Friday, July 29, 2011

Guest post: Get your boots on

Last week, I was pleasantly surprised to see Sheryl Sandberg, Facebook’s COO, featured in The New Yorker. Considering her TEDWomen talk in December, and her recent commencement speech at Barnard College, she has been front and center in the effort to support women’s success at the very tops of their fields.

For those who can’t access the links, Sandberg’s main points from her TED talk are these:

1. Sit at the table; own your own accomplishments. Studies have shown that for men, success and likability are positively correlated, whereas for women, success and likability are negatively correlated. Women need to attribute their own success to themselves, even though there is a risk of not being liked. In her Barnard speech, she says, “[But] I know that the truth comes out in the end, and I know how to keep my head down and just keep working.”

2. Make your partner a real partner. Women still do twice the housework and three times the childcare as men, even though they also are working outside the home. In homes where responsibility is equally shared, the divorce rate is halved. “It’s a bit counterintuitive, but the most important career decision you’re going to make is whether or not you have a life partner, and who that partner is. If you pick someone who’s willing to share the burdens and the joys of your personal life, you’re going to go further.” (Side note: a recent article in Time magazine notes that women and men work about the same hours in the day, although women work more unpaid hours, i.e. in housekeeping and childcare. This is usually accomplished by the woman scaling back her paid hours.)

3. Don’t leave before you leave. It is so common for women, from the moment they even start thinking about having children, to start leaning back from their careers, sometimes without realizing it. “Keep your foot on the gas pedal until the very day you need to leave…and then make your decision,” says Sandberg.

I watch these videos of Ms. Sandberg, and wish she could have teleported herself through the last decade and shaken some sense back into the old college me. You see, I made the wrong career decision ten years ago, and the only reason was because I didn’t believe in myself. I became a nurse when I really wanted to become a physician. Even ten years ago, there was no question in my mind that I would have made a good physician, and no question in my mind that I would love, adore and provide for my future family. But I still feared becoming a mother in medicine.

So why didn’t I go for it? For years, my pat answer was that I wasn’t sure medicine was for me until I was well into my nursing career. Now that I can finally admit this to myself, I think the real reason went deeper than that. I chose nursing because I was afraid that if I chose medicine, my boyfriend might get cold feet, and I might emotionally damage my future children. I was afraid that medical school rejection could be the ultimate social suicide. I worried that my friends and family might judge me for “choosing career at the expense of my family” and turn their backs when I most needed their village around me. As Sandberg might say, I was simply afraid of not being liked—in the most extreme way.

But ten years later, I do have something else to say, and that is that I did go to medical school, I did marry my college sweetheart, and I do have two happy, well-adjusted children. I am surrounded by friends and family, and I have done well in school. The sky, in fact, has not fallen.

While I am so proud of the above accomplishments, I still find at times I still revert to my old ways. I apologize for everything—for taking 20 minutes to pump breastmilk on clerkships, for passing off daycare duty to my husband, for not knowing when I will get home. But here’s the kicker: I don’t actually feel bad about any of the above, and I don’t think anyone in my family even expects me to feel bad. They know it comes with the job. What I feel bad about is that I should feel bad and I don’t. It’s as if I’ve been conditioned to believe that worry is synonymous with love, and that constantly shortchanging myself is penance for wanting children.

This, to me, is the fundamental problem of women today. It seems like we have no faith in our social or professional supports to help us get done what we need to get done. We’d rather hide behind the fa├žade of martyrdom than find a way to get what we need—and then we tell the next generation “I gave up my career because you can’t be a good doctor and a good mother” or “I had to work 100 hours per week, and that is the only way you can deserve this job.” And so we saddle the next generation of mothers in medicine with the baggage of choosing either success or likability. Again.

