Wednesday, May 23, 2012

Guest post: My brain doesn't function anymore

I’ve just experienced one of the most embarrassing (not worst patient outcomes, just down to the core of my doctor-ego embarrassing) moments so far in my academic career.  I need some positive reinforcement, honesty, and maybe reassurance that maybe it wasn’t as bad as it felt.  Here’s the backstory… I wrote MiM about a year ago when I was trying to decide between a fellowship application to Endocrine or applying for the Chief Medical Resident position. I got some really helpful opinions and turns out I got the Chief job and will be putting off fellowship for a few years, probably with some hospitalist work in between. I also, in the meantime, got pregnant again and had our second child. It was all part of the grand plan to get as much paid maternity leave as possible before the bubble of residency is over and to spend more time with my new baby as I could, because chief year was supposed to be more flexible than being an attending... Plus, I’m already super tired and overworked, might as well just do it all now… right? It doesn’t get any easier? (this is my rationale… flawed as it may be)
So now baby boy #2 is 3.5 months old, older boy is 3 years old. I’ve been on maternity leave for 8 weeks, and then research for 8 weeks.  It’s been blissful bonding time with baby boy #2.   Now I’m coming up on the end of unstructured time in residency… and today I presented my research at the resident research symposium.  I only had to get some slides together to fill a 20 minute time slot with my results.  Pretty simple. Not presenting at ACP or other Fill-in-the-blank Big Subspecialty Conference.  The slides were good and I had some positive results. Problem is… my brain is not what it was a few months ago. I haven’t had to interface with a lot of people at work in MONTHS. Major clinical rotations were done for me over 6 months ago.  Let’s face it: I have Baby Brain and this phenomenon is real.  With my first son, I started intern year when he was 4 months. So okay, I had an excuse for not knowing anything then, because no intern really knows how to do their job in the beginning. What’s my excuse now?  No one really remembers that I just had a baby 3 months ago. Or that this is my first real public presentation outside of my data crunching at home.  
So here’s what happened tonight and why I can't stop crying. Okay, that part is likely hormonal.  But I am honest-to-goodness downright embarrassed…
My slides went well. People were impressed with the findings. Then came questions. I am not a fan of public speaking on a normal day, but now I felt like I was having an out of body experience.  I could not think. Initially, I was able to say “yes, good point, that would be an excellent idea for future study… blah blah blah”  Then the Chair of Medicine asks a question. In hindsight, he was prompting me to recall part of the lipid metabolism mechanism which may explain part of why my research finding was the way it was (without getting too detailed).  I couldn’t come up with anything.  My program director then tried to prompt me again to answer with a knowing sparkle in her eye.  She practically winked (may be an exaggeration).  Again – MIND BLANK – nothing… I asked him to repeat the question.  I couldn’t even come up with filler. It was like the dream where you are naked at school. “uh… uh…”  That’s all I could say. I couldn’t believe it. I thought I was going to vasovagal right in front of everyone.  Saddest thing is, I knew the answer; I just couldn’t recall the words.  Maybe I had a TIA. Nah… it’s baby brain.
The worst of it:  My next major work project is… presenting GRAND ROUNDS for the medicine department.  In 3 weeks.  It’s a tradition for all the incoming chief residents in my program to present grand rounds and I have been preparing, stressing, and thinking about this for 6 months.  But now I’m downright terrified. I’m so scared my brain is going to fail me again and leave an auditorium to fall silent to simple questions that I should know the answer to. Here I am people – the new face of our Big Academic Internal Medicine Program.
I need my brain back.  There are so many patients I need to care for, medical students to teach, a residency to effectively run, and the ABIM to pass in a few short months… I need it back. I need to know that I can still do this job.


  1. If it's any consolation, I had a similar experience at a research symposium last month, during which I genuinely didn't know the answers to any of the questions and therefore just stared awkwardly at the people asking them. It was horrible. And I don't even have a baby as an excuse!

  2. I can't really tell you how bad your gaff was but here is my own baby brain story to maybe provide some perspective:

    When I returned from maternity leave with kid #1, I was managing services for cultural & linguistic access at a hospital. It was a new position and I had only been in it 6 month before having a baby. When I came back, I still had a lot of introductions to do to hospital staff & doctors & community members. I felt really stupid and inarticulate and I was worried that my new serivces were not being taken seriously because I was such a dummy. I know that I said, "You know what I mean?" a LOT because I felt like I was not making myself clear. When I spoke to some co-workers I trusted about it, they were honest with me - THEY could tell I wasn't quite on top form, but that I wasn't nearly the babbling idiot I thought that I was. My program didn't suffer, I managed to get rid of my new annoying verbal tic and things got better.

