Friday, April 30, 2010

MiM Mailbag: Having kids during 4th year before ortho residency?

I am a 1st yr medical student who is interested in Orthopedic surgery. My husband and I were talking about when the best time to have a baby during medical school/residency is. I am military so my residency will be in an Army facility. Based on your experiences, would having a child during 4th year be feasible?

Thanks for your opinions


Thursday, April 29, 2010

Coming Home...

I have mixed emotions about CME courses that take me away from home. Although I enjoy time in a new location and having a break from my typical daily grind, sometimes the toll of being away from family is high, and coming home can be an adventure:

"Mom, while you were gone I forgot to register for my AP exam. What should I do?"

Late fee (after countless calls to coordinator): $50.00

"Mom, before you left, I forgot to tell you I needed a costume for that thing at school"
Improvised costume (NOT Eeyore!): $25.00

Me, sniffing around the kitchen: "What is that smell?"
"Erg, I think I forgot to unpack the milk container from my lunch box last week."
(Husband, shrugging apologetically: "I thought the kids needed showers...")
New milk container and lunch box: $15.00

Finding two dozen chocolate cupcakes in the dining room "Just because we thought you'd like them": PRICELESS
(Cleaning chocolate frosting off of everything for the next 10 days: another post!)

How do you cope with the things that come up while you're gone?

Wednesday, April 28, 2010

Things That I Say Every Day (Home Edition)**

Although the dialogue is less technical, the day to day grind finds me saying many of the same things to my wonderful family. Here are a few of my most well-worn phrases....what are yours?

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Tuesday, April 27, 2010

Things That I Say Almost Every Day (Work Edition)**

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross-posted at Ob/Gyn Kenobi**

Monday, April 26, 2010

Your alternative career

RH+'s last post got me thinking about choice of specialty.

I am pretty happy with my choice of PM&R as a specialty. Right now, I'd say I'm about 90% happy with that choice. But.... about 10% of me kind of wishes I had become a neurologist.

I took neurology as a rotation before PM&R and I really loved it. It was one of the few rotations where I didn't mind putting in ridiculously long hours. I won't get into all the things I liked about it, but suffice to say, a lot of people tell me I should have become a neurologist. I think it's because I'm a HUGE NERD. Why I didn't become a neurologist is a long story, but like I said, I'm 90% happy with my decision as of now. But if I weren't a physiatrist, I would definitely want to be a neurologist.

So your challenge is to complete the following sentence:

If I wasn't a ____________, I would probably be a ___________.

Feel free to complete the sentence even if neither of the blanks can be filled with a medical specialty. (Example: "If I wasn't a lawyer, I would probably be a zookeeper.") And feel free to explain your answer. What you are NOT allowed to do is say something like, "I love being a urologist so much that I can't imagine doing anything else, and if the field didn't exist I'd just have to throw myself off a bridge!" I mean, yes, you could say it, but I'll secretly think you're full of it.

Sunday, April 25, 2010

Why I became an OB/GYN

More than anything in life I wanted to be a family practitioner. Going into medical school there was little doubt in my mind that this was my chosen path. I chose a school that had a significant focus on primary care and was president of the Family Practice Club my second year. I had shadowed several FPs and truly enjoyed the continuity of care that went into FP.

When I started my rotations as a third year student, I was obviously excited to do FP as my first. After about 3 weeks, though, I wasn’t ready yet to admit it to anyone else, I was starting to have doubts. The practitioner I was working with was great he really took a lot of time to teach me and I saw some interesting pathology, but it wasn’t quite what I thought it would be. I told myself I had just built it up too much. I was a little concerned, but knew I had a few (our school required 6 months of FP) more months to try it out.

The next month, I did an away rotation in internal medicine with a wise internist who had been in practice for 30 years. While I didn’t love internal medicine, I did love the internist I worked with. I soaked up every bit of wisdom about life and medicine he sent my way. He really tried to teach me to THINK and not just memorize facts. On my last day of the rotation he sat me down and said essentially that I had done well on the rotation, but he really thought my personality was the most suited for OB/GYN.

My first thought was utter disgust… What a sexist! I was sure he was just saying that because I was a woman. OB was becoming a female dominated field, but the last thing I could possibly be interested in was doing PAP smears all day. Yuck. And child bearing had no interest to me whatsoever. WAY too messy.

I composed my initial thoughts and replied, with a simple No thanks!

When’s your OB/GYN rotation he asked?

The last one of the year I replied. I had postponed it to very last.

You should seriously consider moving it up to earlier, he encouraged me.

I thanked him for his advice as a courtesy. Then thanked him profusely for the other things he had taught me.

