Tuesday, October 30, 2012

MiM Mail: Did you co-sleep?

Hi MiM,

When I had my first son I read a lot and had all sorts of plans for
how it would go and what type of mother I would be.  Co-sleeping did
not fit into that plan.  I knew that the American Academy of
did not recommend co-sleeping and that it may increase the
risk of SIDS.  So into the crib he went.  I didn't intend to co-sleep
with my second son either, but once my sleepless baby boy arrived I
ended up doing whatever worked to get the most sleep.  He naps in his
crib or bassinet but spends a good portion of the night in bed with
me.  I still worry about safety risks and I definitely worry about the
process of breaking this habit at some point.  My question is, as
educated physicians and mothers, how many of you have opted to
co-sleep with your children and for how long?  How do those of you in
pediatrics or family medicine address this with your patients?  I'm
not really looking for advice necessarily, but I think this is an
interesting discussion point.  I found out after talking to other moms
that this is a lot more common than I realized!  This may be somewhat
regional also.  I live near a very liberal, somewhat "hippy" town
where baby-wearing, cloth diapering, and making your own baby food are
often the norm.

I am a PA in dermatology and the mother of 2 boys - 22 months and 5
weeks old.  I love following MiM!


Wednesday, October 24, 2012

Why men earn more than women

Recently I came across an interesting map showing how much women earn for every dollar a man earns. The highlights:

In Utah, the average woman earns 55 cents for every dollar the average man earns.

At best, women earn 3/4 of what men earn.

There are lots of theories as to why women earn so much less than men. Some people say it's because women gravitate toward fields that tend to pay less. But even if you take this into account, women still earn less than men in the exact same job.

The difference does seem to be related to having kids. Apparently, men with children earn about 2% more on average than men without children, whereas women with children earn about 2.5% less than women without children. Women are also more likely to leave the work force for longer periods of time, which further suppresses their earnings.

As a working mom, I really get this. How could I ask for more money when I just took a 12 week maternity leave? How could I ask for more money when I just had to take sick days for a GI bug I caught from my kids? How could I ask for more money when that might make me feel obligated to take on more responsibilities, which I just can't handle right now?

I don't know what the solution is, but I'm sure I'm not the only woman who feels this way. There are probably enough of us to fill at least several binders.

Monday, October 22, 2012

Time for children

Last weekend I was at my friend's baby shower and making small talk with the mother of a baby boy a few months younger than my own son. His mother was a co-worker of my friend, both physical therapists at the local medical center, and the conversation turned to the topic of child care.

I mentioned that I had just worked with an intern who was 38 week pregnant, had planned to take a 4 week maternity leave (she was a prelim and had to start her second program on time), and had a complicated childcare plan in place that involved a sitter coming over to the house around 5 am - when she and her husband (a surgical resident himself) had to leave for the hospital, the sitter would then drop the baby off at daycare when it opened at 8am, pick the child up when daycare closed, and stay with the child until she came home from the hospital around 7 or 8 in the evening.

"Geez", she said, "Maybe she shouldn't be having children. It doesn't sound like she has time for them."

Whoa. Maybe she shouldn't be having children? I should mention that, although I hardly know this intern at all, I like her and I am worried about this plan for what I think are obvious reasons. Children get sick. Patients crash, usually right as you are about to leave. Daycare closes early on Friday for "Teacher In-service" (like every month it seems). Sitters have "things come up". And what about weekends?

My reaction to her situation wasn't that she shouldn't be having children, but that she needed a nanny to get her though a tough few years. I made what I hoped was a polite excuse and left the conversation. 

I was more fortunate than this intern in both the length of my maternity leave and that I had family that could move in with when my daughter was born, but without those two variables my situation wouldn't have appeared that different. I wondered if the same sort of judgement would be passed on me if my early months and years of motherhood were observed by similarly minded outsiders - even now as my mother lived with us for the last two weeks while I was on the inpatient ward rotation. 

I don't feel bad about how I raised my daughter when I was a resident, I feel grateful to my mother and mother-in-law. But I guess we all have different comfort levels for having other people participate in the care and raising of our children. I've had a lot of help with mine and, for the record, I've been pretty happy with the outcome so far. 

Thursday, October 18, 2012

Day 1 of regular exposures

Today I dropped Zo off at his first day of daycare. We finally found a place that we loved with enough diversity so that our little chocolate chip wouldn’t be the only little brown boy in the institution. By word of mouth, we found a quaint cottage-like Spanish immersion preschool run by super cute ladies from Venezuela and Mexico. He loved it during our tour and even attempted to hop out of my arms into the Director’s arms. He was so smitten that I ignored the many dripping noses of the cute 1 year old kiddos who would be in his future class.