What if we women did something radical instead? What if we thought long and hard about what we really want and actually asked for it proudly? Maybe that means finally having “the talk” with your significant other. Maybe it means keeping the kids in daycare one more hour to get something important done. Maybe it means daring to ask for part time—or partner. Maybe it means saving your apologies for when you have actually done something wrong (and, ahem, it is not wrong to have a career and a family).

When I think of the two most radical things I have done in my life—applying early decision to medical school with a marginal MCAT score and asking the cute guy in my dorm to come swing dancing with me, I realize that they are two accomplishments of which I am most proud, because those risks have given me a thousand-fold return. What if, when it came to big decisions, we honored our id as much as we do our superegos? What if we not only made radical decisions but celebrated other women who dared to do the same?

I was a child in the 1980s, and the message to little girls was “you can be anything you want to be.” I still believe that. But I think our daughters need a stronger message: “You can be anything you want to be, on your own terms, and you deserve to be happy.” And when we live out this message, it won’t be in an aggressive, cold-hearted way, but rather our way—with kindness, creativity and collaboration.

I just got back from a U2 concert, and my ears are still ringing. The turning point in the concert for me was watching four men singing at the tops of their lungs:

“You don’t know
you don’t get it, do you?
You don’t know how beautiful you are!”

So ladies, strap on your boots. We are a new generation of mothers, and we are proud to have it all, and share with each other in our successes.

-scrubmama
mamascrub @ gmail-dot-com
******
So now it’s your turn, anonymous or otherwise: Tell me one way in which you have shortchanged yourself. Now tell me one way you might do something radical. What would you do if you knew you could not fail?

Monday, July 25, 2011

MiM Mailbag: Considering a medical career later in life

Mothers in Medicine:

I just stumbled upon your blog in my quest for information about later careers in medicine.  I have been considering a transition to nursing.  I am 32 years old, have never been married and haven't been a mother at this point.  However, I was wondering if you might have any information or resource suggestions regarding preparing and applying to medical school later in life.  While I am interested in nursing, I did not realize medical school could potentially be an option, that older candidates could be considered, and I would love to find more information about how women are doing this.

Thank you for any guidance you might provide - this blog is great!

B


Friday, July 22, 2011

Boards. Tomorrow. Ack.

Sorry I have been incommunicado, but I am taking my Step II CK tomorrow.



Wish me luck.

Tuesday, July 19, 2011

Practical advice for nursing mothers

When you announce on the internet that you're nursing your baby and need advice, women are only too happy to give it to you. However, I've noticed that the women most likely to give advice, the ones who frequent the breastfeeding communities, are the so called "boob nazis." They feel so strongly that breast is best, that even an ounce of formula is criminal. For example, a new mother I know was just "dropped" by her online breastfeeding mentor because she confessed that she started giving her newborn one small bottle of formula at night (for the sake of her sanity).

To me, this seems crazy! If you believe so strongly in breastfeeding, isn't it better to encourage women to at least do it part of the time, rather than reprimanding them for taking measures to make it more doable? I've gotten some ridiculously useless advice from women who refused to compromise their breastfeeding ideals. (i.e. When I started giving my daughter solids, I was advised to have her reverse her sleep cycle to spend most of the night awake so she could nurse during this time. Seriously??)

With that in mind, I'd like to offer some practical tips and advice for breastfeeding and pumping, coming from a working mother who believes strongly in breastfeeding but is not a "boob nazi." You can take this advice with a grain of salt, because this is just based on my own personal experiences:

1) Breastfeeding is actually not that easy. I was amazed how challenging it was the first week. Your nipples hurt, the nursing itself hurts, you get dehydrated, and you never seem to have enough milk. Don't give up after just one week. It gets way easier. Promise.

2) One (or even more than one) bottle of formula will probably not result in terminal nipple confusion or a sharp decrease in supply. Due to an ABO mismatch between me and my husband, we produce very jaundiced babies. They got bottles in the hospital. No evil resulted.