On the drive home I was still fuming about his remark. However, my thoughts began to wander. His wife and all 3 of his daughters were doctors…. none OB/GYNS. There were no other sexist things he had said or done the whole month. I respected him greatly and had trusted all the other advice he had given me. Perhaps, I should listen and at least move my rotation up to earlier in the year.

After several frantic phone calls trying to set up a rotation, the best I could manage was a local private practice doctor, in desperate need of some CME’s who agreed to let me rotate in his office. I ‘did’ very little during this month, but what I observed was life changing. I watched his daily practice, his rapport with his patients and the continuity of care. He was able to practice preventative medicine in a real way (one of my passions) and also do very interesting surgery. I watched babies born then same day I watched him remove a giant ovary full of teeth and hair. On my last day of the month as I drove home and I broke down into tears. I couldn’t believe my month was over… I didn’t want it to end …. Ever. I feel in love with the crazy life of being an OB/GYN.

Then began the soul searching. How could I have a family and balance in my life and be an OB/GYN? I loved my month of OB, but as I looked at the hours that the attending put in, I wasn’t sure I could hack it. After months of pro’s and con’s lists and long discussions with my husband, I finally decided to go for it. I would rather do something I loved for 50 hours a week then something that bored me to tears for 10 hours a week. After my required 6 months of FP…. I knew it wasn’t for me. OB was my Edward and anything else would just be my Jacob.

This life is NOT easy. The hours do get crazy. My husband and family are a constant in my life to help me my life balanced… that and a great practice. Also, I believe it was Dr Whoo who has said that you should only do OB/GYN if you nothing else will make you happy. I totally agree, this life is not for everyone.

So here I am, 5 years into private practice quickly approaching my 35th birthday reflecting on how my life is nothing that I expected it to be when I began this crazy adventure in medicine. I realize now, that it is amazingly better.

So, thank you Dr. Internal Medicine for your excellent advice and seeing something in me that I hadn’t seen in myself.

Friday, April 23, 2010

MiM Mailbag: Feeling like an outsider applying to med school

Dear Mothers in Medicine,

I found your blog about three days ago and it is just what I needed.  It is like I placed a special order with the blog gods.  Thank you all for your humor, insight, and honesty.

What brought me to the site originally was MomTFH's guest post about med school with kids. What I read spoke right to me.

I am a single mother of a beautiful, charming, sweet 15-month-old daughter and I would really like to start med school in the fall of 2011.  Last year I applied to the one med school in my state, but just as MomTFH said, I entered the application process woefully unprepared and blew my application because of stupid stuff (and attended my interview 38 weeks pregnant which certainly made me stick out like a sore thumb).

Now I'm ready to get serious about applying for the fall of 2011, but I'm still woefully uninformed. I have  good undergrad grades (3.96 GPA), good MCAT scores (35Q), a strong research background with a research-based MS from the University of Michigan, and I ran varsity track & CC in college, but I've never been part of the pre-med world and I have no idea what I should  do or know to be prepared.  At the time of my interview I felt like such an outsider and I still feel like an outsider. What do I need to do to be in the know? I volunteer weekly at a Children's Hospital, but what else should I be doing to prepare myself to apply and for any interviews that may come my way? (I do work though, so I don't have TONS of time at my disposal).

Also, sorry to trouble you, but I have a second question: I may not be able to fully grasp the depths of difficulty that come with attending medical school and doing a residency with a child, but I can certainly imagine.  (Luckily if I am able to get in and go, I will probably have a lot of help from my family.) I also understand that there is a lot about being a doctor today that is no picnic.  I think it is only sensible to do this if I am fairly certain that I will be passionate about medicine and being a doctor.  Can you make some suggestions as to what I could do to get a good idea about that?

Thank you so much for your time!

Thursday, April 22, 2010

The little things that kill

Recently, I overheard someone at work saying she went on Zoloft, an antidepressant. "Little things don't bother me anymore," she said. "Something will happen and I'll know that it's something that USED TO bother me, but it just doesn't anymore."

I was jealous. I'm not on Zoloft and I'm definitely guilty of letting little things bother me. I let myself get incredibly aggravated over details in my contract at work. (I definitely get way too aggravated over work stuff.) I worry my vacation won't get approved. I overanalyze every little interaction I have with everyone.

My latest "little" aggravation is over my apartment, where our lease is up at the end of the summer. Instead of accepting the highest rent increase in the building (and a landlady who won't fix things because "it wasn't broken when you moved in, so how could it be broken now?"), we've opted to move. Our landlady, who took a huge loss when the housing bubble burst, has recruited every housing broker in town to rent out our apartment at a monthly rate so high that it might never get leased.

As a result, I've been getting daily calls from sometimes multiple brokers, asking to show my apartment later that afternoon. It's hard to accept that there will be strangers coming into my apartment every day, usually with not more than a few hours notice, and I admit it bothers me. What's more aggravating is the emails from my landlady, criticizing me for having dirty pots in the kitchen, saying that because I am such a slob, the apartment will never get rented.*

My husband tells me to let it roll off my back, that I shouldn't let these things bother me. He's not bothered, after all. And he's right--it's SO unimportant. But I can't help it.

