Tuesday, June 26, 2012

Anti-vaccine Sympathy

Sometimes I will hear other mothers (usually online) freaking out about vaccinations. Here are some of the comments I've heard recently about vaccines:

1) Worried about autism (despite study being discredited)

2) Want to spread vaccines out, not give them all at once

3) Want to skip certain vaccines (usually varicella) since the diseases aren't actually that harmful

4) Want to postpone vaccines

5) Angry and distrustful of doctor for not knowing all inactive ingredients in a vaccine

I read these comments and I just feel frustrated, both as a mother and a doctor. How could these mothers be so stupid? So selfish? Don't they realize these vaccines are safe? Don't they realize the only reason they can even contemplate skipping a vaccine is because the rest of us "risk" our kids? Don't they realize that the kids who can't be vaccinated or do not achieve full immunity are at increased risk because they fail to vaccinate?

Of course, when I'm at the doctor, waiting for my child to get her vaccines, the thoughts in my head are very different:

"OMG, what if she gets a reaction to these vaccines? What if she gets a fever and is awake all night? What if she's cranky for weeks? What if they KILL her?"

"She's so small... maybe we should postpone the vaccines till she's older."

"Why do we have to get so many vaccines at once? This is cruel and inhuman. Maybe we can spread them out?"

"OMG, what if she now becomes autistic??????"

Ultimately, we always get the vaccines. But I do believe most mothers feel that fear when our kids get their shots. That's why I'm sort of resentful of moms who can't man up and go through with it.

Monday, June 25, 2012

MiM Mailbag: Do single moms go to medical school?

Dear Mothers in Medicine,

I have been a VERY long follower of your blog and after reading a few pre-med blog posts find myself wondering if you could give me some advice.

I am a new mother (my baby is 9 months) who has been trying to achieve my dream of medical school for a while. I have a degree in Biology, publications, a TON of research experience (some of which is at an Ivy League school) but because I was an international student, I couldn't guarantee funds for medical school after graduation and hence my application was not accepted. Right away I pursued nursing school as a venue to receive permanent residence in US. I was successful and shortly after graduation resumed studying for the MCAT while working part-time as an RN. Unfortunately, my MCAT score was not good enough to get in (it had been a *few* years since my classes). Being in my late 20s, my OB doctor stated if my husband and I wanted to have children, due to potential complications from some of my health issues, I should achieve pregnancy sooner or later. A year later, we have a baby.

Sadly, my (also in his late 20s) young husband wasn't prepared for a responsibility of having a baby and filed for divorce not too long ago. So, here I am, in what seems like a disastrous situation - a former pre-med hopeful, now a single mom trying to make ends meet with a 9-month-old. I am sure there are worse situations out there, but I am completely bummed as to what I should do. I refuse to give up my dream, but yet, I often wonder do single moms go to medical school? To make matters worse, I reside in a state where my parents don't live and because the divorce is here, my husband is going to restrict my relocation, hence family support will not exist (not physical one in any case).

I often wonder if I should retake the science classes from scratch? I'm afraid to seek guidance of a pre-med counselor because they will just want me to forget it.

Any help/advice would be greatly appreciated. I am trying to explore all my options and not give up hope...

Thank you.


Saturday, June 23, 2012

Last Day: Part 2

Ok, lets try this again (yes, I'm over posting myself).  I just finally put my daughter to sleep.  Its as if she knows something is up.  She has been adorable all day!  

Today I had a marvelous day with my daughter.  We read books, danced like crazy, had a morning sleepover (which involved playing and jumping around on a comforter and pillows on the floor in her room), slow danced to Miles Davis, belted out some Etta James, played catch in the yard, ate munchkins outside in the Dunkin Donuts parking lot, called family to say "I lu y-ooo" and just basically had an awesome day.  Tomorrow I go back to residency after my two year lab hiatus.