3) You are not a horrible person if you allow your partner to give the baby a bottle at night so that you can get a few consecutive hours of sleep and feel human. I resisted this for as long as I could with my older daughter and finally gave in when my health started suffering. It actually ended up being wonderful because it made my husband feel closer to the baby and more comfortable taking care of her.

4) You don't need to have five gallons of frozen milk stored up when you go back to work. If you do: awesome. But if you don't, it's not the end of the universe. Due to a variety of reasons, I had absolutely no stored breast milk when I returned to residency. Despite this lack of foresight and my daughter's monstrous appetite, she didn't get any formula at all for the first three months I was back at work. Obviously it would have been better if I had planned ahead, but I'm just saying that you can make it work.

5) Expect to hate pumping. I have yet to meet a woman who didn't find pumping really depressing.

6) If you're having a hard time pumping during your maternity leave, try pumping first thing in the morning every morning. Your supply will be highest then and the pumping will be most successful. Nurse one breast, pump the other. One 5 ounce bag of milk every morning for 11 weeks will give you about 400 ounces of milk, even if you don't pump any other time.

7) If you work standard hours at your job (Monday through Friday with most weekends off), your supply will probably decrease as the week goes on and be highest on Monday. Take advantage of this by pumping like crazy on Mondays and over the weekend. I used to nurse on Monday morning AND pump out 10 ounces.

8) Keep well hydrated.

9) If you feel you can't breastfeed and your baby gets formula, your baby will still be healthy and absolutely nobody will judge you except for a few nut jobs on the internet. When I was an intern, a graduating resident told me she couldn't make breastfeeding work because of her hem/onc fellowship. That woman was an awesome resident, a wonderful person, and I bet anything she is a great mother. If nursing is going to make you tired, cranky, and unhappy, and you hate it and are only doing it out of guilt... well, I just don't think it's something worth feeling guilty about.

Anyway, that's all I've got for now, but feel free to add your own practical advice. Hopefully, this will help some new moms or mothers-to-be.

Monday, July 18, 2011

Guest post:: Trying to conceive

Twice a day, during my typical 5am - 7pm style day, I sneak away to the bathroom with a little sealed packet.  In that little packet is a small white test strip.  I have a small plastic cup in my hand.  You can buy these little packets online -- 50 of them for about $10.  I  pee in the little cup and dip the stick, waiting to see what lines develop.  One dark line and one lighter line; nope, no LH surge.  Still not ovulating.  Then I wonder, for the hundredth time: is it my irregular schedule?  Is it the q3 call, even though it's home call, still tends to extend my work hours to the 80/week boundary?  Is it the stress of running an Orthopaedic Surgery trauma service?  Is it my complete lack of sleep?  I bury the little stick in the trash, hoping nobody notices it, and I rinse out the cup, dry it off and palm it, heading back to clinic.

I'm disappointed again today.  I do this twice a day -- looking for my LH surge, looking for a sign that I'm ovulating.  On my OR days, it's harder to test in that daytime window.  I usually manage at least one pee-in-a-cup time a day, though.  My cycles aren't regular enough for me to just count calendar days.  My basal body temperature pattern isn't consistent enough just to test around "expected ovulation" time.

When the two lines are the same color, I'll get home at around 7 or 8pm and try to coax some energy into my body in order to get some lovin' from my husband and work on this conception business.  Small windows in time where gettin' busy really matters.  Small windows of time in my life where I want to catch up on sleep.  In the 6 months we've been trying, there have only been one or two cycles where I was pretty sure I had an LH surge and I ovulated.  After those cycles, it was hard not to get hopes up.  Each time, blood in the underwear heralding menstruation left me disappointed.

