or different levels of "part-time" practice after residency.

Even though medicine does require more rigorous training than most careers, it does not necessarily change the way you feel about how your family life should be structured. There have been many times that I have considered cutting back practice hours, myself, in order to enjoy more family (and me!) time. I recently made a move that enabled me to still work full-time, but greatly reduced my time on-call, and therefore, my time away from my family. Currently, I am the bread-winner, and I still have some student loan debt that needs to be paid, so up and quitting is not a viable option for me. However, if I am able to become a partner in my current practice, reduce my in-office time, and still manage a decent living, then I will likely choose that path. There many different ways of finding a work and home balance for women today, and I am thankful that we have the ability to "choose medicine" and we can also "quit medicine" if this is the best thing for us and for our families.

"AMA- Advanced Maternal Age"

Dear MiM,
What things did you wish you had considered before having a baby during residency? Are there any moms out there who had children after residency or who were unable to get pregnant after residency (b/c of advanced maternal age) that have regrets?

Ob-gyn resident from the Bay Area, California

Dear OB/Gyn resident:

Let me start off by stating a simple truth that we all refuse to accept. We are not in control. This was made painfully clear to me only following the dismantling of my perfect plan for having a baby.

Married a week after med school graduation, my husband and I chose not to start a family during residency. We struggled with the initial adjustments to marriage and work, and instead of having a baby had a fantastic time eating out, drinking and traveling. Looking next toward cardiology fellowship, time for baby needed to be in the plan. My first year focused on survival. The second year I volunteered to make the master fellow schedule. A small sacrifice of negotiation + mediation to have control of my own schedule. I stacked my call and cath lab months in the first half of the year. I found a research mentor and agreed to a extra year research fellowship. It would be perfect. November was my last month in the cath lab. Pregnant in December. Start research in July. Have project off the ground, maternity leave in September. With some luck I could extend my research a third year and have number 2!

In reality I was diagnosed with anovulation due to PCOS in April. I then became a fanatic triathlete. By the time I started my research fellowship I was exercising 3 hours a day and was skinny as a rail. I figured I could be the 'best' PCOS patient ever (so it seems PCOS is NOT all about adipose/obesity after all). Fertility drugs in the fall leading up to my first miscarriage. Then a freak accident leading to a broken arm, ORIF in January. Crazy girl running on the treadmill with my arm in a sling. Hip pain, months of physical therapy. Diagnosis of acetabular tear, second to underlying congenital hip dysplasia. MDs doubtful I could walk during a pregnancy. Hip surgery the next January. So by the time I spent 2 years trying to get pregnant and 6 weeks on bedrest following my hip reconstruction I finally said, I give! I get it. I am NOT in control and I cannot make what I want to happen- happen. Not even with a superwoman effort bordering on obsession!

And well, as it turned out it is not too hard to get pregnant. Not hard at all when you are not working, resting, reading, watching TV all day- all while on *bed rest*!

Finding the right time to have a baby is difficult for Mothers in Medicine. You have read on this blog about the challenges of managing maternity time off and negotiating with colleagues the pre-occupations of a mother. The consensus is that no time is the perfect time. In my experience, finally understanding/ appreciating the amazing gift of a healthy pregnancy made all accommodations more palatable. My story is not unique, the complicated world of the female reproductive system has it's quirks. My practical advice to you: take care of your marriage, take care of yourself. When both feel good have a baby. Because in reality we are not in control. Letting go is often required for us to find the future we desire.

Would I have done anything differently?

QUESTION: Is there anything you wish you had done, or done differently (fellowship, 6-month trip to India, get married before rather than after school, etc.) over the course of your training, starting in college?
FROM: GradStudent, child-less, unmarried 20-something aspiring science researcher and medical school instructor

Oh, the “woulda-shoulda-coulda” question! Isn’t it human nature to question what we’ve done and what might have been if we had taken a different course of action at some point?

That said, there are some things that I wish I would have known when I was at your stage of the game. Specifically, I wish that someone had told me that taking a little extra time to complete my schooling would not impact my future adversely. When we’re in undergraduate (and even high school!), there’s a pressure to complete everything ASAP. However, most of us need a little time to percolate (OK, mature) before we reach our full potential. Additionally, learning to savor time away from a job (or books) can help make our productive time that much more productive.

I’m happy that I delayed marriage until after my formal schooling was done – I didn’t have to worry about spending extra time in the library prior to exams, nor did I have to worry that my husband didn’t really understand why a lab finished at 3P one day but not until after 6 on another. I didn’t have children until the end of residency, and I wouldn’t change that – I think I needed the extra time to sow my wild oats!

But, even with these items in mind, as I look back on my experience in college and med school there are a few things that I wish I would have done differently. The college I attended for my undergraduate education had (has) a terrific overseas study program. At the time, I felt that I needed to concentrate on my science courses rather than spend time on additional language classes, and so I didn’t think twice about ignoring the information about the program that crossed my path. In retrospect, I think that to have had an experience of being completely immersed in another culture would have been good for me – personally, to have shaken me out of my cocoon of comfort, and professionally, so that I’d have some empathy for those patients I see who are new to our way of life. In a similar vein, perhaps I should have gone on the “backpacking in Europe” summer trip that I was too afraid to pursue at age 22. I wouldn’t have worried as much about majoring in a science, but would have spent more time in classes that I really enjoyed. I would have learned earlier that just because something comes easily to me doesn’t mean it’s not worthwhile for me to pursue. I would have recognized sooner that life is a journey, not a destination.

So, dear GradStudent, I hope this answered your question. As you look ahead to your career in research, or teaching (or whatever you ultimately decide on), don’t be afraid to take a detour – it might be one of the best decisions you’ll make!


Wednesday, March 24, 2010

Matching to a Different Drummer

 Hi and thanks for the blog, I love reading it when I get a chance to sit at my computer and procrastinate!

My question is this- I'm a caribbean med student from the midwest, and due to odd scheduling, I'll be done with my 4th year electives in July, taking step 2 at the end of that month.
This means I will miss this years' match, of course.
What should I do for the 10 months that I have off before residency starts in July 2011?

