Wednesday, August 31, 2011
Please help me!
Scared? Yes. Overwhelmed? Yes.
In need of advice and reassurance?
Tuesday, August 30, 2011
Just Another Manic Monday
Monday, August 29, 2011
Depression and the Working Mom
I've had periods where I got to briefly experience life as a SAHM, such as during maternity leave or the month between residency and fellowship. I love it in theory. It's nice to be there for your kids all the time, make nice hot dinners on the stove, and keep the house tidy.
And as we all know, juggling full time work and kids can be a huge challenge. I get jealous of women who don't have to resort to bribery to get out the door before their first patient each morning, and get to spend the whole day enjoying their kids. I feel sad sometimes, thinking about how I'm missing out or that my life is too stressful. My kids are only going to be so cute and little once and I'm missing it.
However, my father (obviously reading my mind), recently forwarded me an article about how SAHMs have a higher rate of depression than working moms. (He's always forwarding me helpful and relevant mental health related articles. After I got married, he forwarded me an article about how women who got married and divorced had a lower rate of depression than women who never married. Thanks for the confidence, Dad.)
And actually, reading this article made me feel better. It was a reminder that even when I don't love every aspect of my job, I like feeling productive, interacting with people, and of course, bringing home a paycheck. It makes me appreciate my kids more when I'm with them, and it makes me feel less like taking a bat to the TV whenever I see Spongebob on the screen. And it fills me with pride when my daughter says she wants to be "a doctor like Mommy."
Saturday, August 27, 2011
Running, Running…and More Running
Have you noticed that as time marches on we are always running, often literally. We are rushing to work, to an appointment, answering a page, picking up the kids, making dinner, paying bills, planning vacations, reading CME and just trying to keep our heads above the water. No wonder we are stressed and anxious. Did we just replace our ancestors’ worries of finding food with time consuming errands?
Our lives are so filled with little worries that together they take one big toll on our peace of mind. And then you add economic worries, job loss, news of wars and droughts and is becomes overwhelming! When did life become so busy or was it always like this? When I was a kid we did not have money, computers, vacations or the internet. We had TV but when dad came home he took it over and if you were within hollering distance you became the remote control. Oh, how I hated that. Solution…go to your room and turn on the radio, read or go outside to play with your friends.
So, how did I get from there to here? Here I am in the middle of life and truly believe all the information coming at me has caused me to have issues. I want to participate in many things, travel to foreign lands with my kids, see my children participate in sports and music and excel in school, learn Spanish and the guitar (oh if I could only sing!), train for a marathon, write another book, hike and spend more time taking pictures. Seriously, does anyone else have this problem? Is it a personality disorder yet to be discovered?
I really want to simplify life and slow down to smell the roses but my fear is missing out on an amazing experience. Can you imagine going one week without any TV, radio, internet and cell phone? I know I panic when I realize I can’t find my phone or when the internet is down. How about you? Are you addicted to technology and has it affected you or have you seen it affect your patients?
Tuesday, August 23, 2011
I must have stared at that girl for several minutes, trying to decide if I should alert her parents. On one hand, I think I'd like to know if my child was standing in a puddle of her own urine. Then again, I didn't want to be a busybody. Finally, when the parents still weren't noticing, I decided to say something:
Me: "Um, sir... your daughter...."
Father: "Oh, it's okay. I've got my eye on her."
Me: "No, she, um... peed...."
Father: [looks at girl] "Ava! Oh no!"
I guess I did the right thing by telling him, but I immediately felt kind of guilty for making a comment about someone else's kid. Believe me, this is not something I ever do. I was recently at the zoo and stared in agony at this woman who had a one-month old baby with no head control front-facing in a baby carrier, with his head sagging down like it was about to fall off.... but I never would have said anything in a million years. It's none of my damn business.
While I think it's despicable when someone goes up to a complete stranger and tells them not to give their baby a bottle or something like that, I wonder if there are situations where it's appropriate to intervene. For example, would you say something if you saw a woman hitting her child? Or worse?
Tuesday, August 16, 2011
Ob/Gyns are terrible people who need to die, and other common misconceptions
I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (God forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, the media, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.
It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.
Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.
***cross-posted at Ob/Gyn Kenobi
I failed my gestational diabetes screen by two points.
For those of you not familiar with the screen, it’s a test during pregnancy where you drink this horrible, sugar drink and then come in an hour later to get your blood glucose tested. Considering I was seven months pregnant, not showing, and weighed only 116 pounds, I didn’t think there was any chance of my failing the test. I was so overconfident that I had some crackers right before I had the drink, to make it go down easier. (This was allowed, but probably stupid and likely pushed me over the cutoff.)