Each morning, around 5am, I take my basal body temperature before getting out of bed.  All the temperature/charting folks say 3 hours minimum of uninterrupted, good sleep are necessary for a reliable basal body temperature measurement.  HA!  Have they ever met a surgery resident before?  My chart looks like a saw blade ... up down up down up down ... it's no wonder I can't figure out whether or not I've ovulated.  My OB/Gyn doesn't really know what to make of my temperature charts.  He tells me: "Sure, I'd love to say 'get more regular sleep,' or 'try for a more normal schedule,' or 'work on your stress levels,' but I was a resident once, too, and I know how ridiculous that sounds to you.  He's right - if I had a "normal" job, or a "normal" life, those would be reasonable suggestions.  I do what I can with the life I've chosen.

All of this is difficult, even though I've been off hormonal birth control and we've only been officially "trying" for about six months.  What compounds the difficulty, though, is that all this has to be kept under wraps.  Most women who start down the path of trying to conceive are, understandably, quiet about their journey, unless they have a kindred soul (who may also be trying) with whom to share their experiences.  Being a surgical resident just adds another level to the need for secrecy.

In my program right now, there are several male residents whose wives are pregnant.  All of those announcements were met with a lot of "way to go, man!"  "Congratulations!  When's she due?"  "Not much longer until she'll want #2, eh?  Too bad we've got residents' salaries!"  In my program, we average one woman for every 5 or 6 men -- and that's actually a good number, for an Ortho program.  There have been two women before me who had children during residency, and one woman in the class below me.  When they got pregnant, there were significantly fewer "YEAH!  Way to go!  Congrats"-type responses.  Instead, it was a whole helluva lot of "how much time are you taking off?"  "Wait, you're due during a rotation where you're q3 call -- who is going to cover your call?"  "We're going to have to book down that clinic for a month, aren't we?"  And while they were away on maternity leave - most of them took 4-6 weeks - there was definitely a fair amount of grumbling.  I found myself defensive for them: "If this were YOUR WIFE, I'll bet you'd be fighting for every single day of her leave," I'd tell the complainers.  The double standard still gets me.

And so I continue to sneak away to pee in my cup and look for signs that I might be ovulating, despite this ridiculous schedule and stress I put on my body, my mind and my spirit.  I'll deal with the double standard when I get to that point; right now, I'd just like to see two lines of the same color, and my husband and I will keep hoping.

-I'm an orthopaedic surgery resident on the west coast. No children yet.

Friday, July 15, 2011

Safe Landings


A couple of weeks ago, the kids and I went to Florida with some friends. It was an amazing trip. I didn't get to do a vacation with the kids last year - was so busy with divorce and house selling that it didn't happen. I realized, after this trip, how much we all really needed the break from life.

We flew into Destin/Ft. Walton Beach late on a Saturday night. While standing in line for a rental car to drive 2.5 hours to our final destination, the kids were running around the baggage claim area burning off energy. There was a big display of brochures advertising various activities next to the rental car desk. Cecelia (8), oops I mean Ce-silly - she asked me to change her blog name to a pet name her second grade teacher called her - picked up one on parasailing.

"Mom! I've always wanted to do this! Please can we parasail?"

Me, yawning. "Um, OK maybe? Let me look into it tomorrow." I still had the drive in front of me - unknown territory in the dark - and was a little anxious. I was thinking parasailing? Really? How had she even heard of this? I did it once back when I was 15 or so, but hadn't thought about it much since then.

We arrived safely around 2:30 in the morning and had a magical week with friends and lots of kids. Ce-silly was relentless about the parasailing thing throughout the week. On Wednesday I finally picked up the brochure. It advertised that kids 6 and up could participate, which put Jack (6) into play, if he was willing. More enticingly, we could all ride together. I called the place in Destin and they said they would reserve us a spot at 9:45 on Saturday morning, leaving us plenty of time to parasail and catch lunch before our return flight to Little Rock. Everyone else drove, so it would just be us three. Catch was to convince Jack.

"No way, Mom. I'm not doing that."

I explained the process to him, told him I had done it and he would love it.

"What if the rope breaks?"

"I'm pretty sure the rope won't break. Haven't really heard of that happening. I think you will be fine, but it is up to you. You can stay on the boat if you want, and I will sit with you."