Get a job in research at the hospital that I'd like to get a spot with?
Get a job as an EMT?
Get a job with nothing to do with medicine and study like mad to take step 3 before residency starts?
Is it possible to start residency in September?? ( I want to do Peds)

I'm single and childless- but I have joked that those 10 months off would be the perfect time to be pregnant! :) Current BF grins while looking green... lol. I'm not looking to have a kiddo yet, just seems from reading your stories that this is the last time I'll have 10 months off in a row!

Thanks for any replies!! I appreciate you all.

Being out of step with the match can work to your advantage in several ways. Some positions do open up in the middle of the year, when people drop out, switch specialties and so on. I am not quite sure where such positions are advertised, but the dean of your school may know, or you can check in a specialty newsletter. If you have graduated before you apply, you are not obligated to go through the match at all. This frees up a program director to take a position out of the match and sign you up at any time before submitting a match list. If you are applying to a residency that has trouble filling slots some years, this can work to everyone’s advantage. Programs hate to have positions unfilled on Match Day, and it also frees you up to do whatever you want, knowing your position will be there in July.

If you are looking for interesting things to do, there are many opportunities in international relief related medicine, including disaster relief, maternal child health clinics, HIV clinics and so on. The internet is full of requests for people who want volunteer in Haiti, and the need is going to be there for years (try Partners in Health as a sponsor, in particular). You can also use your time to get far along with another degree—for example, if you take a full semester of courses toward an MPH, you will likely be able to finish it during residency, and that is a great credential to have later on. You could also take courses in humanities, again with the idea of cultivating medical humanities in residency and teaching in this new field in the future.

Another or additional activity is to learn to be a standardized patient—the work pays something, is very flexible, and teaches valuable patient relationship skills that may be helpful during residency. Other medically related, paying jobs that a medical student is qualified to do include phlebotomy, being on an IV team, and being a “sitter.”

Finally, there are some educational experiences that you could pursue if still enrolled, for example, the neurology elective at the Queen’s Square hospital in London or the advanced psychopharmacology clerkship at the National Institutes of Mental Health. Students also can go to some professional meetings for free as recorders—the Child Psychiatry meetings for example—and that could really enrich the time between school and residency.

How To (and not) Breast Pump at Work

A friend of mine (anesthesiologist) is expecting her first baby any day now. She had a lot of questions about breast pumps, ie how difficult was it to pump at work? How did you deal with call? What were your colleagues' attitudes towards pumping? What breast pumps would you recommend? How much time does it take to pump (on average)? How long did you breastfeed for, and was your decision to stop influenced by work issues?
I did read Fizzy's post a while ago (formula vs breast milk) but my friend and I want to know the details. If you don't feel this would be too repetitive, it would be great to hear what the other mothers in medicine think.

My daughter, Sicily, was a dream baby as far as the pumping goes. I'm paying for it now, in elementary school, but that is the topic of another blog. Pumping was tough to learn, but once my friend Mel showed me the ropes, it was smooth sailing. I had a top of the line Medela - I'm sure there's a newer model out now. It was worth it to me to shell out the bucks for efficiency. All of the books recommend that you pump as often as you would nurse, but when you have a hungry, demanding baby this seems unreasonable. I usually tried to pump twice a day at work. I was on clinical pathology rotations my second year of residency - had adequate time to manage my goals. I studied during the process.

I tried to pump in the pumping station at the hospital near OB, but it was so far away and all of the dried milk spots on the chairs, walls, and floors in the cubicles behind sheeted doors freaked me out. So I used Mel as a mentor again and pumped in an empty apheresis room - nice and clean. And I'm nice and clean so it worked out for the apheresis attending. I usually pumped at 10:00 and 2:00 - it took about thirty minutes start to finish, including rinsing out the parts and storing the milk. Toward the end I was able to back off to once a day when my production started waning. There was one unfortunate incident of a male nurse walking in on me while I was pumping - it was embarrassing at the time but funny in retrospect - he couldn't look me in the eye for weeks. I think he was more embarrassed than I was.

I was a cow as far as production goes - I remember once falling to pieces when the power went out on a weekend when I was alone at home. I called the poor Entergy company assistant in tears.
"When is the power coming back on? I have all of my milk in the freezer! If it thaws, I will have to throw it away. Are you sure they are fixing it? Can you please tell me again the exact time you expect it to come back on?"

When you work that hard, a tiny bag of frozen milk is like liquid gold.

I pumped/nursed for eleven months with Sicily. It was just time to quit - we both seemed to know it. It was a very smooth transition to frozen milk, and she was on formula by a year.

When I had my son two years and four months later, I thought I was living my dream. Perfect marriage, doctor husband, girl and boy, and well on my way to (in my opinion, and many others, some will beg to differ - there are a lot of great jobs in this state) the best job in the state. I was going to work at the hospital my dad and husband worked at. Plans don't always work out the way you want them to, but this isn't always a bad thing.

At the time, things were going according to my plan. But with my son John, things degenerated. He didn't sleep all night at three months like my daughter - he wanted to nurse three times a night. Hard to blame him - he didn't get much of me during the day - but it was killing me. I was also on some tougher rotations, so I reduced pumping to once a day. I would nurse in the wee hours of the morning, pump again after getting ready before I went to work, and suck it up until around noon, when my breasts were like lead balloons. Well, not really lead - they were a little more lumpy. Think a million tiny shrubs under your skin, full to bursting point. I had to get a third storage bottle - I was going way over 12 ounces. I didn't have time to go down to the apheresis unit on the first floor. I just ate a quick stash of processed food for lunch, and made fast friends with the residency coordinator/mom, who let me pump in her office. I could squeeze it in (or out!) in twenty minutes, now. I was a little more rushed overall, at that time in my life.

I sat on the residency coordinator's floor with my face to the wall. Sometimes she left. Sometimes she stayed, and we chatted about kids, life, and family. I really enjoyed that - it was one of the highlights of my day. Female bonding.