As I held my little munchkin tonight, after breastfeeding her to sleep, I couldn't stop thinking of the meeting with the scheduling chief a little more that two years ago.  During our meeting we discussed the feasibility of me going into the lab.  I remember thinking that if I pulled this off, the little 10 week old peanut inside me would be a year and a half by the time I started back - practically a grown-up.  Well, here we are.  I am the mother of the greatest 18 month old baby that ever lived.  I can't believe I'm already at that year and a half mark.  I look back at myself then and realize that I am UTTERLY CHANGED.  Completely and utterly changed.  She has changed me in every way.  She colors ever decision I make, she is such a huge part of what defines me, what motivates me, what matters.  During my last trip home for my mom's surgery, my husband taught my daughter how to say "Mommy's a doctor"  or more like "Mah-mie uh dahktur."  Tonight as he handed her to me for our bedtime routine he must have given her the sign, because she said it again, in her cute beautiful little voice.  I nearly melted.  I love her SO MUCH.  I pray that through all of this I can be a good mom and a good doctor.


Last day

I’ve half drafted about 4-5 entries that still are unfinished in my MiM folder.  I definitely plan to eventually post the ones about my journey as daughter and doctor dealing with my mom’s recent breast cancer diagnosis.  It has been a difficult, emotional, strengthening, family building, strange, roller coaster of an experience.  So far, things are going well.  However, I’m writing just a short entry today.  Today is my last day of “freedom.”

Tomorrow I’m back in the hospital, a resident again after my two year lab hiatus.  I start off as transplant chief.  I am completely terrified and completely excited. My life has changed so much in these two years. My special necklace with a pearl and my daughters name on it just arrived from Etsy yesterday.  I love my beautiful girl so much!!  I hope I’m doing the right thing.  I’m completely motivated to make her proud.  My life these two years has been a roller coaster of emotions.  I’ve gone from loving my anesthesiologist who put in my epidural so much that I was convinced anesthesia was my new calling.  Then I was convinced that I must find a way to be a stay at home mom - otherwise I thought my life would be impossible to balance.  But, now the hormones are fading, the Zoloft is working (prob TMI - but you’ll hear more about that if I ever post the post-partum depression entry I wrote), and I’m amped up to be a surgeon.  Two years of cancer research has given me some clarity.  I feel confident that I want to be a breast surgeon (also one of the entries on file).  So, I have 3 more years to get as much out of all the other amazing types of surgery that I also love.

Wish me luck!


Thursday, June 21, 2012

Guest post: We are growing up

Tomorrow is my first day of Intern orientation. I have wanted to become a doctor for my entire life and tomorrow I officially work at my top choice hospital. This moment is bittersweet, mostly because it is the beginning of being a working mother and it is the end of my 9 months as a stay at home mother to Lil’ Zo. I am already missing him but I am so excited to begin my career as a Pediatrician. Pause for my Happy Dance!

I have grown so much as a person since becoming a parent. I am very in tune with Zo’s moods and cues; I know hunger before he cries, when he’s tired by the slightest rub of his eyes or ears, and that a certain face and eyebrow raise mean a poop is on the way. I have learned how to simultaneously nurse, compose emails, and catch up with friends.

I have learned how to be less rigid. For one, Zo sleeps on his belly even though I know it is not the current medical advice. As a newborn, Zo refused for weeks to sleep on his back for more than an hour. During one of her visits, my mother suggested that I try letting him take a nap on his belly. I watched him like a hawk for a week and saw he could turn his head left and right during sleeping, then I slept in his room for an additional week, and his sleeping went from 30 minutes to 3 hours, and I gradually made my way back to my shared bed with my husband.

I have learned that baby wearing is like baby chamomile tea; it soothes and lulls him into a state of contented bliss during which I can clean the house, read blogs, and cook dinner (with him on my back). I have learned that a nursing pre-toddler likes to test out acrobatic moves during his brief, but oh-so-efficient nursing sessions. I swear my boy moves and grooves more than I thought possible all while maintaining a proper latch without biting me with his fresh new teeth (he’s amazing!).