Ce-silly has amazing lawyer-like powers of convincing and negotiation, and by Saturday, Jack was game. We boarded the speed boat and headed out of the bay to the open ocean. We listened to the instructions of the guides and got to watch a couple of people go before us and return safely, so Jack was excited when it was finally our turn. We harnessed up and sat on the front of the boat.

As the boat sped up, the rope loosened and carried us 800 feet up into the air. It was surprisingly quiet up there - I was in the middle of Jack and Ce-silly. Much quieter than on the boat where the motor competed with the 1980's music. Seagulls and pelicans flew by. We watched a plane carrying a bank advertisement in the distance. Jack turned to me in amazement.

"Mom, this is my dream! My flying dream. You made it come true. Thank you so much. I love you."

My heart melted all over my thorax, despite the fact that I worried I had peaked him out at age 6, and it would be all downhill from here. I noticed that his hands were clenched on the ropes.

"Jack, you can relax your hands, if you want. Sit back into the seat. You will be fine. Did you notice down below, how the sun is shining all sparkly on the water? It looks like diamonds, doesn't it?"

He nodded in assent. Ce-silly said, "Mom, I have to pee. I wonder what it would be like to pee 800 feet in the air?"

I laughed and told her - "Well if you have to, I understand. But hold it if you can - we'll find a bathroom as soon as we get off the boat."

"OK, I think I can hold it. Mom, you know what? This is the best 10 minutes of my life. Only I wish it was a little faster - might be more exciting."

Just then the boat slowed us down and dipped our toes into the water before taking off and carrying us back into the air. Ce-silly got her thrill.

We landed safely on the boat and snuggled up happily to watch the last two rides. Both kids and I were sitting serenely, dazzled by the experience. Maybe we'll go again next year. I had to pay $20 bucks for photo service, but for once, I was on the other side of the camera.



Here's to safe landings for everyone.

Tuesday, July 12, 2011

Is 12 weeks long enough?

I was recently on the phone with a friend of mine who is 40 weeks pregnant. (My husband has dubbed 2011 "The Year of the Baby" because pretty much every couple we know is having a baby.) She was having very painful contractions that were coming at regular intervals.

"I think you should go to the hospital," I told her.

"No, I can't," she said. "I still have to go to work tomorrow so it won't count as a day off."

I can't throw stones. I spent most of the day I went into labor having contractions at work that were increasingly painful, and ignored the charge nurse yelling at me that she was NOT going to be delivering my baby. I had to get my work done for the day so that it would "count." (In my defense, the contractions were still 15 minutes apart when I finally went home.)

Honestly, I liked it that when people asked me when I was due, I could reply, "Tomorrow." I was proud of myself for working till the day I went into labor for two pregnancies. But that was pretty much all I liked. The last two weeks of pregnancy were an uncomfortable blur of swollen and achy feet, exhaustion, having to pause dictations multiple times to catch my breath, and Braxton-Hicks contractions that liked to come when I was driving. If staying home during that time wouldn't have cost me any money or time with my baby, I wouldn't have hesitated to do so.

FMLA guarantees 12 weeks off. That seems like a long time in some ways, probably the longest I've gone without work or school since I was three years old, but it also means you're going back to work and leaving a two and a half month old baby behind. It means that you don't want to sacrifice any of that time to stay home without a baby in your arms.

And a lot of residents and other professionals take far less than 12 weeks off. I know many women who took only 6 weeks off. I know a few who only took 4 weeks off.

This is not unique to medicine. Most of the women I know in other fields also worked until the bitter end. I don't know any who were happy to be still working at 40 weeks, but it's a necessity when the law only gives us a maximum of 12 weeks, and often that time is unpaid. Canada gives women a whole year to spend with their babies.

I'm not sure I'd enjoy taking a whole year off or if I'd really do it. But it would certainly be nice to live in a country where it was an easy option.