This style of pumping was OK for John, but not for me. I had a lot more problems with dehydration and blocked ducts. I've got a pretty high pain tolerance, but blocked ducts have to be one of the most painful experiences on the planet. Worse than childbirth (well, I did have epidurals, so that is not a fair comparison). When he was around seven or eight months, in early winter, I let him cry it out at night, and stopped nursing. This was a much more painful emotional experience because A) We weren't ready B) I was exhausted and had to start studying for my Anatomic Pathology/Clinical Pathology boards in June and C) I was beyond sad and depressed and strung out and D) I knew this would probably be my last time to nurse. It was an amazing experience overall, and I couldn't see myself ever doing it again. I was going to miss it. Luckily, I have nursing dreams to remember the rush of relaxing hormones that accompanied contraction and let-down. I am not talking about pumping here, I'm talking about the real thing.

I wish I could speak to the call, but we pathologists get a break, on the call. So hopefully someone will comment on that in the comment thread. Colleagues attitudes - I am sure I occasionally annoyed, but this was usually temporary, situational, and not always my fault. It is tough to control other people's moods, and sometimes they will project their frustrations onto anything. I did have to get coverage some days, especially with John, when I was responsible for junior residents or covering frozens. People ask to be covered for a lot of reasons, and this was one of the few I asked, so I tried not feel too guilty when others worked for me and made sure to do extra favors when I was around. I like to think that overall I was admired tremendously by residents and attendings. I'll bet if I took a survey the results would back up my hunches.

I am proud of all of my efforts and work, even though it got a little crazy, single-minded, and self-sacrificing at the end. I beat myself up way too much for giving Sicily that extra few months - I felt like John needed it more, since he was six weeks premature. But he is a happy, healthy, well-adjusted four and a half year old, so I think I did all right by them both, in hindsight.

Tell your friend good luck, Liana! Thanks for the question.

Tuesday, March 23, 2010

Day Care Drop

How do you manage day care or school pick-ups, drop-offs, holidays and sick days for your children? My husband is a surgery resident so he can't drop my daughter off (he leaves the house at 5am), and most days even if he *thinks* he may be able to leave early, something inevitably comes up and he can't leave as planned. He sometimes can get a day off to care for our sick daughter, but he certainly can't do it every time she's sick. I know there shouldn't be a difference between MiMs and FiMs (Fathers in Medicine) but hey, I think the reality is there is a difference. Just curious.


Bea is married to a PGY-2 surgery resident and writes a blog about medical marriages and her experience thus far.

Thank you for the question Bea.

When I headed back to work after my maternity leave I was surprised to find how pre-occupied I was (constantly) with this very issue. Working mom's may seem busy with the task at hand, but a small part of their attention is always dedicated to the child(ren). During my day there is a second schedule (not included in my outlook). It includes a series of toddler activities: reading time, art projects, music, lunch and nap. As I move through my day I am thinking about my son and what he is up to. As the day winds down this turns into an obsession watching the clock. A real MiM fear, getting caught up with a sick patient and not able to be there for your child.

The day care is a wonderful place, overall. A little less wonderful is the yellow highlighter they use on the classroom sign-in sheet. Ten hours per day, maximum. That seems like a long day for a one-year old. It is a blink of an eye for a Cardiologist. Drop off at 7:30 AM, pick up at 5:35 PM..... violation! Marked in fluorescent yellow for all of the parents in the class to see. Oh the judgement and guilt served by that mark!

My husband is not a Father in Medicine, but he is a Corporate Executive where the majority of his colleagues are married to women who do not work. We try to stagger the drop-off and pick-up so that we can each work a full day. The game plan however, is altered more often than not leading to a frequent race against the clock.

I hope others will chime in and add their creative solutions, depending on your specific situation there may be a novel idea that could be applied. In our house, salvation recently came in the form of Miss Kim. She is a teacher in my son's classroom, and he LOVES her. She is single, and lives between the school and our house. She now "picks up" for us, bringing my son home from school. Sometimes they stop at the park, other times they rush home to take the dog for a walk. She feeds him dinner. Now my husband and I arrive by 6:30 with a happy and fed little one. We then spend the next two hours relaxed, fully engaged in the bedtime routine.

Another strategy for me, our University has Major and Minor Holidays. The Minor holidays being those where school is out but most work places are open. If we work the minor holidays we receive an extra vacation day. I have my admin block all Minor Holidays- Out of Office. It is my Mommy prerogative. That way it is set up in advance, and I am not scrambling the week before to cancel clinic or find child care.

Then for those rare days, when my day is a short one and I can greet the little man mid afternoon. The best is making it for "buggy time" at 430, when the kids are strapped into the multi-kid stroller. Carrying my son around the block while the others ride, taking in part of his day- I am on top of the world.

Feeling the Love

(*Leah lucked out and had 2 MiM writing in response to her question!)

Leah recently earned a PhD in Immunology and is married to a 4th year medical student/ soon-to-be orthopedic surgery intern. She has a newborn and a 2 year-old.

What are some special things that your spouse has done to make you feel loved/supported during your residency?

There are too many things that my husband did (and still does) to make residency a little less miserable for me. Those listed below are just a few of the highlights....

~ Put his career and plans on hold to move with me and follow me from medical school to residency to my jobs thereafter.

~ Wrote me love notes left on the kitchen counter on the days we could not see one another.

~ Listened to me whine, cry, and gnash my teeth, and provided a broad shoulder upon which to cry.

~ Did his best not to vomit when I chose to share certain details about my day (he tends to be a bit squeamish).

~ Went to the grocery store, folded laundry, got a cleaning lady for our house.

~ Put me to bed when I would come home post-call and pass out on the couch with an un-touched open bottle of beer in my hand.

~ Surprised me with the china hutch I had been coveting one weekend when I was on call, and set it up with all of our china displayed so that it was the first thing I saw when I walked in the door.

~ Took care of me when I was having pregnancy complications, and stood up for me when I was being mistreated by the residents that I thought were my friends.