Tomorrow I start my life as a seasoned mommy and Pediatric Resident who still has so much to learn. I know that I will be a better, more compassionate physician because of all of the love my precious little one has showered on me since his birth. Now, off to bed where I will sleep and cuddle and nurse him until I am off for work. We are officially growing up.

-Mommabee is a Pediatric Resident in "The South" with a background in public health. She is married to O, a Librarian turned Doctoral Student and is the momma to Lil' Zo (Fall 2011). She enjoys reading, traveling, spending time outdoors, and of course providing excellent patient care.

Wednesday, June 20, 2012

the off-cycle job hunt

I was recently at ASCO and having dinner with a friend from residency. I asked about his post fellowship job hunt and he shared the details of what sounded like exhaustive process that had finally resulted in a position with a large pharmaceutical company. He asked me what networking I had done - or was planning to- do while at the conference.

Yeah, like to get a job.
Uh, I haven’t started thinking about it.

And thus ensued a forty-five minute lecture. How could I have not started this process already? I should have a letter of intent and an updated CV. I should have started cold calling large oncology practices. I should have come to the conference knowing who was going to be here and how I was going to introduce myself. The fact I will be graduating late should have spurned me into starting the search earlier.

I sank lower into my chair and, as he continued to berate my lack of preparedness, accidentally finished the massive slice of chocolate cheesecake we had intended to share. I left the restaurant not knowing if the queasiness in my stomach was from anxiety or a butter bezoar.

Although technically I am about to enter my third and final year of fellowship, because I started late due to my first maternity leave (in residency) and owe this program time for my second leave, I won’t finish until October 1, 2013.  The heme and onc boards are in late October, so I wasn’t planning on starting “a real job” until November 2013. Factor in a possible move, I might not be ready to start work until December 2013.

But I have to start the search now? My friend is an intensely driven and consummate go-getter. Both of his parents are successful academic physicians, his older sisters are also physicians, and I suspect he learned about RVUs and impact factors at the family dinner table. He knows a shocking amount of information about the business end of being a physician – how to get grants, publications, protected time, compensation, promotions, jobs, etc. During residency, fellowship, and now, apparently at the start of my job hunt, he was, and is currently, trying to tell me what-I-should-know in order to be successful.  Although I know the constant “advice” comes from a place of caring (and it does, despite the fact I am making him sound like a jerk), he can drive me a bit insane.

But he might be right. I will be graduating off cycle, perhaps almost six months after other fellows are ready to start working. I want to move back to my hometown, a medium-sized city with its own set of fellows graduating from the local university. There are some cities where the heme/onc job market is saturated and if I wait to start the search, I might not be able to find a job at all. He reminded me of a mutual friend who couldn’t find a position until a community oncologist actually died.

I think in the writing of this post I have convinced myself of what I already suspected to be true – as daunting as it may seem, I should start looking now.

A real job. Like a grown-up. Who doesn't procrastinate.

Monday, June 18, 2012

MiM Mailbag: 7 on and 7 off

Hello MIM! I love this blog and have been reading it for a couple of years now.  I think its wonderful that a group of female physicians are able to talk at liberty about their personal lives and struggles with motherhood. 
I am currently a hospitalist who has been in practice for a few years.  I love hospital medicine and I really enjoy my job but after I had a child,  everything has changed.  Although I never particularly cared for my 7 on/7 off, I have begun to resent it.  I this roller coaster of a life where I either am with my child 24/7 or only see her for an hour or two a day and its not working.  I've spoken with other mothers in the same situation and I have heard it.  "7 on/7 off is great!  You can be a part time SAHM!"  "7 on/7 off is awful!  How do you ever see your kid??"  People also bring up the point that at least with shift work, you don't feel the pressure of trying to get out early each day and that your time at home is protected.   I'm truly unable to make my own assessment because I have not had the benefit of working another schedule for comparison.   Now I am at a crossroads because I have the opportunity to leave this group and go to a more conventional schedule:  Monday through Friday where you rotate morning and afternoon ER admits and can leave when you're finished.  I'm worried that the naysayers will be right and that my life will be more stressful if I have the opportunity to leave early because I will be rushing through my work.  On the other hand, there are days here when there really is no need for me to be at work for a 12 hour shift and I feel frustrated that I can't leave when I'm finished.  I also feel that my life needs more stability on a regular basis.  Its difficult to keep up with friends, exercise routines, house work when I'm working 12 hour shifts 50% of the month.  Everything tends to go into disarray when I start my work week and I'm hopeful that can change if I am able to have more time in the evening. 
Has anyone had experience with this dilemma?  Any insight into either schedule?
Thank you. 