I'm trying to deal with these aggravations with exercise. I've been walking home every day, weather permitting, and trying to do exercise videos with Melly at night. It helps a little bit, but I still find myself obsessing more than I should.

How do you deal with the "little" stresses in your life?

*Note: Sorry, I probably went on and on about the apartment thing for way too long, but I am just SO ANGRY over the whole thing and I needed to vent. If you want to call my landlady a bad name, that would totally help me out.

Wednesday, April 21, 2010

Guest Post: Call night hijinks

An email from the husband of a resident on-call that caused serious laughter by said resident at the nursing station at 1 am.
Hi Babe, 

Here are your call night pics.  Kind of a rough night here.  I came home to find that [Cat 1] had puked all over our comforter so that's in the wash.  I was in the bathroom with R and he was playing in the cabinet...busy and pulling things out so I thought I could take a quick pee.  Right as I finished, he quickly turned towards the toilet and as I was zipping my fly and reaching down for him he darted to the toilet bowl and put both his hands directly into my fresh pee (gross) so I grabbed him before he could put his hands anywhere and washed his hands for like 5 minutes in the sink.

R was really tired from the time we got home so I started to feed him dinner, which he fussed the whole way through but still ate a decent amount.  Then came bath we're about 75% through the bath and there's a knock at the front door.  Baby boy was sitting down playing and very busy with the ducks so I made a quick run for the door and it was the next door neighbor wanting to talk about the easement again.  I said "Sorry dude, gotta run - my son is in the bath and I can't leave him unattended, come back tomorrow" and basically shut the door in his face. I ran back into the bathtub to find R standing up, holding his business and peeing into the bath.  I guess he just wanted to be like Dad since he just saw me about an hour before that urinating into the toilet.  End of bath time...I grabbed him out of the bath before the pee circulated through the water and drained the tub.

Bottle time and he was pretty fussy through the entire bottle but still being a little sweetheart but he was just really tired!  He just now fell asleep after about 30-45 min of yelling and moaning.  I walk from his room to go put the comforter into the dryer and [Cat 2] has peed in front of the litter box. There was litter literally all over the laundry room20 minutes to clean that mess up.
I hope you're having a good call night because these 3 dudes totally wore me out!  I'm going to be hitting bed early tonight!

I love you and we miss you, looking forward to having you home tomorrow and the good news is that you have Saturday off!!!

Your tired Husband (And Baby boy of course)

Monday, April 19, 2010

MiM Mailbag: Medical school, with a disability

Hi, MiM!

I'd like to start by saying that your blog inspires me each and every time there is a new post or I just can have a moment to pop in and read the archives! Way to go, ladies! Now, I'm Erin, a pre-medical student from Georgia. My case is a little special.

I'm a music therapy major with a pre-medicine advising track. For many reasons, but the main one is the fact that math and science are just not my thing. Having mild spastic cerebral palsy, I didn't know what was possible or if that was even something I should consider due to physical issues.

Then I realized. It's not about me; yes, I'm the one that has to complete the coursework and get the MD behind my name, but the patients that I serve are so much more important than whether or not I think I'm academically capable. I'm not saying that your GPA isn't important because I know that it's one of the biggest things that med schools consider during the admissions process, but it's more important to me to treat my patients with the highest quality of care possible, keeping in mind that though the human body is fascinating, the fact that I'm making sutures in an abdomen isn't "cool"; though unintentionally, i am inflicting pain upon this patient, and why would I think it was "cool" to see the reason for someone's suffering to unfold? I guess that just comes with having twenty years of clinical experience "from the other side of the table" and unfortunately, for nine of those times in the last twenty years, the surgical patient was me.

Currently, my medical school interest in terms of specialty is physical medicine and rehabilitation, so Fizzy's articles are some of my favorites. I'm toying with the idea of taking a fellowship in peds and then adding on a fellowship in developmental peds so that I have the opportunity to be the doctor I wish I had when I was younger, and besides that, they're just cute.

So, while this may be going out on a bit of a limb, my questions are these:

How do you think is the best way to approach a disability in front of the medical school staff?

Which parts of the process, based on what you all know, will be difficult for me?

How should I "keep my head high" despite obstacles I face?

Oh, and I'm a blogger as well. Feel free to check it out at the link below. Look forward to more of your tweets and blogs!

Thanks, ladies!