This morning I dropped him off around 8:45am. And he was one of the drippy-nosed children. For the last 3 days he has been a sneezing, coughing fussy fuss-face. Top it off with a set of 12 month old immunizations and both parents with sore throats and sneezing and you have entered our purgatory. I have flushed and aspirated his nose so many times that he anticipates what is coming and gets his wail ready. He has woken up so many times in the past few nights that I haven’t been able to lay down for more than 5 minutes without hearing his coughing and whimpering. I can’t wait for this cold to be over so that we can officially begin sleep training him. Add a hectic Ward month with long nights and early mornings and all I can say is that I am so tired. I am so very tired.

As I walked out, painted smile on my face, holding back the tears welling up in my eyes, a cute cherubic girl smiled at me and motioned for me to hold her hand. The Director hurriedly waved to one of the teachers so that she could wipe away the thick yellow-green goo running from her nose, sliding down her face. The teacher laughed nervously, I shrugged knowingly. I have been around enough children to know clear, yellow, and green ooze is somewhat of a rite of passage. Thus began Day 1 of our son exposing others to his germs and his classmates exposing him to theirs. Here’s to a robust immune system! Here’s to my growing Little Man!

Monday, October 15, 2012

MiM Mail: Dealing with a chronic illness

Hello MiM blogosphere-

I'm a surgical resident, wife, and mother.  I love planning, writing lists, checking boxes, and emailing my husband with "action items" -- basically, the 21st-century Honey-Do list. 

Despite all of that, I have found myself in a situation that I never planned for. 

Recently, I was diagnosed with a chronic illness.  Without getting too specific, it will impact how I do my job, but won't prevent me from doing it.  Think of something along the lines of Crohn's disease, Type 1 DM, or lupus.  I have to take medication, monitor my symptoms, and go to doctors appointments.  I might have to take a 5 minute break during cases that last more than 6 hours.  But, my doctors and I see no reason why I cannot continue to provide excellent care to patients.  I'm lucky that there is even an attending surgeon at my institution who has the same chronic illness that I do.

All that said, finding out this news has been Really Hard.  It's scary, and overwhelming, and my head is spinning.

I worry about where my disease will take me... What complications are in store?  How will I handle it on those days when I feel really bad?  Why isn't there a cure for this thing, yet?  But, what I'm worrying about most are the practical things...legal protections, financial expenses, keeping insurance, dealing with a chronic illness and surgical residency (a chronic condition in and of itself!).

So, I appeal to you all with three big questions.  Maybe you've been through something like this before?  Or seen someone go through it? 

1.  What and how do I tell my co-residents?  My attendings?  My program is hard and the hours are very long (80 hour workweek, what??), but it's actually not all that malignant.  I know my coresidents and attendings will prioritize my health and giving me 10 minutes of self-care time during a 15-hour workday probably won't be a big deal... But, what I really worry about is the loss of opportunities.  Like, if one of my attendings wants a resident to help with a cool research project, but they don't ask me, reasoning that the extra work will be too burdensome with my illness.  Same thing if a good case comes in late in the evening...what if they don't ask me to stay because of my illness?  Will all the credibility I've built up as a hard-working, excellent resident slowly be eroded by missed opportunities? 

2.  How do I handle this with future employers, when I apply to fellowships and ultimately attending jobs?  Am I obligated to disclose this information?  My field is fairly in-demand (at least right now), and I'm a good resident at an excellent program, but is chronic illness a big enough 'black mark' to mar even an otherwise exemplary CV?  I'm terrified that if I'm not the best-of-the-best--if I'm just average--my illness will make it such that employers pass me over for someone who is totally healthy.

3.  How can my husband and I protect ourselves financially from the risks of my chronic illness?  He works full-time in a well-paying field... though his salary is about half of what my eventual attending salary will be... assuming I don't scale back to a slower-paced practice given my situation.  We always assumed my career would be the primary one... we'd move to follow my job prospects, I'd have the Cadillac disability insurance, he might even eventually work part-time or stay home entirely to focus on parenting.  It seems like all of that is changing, and I'm struggling to figure out how we should reprioritize.

Kind of a heavy post, I know... but I certainly appreciate any insights.


Tuesday, October 9, 2012

Sick Day

I wake up at 4AM feeling nauseous.

I'm not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, "Wow." Then they vomit again. And then a third time. And now it's on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, they burst into tears, because vomiting makes kids cry.

And they want a hug. But they're freaking covered in vomit. I mean, you have to hug them, of course, but you have to at least attempt to strip off some of those vomit-soaked clothes first.

I get this horrible sense of foreboding, but I somehow manage to fall back into a restless sleep and wake up later with my alarm. I still feel really nauseous and my stomach kind of hurts. But I get up and force myself to take a shower.