Monday, July 11, 2011

Feelings of loss post-partum

by FreshMD | Martina Scholtens

When Ilia was a few weeks old, Pete asked, and said it so casually from the couch where he was reading after dinner, "Do you miss our old life?" The relief to hear it said. I did. I missed the old routine, driving in to Vancouver in the mornings with four-year-old Ariana in the back seat, CBC on the radio and a day at the clinic ahead of me. Yes, there will be a similar routine in a few months, with an infant in the car and a graduated return to work, but those other days, the particular way they were, are done.

"I guess you'll never have another son-baby, hey, Mom?" asked my six-year-old son cheerfully as he ate his after school snack the next week. I could have cried. I saved all my kids' clothes in anticipation of this possible fourth, and now that she's here I have boxes of corduroy pants, sneakers, little ball caps to set afloat. Somehow my daughters' infancies seem preserved through Ilia wearing their hand-me-downs, but I can't kid myself: my son's baby days are over.

And then I overheard Ariana greeting her little sister. "Good morning, Ilia," she said seriously. "It's your medium-sized sister." Saskia's still the oldest, and Leif's still the only boy, but the crown of youngest child has been passed from Ariana to Ilia, by my choice. Then, after church an elderly woman tugged on my arm, admired the baby and confided, "Mothers have a very special relationship with their youngest daughter." At that moment Ariana came into view, long dark pigtails, thin legs in purple boots making their way across the room to the gardens outside. There she was, the daughter with whom I would have had that extra special relationship - except I'd taken that from us and given it to this newest baby.

Those first two months, I missed my bodies. The one before this last pregnancy. The one before I had ever been pregnant at all. The pregnant one, even, that at least looked purposeful. A week post-partum, sitting at the breakfast table, Leif gestured at my paunch with his spoon and asked, "You know why that looks like that? Because all the equipment is still in there."

Most of all, I've struggled with the (temporary) loss of my identity as physician. At the little good-bye party over cake in the chart room in February, I asked the clinic to please just stagnate until I returned. Of course they will forge ahead and do all sorts of interesting things while I'm away, and I hate to not be a part of it. Some of my patients requested six-month supplies of medications to tide them over until my return. I didn't comply, but I understood. I'm grateful for my locum, but I'm jealous of her, too. I miss the collegiality of the clinic, the focus on others' lives, the escape from my own head, the sense of contributing to the community, the academic stimulation. I'm back to work in the fall, but in the meantime, I feel a little unmoored.

This is my daughter:

Ilia

How I love this little face. I marvel that someone I couldn't have imagined months ago could feel so inevitable, could have an entire family happily orbiting around her.

Don't mistake this for ingratitude. It's simply an acknowledgment that for this new mother, mixed in with the bliss of those first six to eight weeks, were feelings of loss and grief. Surely I'm not the only one.

Monday, July 4, 2011

Must the doctor ALWAYS be in?

First of all, for any of you who decided to read this post because you thought it might be a follow-on to the discussions about whether it's ok to work part-time in medicine, nope, that's not what this is about. Rather, it's about the tendency to wear our doctor hats even when we're off-duty, when it comes to our own health.

It was a Facebook status update, or rather a string of them, that first got me thinking about this issue: the epidemic of medical hypochondriasis among doctors and other folks in medicine. (For my friends in psychiatry, let me apologize for using hypochondriasis in the lay sense, not with any DSM criteria attached, and for my friends in epi, I know it's not really an epidemic.) A friend of mine, who is a mom of three and a critical care nurse practitioner in the PICU of a large academic center, often posts on FB about her anxiety related to her kids' health. One of them has a fever, and she wonders aloud whether she is the only mom checking for petechiae. Another says she's too tired to bike (in the 98 degree weather) and wants to come in and watch TV in the air conditioned living room instead, and she frets about whether she is severely anemic--it could be acute leukemia! It is easy to witness someone else do this and see the absurdity in it, but when it's YOUR lymph node that you think you might feel in your neck or YOUR lumpy breasts or YOUR bone pain, etc, it becomes a lot easier to let your mind spiral off into the crazysphere.