Sunday, April 18, 2010

Lessons learned on the wrong side of the stethoscope

I was walking down the hall at work on a very ordinary day in December. I had sudden onset of excruciating right shoulder, neck, and upper arm pain. For the first time in my life, the "...if 10 is the worst pain you can imagine" finally had meaning. It took my breath and brought me to tears. I took the Tylox I had been given after childbirth (two years ago) with little relief. By the following evening, I was markedly weak in my (dominant) right arm abduction and external rotation. I couldn't even lift a fork to my mouth righthanded without using my left hand to prop up my right elbow. The next 48 hrs were a whirlwind: emails, calls, and pages to my internist (I am usually a once a year-ish whether I need it or not patient), a possible diagnosis of multiple sclerosis, MRIs of my brain, spinal cord, shoulder, appts with ortho, neuro, and ultimately neuromuscular, including the test that provided a diagnosis: an EMG/NCS. The diagnosis was something rare called Parsonage-Turner Syndrome. I had never heard of it before (which is a very bad feeling as a doctor).

So, what have I learned from this experience of being on the wrong side of the stethoscope? A lot that I am still struggling to put into words and a lot worth sharing.

First, no matter how exciting a case is, how rare, how great a learning opportunity for you, etc, you MUST NOT say this or show your glee in front of the patient. I know such excitement can be hard to contain as a newbie medical student or doctor. I, in fact, have a very experienced internist who nonetheless said "Isn't this cool?" to me during my annual appt on multiple occasions once the diagnosis had been established. As a doctor, I know what she meant. I do recall my days in general internal medicine, when I thought I might fall over dead before the end of clinic if I had to fiddle with the dose of one more antihypertensive. I KNOW what it's like to need a good case to spice up the day. I KNOW this was an awesome medical mystery with a rare diagnosis and ultimately a good long-term prognosis. What could be better, right? But the bottom line is that I am still markedly weak, now 4 months later. I still can't pour milk for my kids from a gallon jug, hold my 2 yr old in my right arm, or lift my work bag right-handed out of the passenger seat when I get out of the car. If I were, for example, an orthopedic surgeon, my career would be over or at least on hold for probably a year or more. It has been life-changing for me, and not in a good way. So, yeah, it's cool for the doctor. Yeah, it's a great case to present (and yeah, I agreed to suffer the indignity of being presented as a case in a conference I used to attend showcasing rare diagnoses at my former residency program, at the hospital where I am still on faculty). But, as the patient, it was decidedly NOT cool. I cringe to think about all the times I presented patients on rounds or in conferences with what I'm sure was obvious excitement over this "great case". Patients, please forgive me.

Second, a little kindness goes a long way when you're in a medical crisis. When I had my first C-spine MRI without contrast, it had motion artifact but was read as potentially consistent with demyelination. As I lay there alone on the MRI table having my repeat C-spine MRI and brain MRI with contrast to look for MS and other badness on a Thursday afternoon, I had a lot of time to worry and grieve for the normal life that seemed to be receding into the past very quickly. When the tech, whom I knew could spot an MS plaque or a met on those MRIs as well as any radiology resident, came in afterwards, I begged her to tell me if she had seen anything bad. She told me that she wasn't authorized to give me any information and that I should be able to get the report in a day or so. I knew that, of course, as a doctor. But, as a patient, I couldn't bear another moment of waiting. My eyes welled up with tears as I went to leave. She hesitated a moment, then put a hand on my shoulder, looked right in my eyes, and said, "Dr. Tempeh, you have a WONDERFUL weekend." It was her code to tell me that things looked ok to her eye. I remember it as one of the greatest acts of kindness I have ever experienced.

Third, it is a really worthwhile and eye-opening question to ask a patient how a medical condition is impacting her life. The first and only doctor to ask me that to date (and I saw several along the way) was actually the neuromuscular specialist. I think that question got him the most accurate picture of the extent of the neurological impairment--I told him that I could no longer use a pitcher of water to rinse my kids' hair in the tub because I was too weak to lift it, that I had quit blowdrying my hair because I could no longer do it right-handed and it turned out weird if I did it left-handed, and that I had quit leading a certain conference because I couldn't hold my right arm above shoulder height for more than a minute or two to write on the dry-erase board. It didn't take him long to ask or for me to answer, but it felt much more "real" than his assessment of my strength through a standard neuro exam, even though the neuro exam ultimately showed the same. I didn't realize how frustrated I felt by these losses until I had a chance to reflect on them and share them with a doctor who showed an interest. And the sharing was therapeutic for me in and of itself.