The living room still sort of smells like vomit. I swear, we cleaned it. I went to the drug store and asked the clerk what would get out baby vomit from the carpet and I got a bottle of Woolite. But I don't know, maybe there's a patch of vomit somewhere that we missed. Probably there is. There was just so much of it.

If anything could have made me feel less like eating breakfast, it's walking into a living room that smells like vomit. Thank God both kids are already awake. I feel like if I have to argue with anyone or do anything unexpected today, I will break down.

The daycare serves breakfast till 8AM, and I think I'm going to make it. We arrive and as I bring my littlest into the toddler room, I see a bunch of one-year-olds sitting around the table with little bowls of food. But I don't see the food cart. "Can she still get breakfast?" I ask.

"Sorry, you're too late," they tell me. It's 8:01AM.

"Is it possible for her to get any food at all?" I beg. "She didn't want to eat before we left." And keep in mind, if you tell me "no," I may vomit on you.

They seat her at the table and say they're going to try to scrounge up some food. If they're deceiving me, I don't even care anymore.

I drive to work. I'm really nauseous now. I wonder if I could throw up. I don't feel like vomiting is imminent. Like I don't think I'm going to have to pull over and yak all over the road. If I'm not actively vomiting, I'm well enough to work. Period.

In the hospital, I make a beeline for the bathroom. My stomach is cramping and I feel like I'm in labor with a vomit-baby. I lean over the toilet but nothing comes right away. It's generally easier to birth a vomit-baby than an actual baby, but it's just not coming. Someone knocks on the door, which totally disturbs my concentration. I can't vomit with someone standing right outside the door!!

I go upstairs and pick up my patient list. It isn't too long. Maybe I can get through it fast. Hopefully nobody will talk to me.

I go to the bathroom. Vomit success!!! But it's not that much. Maybe my symptoms are all psychosomatic, because I watched both my kids throwing up.

No, I should probably just call in sick. The world won't come to an end. It's not fair to anyone for me to be working in this condition.

I leave the bathroom and just stand there, debating what I should do. My boss walks by and I call his name. "Hey," I say.

"Hey," he says. "What's up?"

"Um," I say. "My girls have been throwing up all weekend and I just threw up. So... I guess I should probably go home."

"Yeah, that's fine," he says. "Feel better."

"Here's my patient list," I say, trying to hand it to him.

"I'm not touching that," he says, recoiling in horror. "I'll get a fresh copy."

Fair enough.

I drive home. Maybe I'm not that sick. Maybe I should have just stayed and worked. But then I could have given this awful bug to everyone I work with. I mean, it benefits the hospital if they don't have half the staff out with a stomach flu. I'm sure they'd rather lose me for a day than have that happen.

At home, I try to vomit in the toilet. I can't. Maybe I should have had a bigger dinner last night. How can I be home if I'm not actively vomiting?? Now everyone is going to think I'm an unreliable mom. My husband comes into the bathroom while I'm sitting on the floor by the toilet. "Maybe I should have worked today," I say.

"I can't tell if you're teasing me or if you're really insane," he says.

Little of both, probably.

Sunday, October 7, 2012

Stressed Out

My Life has been a roller coaster for the last couple of months.  I don't mean a nice Disney coaster either, I'm talking about Cedar Point 120 mph craziness.  Two partners have taken maternity leave this year and I have done my best to work extra and be supportive, but I think this year is taking its toll on me.

I feel like I have always kept a a decent work life balance. I exercise, eat well, make time for my family and attempt to take some time for myself in general, but over the last 6 months that balance has been close to impossible.

The additional roller coaster involved being offered  the opportunity of a life time this summer.  I was scheduled to travel internationally for 3 weeks. All expenses paid. Patients were rescheduled, passports obtained and childcare was arranged. I was SOOOO excited. Then the day before departure, the trip was canceled.

{Insert sad trombone}

So, back to work I went.  In hindsight I should have taken some time off, when I already had it blocked, but alas, I'm a glutton for punishment.

Somewhere during these crazy few months I started having these crazy fantasies: what if I had to have emergency surgery?  Wouldn't that  be AWESOME.  I could take a week off to recover. No one could bother me.  Now, before those of you who know me IRL have me admitted to the psych ward, I in no way ever wanted to hurt myself. Or have anything really wrong with me. No crying spells, no anxiety attacks. I just keep dreaming of  having an unruptured ectopic. Serious enough for surgery and a week off, but not life threatening or overly painful.

We go back to fully being staffed next week, and I have scheduled myself some down time to re-energize. I  have been focusing on that and already feel much better.  Hopeful to be back to my peppy self soon.

Anyone else ever get so busy and stressed out that they start imagining how awesome it would be to have appendicitis? 

Friday, October 5, 2012

Guest Post: Pregnancy, Delivery, Postpartum as the Patient

I am a small town girl from the middle of nowhere that recently graduated from OB residency in the big city and I am currently doing an MFM fellowship. I am also now 3 weeks postpartum with my first child. Whoa…what an experience.