~ Arranged a surprise 30th birthday party for me with good friends at a time when I was feeling lowly and friend-less.

~ Always, always, always made home a safe, warm place to fall. Thank you, Mr. Whoo....I would have never survived residency without you!

Helpful Spouses

What are some special things that your spouse has done to make you feel loved/supported during your residency?


(recently earned a PhD in Immunology and is married to a 4th year medical student/ soon-to-be orthopedic surgery intern. She has a newborn and a 2 year-old.)

My spouse was amazingly supportive during residency. He listened to me when I needed to rant about my crazy day, understood when I needed to work late and would make special visits to bring me dinner when I was on call. He had always been helpful around the house, but that also went to a new level in residency.

Residency is about survival, so one thing we found helpful was to dream. We had regular date nights, and early on it was hard not to spend the entire time at dinner just complaining about work. So we began to talk about our future life or plan the next vacation. Having something to look forward too was always helpful.

We had our son during my third year, so that obviously changed the dynamic. At that point he became a stay at home dad and truly embraced that position.

So, I think the answer is to do everything you can to meet his needs. Which will be different for a man than a woman. It will obviously be challenging since you have needs too, a job and 2 small children going into this process. He may not care about the house being clean, so figure out what is most important to him, focus on those things and let the other crap go. I am going to venture out on a guess that his 2 biggest needs are respect and sex. This is based completely on my observation of men and specifically orthopedic surgeons.

Obviously he should try to meet your needs as well, but the question was how to be supportive of your spouse during residency.

Monday, March 22, 2010

How Do Duals Do It?

I am wondering how the women of dual physician couples have shaped their careers to manage their children and families. My husband and I are MD/PhD students nearing the end of the end of the programs and trying to decide what we should do for residency. We have a daughter who is about 1.5 and may have another child before I graduate. I knew exactly what I wanted to do until I had my daughter and now I am feeling very confused about my career. First, I haven't found any examples of dual physician couples with children who both work full time jobs at academic centers and do research etc. Second, even if I could, I am not sure I want to be away from my children so much. Here is what I have observed. 1) The mother doctor works part time. She therefore doesn't do research and usually works in a more private type practice. 2) The mother doctor works full time and her husband has a job that is more flexible and not in medicine. 3) Both people work 3/4 of a job - share a practice. 4) Both people are trying to do everything in a field they like but it isn't working and they have to choose easier/more flexible options in their field or do a bad job (ie fail to get a grant). 5) Both people choose specialties that demand the fewest hours possible. 6) One person does only research. I would like to know how dual physician couples have shaped their lives in order to accommodate their families and careers. Specifically, did your children influence what field you went into, or the center where you practice, or the amount of research vs patient care you do? What is the best strategy as a student deciding on a career after med school and what are the options?

- 7th year MD/PhD student

At times I find myself still wondering as well! But nonetheless I will attempt to answer as an academically inclined MIM married to an academically inclined physician who is also mostly in medicine, primarily doing health-related research for the government. You (yes you, 7th yr MD/PHD student and reader of our MIM blog!) have the answer, many various answers, included right there in the question you so thoroughly posed. Starting with "I knew exactly what I wanted to do until I had my daughter." That’s it precisely, we have certain ambitions and interests which we tackle full force, and then we are moved to incorporate the new people (little people, big people) into our lives as new, sometimes unanticipated (sometimes unintended) passions of ours.

The other set of answers to your questions are all there too…. in your proposed answers #1 though #6 or some combo (choose all of the above), over the course of your careers. All the while having a heightened awareness to recognize that doing a bad job (or a bad parenting job) means something has got to change quickly. You might sometimes work part time, and that might mean part clinical and part research so you have (or make) the flexibility to alter/design your schedule. Or, your partner sometimes does so. You or your husband might take a more flexible job, even within your field of medicine/research. And you might change what you do over time, or your partner might. And so on.

In my situation, I'm in pediatrics, some would say a "less demanding" field, and my husband, also a pediatrician, is primarily a health services research for the government. He does have flexibility, yet he does both research and a small amount of clinical time. I do a quite a mix of clinical, medical education, and research. The mixture keeps it interesting and allows for some tweaking or major alterations throughout the course of one’s career. We had children a few years after my residency and while his residency was coming to a close. So I guess that makes us a little older (though I didn’t have any gray hair until just recently). We found the mix that worked for our family, and we work hard; that is we work hard to get home for a family dinner every night. By dinner I don't mean spectacular meal, but rather time together mostly around the table, chewing and talking and listening to each other (vying for each other's attention, mostly!). And we work hard by day (for the most part) to get home to pick up our kids and be fully present for them, until after they go to sleep, when I tend to do a little more work (husband opts not to).

Back to your primary question: For us, having children didn't influence our choice of field (we were already pediatrician and graduating pediatric resident) but it did influence the ways in which we fulfill our academic goals. At times we do so more slowly, for example, I used to work weekends and evenings (even if not clinical, I mean work on various academic projects) and go to many academic conferences (pre-kids), and nowadays weekends and evenings are family time (when the kids are awake at least), and I now go to fewer (no?) out of town meetings or evening/weekend events. One tip, always plan to present at the national meetings that happen to be held locally in your region! Collaborate, and pace yourself.

I will mention that pediatrics does tend to be family friendly, because while we take care of others' kids all day, our colleagues understand when one's own children's issues have to take precedence. Work among people who support each other. Keep the discussion open with your partner/husband so that you can serve as a support to one another and also as a reality check as to whether the work-family arrangement is working for all of you. And remember, your kids (and we hope your husband/partner) are with you for the duration, in sickness and in health, and all that… but you or your husband/partner can tweak or even overhaul your career choices over time.

PM&R: The Holy Grail?

Hi, kids! I'll be tackling two questions today:

My name is Brittany, and I am a third year medical student obsessing daily about what kind of doctor I should be. I struggle daily because I have loved mostly all of my clinical experiences thus far and could truly see myself in a variety of different fields. All around me my classmates are making decisions about career choices, and it just does not seem like an easy choice to me! Considering family life and how it will factor into whatever choice I make makes the decision even more difficult.