    There are lots of reasons why people blank during public presentations and the feelings about the situation are usually more exaggerated than the actual problem, that is why public speaking is so hard! Consider this, you are awesome enough to be appointed chief, so even when you are not on top form, you are still pretty darn good! Forgive yourself, keep prepping for grand rounds and know that baby brain is a temporary condition!

  3. I have a 3 year old and a 9 month old who has been waking every few hours overnight for the last few months. The inarticulate baby-brain issue is a serious problem for me right now. I can compose my thoughts in an e-mail, but ask me to talk to someone and I feel aphasic. I can't get the words out in the right order to express a complicated thought. I stumble and stutter. This is true for work stuff, especially about my research or giving presentations or talking to senior attending, and for even social conversations with other parents. For some reason, I am a bit better talking to patients -- maybe because so many of those conversations are practiced and almost rote for me at this point.

    I am assuming this is all about the sleep deprivation. It just needs to get better before people decide that I am unintelligent or possibly suffering from dementia. And, no one remembers or considers that you might be up all night with a 9 month old baby, so no one is giving me the benefit of the doubt anymore.

  4. This might not help, but taking extra B12 helped me give better presentations in grad school when I was sleep deprived and wanted to avoid caffeine jitters. Also, to have an audience as you prepare is huge- have a colleague ask you likely questions throughout a practice talk. work those verbal tics out in advance. Have a canned response for when you truly are stuck- like, "I'll have to think about that, and get back to you." I really don't think there's any shame in not drawing the same connection they made right in that moment.

  5. I feel your pain. Same thing happened to me. Don't blow it out of proportion--baby brain goes away and this doesn't mean that you're going to blank out at every public speaking event. I second the advice to practice in front of a colleague that can ask you questions. And there's nothing wrong with deferring to more senior colleagues when you don't know the answer to certain questions. I've also said in front of a large audience, "I'm sorry, I'm having a TIA right now, but I can get back to you on that later."

  6. I think milk brain is a real thing :)

    Honestly, you don't have to be a new mom to have a blank in front of a large audience. Sometimes it's hard to think clearly when dozens of people are staring at you, and I'm sure everyone knows that.

  7. ironic a former colleague sent me a manuscript to revise of my former research project from fellowship. She had added a few follow-up experiments since I've left the lab for my new (clinical) job,and wanted some feedback.
    I had a baby 8 months ago and I'm reading through the manuscript thinking to myself, "WHAA? what is she talking about? I don't understand a single word of it. " The sad thing is that I pulled out my original manuscript that I wrote and gave to her before I left the lab and realized that she had changed very little of the wording. It's just that I have baby brain and can no longer think about basic science research. auugh.

  8. Thank you all for your comments! Baby brain is so frustrating... I know that in the future I'll get my clinical mojo back but it does feel a little better knowing that there are others out there feeling the same way. I love this MiM community and the support that it gives us!

  9. I'm relieved to be reading this thread - I'm an intern and just had a baby 4 months ago. This is month 2 of being back on the floors and I feel like it's july 1 all over again only I feel even dumber than I did back then. So baby brain/milk brain is a for real thing??? You mean I'm not permanently stupid? Not that I was ever Numero Uno but I could at least reason through pimp questions compared to now, things don't even ring a bell or sound familiar. I feel like such a fraud, like I'm in first year med school but getting paid to walk around in a longer white coat and put in orders.

  10. This is a related post by psychiatrist juliaink way back from 2008:

    Don't let this minor slip (and yes, it is always so much larger in our own minds) psych you out for Grand Rounds. It will go great! And agree with practicing answering anticipated questions.

  11. Sit down before grand rounds and write out a list of questions people might ask you (you can also practice the talk before an educated group of friends colleagues to find out what questions they come up with). Then write down the answers and practice them, so you are pretty much ready for any question. This is useful, by the way, even if you don't have 'baby brain.'

  12. Grand rounds will be fine, and I believe you can totally do this! It's just a matter of preparation for the talk and questions they throw at you, as everyone else has mentioned. This brings me back, though... I remember returning to present my research about 5 weeks after delivery of my baby, and I also had a complete brain fart on the stage after being asked a question. I just asked them to repeat the question and said, let me think about it and get back to you. When I had to present again a few months later at the real conference, it went fine. Just give yourself some time (I know, easier than it sounds) and it'll be fine!


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