Finally, validate your patients. As an internal medicine resident, I was never good at taking care of the patients with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome. I had always been taught that the best way to approach these patients is to validate their symptoms--telling them "I know that you are in real pain," etc. I couldn't ever do that, or not very well anyway. In my heart, I wasn't even sure these were real diseases. I have to tell you that although I have never been eager to hear my name and the word "disability" in the same sentence and that I still hope never to take advantage of the disability policy I have been paying for since residency (which you should get by the way), it was a relief when the neuromuscular specialist said after examining me and doing my EMG/NCS, "You have a real disability. This is something called Parsonage Turner Syndrome." It all happened so quickly, the development of weakness literally over the course of hours, to the extent that I struggled to wash my own face and dress myself. For days as the diagnostic workup went on, I vacillated wildly between being convinced that I had something devastating--a demyelinating disorder, brain metastases, something--and that I, a previously healthy person, had for some reason actually gone crazy. Just hearing from someone in a position of medical authority that I was not crazy--that this was real and had a name even--inspired my total gratitude. I wish I could go back and have a do-over now with all of those patients. I could have done so much better for them.

Humility is hard-won.

Friday, April 16, 2010

Who would have thought a volcano would erupt?

I'm stuck in Frankfurt...alone. I planned it all so well. I was attending a conference this week in Luxembourg, planned to be away for four nights from my three kids. My parents are helping, nanny is helping etc. I was supposed to get back on Friday and my husband was to leave for a meeting in Houston - essentially passing the baton....I don't travel much so needless to say I spent a lot of time making detailed plans for the kids - sleepover at grandparents home, rides to activities etc....after all that planning and a deep wish for my travel not to become a burden on anyone, I am now stuck for what looks like three more nights!! I guess you can plan all you want but who would have thought a volcano would erupt?

I was supposed to fly out of Luxembourg this morning but when I realized my flight was not going to leave, I took a train to Frankfurt and re-booked for a flight out tomorrow morning. As soon as I got here, I was told that the Frankfurt airport is also closed and that I would likely not be able to get out before Monday....Monday!!!

The worst part is that I have spent the last 24hours in panic-mode unable to relax. I finally went for dinner in my hotel and took a Real Simple Magazine, trying to relax...I'm so used to multi-tasking it was a really hard day to just be in the moment. I kept thinking I should open my netbook and finish checking email, or work on some of my work projects or send emails from the conference contacts.

Finally, it occured to me that I needed to do what I do best. Make a To-Do list for my weekend away. And finally I started to realize that this weekend is an opportunity to indulge in some 'me' time. I made a list of all that I would do if someone gave me a weekend off...

Now I'll do what I always do and spend the next two days checking things off that list! What's on my list? Well - it definitely includes shopping, pampering and some blogging as well :)

Guest Post: Second-guessing career choices

As of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D..  I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day.  I sit here, where I worked so hard to get, wondering if I made the right decisions.
My grandfather died from CML when I was 6, the years prior to his death being spent meeting his medical needs.  My experience of the impact of illness upon a family drew me toward medicine and at the age of 6 I embarked upon the road to becoming a physician.  While I could not understand this at 6, I suspect now, that I yearned for some power over illness and becoming a doctor seemed to meet this need.

In high school I decided upon pediatrics.  I continued to follow this path, volunteering with pediatric oncology programs and the like.  One summer during college I returned to my hometown and happened to find my way into a women’s health clinic where I served as an intern, counseling women on abortion procedures and birth control.  I loved every minute of it and was eager to learn more so that I could help my patients.  I got involved in activism in a way I hadn’t before.  From the day I started, I knew that Ob/Gyn was my calling.

Halfway through my third year of medical school, however,  I stood in the OR, 33 weeks pregnant, having held a bladder blade for who knows how long, thinking I just couldn’t do this anymore.  My ob/gyn rotation, the 6 weeks I had expected to confirm my career choice, left me wanting.  I hated the OR, I really didn’t want to be like the residents I was working with, I wanted to see my family, and I didn’t want to worry about the malpractice.  The 3 past weeks I had spent on the gyn service had been 3 of the most trying of my education to that point.  The next week I moved on to the OB portion of my rotation and absolutely loved it.  I loved following patients through prenatal care and delivery.  I loved the raw emotion and I never thought of it as work.  I was thrilled to be able to be part of my patient’s lives in such a real way.  Maybe I could do this after all.

My son was born at 37 weeks and after having a placental abruption, I was scared to death of ever being the doctor in charge of a delivery like my own.  I lumped together my loathing of operative gynecology with my new-found fear of the sudden twists a routine low-risk pregnancy can take and decided against ob/gyn.  This, despite my love of prenatal care, primary care, and procedures.  This despite the relative ease I had with the material, my true interest and passion in the field.  My decision was final, I didn’t think I had what it took to be an ob/gyn.  I set about finding another specialty and over the next year and a half (I took 5 years for medical school) flipped-flopped between fields.  My husband calls my decision making process the Hamlet approach, one which I do not suggest to other medical students choosing a specialty.  In the end, after much drama and many second guesses of myself, I landed a spot in Dermatology.  In the end, it was a well thought out, rational decision.   I was thrilled with my match for all the reasons I told myself I should be.   Dermatology offers a great combination of surgery and medicine, plenty of small, what I like to call non-scary surgeries, great pay, weekends to spend with my family, and the list goes on.