The cutoff my practice used was 135 and I had a blood sugar of 137. In some practices, a cutoff of 140 is used. And when I looked this up in research studies, in a woman of my age, race, and BMI, it is appropriate to use a cutoff of 140. Or actually, some say the screen isn’t even necessary in the first place in someone like me.
Now if you fail the screen, the next step is a three hour glucose tolerance test. You come in for a fingerstick and if that’s normal, they give you a huge amount of sugar, do a venous draw for blood glucose, then repeat that every hour for three hours. I did not want to do this test.
You are probably thinking to yourself, “Why is she being such a baby? It’s just four blood draws.” That’s exactly what I’d be thinking if someone told me that story, believe me. I’ve had like a billion blood draws in my life and I’ve always thought of it as no big deal… needles don’t bother me.
Except for some unknown reason, my ob/gyn practice gave the most painful blood draws known to man. Now I can deal with short-term pain, no problem, but on two separate occasions of having my blood drawn at this practice, my arm was basically incapacitated. The pain in my biceps was so bad that I was actually awakened during the night due to pain. I could barely move my arm to drive and I had bruises going all the way up to my deltoids. And the pain persisted for over a week. Both times! Their phlebotomist was obviously not the greatest.
So I wasn’t thrilled by the idea of having four of these blood draws in a row at that practice. (The only other place they’d do them was at a hospital a million miles from my office.) My job involves a lot of writing and I was terrified by the idea of my arm being taken out of commission. I was literally in tears at the thought of being unable to function or sleep due to these blood draws--blood draws that I felt were basically unwarranted given the fact that it was so unlikely that I had GD. If I felt the baby were in danger, I’d have done anything, but it seemed more like this test was being done so they could cover their ass.
Anyway, I did try to keep a somewhat open mind. I felt if they had a convincing argument, I’d do the test. I went to my appointment for the 3 hour test at 8:30AM. I did the fasting fingerstick, which was 90. I asked if it would be possible to briefly speak to any OB at the practice about the test before doing it. Immediately the phlebotomy tech looked really put out, and acted like this was a ridiculous request that would take hours to fulfill.
About five minutes later, they miraculously located an OB that was between patients and she came over to talk to me. Except before I even opened my mouth, the doctor’s arms were crossed and she looked really angry at me for taking up 2 minutes of her precious time.
I explained that I was a doctor, that I researched the test myself and that I knew I was extremely low risk. I explained that research showed that with someone my age, race, and weight, testing wasn't indicated at all, or at the very least, a cut-off of 140 was warranted.
Doctor: [snippily] "OUR cut-off is 135."
I then tried to explain to her about how painful the blood draw had been at that office. They clearly went through the vein both times due to the pattern of bruising. I had been awake all night in pain. And then continued to have pain for a week after both times.
Doctor: [snippily] "That's impossible."
So I guess I was lying?
At this point, all I wanted to do was run home crying. Finally, I said I would do the test in fingersticks on my left hand.
Doctor: [snippily] "Fine, so I'm documenting your refusal to do venous draws!"
The phlebotomist was kind of cold to me after that too, possibly since she was the one who gave me the two painful draws. She started ranting about how she didn't know how to document my results. I felt like I had to apologize with every single hourly fingerstick.
I don’t know exactly what the doctor could have done differently. I would have preferred if she gave me an actual explanation of why it was so important for me to have the test, aside from just reiterating the cutoff. Or if she did agree with me the test was unnecessary, she could have nicely explained to me that she had to document a refusal, but admitted that I was very unlikely to get a positive result.
Anyway, three of the four fingersticks weren't even close to the cut-off. The fourth was below the cut-off, but only slightly. I was terrified the entire night that the mean doctor would call me and try to bully me into repeating the test and threaten to kick me out of the practice.
What did end up happening was that I had to call the next day (originally, they promised they’d call me, but apparently they wrote me off) and they got a different OB to speak to me. It wasn't my usual doctor, but it was one I had seen before and liked. He told me that the test was definitively negative. He didn't know what to make of the one borderline number, but said their glucometer tends to run high, and one abnormal value wasn't enough to diagnose GD anyway. He said to me, “I kind of remember from seeing you and from looking at your weight here… you’re pretty tiny, aren’t you? I really don’t think you could have diabetes. That test was probably overkill. Just, you know, eat healthy.”
(I then proceeded to not gain any weight for the next month because I was so nervous about eating carbs, and meat made me ill.)
Even though I guess it worked out in the end, the whole thing left me with a negative feeling about the practice. I felt uncomfortable coming to my visits and I imagined everyone was angry at me. Moreover, guess which OB in the practice was on call the night I went into labor?
So now that it’s all over and I’ve given birth to an average sized baby, you can go ahead and feel free to judge me and tell me that I sacrificed my baby’s health for the sake of avoiding discomfort.