Wednesday, June 13, 2012

MiM Mailbag: When to disclose your pregnancy at work?

Two MiM Mailbags with a similar theme...

I am about to start Internal Medicine internship at a medium-sized county program.  I have a 2 year old son.  I had originally applied to residency when I was pregnant with him, but withdrew my application.  The Program Director of the program I matched in told me at that time "We wondered what you were going to do when you had the baby.  Glad you made the choice to take time off before starting."  Well, now I find myself pregnant again.  I am due Dec 20.  My current schedule has me scheduled for Medicine wards from Dec 13-Feb 6.  I know that I will definitely need to make a schedule change.  I am nervous to tell my Program Director.   Luckily, I am not showing yet at all (so my family and friends tell me).
Regarding childcare, my husband is taking a leave of absence from his career to care for our son and for our future child. So, While I do not really "want" a short maternity leave, I am prepared to only take off the minimum I will need.
Any thoughts or advice on how to navigate these waters?



I am pregnant with twins and going to start my new job in the fall, and I am trying to decide whether to tell the hospital/group I am working with before I start which is right at the beginning of the second trimester.  Or should I tell them before they pay for my move in case they don't want me?  I think they will as it took them a long time to recruit me and recruiting has been an issue since it is somewhat rural.  And they knew I was planning on becoming pregnant at some point and were fine with that.
What would you do?

Tuesday, June 12, 2012

Water water everywhere...

If you haven't heard this news, Mayor Bloomberg has proposed a ban on sodas larger than 16 ounces in NYC, as a response to the obesity epidemic.

I'm not a big fan of laws designed to save us from ourselves. I appreciate the smoking bans, because I've been in restaurants where I couldn't enjoy my meal because there was smoke being blown on my face, but it doesn't keep me from enjoying a movie if the guy next to me is drinking a 20 ounce soda.

I know I've written a few posts here that make me seem like I'm some kind of champion of bad health, so I'd like to do the opposite today. I'd like to ask that instead of making laws to save us from ourselves, like no large sodas, they should make laws to help us be healthy.

For example:

A few years ago, I gave up soda. I used to drink one can of Coke every evening with dinner, and I decided I wasn't going to do that anymore. Now I mostly only drink water (or Gatorade when I get very dehydrated). I do think soft drinks are pretty unhealthy, although I mainly stopped doing it because I wanted to eliminate caffeine. Thanks to my example, my husband stopped drinking soda at home too. And my daughter drinks mostly water or milk.

On a recent road trip, we stopped at a McDonald's off the highway. I got a chicken sandwich and I wanted a water to drink. Was it actually possible to get tap water to drink in a cup? No. I had to purchase a bottle of water.

Then when I went to fill the bottle up with more water later, there was no "water" option at the soda station. I could have gotten any sugary beverage I wanted, but not water. So I went to the counter, hoping they could help me:

Me: "Can you fill this bottle up with tap water for me?"

Cashier: "No."

Me: "Really? You mean there's no way I can just get plain water?"

Cashier: "Nope, sorry."

I finally filled it up in the bathroom. Still, it's an outrage that in mall food courts and many chain restaurants (ranging from McDonald's to Chipotles), you can't just get plain water to drink. This happens to me all the time. I'm at the mall food court and I ask for a cup of water with my food, and they look at me like I'm crazy. I've been refused or I've been given a tiny cup that contained three swallows of water. Even if I offer to pay for price of the cup, sometimes they won't give it to me.