One week after my match, my second son was born.  Within a few days, I immediately felt that my decision to go into dermatology was the wrong one.   I felt an immense sadness knowing that I may never be involved in birth in such a personal way.  I cannot be sure what part of this to attribute to the fact that I may not have any more children myself and what to attribute to my second thoughts about my career choice.  I know teenagers can get emotional about acne and that skin cancer is a very real and serious problem, but I have a hard time getting emotional about accutane and imiquimod, in the way I get emotional about abortion and pregnancy.   I have begun to look at the medical journals that arrive in the mailbox in a completely different way.  While I want to read the articles on preterm birth, I feel I must force myself to concentrate on the newest treatments for lice and scabies.   

So it is that I sit here, wondering which would have been the more perfect decision, ob/gyn or dermatology.  Perhaps that is my problem, that I believe there was a perfect solution.   To be honest, my family came first in my decision to pursue dermatology over ob/gyn.  My husband has been a saint throughout my medical education, finding ways to occupy himself as I set about marathon study sessions most every weekend, taking on more than his fair share of childcare duties, and making numerous sacrifices in terms of his career, so that I may follow my dream of becoming a doctor.  I made the decision to become a dermatologist, in part to allow us to have a life with a bit more balance, where he will eventually be able to follow his own career goals.   But as I reflect upon my decision, I wonder if it was actually to his benefit and to that of my children.  Would I have been happier doing something where I did not have to convince myself that my work was important?  If I felt like I was making more of a difference with my work and truly loving it, would I be a better mother and role-model?  Or would the continuous strain on my family and relationship with my husband have outweighed this benefit?

For those who have lived through this decision, what are your thoughts?  If you had it to do over again, would you?  Have any of you switched specialties after your initial match?  How have your spouses and children dealt with the continuous demands of your career in medicine?

Monday, April 12, 2010

MiM Mailbag: Anesthesia vs Cardiology (vs OB/GYN?)

Dear MiM,

My name is Taj. Let me just start off by saying I am 100% sure that I am going into the medical field. There's no backing down on my part. I am a highschool junior getting ready to start applying to schools next year and my first choice is the Sophie Davis School of Biomedical Education, a 7yr BS/MD program (not sure if you ladies heard of it). Also any advice you can give on surviving pre-med and medical school I will gladly take :)

I am really interested in anesthesiology and cardiology so my question is really for MommyDoctor and JC. I wanted to know how and when did you ladies juggle and decide when to have kids and also what do you both love about your careers?

MommyDoctor do you work oncall? How did you know you wanted to go into anesthesia and why? What do you love about your job? If you weren't an anesthesiologist what other specialty may you have chosen?

JC what type of cardiologist are you...ex: an interventional cardiologist, cardiac surgeon or just general area cardiology? How did you know you wanted to go into cardiology and why cardiology? Do you think you would have ever gone into cardiac surgery? If so do you think you would still have time to have children? If you weren't a cardiologist what other specialty might you have chosen?

I also have a question for Dr. Whoo.

I actually like babies and the whole aspect of pregnancy and delivery that's how I know no matter what specialty in medicine I choose I want to have kids. But Dr. Whoo how did you come to terms with going into ob/gyn. I think I am interested in it but I am just scared of the malpractice suits.... :( I think that would scare me from going into that specialty.

Thanks in Advance,


Saturday, April 10, 2010

Freaking out about away rotations

Hi, I’m MomTFH (from Mom’s Tinfoil Hat and Foodie Loves Picky). I have written three guest posts here at Mothers in Medicine, and participated in the last topic week, but this is my first post as a (squeal!) contributor. I love this site and its contributors, and I am so honored that they want me as a mom medical student voice.

I am a medical student at an osteopathic medical school in Florida, and a mom of two boys, currently 11 and 5 1/2. I am just about to finish a year long pre-doctoral research fellowship. I will resume my medical education as a third year student starting clinical rotations in July.

I was planning on writing a touching, self-actualizing first post, based on the recent birth of my cousin Susan, weaving in reflections on the birth of my first child, my journey to obstetrics, and the joy of observing a practitioner who is an incredible example of how to combine evidence based medicine with woman centered obstetrics. That post still may come.

But, for right now, I’m freaking out about away rotations.

The fourth year of medical students consists mostly of elective rotations. Those rotations usually involve “audition rotations” in your specialty(ies) of choice at your location(s) of choice. These are usually month long commitments, in which you are supposed to work your little tail off, so this potential residency site wants you to be part of their incoming team of residents.