Monday, August 15, 2011
Being a difficult patient
In some sense I've succeeded. As a mother, I don't call the pediatrician's office after hours more than once or twice a year. Aside from making appointments, I only called my OB's office once: while in labor. But I also feel like I should advocate for myself a little bit as a patient, and I worry that sometimes might cause me to be perceived as annoying.
At my last visit to the OB/GYN, it was noted that I had my last pap smear six months ago. As such, the doctor told me I'd need to come back in six months for my next annual pap.
Now don't get me wrong, I love getting paps. I love having to pay for them out of pocket due to my deductible, I love waiting an hour to get in to see the doctor, and the exam itself is pure enjoyment. I wish I could get them every week. But in actuality, the guidelines from the ACOG say:
Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years
And actually, the last doctor I saw before I moved a couple of years ago was a primary care physician who confirmed that I only needed to get this delightful test every three years.
So now I have two choices: I can either get an inconvenient and expensive test I don't need, or I can be that patient who shows up with the ACOG guidelines in my hand and explains why I'm refusing the exam.
Saturday, August 13, 2011
The 4 Stages of EMR Adaption
Wednesday, August 10, 2011
Sexual Harassment in the Workplace
I think this is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly - made me physiologically recoil, but I quickly regained my composure.
So I am posting this because I hope that some readers out there that may be in a situation they are uncomfortable with can know that they are not alone. It is OK to speak up. Or walk away. We do not have to tolerate this behavior, in the workplace. My friend and I have discussed our current inappropriate interactions with many male and female colleagues, with details, and have found lots of support. To quote Hillary, it takes a village. We can drive this behavior out of it, together.
I have sought and received the permission of both of my friends mentioned in this article to write this post. They have read it and are comfortable with what I have said. The older incident – ten years past now – contains more details, as it is in the past. The current situation is still too fresh to flesh out online.
Tuesday, August 9, 2011
Trying not to be "one of those" mothers.
Enter these last few months, where CindyLou chose cheerleading and tumbling (With or without a nudge from her mother? A former cheerleader, who always regretted a lack of formal tumbling training? Ok, probably a little nudge.) Bean chose soccer (pretty much of his own accord, well, that, and the fact that it is pretty much the only organized sport available for boys at age 3). We started out with the best intentions, and really, watching 3 year olds playing soccer is a bit like watching cats being herded on the field. Except, then Bean really started to *get* it, and then he got *really good* (for a three year old). Each game he would score at least a couple of goals, setting his own goal for each game for *at least* five goals per game. Then he achieved that goal, and all of the sudden, Mr. Whoo (assistant coach) felt like he had to take his own son out so other kids had a chance to score. The other parents would ask where or how often we practiced with him (exactly twice, right before the first game and then again right before play-offs), like they were somehow implying that we were driving him to his successes (we were not). It made me uneasy to have that feeling of competitiveness creep anywhere near my sweet 3 year old baby, who was just there to have fun.
Things were no better with CindyLou, sitting behind the glass with the other "gym moms." I did my best to fade into my chair while the other mothers, obviously veterans, systemically analyzed and subsequently ripped apart each girl in the gym, including their own daughters. Despite my best intentions, however, it completely stoked my competitive fire, and made me want to take CindyLou home and drill motions and practice flexibility for hours on end. How dare they judge my babies like that, and, indirectly, how dare they judge *me*? It is a strange new world, the world of competitive extra-curricular activities, where the parents are just as cruel and mean as the kids can be.
Growing up, for me, it wasn't this way. Parents did not hang around at our practices and activities and compare notes. I did tap at 5, piano at 8, softball and cheer in 4th and 5th grade, band (clarinet) in middle school, and cheerleading through middle and high school. Parents were only there for recitals/games. Maybe that made it easier to not be so fiercely competitive. I think this can apply to the academic setting as well, although, to this point, we have had no "real" report cards with As or Bs, just Ms for "meeting criteria." So tell me MiMs, how do you stifle your competitive streak and just keep your cool around other "tiger-like" mothers and fathers? How do we teach our children to be *their* best, without making them feel like they have to be *the* best?
Monday, August 8, 2011
Then, miracle of miracles, I got the chicken pox and my mother bought me the dolls! It was totally worth being covered in pox to get that toy. I will never forget it.
My daughter is now four years old. She doesn't need to be pox-stricken to get toys. We buy her toys all the freaking time because she wants them and we can easily afford it. And as the only grandchild on both sides, her grandparents shower her with toys.
A couple of weeks ago, I bought a present (a pet shop dollhouse) for the birthday girl at a party we were going to and my daughter saw the present and threw a fit because she wanted it for herself. She even said she'd skip the party if she could keep the present. And in the back of my mind, I thought to myself that it wouldn't be so bad if we bought a second pet shop dollhouse and it would make her SO happy. Then I was disgusted with myself. What have I become that I would even consider such a thing?