So, my question is how did you choose the specialty you went into? Was there a moment or a series of choices or did it just make sense? How much did family factor into this decision?

I realize that everyone says, "do what you love and you'll be alright." However, I love medicine as a whole and different specialties for various reasons, sometimes completely unrelated--there are other factors that influence this decision, and I am curious how others dealt with them.

And more specifically:

My name is Alli and I'm an MS 3 who is in search of the holy grail in medicine-- a profession that provides both financial stability and flexibility. Here's my story: I live with my boyfriend, and future fiance, on Long Island and as I get deeper into looking into residency I am petrified. I love my boyfriend, and want nothing more to have a family (why didn't I want to be a math teacher again??) but I'm really concerned, not only about juggling being a mother and wife with being a doctor, but about finances. I am SO in debt and my boyfriend is a firefighter and doesn't make much money, meaning I would be the primary breadwinner (shudder). Is there a medical field that exists that would allow me to provide for my family while also being a dedicated wife/mother? Don't get me wrong, I'm not trying to get out of working hard and I honestly love what I do. I'm just afraid that years later I will burn out and realize that I wasn't there for my family and that I could have made just as much money doing something else. I have already ruled out certain specialties that I have an interest in because I'm afraid they demand too much (i.e. surgery, ob/gyn) and others because while they might be low key they don't have enough financial stability (i.e peds). I honestly love pediatrics, and was considering it up until I discovered physiatry. Physiatry is a great field, and certainly a strong second choice. I was just wondering your thoughts on my situation, if you have any input about physiatry programs in NY and physiatry salaries in general for a future Mother in Medicine.

OK, since I just blew a bunch of space posting those questions, I'm going to cut right to the chase and be brutally frank here:

For many graduating med students, lifestyle matters. A lot. When we applied to med school, we all had a convincing story about how we want to help people, blah blah blah. And maybe at the time, we meant it. Or at least, some of us did. But when it comes time to decide what specialty we want to do for the rest of our lives, other things become more important than just "helping people" and generally doing good. We've all got loans, rent, children or potential children, future alimony payments, etc., so money is important. And many of us have gone through waking up at 4AM for surgery rotations (on Saturday! horrors!) and decided that's not so much for us.

I'm going to continue to be brutally frank. Get ready:

I don't like to work that hard. I don't particularly like to wake up at 4AM. In fact, even 7AM is a bit early for me. And that whole going to work on weekends thing? Not a fan. Or staying up the entire night on call? Also, not my favorite thing. When I was entrenched in my third year of med school, I realized that I desperately wanted a 9 to 5 type of job. Lots of people have 9 to 5 jobs. Why not me? Why?? Why did I have to suffer through 3+ years of a horrible lifestyle in residency just to possibly have an equally busy practice after residency? I had already worked SO HARD in med school. It wasn't fair. IT WASN'T FAIR DAMMIT!

There were specialties out there that could have catered to the lifestyle I wanted. Dermatology residents have it pretty good. But my grades weren't good enough for that. My grades were good enough for radiology perhaps, if I was willing to go anywhere. But I wasn't. I was following my husband where he wanted to go for his career. (Yes, I was one of THOSE women.)

The brutal frankness continues below...

If you want an eas(ier) lifestyle during residency and your options are limited by your grades and/or geography, there are two options: psychiatry and PM&R.

Psychiatry: Everyone knows what a psychiatrist is. I know this, because people accidentally call me a psychiatrist about five times a day. In any case, psychiatry wasn't for me. I won't get into the reasons, but I was pretty sure about that.

So that left PM&R, which stands for either Physical Medicine & Rehabilitation or Plenty of Money & Relaxation, depending on who you talk to. I did a rotation as a med student, expected to be bored, but actually really liked it. I did my residency in PM&R and it was.... easy. It was rare that I had to wake up before 7AM. I got home most days around 5PM. I spent maybe one or two nights in the hospital during my entire residency. I had a life like a normal human being. Amazing.

The field itself is a hodgepodge of different things. One day you're directing the care of a 24 year old with a new spinal cord injury, the next day you're treating a 60 year old stroke patient. I injected a lot of knees, shoulders, and spines. I performed hundreds of electromyography studies. I got to see young patients who couldn't run two marathons next week because of knee pain. I did acupuncture as part of my residency. I worked races. I had fun.

Even though I was a mother for most of my residency, I was still able to be a great resident. I knew my shit, I was responsible, I was enthusiastic (and I was also modest). I was able to fulfill all my work responsibilities and beyond, had free time to study, time to spend with my daughter, and even *gasp* time for myself. In most other residencies, I would have had to sacrifice something.

On graduation, there were definitely job opportunities, although you may have to be a little flexible about geography. Also, for people interested in research, PM&R is wide open, especially compared with older fields. Now for the salary: according to the Medical Group Management Association's Physician Compensation and Production Survey in 2007, the median salary for physiatrists after 1-2 years in practice is $213,701. A lot of my class ended up doing one year fellowship to specialize in Pain, which commands a much higher salary.

The worst thing about the field is that nobody knows what I do. Even my parents don't know. I mean, nobody here is writing a post called "What is a Pediatrician?" It gets tired to keep explaining to patients what a physiatrist is, especially since the answer requires a few paragraphs.

Let me be totally clear though:

Do NOT do PM&R just because it's easy. We hate it when med students say that and it's always a big mistake to go that route. PM&R is a really fun field with lots of procedures and a chance to really develop relationships with your patients. It's got a good lifestyle, which is something I love about it, but is only one of many things I love about the field. If you work in a field you love, you'll never work a day in your life. (I never really could have been a dermatologist.)

Also, please check out my FAQ on PM&R.

Tips for Surviving Call during Pregnancy

Great timing for Q&A week! I just found out last week that I'll be a new mom in November, making me an official mother in medicine! I've been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here's my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?