Instead of trying to save us from ourselves and banning 20 ounce drinks, I think Mayor Bloomberg et al. should make it easier for those of us who want to avoid sugary drinks to do so! Whatever else you can say about the health value of these foods, soda is certainly tons of empty calories. If you agree, urge local vendors to make water more readily available!

Monday, June 11, 2012

Guest post: Heavy heart

It's been a long day on ICU, and I'm patiently waiting for the night float resident to relieve me of my duties so I can go home, sneak into my kids bedrooms and kiss them goodnight.  Although they won't see me with their smiling faces for another 2 days.  I am a second-year family medicine resident in the southwest, and am at this point officially burned out and miss my kids terribly.  I had my second child (a girl) 8 months ago.  My son is 2 1/2.  Dad works full-time as well, but carries the brunt of the duties when I'm on challenging inpatient rotations.  "Guilty" does not go far enough in describing the perpetual feelings I harbor about leaving home every day to take care of others, when all I really want is to be taking care of my family.  Don't get me wrong, I love being a doc, and have worked years and years to achieve this goal.  But I can't help but wonder whether I will regret this all when my kids ask "Mom, did you stay at home with us?" or "Mom, who did you leave us with when you were at work?"  They are cared for by a very good friend of mine who cares for a few other kids together in her home.  She is the mother we all want and want to be for our children.  And they LOVE her.  But I can't get past the fear that they will somehow resent me being gone when they are older, and realize just how much I have been absentee.  Thus, I carry a heavy heart, nearly every day that I am away.  I've never felt like this about anything.  It's always been about me, about my goals, about my plans.  Now it's about them, and I want to give them the best of everything.  Can I still do that even when I'm away?

Monday, June 4, 2012

MiM Mailbag: Medical school interview advice

Hi Mothers in Medicine,

I have been reading this blog for a year now, and all of your stories and triumphs (heartache too!) have inspired me to fulfill my dream of being a doctor. I was told when I was 18 that, "if you really want to be a good mother dear you shouldn't be a doctor, I've just never seen anyone be able to pull if off." So I went and did nursing school. A fabulous career, but after three years I am pretty bored and ready for something more challenging. After reading almost every single post on this blog, I've realized I can be a mother and a doctor. I also married a wonderful man who is encouraging me to pursue medicine.

The point of this post is to ask for some help to prepare for my interview. I have one in three weeks with my top medical school pick (an overseas institution, hence the summer interview).
Seeing as many of you (maybe many years ago) all went through the interview process I am asking for any tips, do's/dont's and general advice.
How did you answer that favorite question - "Why do you want to be a doctor?" other than saying, "well I want to help people"... I mean, that's why I want to do it, but doesn't everyone say that?

Warm Regards,


Saturday, June 2, 2012

My Postpartum Overhaul: First Physical, and Now Mental

OK, It's a rainy Saturday. I am not on call. My husband is watching our 2 kids (under 2 years old) so I can work out. I just jumped on our Spinning bike and banged out 15 minutes of hard up-down cycling, while watching Cupcake Wars (It makes the time go really fast, and I vicariously enjoy the cupcakes, while actually burning calories!).

I thought up this post in the midst of the workout, and I jumped off the bike. Now I'm sitting here, sweaty, trying to bang out the writing. Meantime I can hear my toddler boy yelling. He's got a cold and is just  cranky, and he wants me. The baby is whimpering, and Hubby will have to make her a bottle one-handed, while our toddler howls and hurls things around the living room.

So let me be brief.

Quick backstory: I'm a part-time internist in group practice, and I had my second baby 5 months ago. My last few posts here on Mothers in Medicine have focused on my journey back to fitness after baby #2. I was 4 weeks postpartum, and realized that at 5' 2" and 163 pounds, I was officially obese. In spite of the fact that I was breastfeeding exclusively, I was gaining weight (and yes, that is common). It was my eating habits. Carbs, carbs, carbs. Bowl of Cheerios here, toast with butter and jam there.