I thought I knew everything there was to know about pregnancy, delivery and postpartum issues. Let me just say….life from the table side of the stirrups is a whole new world.

Pregnancy was a whirlwind, with the exception of 5 weeks of nearly continuous nausea and terrible heartburn, I loved being pregnant. I, like many pregnant women, had this perfect plan for how I wanted my delivery experience to be: spontaneous labor, short second stage, no episiotomy, no operative delivery, 7 pound baby.

Well…I was long/closed/posterior and floating at 39+ weeks and I got a primary elective c-section for macrosomia. Baby boy ended up being 8’14 and he is perfect. I have no regrets. C-section recovery wasn’t so bad…the first 36 hours were rough, but otherwise pretty smooth sailing. Baby boy nurses like a champ…although I referred to him as “baby T-rex” for the first 2 weeks. Seriously…the sore nipples are no joke.

So now I am staring down the barrel of the end of my maternity leave. I have always loved my job. Everyday I felt like I did something good. Every baby that I deliver is an amazing experience. If you have to wake up at 2am…why not deliver a baby and change someone’s life forever. I thought my life would never be complete without it. Now I consider leaving my fellowship on a nearly daily basis.  I can’t imagine leaving baby boy for 10-12 hours a day.

I chose to do a fellowship for the potential for a better lifestyle as my children get older and because I truly love “maternal medicine.” But these days I think maybe I should just leave fellowship and moonlight a few shifts a month. At least where I live, I could moonlight 4-5 nights a month and make the same money I make a fellow.

Will I ever love my job the way I used to again? Or will I look at the clock all day and just want to be home? Will I regret it if I quit? Can one really do it all…be a good fellow and a good Mommy? My poor husband doesn’t know what to say to make it better. I have never been a crier…but several times since having the baby he has found me rocking the baby in the nursery with tears streaming down my face. I can’t help but think that by going back to work I will miss all these sweet moments.


Tuesday, October 2, 2012

Cure for what ails ya

Hi, MiM folks. Long time no see.

I have a lot going on. I am a few months into my internship. I am applying for obstetrics residency again. I just submitted four abstracts to two conferences, I just presented at one conference and will be a presenter at another, and there is a lot going on, women's health wise, in politics and in the news.

So what am I so worked up about that I am going to break my blogging fast?

Facebook medical advice.


I joined Facebook when I got accepted to medical school. My incoming class started a Facebook group and used it for introductions and announcements. I'd never used MySpace. I started off Facebook with a bang, since our class had almost 250 members in it, many of whom were young whippersnappers used to this social media stuff. Now, of course, I'm a pro, and have been recently accused of being a "Facebook slut" because I have so many "friends." They come from many, many different walks of life. Definitely not all medical people, and not all mainstream.

So, one of my non medical friends (someone I know from an online mothering support group from years back) posted about some symptoms she found troubling. She was suddenly very dizzy - the room was spinning, and her vision and balance were off. Not really nauseous, no other significant symptoms, and I know she doesn't have a significant medical history and she said she wasn't on any medications. She said - anyone have any idea what could be causing this?

"Hmm, sounds like vestibular neuritis," I thought. I posted "Most likely vestibular neuritis - sorry :(" I purposely said "most likely" because hey, who knows, and I didn't want to sound like a know it all. I threw in the frowny face to seem more friendly and less know it all-y, too.

I wasn't so perturbed by the people posting guesses about low blood sugar or low blood pressure, even though those are technically more likely to cause lightheadedness than dizziness. I know that distinction can be difficult even for a trained medical professional. Or a patient describing symptoms, for that matter.

But, then there were some more productive suggestions:

"Go to the ER immediately and ask for a blood test, which will most likely show it is dietary affecting your blood preasure(sic)".
"I felt really bad recently and it turns out it was food poisoning. I poo'd and I felt better!"
"Intestinal parasites can cause this!"

I made a snarky follow up comment about how it was definitely sporns and she should drink some OJ. I didn't mention that I was a doctor and would you people just! listen! and stop making dumb suggestions for non existent blood tests or very unlikely etiologies. Especially since I had twice, nicely, suggested a likely cause that they could have googled. Maybe that would have been better than the sporns comment, I don't know.

I knew I wasn't fit for further commenting when someone posted how it was "Vertigo. OR an inner ear infection" and I wanted to write in all caps "VERTIGO IS A SYMPTOM, NOT A DIAGNOSIS! SO, NOT "OR"!! AND INNER EAR INFECTION WITH VERTIGO = VESTIBULAR NEURITIS!!"

When did I become such an insufferable know it all?


I should just go take a poo, and I bet I would feel better.