Most of the mothers in medicine with whom I have discussed this freely admit, "Oh yeah, my thing is cancer" or whatever. Everyone seems to have something she is convinced she is going to get, and it's often what she's surrounded by, not what she actually might be at increased risk for due to lifestyle or family history, that seems to drive the fears. My good friend from medical school who is now a pulmonologist in a tertiary care center became convinced that she had pulmonary fibrosis when she found herself out of breath in kickboxing (after taking off 2 mos from it). Another friend who is a high-risk OB attending just about drove herself insane with fear that she would have fetal death in utero. I have seen her on multiple occasions in all of her (3 healthy) pregnancies sitting in the hospital cafeteria with a sugary drink in one hand and the other hand on her gravid belly, brow furrowed, checking for fetal movement. Another who is a rheumatologist is obsessed with developing lupus, and given that lupus can cause any number of symptoms/signs, she gets a near-weekly dose of affirmation that THIS TIME, she really does have lupus. Kind of ridiculous, right? Except when you're in it rather than on the outside looking in.

I find myself worrying about cancer mostly, which I guess isn't shocking since I'm an oncologist. Every patient I see--well, except for a fortunate few who have been misdiagnosed--has cancer, 100% of them. And I see mostly second opinions, so they are usually pretty sick and often complicated patients. Though they all come with a big, thick chart, I always take my own history, and even in patients with several years of metastatic cancer, I always start with how the cancer first presented. I am struck again and again by how subtle the first signs were--that little twinge of pain in the chest that only lasted for a few minutes or noticing that she was slightly winded, just slightly, after dashing up a couple flights of stairs. Or whatever. I don't see the zillions of people who also had little twinges of pain in their chest or mild dyspnea who turned out to have costochondritis or an albuterol deficiency or absolutely nothing at all. I don't see ANY of those people. In other words, I have no denominator to provide me with perspective. Of course, these histories I'm taking are all retrospective, and maybe the "first signs of cancer" patients report were in fact utterly unrelated to their diagnosis, but have taken on significance in the wake of being diagnosed and repeatedly asked these questions by oncologists. All of this, I know, but I can't seem to remember any of it when it really matters.

So, I wonder: does this worry simply come with the territory when one works in a field where life-threatening diseases are the price of admission? Would I still worry if I were a primary care pediatrician, where the majority of my patients are so healthy they are actually labeled "well child"?

Do you find yourself worrying more than you feel is reasonable about your own health or that of your family/friends? Do you worry about the diseases you see in your own practice, or do you have "a thing" like cancer that you worry about, even if it's outside of your usual practice? And if so, how can we do a better job of being a voice of reason to each other? Because we are doctors. And we are mothers. Which means we have more than enough REAL things to worry about!

Sunday, July 3, 2011

My Grams, Her Battle Was My Battle

There are some wonderful people that will pass through your life and when they leave it is very difficult to go on at times. Holidays, special events, and birthdays become painful reminders of their absence. I wrote this article a few years ago when my Grams was still alive and I read it at her funeral two weeks before I deployed overseas to the Middle East with the Air Force. 2007 was a tough year for my family but my Grams was a beautiful person who blessed my life.

"When my grandmother, Grams, came to live with us in 1997 she was depressed and a shell of person that I had known in my childhood. She came to us because she was leaving a violent marriage of 20 years. The Grams of my youth was vibrant and energetic, spending many summers with my younger sister and I shopping or playing miniature golf. But that cold day in April of 1997 I saw a sad hunched over figure in a wheelchair being wheeled off the airplane. I almost did not recognize her.