There is only one residency site in my immediate vicinity. All of the other sites of interest to me are at least a half day drive, if not a several hour flight. If I could combine this into a summer vacation for my family, we would possibly be able to work something out with them coming with me to one or more of these locations. But, these elective rotations usually happen in the fall and winter, when the kids, S (11) and Z (5) and my husband, Coach Stu, are in school. There are months of elective rotations for most of the year, but interviews occur in November, December and January, so your audition interviews should occur just prior to or during those months. Let's not even get into the fact that a lot of huge, family oriented holidays occur during October, November and December.

How can I just disappear for several months? Many programs end up selecting many residents who don’t do an elective rotation at their site. But, most sites do choose many new residents who did a rotation there. I have no affiliation or connection with many of these sites, otherwise. I am a pretty good student with pretty good test scores, but I am also an osteopathic student competing to get into an MD system. Not to mention I am going to be forty my first year of residency, and have two kids and a husband in tow. I need any edge I can get in applying.

Is there any way I can put my kids, husband and pets in deep freeze hibernation (Alien style) for a year? I can fly around, do away rotations, fly to interviews in several cities, and not worry about abandoning my family. Then, I’ll get my match results, hopefully in some fabulous, progressive, friendly city with seasons at a wonderful, academics and research-heavy focused residency program with night float, while still being family friendly, in a place I happen to know some moms already (hey, I can dream, can’t I?). Then, I can thaw them out, and we can all move there together.


Friday, April 9, 2010

MiM Mailbag: Maternity leave for residents

Editor's note: Any reader who has experience with this is welcome to post her answers to the questions below (i.e., not just limited to MiM's bloggers!).

I was happy to find your site today.  I'm a physician in academics and the issue of maternity leave for residents is important to me for two reasons. I was the first woman in my program to have a baby as a resident and, now that I am faculty, I feel some responsibility to help the female residents navigate motherhood during their training.

One question for your bloggers:  How commonly have women had to extend their training due to maternity leave?  Was this due to taking longer than the 6 weeks allowed by the specialty's academy or the hospital (or maybe it's longer for some specialties)?  Or were some women required to "make up" the weeks they missed, even if they only used 6 weeks of maternity leave?  At our hospital, it appears that there are different standards in different departments.  Some faculty are concerned that women are missing too much time in their training, especially if they deliver during chief year.

Erin O'Brien MD

Thursday, April 8, 2010


Abscess incision and drainage does not disgust me; in fact, I find it out-and-out gratifying. Most clinical events which might make non-medical types blanch induce absolutely no squeamishness in myself, including hemorrhage, open fractures, limb amputation and digital rectal exams. Diagnosing lice makes my own head violently itchy but doesn't make me squirm. Contrary to the belief of every patient whom I have asked to remove their shoes, feet - no matter what their condition - will not offend me. Same goes for unshaven legs and unmanicured perineums: I truly take no notice.

As a mother, the list of biological events with potential to repulse me has long since dwindled to almost nothing. I have survived the following with grace: vomit splashed down the neckline of my shirt, infant stool jetting up the back of a onesie and beyond, nares perpetually flowing with green discharge, and potty-training errors on carpet.

Between the two professions, I've got almost all offensive agents mastered. Almost. There are a few holders-on whose power to disgust me I can't dislodge:

  1. Soiled bandages. Whether it's gauze peeled from a surgical incision or a tiny band-aid ring that's fallen from my daughter's toe, there's something about absorbed drainage that I find revolting.
  2. Eyes. Specifically: globe rupture.
  3. Earwax. Cerumen being flushed into a little basin in my office is acceptable. Q-tips dropped into a wastebasket without being shrouded in Kleenex is not.
  4. Collections of cheesy substance in body creases of those who don't wash with due diligence.
  5. Vermin. I'll examine insect bites with interest, but bedbugs scuttling from the cuffs of a patient's shirtsleeves across my desk is too much.
  6. Prolonged coughing or throat-clearing where the sputum is clearly substantial in amount but difficult to expel.

Tell me yours.

Tuesday, April 6, 2010

The Book Report

The other night at about 7:15 p.m., 15 minutes from teeth brushing, book and song time in my house, Sicily announced excitedly, "Mom! I've got something we need to work on! A book report! Let's do it now."

She ran to her backpack and got the worksheet. I told her, "Sicily, I've already seen the note. We've got two weeks. You need to pick out a book, one over 32 pages, to read. That's what we will do tonight. Then you can write it, I will help, and we can practice the presentation and get the outfit so you can dress up like your favorite book character. It doesn't all have to happen tonight."

She grabbed a book I bought for her over a year ago - Hope For the Flowers. I read it to her a few months back. I bought it because I remember reading it when I was little and loving all of the pictures. It was well over the 32 page limit, and it had a nice moral, one that I probably failed to pick up on when I read it as a little girl. Get out of the rat race - it is pointless. Follow your heart and you will fly.