From a future mom and Family Medicine resident in the midwest

Congratulations on your pregnancy! I know that being pregnant during such a difficult time as residency seems daunting, but you can (and will) survive! Overnight call is never fun, but with a few small changes, you can get through a 24-30 hour call with relatively minimal discomfort.

Survival Tip #1 - Bring lots of snacks to work with you. As a resident, especially on call, you often have an erratic schedule, and sometimes it is difficult to eat at regular intervals. If you are fortunate enough to avoid severe nausea in the morning, then try to eat before you leave the house. Pack your pockets with snacks that are portable, like protein bars ( bars are really good, more crunchy than chewy, and covered with chocolate. Yum!), hulled sunflower seeds mixed with dried cranberries or raisins, or even the standard peanut butter crackers. Having something on your stomach at all times will help stave off nausea and fatigue.

Survival Tip #2- Some caffeine is still ok! No, really! I am not sure how much caffeine you have been consuming prior to pregnancy, but a small amount (150 mg-300 mg) of daily caffeine has been shown to be safe in pregnancy. The official March of Dimes recommendation, I believe, is 200 mg or less. One (regular) cup of coffee or 2 caffeinated sodas per day should definitely fall well within the safe range, not to mention the occasional chocolate fix (so needed on certain call days).

Survival Tip #3 - Learn how to prioritize your duties while on call. It is likely that you already do this to a certain degree. Do the most physically strenuous tasks (procedures, lines, rounding) as early as you can in the call day, when you have the most energy. Try to chunk as many things as you can on a single floor, and "gravity round" (start at the top of the hospital and go down floor by floor). Don't be ashamed to use the elevator, but by going down steps, you can get a little physical activity without straining yourself. Do your best to anticipate any additional orders (nausea medications, sleep aids, pain medicine, diet orders, etc.) that may be needed throughout the day and write them while you are on the floor, saving yourself middle of the night phone calls for Tylenol during the 2 hours that you may have been resting! Another thing you can try is to do quick PM rounds. Alternatively, call and talk to the nursing staff, floor by floor, asking about any issues that may need to be addressed prior to trying to lie down, thus avoiding the "sit on bed, pager goes off" phenomenon to the best of your ability.

Survival Tip #4 - Stay hydrated. I know it is hard to do, and even more annoying when you have to stop working and actually *use the bathroom* on occasion, but trust me, adequate hydration can stave off multiple discomforts of pregnancy and decrease the development of more serious complications like pre-term contractions. Have a bottle of water accessible throughout the day, and refill it often.

Survival Tip #5 - Don't stand when you can sit, don't sit when you can lie down. Rest as much as humanly possible, even if it is just the short time between one clinic patient and the next. Go to the call room and lie down on the call bed instead of sitting around and chatting at the nurses' station, even if you don't sleep, you will be much better rested and prepared for that inevitable page from the ER at 3 am.

Survival Tip #6 - Bring your meds with you. If you are one of the less fortunate ones (like me) who happens to be plagued with persistent nausea/vomiting throughout the pregnancy, Zof.ran will likely be your very best friend. Bring it to work with you, along with Tyle.nol, Sud.afed, Zan.tac, Tum.s, and your pre-natal vitamins. It will help you to avoid having to get IM shots of Zof.ran from the nursing staff or walking around with an IV (both happened to yours truly) for fluids.

Survival Tip #7 - Utilize any support that you have. I'm not sure if in your program you take solo call, or if you have a junior person and a senior person on call at the same time. If the latter is the case, then utilize your support person to their fullest potential (if they are amenable, that is). Try to "divide and conquer" tasks instead of tackling them together. If you are the senior, then trust your junior to do good work without you hanging over their shoulder. If you are the junior resident, don't be afraid to ask the senior for help if you feel you are in over your head.

Survival Tip #8 - It's ok to whine....but don't whine about your pregnancy discomforts to your co-residents or to the nursing staff. Call your husband or your best friend, or compose a long, whiny email and then delete it if you must. It is normal to feel whiny when you are pregnant, but it may ultimately foster unwanted and unpleasant feelings in your co-workers if you vocalize these feelings. It saddens me to have to write this tip, but this is a mistake that I made in my pregnancy that came back to bite me. Sympathy is not always rampant in the medical community, so try not to seek it there, and you will not be disappointed.

Survival Tip #9 - Be aware of your limits. As you progress in your pregnancy, you should not be lifting more than 20-25 pounds, nor should you be feeling more than 4 contractions in an hour. Don't push your body's limits in order to be a "super resident." It is ok to ask for help if you need it, and don't ignore the warning signs that something may be wrong. Often, we as physicians will push aside our own physical discomforts and keep on working. Don't ignore serious signs like contractions, shortness of breath, headaches, excessive swelling, or increasing abdominal pain.

Survival Tip #10 - When you go home, do nothing else but take care of yourself and your needs. If you need to go home and sleep for 10 hours, then do it, dishes and housework be damned. Celebrate the fact that, in spite of being up all night, you have this time catch up on sleep. When the baby arrives, your call shift will never truly be over. Luckily, in many ways, motherhood is infinitely more rewarding! I wish you all of the best as you enter this exciting new time in your life, you can do this.

Wednesday, March 17, 2010

Playing doctor

This week, I got to have one of my best experiences ever as a physician: I got to teach the kids about being a doctor at Melly's daycare!

I have literally been waiting for this moment for 25 years, since my own father came to my school and taught my classmates about being a doctor. And it was every bit as fun as I hoped it would be. I dressed the kids up in masks and caps with rubber gloves, let them use my stethoscope to listen to each other's chests, let them pump up my sphygmomanometer, and checked knee jerk reflexes on every one of them.

It was a hit. The kids were shooting their hands up to volunteer. I kept a dozen kids ages two through four captivated for 45 minutes, and when the teacher broke it up for snack time, the kids were crowding around me for more. I loved hearing the other kids saying to my daughter, "I didn't know your mommy was a doctor!"

It made me happy that I have a career that seems so fun to little kids. If I were, say, an investment banker, I'm not sure what I could have done. I wonder if I converted any of the kids to wannabe doctors.