Grams settled into our home, spending many hours with my young daughter, Emily, looking at the stars and discussing what to wish for. Over the course of the next 7 months her divorce was finalized and we moved from Ohio to Texas closer to my mother. By this point I was beginning to see shimmers of happiness and energy from Grams, but on occasion she would fall back into the depths of depression. She struggled with being dependent on us for everything and pushed away opportunities of socializing with others outside the family.

By 2001 I had begun my third year of medical school and my grandmother watched the youngest of my 3 children, Gabriel. In October she called to tell me that her mammogram had showed an irregularity and she was told by her doctor that it would need further evaluation. My heart sank as I had a gut feeling that it was going to be bad news. I spoke to many physicians asking which surgeon they would take their mother to and Dr. Ronaghan's name came up more than once. We had her referred and Dr. Ronaghan gave us the grave news. She indeed had what looked like breast cancer and biopsy would be the only positive answer. Grams took the news as if you told her that she had a simple cold. My assumption was either she was in denial, had completely lost her mind, or extremely stoic. I, on the other hand, was falling to pieces inside. The thought of losing my grandmother made me nauseous, but I knew she was counting on me to be there for her. Little did I know that I was going to be leaning more on my grandmother during this process than she on me.
A few days later she had a lumpectomy which revealed lobular carcinoma and would need further surgery. Grams remained enthusiastic and positive about her outcome, she almost seemed happier than I had seen her in 4 years. I didn't know what to make of it, but then again things flew by so fast that I didn't have time to process it.

She went on to have a bilateral mastectomy with positive lymph nodes on the right side. So, we weren't out of the woods yet, she would require chemotherapy and radiation. Chemo would begin in December, 2-3 times per week for several weeks. By the tenth day her hair began to fall out in clumps and we began looking for wigs. One night she asked me to shave her head so she would not have to deal with her hair falling out anymore. I had cut hair many times, even Grams', but this request made me anxious and hesitant, almost to the verge of tears. It made me feel as though the cancer was winning, she was losing herself to the enemy. It was taking her beautiful thick white mane that made her my Grams. Well, we went to the kitchen and I plugged in the electric razor. I stared at her for a long time until she prodded me saying, "Laurie, it will be alright, don't worry. Anyway, I am hoping that it will come back curly!" At that moment I began to realize that the cancer was not going to win, because my Grams was strong and positive in heart and mind. I was looking at the Grams of many years ago, vivacious and alive! Yes, alive...she hadn't died yet. Wake up Laurie and join the fight! I went on to shave her head of course after we entertained the idea of a mohawk.

She continued with the chemotherapy and had good and bad days of vomiting and fatigue but her optimistic attitude never wavered. The children had adjusted to having a Grams without hair, the boys, Jonathan and Gabriel, loved to run around in her wigs. In preschool Jonathan was asked to draw a picture of his family. He drew his mom, dad, brother, sister, and Grams. We all had hair except one figure had no hair and was holding something in her hand. When asked who this was and what were they were holding, Jonathan promptly replied, "That is Grams holding her wig." As the story was relayed to her, Grams eyes twinkled as she replied, "Well, it's too hot to wear a wig all the time."
Grams went on to have six weeks of radiation therapy that resulted in severe burns across her chest. She was in pain most of the time and we did what we could to make her comfortable. She never cried or felt sorry for herself. She always asked me how my day went, always worrying that I wasn't eating right, getting enough sleep, or working too many hours. All the meanwhile she was in the middle of a life and death battle with an ever imposing enemy. She prayed and read her Bible daily, always reassuring the rest of us that she would make it.

Indeed, 5 years later my Grams is still here without any signs of recurrence of the cancer. She taught me the power of positive thinking, humility, love of family and faith in God. I can only hope and pray to be a fraction of the woman that is my Grams. And yes, her hair came back curly."

I hope you enjoyed this and share it with others. Remember each day is a blessing and there is only a finite number of these! Create an impact on someone's life, and it can only improve yours.