I told her, "You have plenty of time to read it on your own." She is reading chapter books well into the late evening now - lots of Amelia Bedelia and Junie B. Jones. Her reading level has shot up by leaps and bounds in first grade this year. While I was reading and singing to John, she had her own agenda. I entered her room after I settled him down.

"Mom, I've got the report almost done. Will you check the spelling?"

I noticed she had basically copied the first few sentences of the book in her summary. It was her first book report - and she clearly didn't have the rules down. I explained to her gently, "Sicily, you can only write a book report about a book you have read yourself. Remember, the characters had names? Stripe and Yellow, I think? You have plenty of time to re-read it, and I'll teach you how to summarize it in your own words. I know a little about writing, so I can help you."

She barely contained a total melt-down, but she contained it well. "What do you know about writing, mom?"

"Well, I write a little on the computer. That is what I do at night, while you are getting to sleep. Lots of people read what I write, and I get a lot out of it. A sense of community."

"Is that what all that clicking on the computer is?"


She went to the task of picking out her own book, even though we were well past bedtime, now. I told her she only had to pick her book tonight, and the rest had time. She entertained and rejected a few Amelia Bedelias. At about 10:30 at night, while I was on the couch reading, she sneaked in the living room. Kept her distance, and quietly announced, "Mom. I found the perfect book. Hello Kitty. It is 42 pages. I read it and I wrote a report. Please read it for me?"

"I'll read it tomorrow, Sicily, and we'll talk about it then. You really need to get to bed. It is a school night."

Ever since she started reading well, she stays up way too late. She is like a teenager in the morning, grumping around and wallowing in the covers until I lose my temper and start ordering her around like a prison warden. We both hate it. I have a hard time outlasting her stamina - she is like the Energizer bunny at night. On Easter eve, I accidentally fell asleep on the couch reading. When I woke up, I worried that I had missed my charge, and frantically looked at my watch for the time (midnight, thank goodness - still time to head to the attic and get the baskets - fill them with the goodies I had stashed in the basement). When I was supposed to be the Tooth Fairy a couple of months ago, and forgot, I had to frantically put some $$ under John's pillow and make up a story that the Tooth Fairy got confused.

When she is not reading at night, she is performing elaborate art projects on her bathroom counter. One morning last week she had nothing short of a sheer masterpiece - a beautifully decorated jewelry box full of original art (glue, colored stones, glittery tiles, etc.) for her first grade teacher.

My heart goes out to her, because I remember reading with a flashlight under the covers on the top bunk of my sister's and my bunk bed, long after lights out. She is very different from me - way more extroverted and spunky, but once again, the apple does not fall far from the tree.

My question to any readers is, what do I do? How do I draw boundaries, here? Do I draw boundaries? Mornings are so rough - I feel like I need to try, but I don't want to stifle her creativity and thirst for knowledge. Anyone have similar experiences with a 7 year old in their house - present or past?

In the carpool line the next morning, after she and her brother fought the whole way there (some mornings are more difficult than others), she got out of the car, and I told her I loved her. To have a great day. I promised her I would read the report, and we would work on it. I told her I would search for a good Hello Kitty costume, for her presentation on April 15th.

"Mom, I don't want to be Hello Kitty. I want to be the puppy. Look for a puppy costume, OK?"

I told her I would try.

Sunday, April 4, 2010

(Sort of) Home cookin'

I thought when I moved to a neighborhood filled with little shops and restaurants, I was going to be in takeout heaven. As it turned out, not so much. All the restaurants are overcrowded and overpriced, and the only place with reasonable prices is the supermarket, so I've found myself cooking at home most nights.

Top Chef, I am not. At the end of the day, I'm usually too tired for an elaborate meal, and if I spend more than 30 minutes cooking there's threat of a revolt. Plus I don't have lots of what you chefs might call "raw ingredients."

So I try to be resourceful. Most of the time, that involves a bag of frozen pasta and sauce "for two" (that is usually enough for one), then add frozen meatballs/chicken and frozen vegetables. It all sautees into a reasonable meal for three.

Lately, I've been slightly in love with my $20 crockpot though. That is the ultimate for those of us who can't really cook and don't have much time. I toss in carrots, potatoes, celery, green beans (all vegetables optional), lean beef stew meat, a package of Lipton's onion soup mix, and a cup of water, then I turn on the crockpot and go to work. When I come home, either the house has burned down or I have a delicious beef stew cooked that people comment on (favorably) in the hallway. Pour it on some instant rice. You cannot screw this up... it's not possible!

And the best part is, there's usually tons of leftovers, sparing me having to eat lunch in the hospital cafeteria the next day.

All right, so I've divulged my secret. What is your easy 30 minutes or less recipe?