And today they made me a card to say thank you.

P.S. Good luck to everyone on Match Day! Apparently, there's a very scientific method to assure everything works out OK.

Saturday, March 13, 2010

Stat Pap

This week, I was rotating on EV cytology. EV means "extra-vaginal." I always wondered why my group doesn't call it NG (non-gyn) like the rest of the world, so I don't have the word "vagina" in my rotating service. EV cytology is anything other than pap smears. Fluids, fine needle aspirates, ultrasound-guided thyroid biopsies, and CT-guided biopsies.

The only exception is when there is a "stat" pap smear. Stat pap smears don't come up very often - they are usually done in the OR when the surgeon sees a fungating mass on the cervix or something, and wants to confirm cancer prior to his or her surgical removal.

Earlier in the week, the head of cytology came into my office.

"I've got a stat pap. I think I need to explain it to you, it's kind of confusing."

She told me that a patient received a diagnosis of High Grade Squamous Intraepithelial Lesion (HGSIL) a week earlier. All paps these days also get molecular HPV (Human Papillomavirus - that is the virus that causes cervical cancer) testing - the wave of the present and future. The molecular testing for high risk HPV types came back negative. I've been in practice for almost three years now, and that is a first for me. The molecular always backs up our diagnoses. She's got a lot more experience than me, so I asked her, "Has this ever happened before?" She shook her head like she couldn't remember a time, and said, "Not often."

I said, "Do you have the pap there? Why is it stat?"

"The OB referred it to someone else, and the new clinician wants to know why the results don't match up. We, of course, would check this ourselves, but they are already aware of the mismatch and want it resolved quickly."

My first question was, "Who reviewed the original pap?" I didn't want to step on any toes. If it was me who reviewed it, I would want to be in on the problem, and I would want to be part of the solution. I saw the pathologist's name, and looked up at the schedule. He was off this week. Darn it. Oh well, I could fix this without him.

I looked at the pap smear while she was standing there. All of the techs had already reviewed it, and all were on the fence between HGSIL and ASC-H (atypical squamous cells of undetermined significance-cannot rule out a high grade lesion). As I moved the slide up and down on the stage, I immediately saw the problem.

Usually, when we see high grade lesions, it is pretty easy because there is a lot of low grade, raisinoid nuclear change in the background, and there are clumps of ugly, hyperchromatic cells with irregular nuclear borders - classic high grade lesions. Here, I saw a few single cells that I learned in fellowship were called "litigation cells." Easy to miss (and subsequently get slammed with a lawsuit because you've got to pay attention to every cell) - because there is no low grade change in the background, no clumps, just rare single cells with really ugly nuclei.

"OK, I see why he called it high grade. In retrospect, in light of the molecular, we could go back and change it to ASC-H, if the OB wants us to do that to triage the patient for proper treatment and follow-up. But first, let's call the molecular company (we currently send these out) and ask them to repeat the hybridization studies. When you call them, find out how often this happens and if there is an explanation - I know there are some rare strains of high grade HPV that aren't covered in their assay. Let's find out what they are, and if we can test for them."

She agreed, and called me later in the day. "The company is going to repeat the qualitative hybridization assay and also run concurrent quantitative PCR studies, which should be more sensitive. They'll call us with the results."

I worried over calling the clinician. I worried over having to change a colleague's diagnosis. I showed the pap to another cytopathologist, didn't give her any of the history so she wouldn't be biased, and she basically agreed with me and the techs. "I'm on the fence. Could go either way." It was easier for us all to be hedge-y in light of the molecular. Those few cells were darn scary.

The cytotech called me the next day. "PCR came back positive. They think it is a rare high risk strain. The diagnosis stands fine, and we will just release the report to the clinician."

Whew. It feels good to make the right call, so the patient can get the right treatment.

Thursday, March 11, 2010

Bradley Method for Life *

At 3 am this morning I stood by my laboring patient's bed. I know her very well. Her heart's desire was to have a natural childbirth. She was 6 cm and progressing well. She looked at me after her contraction.... "Doctor, How much LONGER will this Take.... I can't do this for hours!"

I encouraged her, you don't have to make it for hours. Just make it through the next contraction. Then will think about the one after that. Relax in between. Breathe.

Two hours later she delivered a beautiful baby girl naturally. Tears of joy rolled down her face.

Tonight as I finally drove home, after a full day at the office, my mind raced. I miss my kids, deadlines and responsibilities are looming everywhere. How on earth am I going to make it through the stress of the next few weeks. I am currently back in survival mode. I haven't been here in a while and its not pleasant.

I will make it, though. One day at a time. One patient at a time. I'll try to find moments in between to go to my happy place. Perhaps when it gets really bad, I'll get in the 'knee chest position' and moan or perhaps soak in the tub..... but I will make it.

*I am not an expert on the Bradley Method, though I am a fan.

Wednesday, March 10, 2010

Announcing Next Topic Week March 22-26: Q & A

Our next topic week is going to be in a couple of weeks, with a theme of Questions & Answers. We invite all readers to submit questions - either specifically for one our our regular MiM contributors, general questions that one of us will try to answer, or questions directed at the greater MiM community.

What do you want to know?

We hope this will a fun Topic Week to get to know our contributors better, involve you, the readers, more, and answer any burning (or not so burning) questions you may have for mothers in medicine.

Please feel free to submit your questions starting now at You can also submit questions via our Facebook page or on Twitter (@motherinmed).

Hope you will join in and submit something! Include a short one-line bio (anonymously, if you prefer), for example: Izzy is a surgical resident in the Pacific Northwest.

If you are new to the blog, check out our prior Topic Weeks and Topic Days in the sidebar, under Labels.
For all those students about to find out where they are matching: check out Match Day Topic Day from last year.

Thanks for reading and making this such a wonderful online community.

Sunday, March 7, 2010

The brutal nanny hunt

Tomorrow morning my nanny starts and this is not something I take for granted.