I was shocked, but motivated. I got on the South Beach Diet and I lost a ton of weight. Listen, folks, the low-carb diets work. (I get no endorsement monies from them, BTW) (Though I would take some in a second, if they offered :)

I also started exercising again. For the first 3 months, I just ran outside when I could (though to call it running would be exaggerating. More like jog-walking) and did some Pilates on the floor before bedtime. This month I added back the gym.

And in 4 months, I have lost 30 pounds, down to 133 pounds, only 10 pounds away from my goal. I am well out of obese BMI range, and I feel great. Physically.

However, mentally, I am sagging. Now, Babygirl is still not sleeping through the night. My husband travels for work, alot. Though we have great family support, it is just a hectic schedule. My reserve is low.

But, some days, I find myself just suffering through clinic. The day will start out OK and manageable, and then, as happens not infrequently, I will encounter a difficult patient, and I will just get so down. I mean, so down that I come home and start surfing the net for non-clinical doctor jobs.

Now, the vast majority of my patients are absolutely lovely. Honestly. I have been so boosted, even blown away, by the interest people take in me and my family; by the unsolicited support for my working part-time; by thoughtful cards or baby gifts; by positive feedback on my clinical work

But just one angry/ blaming/ abusive/ demanding patient, and I am just crushed. Even when I am in the right (like in diagnosing an alcohol problem, or not prescribing narcotics). Even when I know the patient has psychological issues, and is only acting out at me because I happen to be sitting there. The negativity will get to me, even if there is no overt confrontation, or raised voices, or complaints. If a patient is unhappy, I feel like a failure. I get shaken, even to the point of physically shaking. I feel like I will have a panic attack in the office.

Colleagues are supportive. We all see many patients a week, and we all have similar experiences, day in and day out. There is plenty of camaraderie, and I can always find someone with whom to vent, and feel validated.

But, at the end of the day, I hate these negative encounters. They make me want to quit my job.

I'm trying to look into this, to see what steps I can take to build resilience so that I don't feel like I need to please everyone; so that I don't feel a failure when a patient is unhappy. I used to be much better at this.

I'm currently looking at the concept of Compassion Fatigue. This is new territory for me. What do other MiM know about this? Is this something that applies? Or am I just an exhausted new mom with little reserve in a demanding profession having a normal experience?

Study: Breastfeeding Results in Increased Morbidity and Developmental Delay

Abstract: Breastfeeding has long been touted as improving immunity and having other benefits. However, this study demonstrates that the opposite is true, and that breastfeeding results in increased infections and delayed development.

Introduction: Many studies have shown benefits of breastfeeding, but there are limitations to all these studies since the breastfeeding and non-breastfeeding groups are different. This study looks at babies of the same sex from the same parents, so obviously they're exactly the same.

Methods: Two babies, both girls, from the same parents were studied, examining the number of infections, rate of growth, and developmental milestones. Subject #1 received breastmilk for only six months and got formula supplementation during that time. After six months, Subject #1 received only formula. Subject #2 received only breastmilk for the first six months, then very minimal formula supplementation for the rest of the first year.

Results: At the end of the first year, Subject #1 was at the 99th percentile for both height and weight. She had zero ear infections and zero infections requiring antibiotics. At the end of the first year, Subject #2 was at the 5th percentile for weight and 50th percentile for height. She had been treated for two cases of conjunctivitis and three ear infections. She also threw up a bunch of times. Subject #1 crawled and pulled up two months earlier than subject #2. Subject #1 walked at 10 months of age (data on Subject #2 still pending).

Discussion: Subject #1 showed significantly decreased infection rate compared with Subject #2, in addition to improved growth and reaching milestones. Since Subject #2 received more breastmilk than Subject #1, this likely accounted for the differences.

Conclusion: Breastmilk, once thought to be so great, is actually a source of infection and developmental delay. Who would have thought it?