That's the problem with being financially comfortable. You can easily afford to buy your child whatever toy they want, and in fact, it's easier to do so than to listen to them scream. It takes real self-restraint to say no. But every time I buy her something, I feel like I'm spoiling her and turning her into a person who doesn't appreciate what she has. There's no way she's going to look back fondly on most of the toys in her room 25 years from now.
Our resolution was to make a sticker chart on the wall, to allow her to earn the present by cleaning her room, brushing her teeth, etc. Since then, she's entirely forgotten about the pet shop dollhouse and now wants something called a pillow pet. (It's a pillow! It's a pet! It's a pillow pet!) But either way, she's going to earn it and maybe that will make it worth more to her.
Friday, August 5, 2011
MiM Mailbag: Third year med school schedule as a mom
My son will be two when I start my M3 year, and he's never spent the night away from me (at my school, surgery is the only rotation with overnights). I was thinking about starting with the lightest rotations and working up to surgery last, so my schedule won't vary wildly every few weeks. But does anyone have any suggestions as far as how it will affect him? (or just tips on how to maximize our time together? Or how to ease the transition from him having a mostly stay at home mom to having me be gone a lot more?)
Thursday, August 4, 2011
This Won’t Hurt a Bit (and other white lies) - My Education in Medicine and Motherhood – A Book Review
I first heard of Michelle Au on Mothers in Medicine – saw that KC, our fearless leader, admired her blog. As an admirer of KC and all things MiM, I started to follow her blog over a year ago. I was not disappointed. Her mind is incredible, I envy her picture-taking abilities, and she is an endless font of entertainment and wisdom. She’s a hop, skip, and a jump away from my home in Little Rock, AR, and I enjoyed watching her struggles through the ice storm last winter as I flew into her current home Atlanta to visit my brother and sister at the end of their long icy convalescence. She drove to work bravely and safely, I drove to work bravely and safely. I feel a kinship with her.
I’ve been following the acceptance for publication of her first book, and stole away from work one day to buy it at Barnes & Noble toward the beginning of the summer. So when KC posed the question in Big Tent – that is our group discussion area for all the bloggers – “Who would like to read and review Michelle Au’s new book for MiM?” I literally jumped at the chance. “I do! You don’t have to send me a free copy – I’ve already bought it!” And so here we are.
The book is a series of vignettes that takes us through her med school experience, residency with major decision changes, and new path to motherhood. She is brilliantly funny, has enormous emotional wisdom beyond her years, and displays honesty and humility that brings the reader to the center of her journey, rather than preaching from a false ivory tower of medicine.
Art, music, and books are as important to humankind as serving others. They forge a common link by bringing out experience and emotion that we all share. Nowhere is this more real for me than sadness. There is a story in the book – I hate spoilers so I will be generic – about a pediatric patient she encountered in her training. Her description of witnessing a bedside interaction between the patient and two other children brought me to tears – they don’t come easily to me. When I collected my feelings to return to the book, I saw that she too collapsed in sadness at the nursing station, and I felt a strong connection, even though I don’t know her. That is what makes a great book.
I obviously enjoyed the book because since her path is so similar to mine, it brought back many memories from my training. One thing that was remarkable to me was watching her navigate the physician/physician parenting dynamic. She and her husband seem to support each other so well. Physician/physician couples have a higher than average rate of divorce – those who know me here know of my own experience in this arena. I asked her today in an online interview (swoon! I talked to her!) to give advice, which I think applies well to any home situation where both parents are working.
“Well, first of all I'd like to ask your readers to e-mail me any tips that they might have, because even twelve years into our relationship, we're still trying to work these things out. But I'd say that most important thing in a two-physician family is the idea of triage. On the whole, a family with two working physician parents is going to be strapped for time, and quite simply there is not enough time in the day to do all the things you would like to do. So just do the things you need to do and screw the rest. You need to spend enough time with your patients and do a good job at work. You need to feed and clothe and bathe your kids. You need to spend time with your family before bedtime, just goofing around and loving them. Everything else can wait. Triage.”
Love the medical parallel. Triage. Take care of your needs. I went to visit my best friend from med school, who recently had her second child. Her house was an absolute mess, but her family was happy. Taking care of your basic needs is most important when times are tough.
So I hope it’s obvious, I loved the book. Highly recommend. I might even go out on a limb to say that it should be required reading for all women interested in medicine and/or starting a family. I could go on and on, but then I would be telling the story. Of the book. And frankly, I think you should just go out and get a copy and read it. I have no financial interest in saying that. Incidentally, I also discovered in my interview that Michelle loves Chinese soup noodles. And she cannot write while listening to music (me neither!). She is super cool.