I had a nanny for almost five years, she now wants to only work part-time so three months ago, I went about looking for a replacement. Yes, amazingly, it has taken me three months to find a nanny.

There are so many things about this search that were painful. Amazingly, despite the slump in the economy, experienced and affordable nannies are hard to come by.

In our area, the cost is crazy - most nannies value themselves on their hourly rate, feeling that they are entitled to at least $15/hour. Well, that's fine except that they also want all the benefits of being on salary - like vacation, sick leave, personal days, health benefits etc...for my husband who runs his own company, this drives him crazy because because we are paying more per hour than his (more formally educated) office manager and this 'hourly' rate that nannies use doesn't include the 'true' cost to us - the real baseline is $17/hour since we have to pay social security and unemployment on top....(painful since these are all AFTER tax dollars).

The second most painful thing was finding the right person. I hired one lady who I thought was perfect, and she didn't show up for work the first day because of something 'personal'.

Then I hired another lady who was cheaper, a little less experience but willing to work longer days and she just had no instincts about caring for a baby (mine is now 10 months). Plus, she was missing her own two kids while working long days so that didn't last but a week.

Third, I hired a 25year old student who was taking classes on the weekend. I was really excited about her because she was young, energetic and would live with us so we would have the flexibility of having her babysit in the evening. So we moved all 3 of our kids into one room to accommodate her (yes, I really thought I could manage with all 3 in one room...). The second day she was watching TV, on email while my baby was sitting under the table. The next day my Mom came to check in on them and she was barefoot in the garage, trying to adjust the stroller while she had the baby PROPPED UP on a box...ultimately she confessed that she had no time to babysit and we both agreed it was not a good fit.

The fourth lady seemed amazing on the phone but it turned out she had NO filter. When she came over for the first time, she expressed many opinions including inappropriate commentary about my kids in front of them. She also only provided references from five years prior and didn't show up to her second day on trial because she thought it would be ok....when I called her to tell her she didn't get the job she really let her words sneak out of her mind and I was reassured that I made the right decision.

Finally, we found our current nanny who has been with one family for the last 8 years- she's wonderful. We found her from a teacher at the preschool.

I must have interviewed over 30 ladies on the phone and brought 20 ladies home over the last few months. I bought subscriptions to all the nanny websites and as good as their services are, the nanny I loved came from a personal reference...which in the final analysis is really the best way to find a caregiver.

For anyone who's interested, Here are the sites I used: - good listings, good sample documents to use - utlimately the best site I found, I got a lot of responses from this site and found the spectrum of young and mature
- found most of them to be quite young and a lot of people who just want part time work - the indian classified ads, people willing to work for good rates, good hours but most want cash

Others include:;

I would be happy to share many more pearls from the nanny hunt for anyone who's interested. For now, I'm just enjoying all the free time I have!

Saturday, March 6, 2010

MiM Mailbag: Self-entitled?

Editorial note: We received an anonymous comment this past week to a post that was published about a year ago on this blog (Fizzy's I hate boys). I debated whether or not to publish this as a MiM Mailbag since it has the potential to become an inflammatory discussion that would ultimately not be constructive. However, the comment presents challenging views that many women face when having children during training (and sometimes beyond); a thoughtful and respectful discussion about the issues raised could further understanding by all. So, feel free to join in, but please keep comments constructive and respectful so we can have an intelligent discussion. Thanks.

I am not really sure why all of you self-entitled people in medical school and residency, think that it is actually an acceptable time to be having children at all.

Your absence put a huge burden on the remainder of your class, and your constant need to leave early to "be with the kids", "take care of sick kids", etc. just highlights the fact that maybe you should have chosen a career more inline with what you percieve to be an ideal life - like being a PA, nurse, etc.

The ultimate problem lies in the people who seems to "want it all", but feel they are "special" and don't need to sacrifice anything. Because some of us don't want children doesn't mean that we should supercompensate for those that do. Not everyone was meant to be a doctor, and if other people started using similar excuses in would certainly raise eyebrows - eg: I NEED to go on frequent climbing trips because it is consistent with my world view of life and you OWE it to me.

Basically just entitlement by another name, but not overly surprising in this society.

Wednesday, March 3, 2010


When I was pregnant with my son (now 15 months) I sat down with Dr. Sears' book. I probably did not fully grasp the true philosophy of attachment parenting. What I do remember is one statement in an early chapter that disturbed me at the time and haunted me since.

I remember reading that mothers who work full time and take time off for maternity leave have a high risk of attaching poorly to their babies. That instead of completely focusing on the role of mother they instead are preparing for the day they will leave the child. Preoccupied with their career they are unable to be fully responsive to the needs of the child.

I am sure many reader's blood is boiling right now. Now if I have mis-quoted Dr. Sears I apologize, but even if I did my real point is this: I think about this all of the time. When my son was a newborn and would not nurse, my sleep deprived hormone toxicated brain determined it must be because I planned to pump when returning to work. When he did beautifully with the transition to day care, I figured he didn't really miss me. When he runs to daddy when tired, I take it as further evidence of my shortcoming.

This is working mommy guilt and as a Mother in Medicine I did not invent it. Upon reflection I think overcoming this thinking is a unique challenge for the following reasons. First, I sacrificed a remarkable amount of sleep, happiness and personal well being to become a cardiologist. The idea that I could continue to sacrifice in a way that I would later regret is a true possibility. Second, in reality if I had to choose either my career OR motherhood it is not 100% that I would have chosen motherhood. This is perhaps difficult to explain but I feel like my work is a calling that I was born to do and is my mission in life. Finally, I am a master organizer/ planner. Indeed I was pre-occupied during maternity leave planning my return to work. But only because of my deep respect for how challenging it was going to be- and my desire to arrange help so that I could enjoy my son (an hopefully not kill anyone in my mommy-head state).

So I put this out there to share how my consideration of attachment parenting led to a judgment that is difficult to shake. The challenge to be a mother, as a full time physician, as a perfectionist, as a woman committed to caring when it seems no philosophy can be easily applied to my reality.